1 00:00:05,960 --> 00:00:09,480 >>WELCOME TO THE 2 00:00:09,480 --> 00:00:14,400 17ANNUAL PAIN CONSORTIUM. 3 00:00:14,400 --> 00:00:16,720 USE YOUR Q&A BOX. 4 00:00:16,720 --> 00:00:19,120 THERE'S NO MICROPHONE OR CAMERA 5 00:00:19,120 --> 00:00:20,960 OPTIONS FOR OUR ATTEND'S, FOR 6 00:00:20,960 --> 00:00:23,480 OUR SPEAKERS AND PANELISTS 7 00:00:23,480 --> 00:00:25,400 REMAIN ON MUTE UNTIL YOUR PANEL 8 00:00:25,400 --> 00:00:27,600 SESSION IN Q&A AND KEEP YOUR 9 00:00:27,600 --> 00:00:29,960 CAMERAS OFF UNTIL YOUR Q&A AND 10 00:00:29,960 --> 00:00:32,320 DISCUSSION PANEL SESSIONS SUBMIT 11 00:00:32,320 --> 00:00:34,200 QUESTIONS FOR OTHER SPEAKERS AND 12 00:00:34,200 --> 00:00:35,600 ANY TIME DURING THEIR 13 00:00:35,600 --> 00:00:36,920 PRESENTATIONS THROUGH THE CHAT 14 00:00:36,920 --> 00:00:37,320 FUNCTION. 15 00:00:37,320 --> 00:00:39,600 FOR TECHNICAL ASSISTANCE, IF YOU 16 00:00:39,600 --> 00:00:41,120 NEED ZOOM, TECHNICAL ASSISTANCE, 17 00:00:41,120 --> 00:00:48,920 DIRECTING MESSAGE HALIGONIANS HY 18 00:00:48,920 --> 00:00:51,440 HARRINGTON OR SUBMIT A QUESTION 19 00:00:51,440 --> 00:00:56,360 OR E-MAIL HOLLY AT THE WEBSITE. 20 00:00:56,360 --> 00:00:58,240 PLEASE NOTE THIS WORKSHOP IS 21 00:00:58,240 --> 00:01:00,680 STREAMING LIVE ON NIH WEBCAST 22 00:01:00,680 --> 00:01:02,440 WITH LIVE CLOSED CAPTIONING AND 23 00:01:02,440 --> 00:01:05,120 IT'S BEING RECORDED AND WILL BE 24 00:01:05,120 --> 00:01:07,160 VIEWED AND ARCHIVED FOR LATER 25 00:01:07,160 --> 00:01:07,520 VIEWING. 26 00:01:07,520 --> 00:01:16,320 AND WE'D LIKE TO INTRODUCE Dr. 27 00:01:16,320 --> 00:01:16,760 LEAH. 28 00:01:16,760 --> 00:01:18,760 >> GOOD MORNING, EVERYONE. 29 00:01:18,760 --> 00:01:19,880 I'M FROM THE OFFICE OF PAIN 30 00:01:19,880 --> 00:01:21,200 POLICY AND PLANNING AT THE 31 00:01:21,200 --> 00:01:22,800 NATIONAL INSTITUTE FOR 32 00:01:22,800 --> 00:01:24,360 NEUROLOGICAL DISORDER AND 33 00:01:24,360 --> 00:01:24,680 STROKE. 34 00:01:24,680 --> 00:01:25,840 WE HOPE TO BE ABLE TO WELCOME 35 00:01:25,840 --> 00:01:30,120 YOU ALL BACK IN THE FUTURE BUT 36 00:01:30,120 --> 00:01:32,440 FOR NOW WE'RE STILL VIRTUAL SO 37 00:01:32,440 --> 00:01:33,880 I'M GOING TO INTRODUCE YOU FOR 38 00:01:33,880 --> 00:01:35,880 THE NEXT FEW DAYS. 39 00:01:35,880 --> 00:01:37,400 THE CHAIRS OF THE PC SYMPOSIUM 40 00:01:37,400 --> 00:01:38,960 PLANNING COMMITTEE THIS YEAR. 41 00:01:38,960 --> 00:01:49,680 Dr. EINABELL FER FOR -- WHERE SE 42 00:01:49,680 --> 00:01:53,200 MANAGED PART OF THE PAIN NCCI 43 00:01:53,200 --> 00:01:54,600 PAIN FORT FOAL. 44 00:01:54,600 --> 00:01:55,280 MELISSA GHIM SAY PROGRAM 45 00:01:55,280 --> 00:01:57,320 DIRECTOR AT THE NATIONAL 46 00:01:57,320 --> 00:01:59,200 INSTITUTE OF DIDN'TAL AND CRANE 47 00:01:59,200 --> 00:01:59,960 YAN AND FACIAL RESEARCH WHERE 48 00:01:59,960 --> 00:02:02,680 SHE MANAGES THE NEUROSCIENCE OF 49 00:02:02,680 --> 00:02:05,680 (INAUDIBLE) AND THE DISORDER 50 00:02:05,680 --> 00:02:05,960 FORT FOAL. 51 00:02:05,960 --> 00:02:07,760 THEY HAVE WORKED TIRELESSLY TO 52 00:02:07,760 --> 00:02:08,800 PUT THIS PROGRAM TOGETHER FOR 53 00:02:08,800 --> 00:02:12,120 YOU AND LEAD US THROUGH THE NEXT 54 00:02:12,120 --> 00:02:12,760 FEW DAYS. 55 00:02:12,760 --> 00:02:15,080 YOU WILL SEE THEM POPPING UP TO 56 00:02:15,080 --> 00:02:15,760 SHEPHERD US ALONG. 57 00:02:15,760 --> 00:02:17,840 WITH THAT IT'S MY PLEASURE TO 58 00:02:17,840 --> 00:02:19,800 INTRODUCE Dr. WALTER 59 00:02:19,800 --> 00:02:23,720 KOROSHETZ, THE DISTRICT OR OF 60 00:02:23,720 --> 00:02:24,640 NEUROLOGICAL STROKE AND CHAIR OF 61 00:02:24,640 --> 00:02:27,200 THE NIH PAIN CONSORTIUM 62 00:02:27,200 --> 00:02:28,480 EXECUTIVE COMMITTEE TO 63 00:02:28,480 --> 00:02:31,120 OFFICIALLY WELCOME YOU TO THE 64 00:02:31,120 --> 00:02:34,520 SYMPOSIUM THIS YEAR. 65 00:02:34,520 --> 00:02:35,040 THANK YOU. 66 00:02:35,040 --> 00:02:37,240 >> THANK YOU, VERY MUCH. 67 00:02:37,240 --> 00:02:41,000 AND ARE YOU SEEING THE SLIDES 68 00:02:41,000 --> 00:02:44,080 CORRECTLY? 69 00:02:44,080 --> 00:02:44,840 >> THANK YOU. 70 00:02:44,840 --> 00:02:50,400 SO AS I MENTIONED I'M WALTER 71 00:02:50,400 --> 00:02:52,960 KOROSHETZ AND THIS IS OUR 17th 72 00:02:52,960 --> 00:02:55,720 ANNUAL AND NIH PAIN CONSORTIUM 73 00:02:55,720 --> 00:02:58,880 SYMPOSIUM AND I WANT TO WELCOME 74 00:02:58,880 --> 00:03:00,600 EVERYONE AND EMPHASIS HOW 75 00:03:00,600 --> 00:03:03,000 IMPORTANT THIS SYMPOSIUM IS FOR 76 00:03:03,000 --> 00:03:06,040 PAIN RESEARCH GOING FORWARD AND 77 00:03:06,040 --> 00:03:08,840 TODAY, THE FOCUS OF THE 78 00:03:08,840 --> 00:03:11,640 SYMPOSIUM IS PAIN MANAGEMENT 79 00:03:11,640 --> 00:03:13,880 THROUGH THE LENS OF A WHOLE 80 00:03:13,880 --> 00:03:15,400 PERSON HEALTH. 81 00:03:15,400 --> 00:03:18,720 CLEARLY, I'M SURE MANY OF YOU ON 82 00:03:18,720 --> 00:03:21,440 THE SYMPOSIUM TODAY UNDERSTAND 83 00:03:21,440 --> 00:03:24,520 HOW PAIN EFFECTS SO MANY 84 00:03:24,520 --> 00:03:27,160 DIFFERENT OTHER SYSTEMS IN OUR 85 00:03:27,160 --> 00:03:29,200 BODIES WHETHER IT'S MOOD, 86 00:03:29,200 --> 00:03:32,200 MOBILITY, IT ALL CONTRIBUTES TO 87 00:03:32,200 --> 00:03:33,160 DECREASING THE PERSON'S ABILITY 88 00:03:33,160 --> 00:03:34,720 TO FUNCTION THE WAY THEY WOULD 89 00:03:34,720 --> 00:03:36,440 LIKE TO IN THE WORLD AND THEN 90 00:03:36,440 --> 00:03:37,680 ALSO, HOW THERE ARE SO MANY 91 00:03:37,680 --> 00:03:40,800 OTHER THINGS THAT HAPPEN TO US, 92 00:03:40,800 --> 00:03:41,680 CO-MORBIDITIES, WHETHER THERE 93 00:03:41,680 --> 00:03:45,640 ARE HEALTH RELATED INJURY 94 00:03:45,640 --> 00:03:49,600 RELATED THAT IMPACT ON PAIN. 95 00:03:49,600 --> 00:03:52,360 SO BEING ABLE TO STEER THE 96 00:03:52,360 --> 00:03:53,920 PROBLEM FROM THE PERSON WHO IS 97 00:03:53,920 --> 00:03:55,840 EXPERIENCING IT, THROUGH THAT 98 00:03:55,840 --> 00:03:57,520 LENS, IS WHAT WE'RE GOING TO BE 99 00:03:57,520 --> 00:03:59,440 TALKING ABOUT TODAY AND I JUST 100 00:03:59,440 --> 00:04:01,720 WANTED TO MENTION, WE CAN'T HELP 101 00:04:01,720 --> 00:04:03,360 BUT MENTION THAT THE REASON WHY 102 00:04:03,360 --> 00:04:05,200 THESE SYMPOSIUM NOW ARE MORE 103 00:04:05,200 --> 00:04:08,240 PORT AN THAN EVER IS BECAUSE 104 00:04:08,240 --> 00:04:09,200 WITH THE HEEL INITIATIVE HELPING 105 00:04:09,200 --> 00:04:11,600 TO END ADDICTION LONG-TERM, NIH 106 00:04:11,600 --> 00:04:13,480 HAS RECEIVED CONSIDERABLE FUNDS 107 00:04:13,480 --> 00:04:16,040 TO KIND OF DO THINGS AT THE 108 00:04:16,040 --> 00:04:19,080 RESEARCH LEVEL THAT WERE 109 00:04:19,080 --> 00:04:20,000 PREVIOUSLY UNMANAGE ABLE SO WE 110 00:04:20,000 --> 00:04:25,200 HAVE A TREE MEN -- UNIMAGINABLE. 111 00:04:25,200 --> 00:04:27,040 SO WE CAN HOPEFULLY GET BETTER 112 00:04:27,040 --> 00:04:29,880 TREATMENTS FOR PATIENTS AND 113 00:04:29,880 --> 00:04:32,040 THESE ARE REALLY IMPORTANT IN 114 00:04:32,040 --> 00:04:34,960 KIND OF ADVISING OR INFORMING 115 00:04:34,960 --> 00:04:37,360 THE NIH FOLKS ON WHICH WAY TO 116 00:04:37,360 --> 00:04:39,840 MOVE THOSE PROGRAMS. 117 00:04:39,840 --> 00:04:41,640 SO, AGAIN, REALLY IMPORTANT 118 00:04:41,640 --> 00:04:43,640 TOPIC AND GO TO THE NEXT SLIDE. 119 00:04:43,640 --> 00:04:45,360 I HAVE THIS CONTROL. 120 00:04:45,360 --> 00:04:47,200 SO, JUST TO MENTION THE PAIN 121 00:04:47,200 --> 00:04:49,000 CONSORTIUM HAS BEEN AROUND AS I 122 00:04:49,000 --> 00:04:51,440 SAID, FOR OVER 17 YEARS AND IT'S 123 00:04:51,440 --> 00:04:53,640 MULTIPLE DIFFERENT INSTITUTES AT 124 00:04:53,640 --> 00:04:56,080 NIH AND WE'RE ALL GALVANIZED BY 125 00:04:56,080 --> 00:04:58,440 OUR MISSION TO ENHANCE PAIN 126 00:04:58,440 --> 00:05:00,120 RESEARCH, PROMOTE COLLABORATIONS 127 00:05:00,120 --> 00:05:01,400 ACROSS THE INSTITUTES AND TO 128 00:05:01,400 --> 00:05:02,960 HAVE PROGRAMS AND ACTIVITIES 129 00:05:02,960 --> 00:05:04,240 THAT ADDRESS PAIN AND AS I 130 00:05:04,240 --> 00:05:05,640 MENTIONED WITH THE HEAL 131 00:05:05,640 --> 00:05:06,680 INITIATIVE, WE ARE FUNDING THAT 132 00:05:06,680 --> 00:05:08,160 WE NEVER HAD BEFORE TO DO THAT 133 00:05:08,160 --> 00:05:09,080 KIND OF THING. 134 00:05:09,080 --> 00:05:12,120 THE LEADERSHIP FOR THE PAIN 135 00:05:12,120 --> 00:05:15,720 CONSORTIUM IS REALLY DISTRIBUTED 136 00:05:15,720 --> 00:05:22,000 BETWEEN MYSELF THAT Dr. 137 00:05:22,000 --> 00:05:30,880 LANGEVIN AND SHANNON ZENK, Dr. 138 00:05:30,880 --> 00:05:34,280 D'SOUZA AND Dr. VOLKOW AND 139 00:05:34,280 --> 00:05:36,560 THIS IS THE PEOPLE THAT PUT 140 00:05:36,560 --> 00:05:39,360 TOGETHER FROM THE PAIN POLICY 141 00:05:39,360 --> 00:05:44,920 AND PLANNING AND LEAH AND LAURA 142 00:05:44,920 --> 00:05:46,840 WANDNER AND LINDA PORTER WHO 143 00:05:46,840 --> 00:05:47,560 RUNS THAT OFFICE. 144 00:05:47,560 --> 00:05:49,760 THANK YOU FOR THE PEOPLE DOING 145 00:05:49,760 --> 00:05:51,920 THE WORK YEAR IN AND YEAR OUT. 146 00:05:51,920 --> 00:05:54,200 THESE ARE THE LIST OF THE 147 00:05:54,200 --> 00:05:54,880 INSTITUTES AND CENTER INVOLVED 148 00:05:54,880 --> 00:05:56,920 IN THE PAIN CONSORTIUM AT NIH SO 149 00:05:56,920 --> 00:05:58,720 IT'S PRETTY MUCH ANY DISEASE 150 00:05:58,720 --> 00:06:01,040 ORGANIZATION AND NUMBER OF 151 00:06:01,040 --> 00:06:03,200 DIFFERENT OFFICES ALL HAVE PAIN 152 00:06:03,200 --> 00:06:05,320 AS PART OF THEIR MISSIONS AND 153 00:06:05,320 --> 00:06:06,920 OUR JOB IN THE PAIN CONSORTIUM 154 00:06:06,920 --> 00:06:09,840 IS TO KIND OF COLLABORATE ACROSS 155 00:06:09,840 --> 00:06:12,000 ALL THESE INSTITUTES AND CLEARLY 156 00:06:12,000 --> 00:06:16,760 THE EMPHASIS TODAY WILL BE 157 00:06:16,760 --> 00:06:20,720 HEAVILY ON SOME OF THE 158 00:06:20,720 --> 00:06:22,520 INSTITUTES PARTICULARLY NCCIH, 159 00:06:22,520 --> 00:06:25,520 NURSING INSTITUTES, BUT ALL OF 160 00:06:25,520 --> 00:06:28,000 THE INSTITUTES HERE LISTED WILL 161 00:06:28,000 --> 00:06:30,120 HAVE INTEREST. 162 00:06:30,120 --> 00:06:32,920 AND SO THE PANEL SESSIONS WE'LL 163 00:06:32,920 --> 00:06:34,480 BE TALKING ABOUT IS THE COMMENT 164 00:06:34,480 --> 00:06:37,200 PLEX TEE OF PLAIN AND 165 00:06:37,200 --> 00:06:38,440 CO-MORBIDITY AND INTEGRATION 166 00:06:38,440 --> 00:06:39,520 WHOLE PERSON TOOLS AND 167 00:06:39,520 --> 00:06:40,560 APPROACHES AND WHOLE PERSON 168 00:06:40,560 --> 00:06:43,880 APPROACHES TO PAIN MANAGEMENT. 169 00:06:43,880 --> 00:06:47,480 AND WITH THAT I AM REALLY HAPPY 170 00:06:47,480 --> 00:06:49,320 TO INTRODUCE OUR KEYNOTE 171 00:06:49,320 --> 00:06:52,040 SPEAKER, TRACY GAUDET. 172 00:06:52,040 --> 00:06:54,000 SHE IS THE EXECUTIVE DIRECTOR OF 173 00:06:54,000 --> 00:06:57,240 THE WHOLE HEALTH INSTITUTE AND 174 00:06:57,240 --> 00:07:00,000 IT'S A PHILANTHROPIC INSTITUTE 175 00:07:00,000 --> 00:07:02,840 DEDICATED TO REALLY TRANSFORM 176 00:07:02,840 --> 00:07:06,320 HOW HEALTH IS SEEN, DELIVERED, 177 00:07:06,320 --> 00:07:07,920 ASSESSED, WITH THE WHOLE PATIENT 178 00:07:07,920 --> 00:07:09,720 IN MIND AND SO COULDN'T HAVE A 179 00:07:09,720 --> 00:07:14,160 BETTER SPEAK ARE FOR TODAY'S 180 00:07:14,160 --> 00:07:16,280 SYMPOSIUM AND PRIOR TO GOING TO 181 00:07:16,280 --> 00:07:20,600 WHOLE HEALTH, SHE WAS THE 182 00:07:20,600 --> 00:07:23,400 EXECUTIVE DIRECTOR AT THE V.A. 183 00:07:23,400 --> 00:07:24,280 ADMINISTRATION'S NATIONAL OFFICE 184 00:07:24,280 --> 00:07:25,760 OF PATIENT CENTERED CARE AND 185 00:07:25,760 --> 00:07:30,760 CULTURAL TRANSFORMATION AND SO 186 00:07:30,760 --> 00:07:32,240 THROUGH A LOT OF EXPERIENCE AND 187 00:07:32,240 --> 00:07:33,240 THAT HEALTH-CARE SYSTEM WHICH IS 188 00:07:33,240 --> 00:07:34,920 THE ONE WE WORK WITH HEAVILY 189 00:07:34,920 --> 00:07:37,760 HERE AT NIH TO ACTUALLY TEST NEW 190 00:07:37,760 --> 00:07:39,880 WAYS OF MANAGING PAIN IN 191 00:07:39,880 --> 00:07:42,080 HEALTHCARE SYSTEMS. 192 00:07:42,080 --> 00:07:44,400 AND PREVIOUS TO THAT, OUR EXTENT 193 00:07:44,400 --> 00:07:46,440 WITH THE V.A. SHE WAS WITH THE 194 00:07:46,440 --> 00:07:49,440 DUKE UNIVERSITY HEALTH SYSTEM 195 00:07:49,440 --> 00:07:51,640 AND SHE RECEIVED THE NATION'S 196 00:07:51,640 --> 00:07:53,960 VETERANS WITH EX POLICE CAR' 197 00:07:53,960 --> 00:07:56,120 SERVICE AWARD AND THE VISIONARY 198 00:07:56,120 --> 00:07:58,120 AWARD OF THE ACADEMY OF 199 00:07:58,120 --> 00:07:58,840 INTEGRATED HEALTH AND MEDICINE 200 00:07:58,840 --> 00:08:00,000 FOR HER LEADERSHIP IN 201 00:08:00,000 --> 00:08:04,080 TRANSFORMING HEALTHCARE AND 202 00:08:04,080 --> 00:08:07,800 TRACY, WE'RE INTERESTED TO HEAR 203 00:08:07,800 --> 00:08:15,280 YOUR THOUGHTS AND ON RESEARCH 204 00:08:15,280 --> 00:08:16,480 AND PATIENTS SUFFERING WITH PAIN 205 00:08:16,480 --> 00:08:18,480 AND NOT REALLY GETTING THE 206 00:08:18,480 --> 00:08:20,800 RELIEF TO GET TO THE FUNCTIONAL 207 00:08:20,800 --> 00:08:22,200 LEVEL THEY'D LIKE TO GET TO. 208 00:08:22,200 --> 00:08:23,280 WITH THAT I WANT TO HAND IT OVER 209 00:08:23,280 --> 00:08:23,760 TO TRACY. 210 00:08:23,760 --> 00:08:25,880 THANK YOU, VERY MUCH. 211 00:08:25,880 --> 00:08:26,400 I'LL STOP SHARING. 212 00:08:26,400 --> 00:08:28,760 >> THANK YOU SO VERY MUCH AND I 213 00:08:28,760 --> 00:08:30,880 WILL SAY A LITTLE BIT AT CLOSE 214 00:08:30,880 --> 00:08:32,800 OF MY TIME WITH YOU THIS 215 00:08:32,800 --> 00:08:33,040 MORNING. 216 00:08:33,040 --> 00:08:34,320 HOW SIGNIFICANT I THINK THIS 217 00:08:34,320 --> 00:08:35,800 MEETING IS AND HOW HONORED I AM 218 00:08:35,800 --> 00:08:38,920 TO BE A PART OF LAUNCHING THE 219 00:08:38,920 --> 00:08:39,840 CONVERSATIONS. 220 00:08:39,840 --> 00:08:41,000 SO, THANK YOU VERY MUCH. 221 00:08:41,000 --> 00:08:42,200 THERE'S NEVER BEEN A MORE 222 00:08:42,200 --> 00:08:43,360 IMPORTANT TIME FOR THIS 223 00:08:43,360 --> 00:08:44,160 CONVERSATION. 224 00:08:44,160 --> 00:08:49,080 SO, I'M GOING TO MOVE RIGHT INTO 225 00:08:49,080 --> 00:08:49,880 MY SLIDES. 226 00:08:49,880 --> 00:08:51,240 I LOVE THE FACT THAT WE'RE 227 00:08:51,240 --> 00:08:53,320 ASKING QUESTIONS OF HOW CAN A 228 00:08:53,320 --> 00:08:56,080 WHOLE HEALTH APPROACH INFORM HOW 229 00:08:56,080 --> 00:08:58,280 WE THINK ABOUT TREAT, RESEARCH, 230 00:08:58,280 --> 00:09:00,160 THE ISSUES OF PEOPLE DEALING 231 00:09:00,160 --> 00:09:01,560 WITH PAIN AND SO I THINK YOU 232 00:09:01,560 --> 00:09:04,200 GUYS ARE OPERATING MY SLIDES IF 233 00:09:04,200 --> 00:09:14,720 I AM UNDERSTANDING THAT RIGHT. 234 00:09:16,680 --> 00:09:19,480 HE CAN GO AHEAD AND SAY THAT I 235 00:09:19,480 --> 00:09:20,840 THINK YOU KNOW, I'M GOING TO 236 00:09:20,840 --> 00:09:22,840 START WITH A FEW ILLUSTRATIONS 237 00:09:22,840 --> 00:09:24,440 OF CONTEXT SINCE THIS IS THE 238 00:09:24,440 --> 00:09:26,120 KICKOFF TO THE CONVERSATION OVER 239 00:09:26,120 --> 00:09:28,560 THE NEXT TWO DAYS ABOUT -- ARE 240 00:09:28,560 --> 00:09:30,080 YOU SEEING MY SLIDES BECAUSE I 241 00:09:30,080 --> 00:09:30,800 AM NOT? 242 00:09:30,800 --> 00:09:32,680 >> NOT YET. 243 00:09:32,680 --> 00:09:33,440 >> GREAT. 244 00:09:33,440 --> 00:09:34,960 NOW YOU CAN GO TO THE NEXT 245 00:09:34,960 --> 00:09:35,160 SLIDE. 246 00:09:35,160 --> 00:09:37,360 I WANTED TO MAKE SURE THAT I AM 247 00:09:37,360 --> 00:09:40,000 ON THE SAME PAGE AS THE REST OF 248 00:09:40,000 --> 00:09:40,640 YOU ALL. 249 00:09:40,640 --> 00:09:42,640 IN TERMS OF SETTING THE LARGER 250 00:09:42,640 --> 00:09:43,480 CONTEXT, I KNOW MOST PEOPLE IN 251 00:09:43,480 --> 00:09:44,720 THIS AUDIENCE ARE VERY FAMILIAR 252 00:09:44,720 --> 00:09:46,680 WITH THIS BUT I THINK IT'S 253 00:09:46,680 --> 00:09:47,920 IMPORTANT THAT WE STOP AND PAUSE 254 00:09:47,920 --> 00:09:49,600 AND LOOK AT LARGER CONTEXT OF 255 00:09:49,600 --> 00:09:51,760 WHAT WE'RE DEALING WITH HERE 256 00:09:51,760 --> 00:09:53,080 THAT IF WE THINK ABOUT 257 00:09:53,080 --> 00:09:54,000 HEALTHCARE IN GENERAL AND THE 258 00:09:54,000 --> 00:09:57,720 UNITED STATES, WE ARE IN A DIRE 259 00:09:57,720 --> 00:09:59,320 SITUATION AS PEOPLE KNOW, 260 00:09:59,320 --> 00:10:00,920 FINANCIALLY, IT'S INCREDIBLE AND 261 00:10:00,920 --> 00:10:03,120 WE'RE UP TO 20% OF OUR G.D.P. 262 00:10:03,120 --> 00:10:04,680 AND GOING TOWARDS HEALTHCARE 263 00:10:04,680 --> 00:10:06,320 COSTS AND WHILE OUR OUTCOMES ARE 264 00:10:06,320 --> 00:10:07,280 NOT WHAT WE WANT. 265 00:10:07,280 --> 00:10:10,760 IF YOU LOOK AT LIFE EXPECTANCY, 266 00:10:10,760 --> 00:10:12,960 ALL 2020 OUR LIFE EXPECTANCY 267 00:10:12,960 --> 00:10:14,720 DECREASED TO 77 YEARS AND WHEN 268 00:10:14,720 --> 00:10:17,080 YOU COMPARE US TO OTHER 269 00:10:17,080 --> 00:10:18,800 COUNTRIES, COMPARABLE COUNTRIES 270 00:10:18,800 --> 00:10:21,840 ARE ABOUT 81.1 YEARS IN 2020 SO 271 00:10:21,840 --> 00:10:24,320 THE GAP BETWEEN US AND THE OTHER 272 00:10:24,320 --> 00:10:28,120 PEER COUNTRIES IS WIDENING. 273 00:10:28,120 --> 00:10:30,280 CHRONIC CONDITIONS ARE CONSUMING 274 00:10:30,280 --> 00:10:31,680 A VAST MAJORITY OF THAT HAVE AND 275 00:10:31,680 --> 00:10:34,200 THE KEY FOR THIS CONVERSATION IS 276 00:10:34,200 --> 00:10:35,880 THAT MUCH OF CHRONIC CONDITION 277 00:10:35,880 --> 00:10:38,840 IS IMPACTED BY PEOPLE'S 278 00:10:38,840 --> 00:10:39,880 LIFESTYLE, BEHAVIOR, CHOICES, 279 00:10:39,880 --> 00:10:42,160 AND THE BOTTOM LINE IS IN 280 00:10:42,160 --> 00:10:43,200 CERTAINLY MY OPINION AND MANY 281 00:10:43,200 --> 00:10:45,480 OTHERS IS ONE OF THE MAJOR 282 00:10:45,480 --> 00:10:46,720 PROBLEMS THAT WE HAVE 283 00:10:46,720 --> 00:10:48,720 UNDERLINING THIS CRISIS, IS THAT 284 00:10:48,720 --> 00:10:49,960 THE CURRENT APPROACH TO HEALTH 285 00:10:49,960 --> 00:10:53,040 AND DISEASE MANAGEMENT, ACTUALLY 286 00:10:53,040 --> 00:10:55,480 DOESN'T FOCUS ON ENGAGING PEOPLE 287 00:10:55,480 --> 00:10:57,200 AND OPTIMIZING THEIR SELF-CARE 288 00:10:57,200 --> 00:11:00,200 AND WELL BEING SO WE DO PARTS OF 289 00:11:00,200 --> 00:11:01,680 HEALTHCARE VERY EFFECTIVELY AND 290 00:11:01,680 --> 00:11:04,000 THE ASPECTS THAT ARE SO CRITICAL 291 00:11:04,000 --> 00:11:05,640 TO THESE OUTCOMES AND THE COST 292 00:11:05,640 --> 00:11:07,000 WE DON'T REALLY PAY ATTENTION 293 00:11:07,000 --> 00:11:07,400 TO. 294 00:11:07,400 --> 00:11:09,240 THE SYSTEM ITSELF, NOT 295 00:11:09,240 --> 00:11:11,080 INDIVIDUALS, THIS IS NOT ABOUT 296 00:11:11,080 --> 00:11:13,440 THE INDIVIDUAL CLINICIANS OR 297 00:11:13,440 --> 00:11:14,560 RESEARCHERS BUT THE SYSTEM IS 298 00:11:14,560 --> 00:11:16,760 NOT DESIGNED AS A CORE 299 00:11:16,760 --> 00:11:19,600 COMPETENCY TO ENGAGE PEOPLE IN 300 00:11:19,600 --> 00:11:20,960 THEIR OWN SEVERAL CARE AND TEACH 301 00:11:20,960 --> 00:11:22,400 THEM THE SKILLS THEY NEED TO DO 302 00:11:22,400 --> 00:11:23,760 THAT EFFECTIVELY. 303 00:11:23,760 --> 00:11:25,360 WE'RE GOING TO TALK MORE ABOUT 304 00:11:25,360 --> 00:11:25,640 THIS. 305 00:11:25,640 --> 00:11:27,400 I THINK THE OPIOID CRISIS FROM 306 00:11:27,400 --> 00:11:30,320 MY PERSPECTIVE IS A VERY CLEAR 307 00:11:30,320 --> 00:11:32,200 DEMONSTRATION OF THE LIMITATIONS 308 00:11:32,200 --> 00:11:34,520 OF WHAT I WOULD CALL A FIND IT, 309 00:11:34,520 --> 00:11:36,880 FIX IT OR A REDUCTION IS TICK 310 00:11:36,880 --> 00:11:39,000 PARADIGM THAT I THINK WE NOW 311 00:11:39,000 --> 00:11:40,920 HAVE WITH THE LEADERSHIP OF THIS 312 00:11:40,920 --> 00:11:42,840 GROUP, HAVE AN OPPORTUNITY TO 313 00:11:42,840 --> 00:11:45,640 REALLY, REALLY TRANSFORM IN A 314 00:11:45,640 --> 00:11:55,760 VERY SIGNIFICANT WAY. 315 00:11:55,760 --> 00:11:56,880 THIS IS A LITTLE SHOCKING WHEN 316 00:11:56,880 --> 00:11:58,240 YOU LOOK AT THE LINE. 317 00:11:58,240 --> 00:12:00,680 THE PURPLE LINE IS THE 318 00:12:00,680 --> 00:12:01,800 PER-CAPITA SPENDING IN THE 319 00:12:01,800 --> 00:12:05,680 NATIONS ACROSS THE BOTTOM. 320 00:12:05,680 --> 00:12:07,080 TRACTOR-TRAILER THE AVERAGE LIFE 321 00:12:07,080 --> 00:12:12,840 EXPECTANCY AND YOU CAN SEE AND 322 00:12:12,840 --> 00:12:14,520 AND IT'S WAY DOWN THE LINE NEXT 323 00:12:14,520 --> 00:12:16,720 TO CUBA IN TERMS OF LIFE EXPECT 324 00:12:16,720 --> 00:12:18,160 ANTSY SO ANOTHER WAY TO PAINT 325 00:12:18,160 --> 00:12:23,360 THE PICTURE OF THE PROBLEM WE'RE 326 00:12:23,360 --> 00:12:23,640 FACING. 327 00:12:23,640 --> 00:12:24,920 AND I LOVE THIS. 328 00:12:24,920 --> 00:12:27,520 I WOULD ENCOURAGE YOU TO HOLD 329 00:12:27,520 --> 00:12:34,200 THIS QUOTE IN YOUR CON SUNNESS 330 00:12:34,200 --> 00:12:34,600 CONSCIOUSNESS. 331 00:12:34,600 --> 00:12:36,240 PROBLEMS CANNOT BE SOLVED WITH 332 00:12:36,240 --> 00:12:37,960 THE SAME LEVEL OF THINKING THAT 333 00:12:37,960 --> 00:12:38,640 CREATED THEM. 334 00:12:38,640 --> 00:12:40,440 AS I'M UNDERSTANDING THE 335 00:12:40,440 --> 00:12:41,960 INTENTIONS FOR THE TWO DAYS, 336 00:12:41,960 --> 00:12:45,360 IT'S TO LAUNCH US INTO ADVANCING 337 00:12:45,360 --> 00:12:48,560 OUR THINKING ABOUT THE PROBLEMS 338 00:12:48,560 --> 00:12:50,400 WE'RE FACING AND HOW WE THINK OF 339 00:12:50,400 --> 00:12:51,360 THIS DIFFERENTLY. 340 00:12:51,360 --> 00:12:54,360 IN A DIFFERENT WAY, DOING MORE 341 00:12:54,360 --> 00:12:56,560 OF THE SAME IS NOT GOING TO FIX 342 00:12:56,560 --> 00:12:58,360 THE PROBLEM THAT WE'RE CURRENTLY 343 00:12:58,360 --> 00:12:58,800 FACING. 344 00:12:58,800 --> 00:13:03,440 SO NEXT SLIDE, PLEASE. 345 00:13:03,440 --> 00:13:04,800 A QUICK GLANCE AT -- IF YOU 346 00:13:04,800 --> 00:13:07,440 CLICK AGAIN, I DIDN'T KNOW I 347 00:13:07,440 --> 00:13:08,040 PHASED THAT. 348 00:13:08,040 --> 00:13:09,520 THERE WE GO, THANK YOU. 349 00:13:09,520 --> 00:13:11,640 A QUICK LOOK AT OVERLY 350 00:13:11,640 --> 00:13:13,000 SIMPLIFIED VERSION BUT I THINK A 351 00:13:13,000 --> 00:13:14,280 USEFUL PERSPECTIVE WHEN WE'RE 352 00:13:14,280 --> 00:13:15,680 TALKING ABOUT CHANGING OUR 353 00:13:15,680 --> 00:13:17,480 PARADIGMS AND LOOKING AT THE 354 00:13:17,480 --> 00:13:21,600 COMMENT PLCOMPLEXITY OF PAIN, YK 355 00:13:21,600 --> 00:13:23,000 ABOUT OUR SCIENCE IN THE 1900S 356 00:13:23,000 --> 00:13:25,160 COMPARED TO THE 2000s, SCIENCE 357 00:13:25,160 --> 00:13:27,160 HAS ADVANCED TREMENDOUSLY, 358 00:13:27,160 --> 00:13:27,560 RIGHT. 359 00:13:27,560 --> 00:13:29,480 WE'VE GONE FROM UNDERSTANDING 360 00:13:29,480 --> 00:13:31,760 WHAT THE LIST AND WE'VE GONE 361 00:13:31,760 --> 00:13:33,800 FROM A REDUCTIONISTIC APPROACH 362 00:13:33,800 --> 00:13:37,480 AND THE 1900S AND RESULTED IN AN 363 00:13:37,480 --> 00:13:40,160 APPROACH OF FINDING A CORE 364 00:13:40,160 --> 00:13:49,800 PROBLEMS AND FIXING IT AND AND 365 00:13:49,800 --> 00:13:50,920 THOSE THINGS ARE GREAT WHEN YOU 366 00:13:50,920 --> 00:13:52,400 CAN DO THAT BUT WHAT WE LEARNED 367 00:13:52,400 --> 00:13:54,440 IT'S NOT THAT SIMPLE AND THESE 368 00:13:54,440 --> 00:13:58,040 THINGS ARE VERY COMPLEX AND OUR 369 00:13:58,040 --> 00:13:59,160 SCIENTIST ADVANCE INTO MUCH MORE 370 00:13:59,160 --> 00:14:00,880 OF A SYSTEMS APPROACH BUT I 371 00:14:00,880 --> 00:14:03,040 WOULD PROPOSE TO YOU THAT OUR 372 00:14:03,040 --> 00:14:05,320 MEDICAL APPROACHES HAVE NOT KEPT 373 00:14:05,320 --> 00:14:08,760 PACE WITH THAT. 374 00:14:08,760 --> 00:14:12,000 NEXT SLIDE. 375 00:14:12,000 --> 00:14:14,480 WHEN WE THINK ABOUT THIS WHEN WE 376 00:14:14,480 --> 00:14:15,280 TALK BASIS TOMORROW'S THAT THE 377 00:14:15,280 --> 00:14:25,840 APPROACH AND PARADIGMS WE REALLY 378 00:14:37,720 --> 00:14:41,040 FELT LIKE OK, IF WE CAN FIND THE 379 00:14:41,040 --> 00:14:41,800 PROBLEM, WE CAN CREATE THE 380 00:14:41,800 --> 00:14:43,400 SOLUTION AND FIX THE PROBLEM BUT 381 00:14:43,400 --> 00:14:46,000 THAT IS A VERY CONCEPT OF A 382 00:14:46,000 --> 00:14:48,880 SINGLE FACTOR AND THERE'S A 383 00:14:48,880 --> 00:14:50,360 MICROBE CAUSING AN INFECTION AND 384 00:14:50,360 --> 00:14:54,400 WE JUST CREATE THE CURE FOR THAT 385 00:14:54,400 --> 00:14:55,880 AND WE'RE GOOD TO GO. 386 00:14:55,880 --> 00:14:58,160 NEEDLESS TO SAY IT'S NOT THAT 387 00:14:58,160 --> 00:14:58,720 SIMPLE. 388 00:14:58,720 --> 00:14:59,720 CERTAINLY PAIN AND PEOPLE'S 389 00:14:59,720 --> 00:15:03,360 SUFFERING WITH PAIN, ARE ONE OF 390 00:15:03,360 --> 00:15:05,800 THE MOST IS POIGNANT 391 00:15:05,800 --> 00:15:07,040 ILLUSTRATIONS OF HOW COMPLEX 392 00:15:07,040 --> 00:15:08,400 THESE ILLUSTRATIONS ARE. 393 00:15:08,400 --> 00:15:10,400 THERE ARE FACTORS IN THE PERSON 394 00:15:10,400 --> 00:15:13,040 THEMSELVES AND ALSO IN THEIR 395 00:15:13,040 --> 00:15:13,360 ENVIRONMENT. 396 00:15:13,360 --> 00:15:15,200 THERE IS THEIR GENOMIC RISK AND 397 00:15:15,200 --> 00:15:17,480 SOCIAL DETERMINANTS, LIFESTYLE 398 00:15:17,480 --> 00:15:20,040 CHOICES, WE ARE COMPLEX ADAPTIVE 399 00:15:20,040 --> 00:15:24,480 SYSTEMS AND YET I THINK OUR 400 00:15:24,480 --> 00:15:26,000 MEDICAL APPROACH, AND I WOULD 401 00:15:26,000 --> 00:15:27,840 LEAVE IT TO YOU TO SAY, IF OUR 402 00:15:27,840 --> 00:15:29,080 RESEARCH APPROACH, HAS CAUGHT UP 403 00:15:29,080 --> 00:15:33,120 TO THAT AND ADVANCED BEYOND THE 404 00:15:33,120 --> 00:15:35,120 MORE REDUCTIONISTIC APPROACH. 405 00:15:35,120 --> 00:15:36,960 IT'S A BIG CHALLENGE THAT WE'RE 406 00:15:36,960 --> 00:15:44,760 FACING RIGHT NOW. 407 00:15:44,760 --> 00:15:47,320 >> I'M A PHYSICIAN CLINICIAN AND 408 00:15:47,320 --> 00:15:48,800 LOOKING AT HEALTHCARE DELIVERY 409 00:15:48,800 --> 00:15:50,000 SO I'M BEING CRITICAL OF THE 410 00:15:50,000 --> 00:15:52,800 WORLD I COME FROM AND THE 411 00:15:52,800 --> 00:15:54,560 SCIENCE HAS ADVANCED MUCH 412 00:15:54,560 --> 00:15:55,560 FURTHER THAN THE HEALTHCARE 413 00:15:55,560 --> 00:15:56,800 DELIVERY AND ONE ILLUSTRATION OF 414 00:15:56,800 --> 00:15:59,080 THIS, YOU KNOW, THE NOBEL PRIZE 415 00:15:59,080 --> 00:16:01,480 IN 2018 WAS AWARDED BASED ON 416 00:16:01,480 --> 00:16:04,160 THIS IS THE LANGUAGE THAT WAS 417 00:16:04,160 --> 00:16:07,040 DESCRIBED, THAT THIS IS A NEW 418 00:16:07,040 --> 00:16:09,320 PRINCIPLE FOR TREATMENT AND THIS 419 00:16:09,320 --> 00:16:11,480 WAS CANCER TREATMENT AND WHERE 420 00:16:11,480 --> 00:16:13,440 PREVIOUS TREATMENTS TARGETED THE 421 00:16:13,440 --> 00:16:14,760 CANCER CELLS AND THIS TARGETED 422 00:16:14,760 --> 00:16:16,720 THE HOST SO WHAT THAT MEANT IS 423 00:16:16,720 --> 00:16:20,320 IN THE SCIENCE DONE BY THESE TWO 424 00:16:20,320 --> 00:16:21,400 GENTLEMAN, INSTEAD OF FIGHTING 425 00:16:21,400 --> 00:16:23,600 THE CANCER CELL AND THE FIND IT 426 00:16:23,600 --> 00:16:25,760 AND FIX IT MODEL, WE'RE GOING TO 427 00:16:25,760 --> 00:16:27,240 FIND THE CANCER CELLS AND FIND 428 00:16:27,240 --> 00:16:29,840 NEW WAYS TO DESTROY THE CANCER 429 00:16:29,840 --> 00:16:31,320 CELLS, THEIR PRIZE WAS AWARDED 430 00:16:31,320 --> 00:16:32,720 BECAUSE THEY WERE ACTUALLY 431 00:16:32,720 --> 00:16:35,280 LOOKING AT THE HOST, MEANING THE 432 00:16:35,280 --> 00:16:37,440 PERSON, AND COULD THE TREATMENTS 433 00:16:37,440 --> 00:16:40,560 FOCUS ON, THIS IS MY LANGUAGE, 434 00:16:40,560 --> 00:16:42,400 NOT THEIRS BUT COULD THE 435 00:16:42,400 --> 00:16:45,200 TREATMENTS FOCUS ON THE 436 00:16:45,200 --> 00:16:48,920 AMPLIFYING THE BODIES OWN INNATE 437 00:16:48,920 --> 00:16:50,680 CAPACITY TO FIGHT THE CANCER 438 00:16:50,680 --> 00:16:51,080 CELLS. 439 00:16:51,080 --> 00:16:53,480 IT'S A SWITCH IN THAT PARADIGM 440 00:16:53,480 --> 00:16:55,000 THAT WAS RECOGNIZED AS VERY 441 00:16:55,000 --> 00:16:56,960 TRANSFORMATIONAL AND I WOULD 442 00:16:56,960 --> 00:16:58,600 PROPOSE TO YOU, IN MY 443 00:16:58,600 --> 00:17:00,720 EXPERIENCE, THAT THE HEALTHCARE 444 00:17:00,720 --> 00:17:02,320 DELIVERIES SYSTEM HAS NOT 445 00:17:02,320 --> 00:17:04,360 ADVANCED IN THE SAME WAY. 446 00:17:04,360 --> 00:17:06,480 AND THAT WE'RE STILL VERY MUCH 447 00:17:06,480 --> 00:17:09,320 CAUGHT IN THE FIND IT-FIX-IT 448 00:17:09,320 --> 00:17:10,840 REDUCTIONISTIC APPROACH IN LARGE 449 00:17:10,840 --> 00:17:12,000 PART BECAUSE THAT'S WHAT THIS 450 00:17:12,000 --> 00:17:13,320 SYSTEM IS SET UP TO DO AND 451 00:17:13,320 --> 00:17:15,120 THAT'S WHAT WE'RE PAID TO DO 452 00:17:15,120 --> 00:17:16,640 PRIMARILY SO IT'S NO ONE'S 453 00:17:16,640 --> 00:17:18,800 FAULT, IT'S A SYSTEMS ISSUE BUT 454 00:17:18,800 --> 00:17:20,280 THINK WE HAVE TO RECOGNIZE THE 455 00:17:20,280 --> 00:17:22,560 SYSTEMS ISSUE IF WE'RE GOING TO 456 00:17:22,560 --> 00:17:26,000 ADDRESS IT. 457 00:17:26,000 --> 00:17:28,040 NEXT SLIDE. 458 00:17:28,040 --> 00:17:30,640 I WANTED TO REFLECT A BIT ON HOW 459 00:17:30,640 --> 00:17:31,880 WE'VE BEEN TRAINED TO THINK. 460 00:17:31,880 --> 00:17:33,720 AGAIN, I'M A PHYSICIAN BY 461 00:17:33,720 --> 00:17:35,800 TRAINING AND SO I AM JUST 462 00:17:35,800 --> 00:17:37,640 REFLECTING AND I THINK WE HAVE 463 00:17:37,640 --> 00:17:39,160 GOTTEN BETTER THAN WHEN I WAS IN 464 00:17:39,160 --> 00:17:40,280 MEDICINE SCHOOL AND RESIDENTS 465 00:17:40,280 --> 00:17:41,920 DEN SEE BUT IT'S USEFUL WHEN 466 00:17:41,920 --> 00:17:43,520 WE'RE THINKING ABOUT CHANGING 467 00:17:43,520 --> 00:17:46,600 THE LENS, THROUGH WHICH WE LOOK, 468 00:17:46,600 --> 00:17:48,920 WHICH Dr. KOROSHETZ SHARED AND 469 00:17:48,920 --> 00:17:49,920 WHAT HAPPENS WHEN WE CHANGE THE 470 00:17:49,920 --> 00:17:50,320 LENS? 471 00:17:50,320 --> 00:17:52,000 I WANTED TO TAKE A MOMENT TO 472 00:17:52,000 --> 00:17:53,880 LOOK AT LENS THROUGH WHICH MOST 473 00:17:53,880 --> 00:17:58,000 OF US HAVE BEEN TRAINED TO THINK 474 00:17:58,000 --> 00:18:00,000 IF YOU THINK ABOUT WELL ASK 475 00:18:00,000 --> 00:18:02,040 YOURSELF HOW DO ANTIBIOTICS 476 00:18:02,040 --> 00:18:02,320 WORK? 477 00:18:02,320 --> 00:18:05,200 MOST OF US WILL SAY THE 478 00:18:05,200 --> 00:18:08,680 ANTIBIOTICS ANTI-BUYOT CURE THEE 479 00:18:08,680 --> 00:18:10,840 THEY KILL OFF THE MICROBES. 480 00:18:10,840 --> 00:18:13,840 A DIFFERENT WAY, PARALLEL TO THE 481 00:18:13,840 --> 00:18:15,720 NOBEL PRIZE-WINNING CANCER SHIFT 482 00:18:15,720 --> 00:18:16,920 AND A DIFFERENT WAY TO THINK 483 00:18:16,920 --> 00:18:19,240 ABOUT THAT IS YEAH, THEY 484 00:18:19,240 --> 00:18:21,040 ABSOLUTELY HELP BUT PERHAPS THE 485 00:18:21,040 --> 00:18:22,840 WAY WE CAN THINK ABOUT THAT IN A 486 00:18:22,840 --> 00:18:24,080 DIFFERENT LENS TO THINK ABOUT 487 00:18:24,080 --> 00:18:26,640 THAT IS THE ANTIBIOTICS REDUCE 488 00:18:26,640 --> 00:18:29,960 THE BACTERIAL LOAD SO THAT THE 489 00:18:29,960 --> 00:18:36,520 BODIES INNATE CAPACITY TO HEAL, 490 00:18:36,520 --> 00:18:37,840 CAN BE MORE SUCCESSFUL SOLVE 491 00:18:37,840 --> 00:18:40,880 THAT MIGHT SOUND LIKE A SUBTLE 492 00:18:40,880 --> 00:18:42,200 SHIFT BUT IT'S IMPORTANT IN HOW 493 00:18:42,200 --> 00:18:42,920 WE THINK. 494 00:18:42,920 --> 00:18:44,680 THE PARADIGM AND THE LENS WHICH 495 00:18:44,680 --> 00:18:47,800 WE LOOK AND PARALLEL TO ARE WE 496 00:18:47,800 --> 00:18:50,960 FIGHTING CANCER AND ENABLING THE 497 00:18:50,960 --> 00:19:01,440 HOST AND THE INNATE MY NEXT 498 00:19:13,240 --> 00:19:14,760 LIFETIME I WANT TO BE ANNAN 499 00:19:14,760 --> 00:19:15,640 THROW POLL GIST. 500 00:19:15,640 --> 00:19:17,200 SO TO REFLECT ON THE LANGUAGE WE 501 00:19:17,200 --> 00:19:18,720 USE IN MEDICINE AND SCIENCE AND 502 00:19:18,720 --> 00:19:20,880 WHAT DOES IT TELL US ABOUT OUR 503 00:19:20,880 --> 00:19:21,840 PARADIGM? 504 00:19:21,840 --> 00:19:25,480 IT'S VERY TELLING AND ANTI 505 00:19:25,480 --> 00:19:26,880 EVERYTHING AND YOU HAVE A 506 00:19:26,880 --> 00:19:31,240 PROBLEM AND I HAVE AN ANTI, 507 00:19:31,240 --> 00:19:33,280 RIGHT. 508 00:19:33,280 --> 00:19:35,240 WE HAVE ANTIBIOTIC. 509 00:19:35,240 --> 00:19:39,080 YOU HAVE DEPRESSION AND I HAVE 510 00:19:39,080 --> 00:19:43,400 AN ANTI A PARADIGM COMES BACK TO 511 00:19:43,400 --> 00:19:45,480 THIS REDUCE IS TICK, HERE IS THE 512 00:19:45,480 --> 00:19:48,040 FIND IT AND THE FIX IT AND IF IT 513 00:19:48,040 --> 00:19:50,840 WERE THAT SIMPLE, IF THAT WERE 514 00:19:50,840 --> 00:19:52,040 SUCCEEDING, THERE'S NOTHING 515 00:19:52,040 --> 00:19:58,840 INNATELY WRONG IT'S JUST 516 00:19:58,840 --> 00:19:59,680 INSUFFICIENT. 517 00:19:59,680 --> 00:20:01,160 AND THE LANGUAGE HELPS US 518 00:20:01,160 --> 00:20:02,080 RECOGNIZE WE'RE LOOKING THROUGH 519 00:20:02,080 --> 00:20:02,840 THE LENS. 520 00:20:02,840 --> 00:20:04,760 THE QUESTION OF, IS THERE AN 521 00:20:04,760 --> 00:20:08,920 INNATE CAPACITY TO HEAL? 522 00:20:08,920 --> 00:20:13,400 SOMETIMES THIS QUESTION TRIGGERS 523 00:20:13,400 --> 00:20:14,600 PEOPLE BECAUSE THERE'S IT COULD 524 00:20:14,600 --> 00:20:16,200 SAY IF DO YOU ANYTHING RIGHT, 525 00:20:16,200 --> 00:20:17,520 YOU WILL NEVER GET SICK OR DIE 526 00:20:17,520 --> 00:20:19,720 AND OBVIOUSLY IT'S NOT TRUE. 527 00:20:19,720 --> 00:20:20,680 WE'RE ALL MORTAL BEINGS AND 528 00:20:20,680 --> 00:20:24,760 WE'RE GOING TO GET SICK AND DIE. 529 00:20:24,760 --> 00:20:30,840 IT'S NOT LIKE IF YOU DO IT ALL 530 00:20:30,840 --> 00:20:39,160 RIGHT AND ARE WE DESIGNED AS 531 00:20:39,160 --> 00:20:40,840 HUMAN BEINGS WITH INNATE 532 00:20:40,840 --> 00:20:41,520 CAPACITY TO HEAL. 533 00:20:41,520 --> 00:20:42,960 SIMPLE THINGS LIKE CUTS. 534 00:20:42,960 --> 00:20:46,000 IF YOU REALLY THINK ABOUT IT AND 535 00:20:46,000 --> 00:20:48,160 WE BECOME SO ACCUSTOMED TO WELL, 536 00:20:48,160 --> 00:20:49,800 I GOT A CUT AND IT HEALED. 537 00:20:49,800 --> 00:20:52,080 WE FORGET HOW AMAZING IT IS AND 538 00:20:52,080 --> 00:20:54,040 HOW MANY MECHANISMS ARE IN PLAY 539 00:20:54,040 --> 00:20:58,080 FOR THE BODY TO ACTUALLY HEAL A 540 00:20:58,080 --> 00:20:58,440 CUT. 541 00:20:58,440 --> 00:20:59,840 A BROKEN BONE. 542 00:20:59,840 --> 00:21:01,720 EVEN MORE SIGNIFICANT IF IT'S 543 00:21:01,720 --> 00:21:03,680 ALIGNED AND NOT OUT OF ALIGNMENT 544 00:21:03,680 --> 00:21:07,280 OR COMPLEX BREAK, LEAVE IT 545 00:21:07,280 --> 00:21:07,560 ALONE. 546 00:21:07,560 --> 00:21:09,000 THE BODY HAS THE CAPACITY TO 547 00:21:09,000 --> 00:21:10,320 HEAL THE BONE. 548 00:21:10,320 --> 00:21:12,320 I MEAN, AGAIN, IF WE PAUSE AND 549 00:21:12,320 --> 00:21:14,680 THINK ABOUT HOW AMAZING THAT IS, 550 00:21:14,680 --> 00:21:15,760 IT'S SIGNIFICANT. 551 00:21:15,760 --> 00:21:18,960 AND WHAT ABOUT AT THE MOLECULAR 552 00:21:18,960 --> 00:21:20,320 LEVEL IT'S AMAZING WHEN YOU 553 00:21:20,320 --> 00:21:25,040 THINK ABOUT, THERE'S TRANSFER 554 00:21:25,040 --> 00:21:26,800 RNA AND THERE ARE ALL OF THESE 555 00:21:26,800 --> 00:21:29,640 MOLECULES THAT ARE DESIGNED TO 556 00:21:29,640 --> 00:21:35,800 HELP FIND ERRORS IN A MOM MOLECR 557 00:21:35,800 --> 00:21:37,920 LEVEL AND CORRECT THEM, SIMPLY 558 00:21:37,920 --> 00:21:38,400 PUT. 559 00:21:38,400 --> 00:21:39,960 PULLING BACK AND SAYING, WHAT IF 560 00:21:39,960 --> 00:21:41,440 WE LOOK THROUGH OUR CLINICAL 561 00:21:41,440 --> 00:21:43,520 APPROACHES AND OUR RESEARCH 562 00:21:43,520 --> 00:21:44,320 APPROACHES, JUST AS THE 563 00:21:44,320 --> 00:21:46,360 GENTLEMAN WHO WON THE NOBEL 564 00:21:46,360 --> 00:21:47,680 PRIZES, WHAT IF WE LOOK THROUGH 565 00:21:47,680 --> 00:21:51,800 THE LENS OF HOW CAN WE OPTIMIZE 566 00:21:51,800 --> 00:21:54,240 THAT CAPACITY TO HEAL? 567 00:21:54,240 --> 00:21:56,280 HOW CAN WE, ANOTHER WAY TO SAY 568 00:21:56,280 --> 00:21:58,520 THAT, HOW CAN WE ACTIVATE A 569 00:21:58,520 --> 00:21:59,560 HEALING RESPONSE? 570 00:21:59,560 --> 00:22:01,880 AND IN MY CONCEPT OF AK TA RATE 571 00:22:01,880 --> 00:22:08,880 TA RATEISED HEALING, AK TA RATEA 572 00:22:08,880 --> 00:22:11,320 HEALING RESPONSE IS PLACEBOS. 573 00:22:11,320 --> 00:22:12,800 THE ONLY THING I WANT TO BRING 574 00:22:12,800 --> 00:22:16,280 UP IN THIS CONTEXT IS WHEN I 575 00:22:16,280 --> 00:22:17,520 BACK IN THE DARK AGES WHEN I WAS 576 00:22:17,520 --> 00:22:21,160 IN TRAINING, PLACEBOS WAS A 577 00:22:21,160 --> 00:22:22,120 THING TO TRICK PATIENTS TO SEE 578 00:22:22,120 --> 00:22:24,360 IF THE REAL INTERVENTIONS WORKS 579 00:22:24,360 --> 00:22:29,200 AND THE REFRAME IS, WOW, THINK 580 00:22:29,200 --> 00:22:32,240 ABOUT A REAL PLACEBO EFFECT? 581 00:22:32,240 --> 00:22:33,640 THE FACT THAT THERE COULD BE 582 00:22:33,640 --> 00:22:35,760 SOMETHING LIKE A PLACEBO PILL, 583 00:22:35,760 --> 00:22:40,480 OR A DIFFERENT INTERVENTION THAT 584 00:22:40,480 --> 00:22:44,840 THEN AK TA VISITS THE MIND TO 585 00:22:44,840 --> 00:22:48,040 HEAL WITHOUT AN ACTIVE AGENT. 586 00:22:48,040 --> 00:22:50,720 WE SHOULD BE FIGURING OUT HOW TO 587 00:22:50,720 --> 00:22:52,400 DO THAT MORE CONSISTENTLY AND 588 00:22:52,400 --> 00:22:55,000 THAT IN MY OPINION SHOULD BE ONE 589 00:22:55,000 --> 00:22:57,000 OF OUR QUESTS RIGHT. 590 00:22:57,000 --> 00:22:58,840 IT'S A GREAT ILLUSTRATIONS OF 591 00:22:58,840 --> 00:23:06,800 THE BODY'S INNATE CAPACITY TO 592 00:23:06,800 --> 00:23:10,160 HEAL. 593 00:23:10,160 --> 00:23:14,800 HOW WE DO THE RESEARCH AND WHAT 594 00:23:14,800 --> 00:23:16,680 IF WE CHANGE THE LENS THROUGH 595 00:23:16,680 --> 00:23:17,680 WHICH WE LOOK. 596 00:23:17,680 --> 00:23:21,000 NEXT SLIDE, PLEASE. 597 00:23:21,000 --> 00:23:22,760 I HAVE A COUPLE OF QUOTES 598 00:23:22,760 --> 00:23:24,840 SPRINKLES IN HERE BECAUSE I LOVE 599 00:23:24,840 --> 00:23:25,200 THESE. 600 00:23:25,200 --> 00:23:26,240 DAVID BOR STEEN, NOT SOMEONE I 601 00:23:26,240 --> 00:23:27,880 KNOW, HE WAS WITH A LIBRARY OF 602 00:23:27,880 --> 00:23:29,680 CONGRESS BUT THE GREATEST 603 00:23:29,680 --> 00:23:32,400 BARRIER TO DISCOVERY IS NOT 604 00:23:32,400 --> 00:23:36,000 IGNORANCE, BUT THE ILLUSION OF 605 00:23:36,000 --> 00:23:36,280 KNOWLEDGE. 606 00:23:36,280 --> 00:23:38,080 NOW I'M GOING TO READ THAT AGAIN 607 00:23:38,080 --> 00:23:44,480 BECAUSE PARTICULARLY THE 608 00:23:44,480 --> 00:23:47,400 RESEARCH. 609 00:23:47,400 --> 00:23:49,000 WHEN WE GET CAUGHT IN OUR OWN 610 00:23:49,000 --> 00:23:50,400 WAY OF THINKING ABOUT THINGS, 611 00:23:50,400 --> 00:23:52,760 IT'S REALLY RELATED TO THE FIRST 612 00:23:52,760 --> 00:23:55,120 QUOTE, RIGHT, THAT WE CAN'T 613 00:23:55,120 --> 00:23:57,040 SOLVE PROBLEMS WITH THE SAME 614 00:23:57,040 --> 00:23:58,560 THOUGHT PROCESS THAT GOT US INTO 615 00:23:58,560 --> 00:23:59,760 THE CIRCUMSTANCES WE'RE IN. 616 00:23:59,760 --> 00:24:01,440 SO, I WOULD ENCOURAGE YOU TODAY 617 00:24:01,440 --> 00:24:03,840 AND TOMORROW, TO REALLY STAY 618 00:24:03,840 --> 00:24:06,840 OPEN AND BE AWARE OF PERHAPS 619 00:24:06,840 --> 00:24:07,720 YOUR OWN ILLUSION OF KNOWLEDGE 620 00:24:07,720 --> 00:24:09,720 IN CERTAIN AREAS AND WHAT MIGHT 621 00:24:09,720 --> 00:24:14,840 HAPPEN IF YOU STEP OUT OF THAT. 622 00:24:14,840 --> 00:24:16,240 SO THIS IS INTERESTING. 623 00:24:16,240 --> 00:24:18,160 A LOT OF MY WORK IS IN THE 624 00:24:18,160 --> 00:24:20,680 TRANSFORMATION OF HEALTH SYSTEMS 625 00:24:20,680 --> 00:24:22,080 AND WHEN PEOPLE USE THE CONCEPT 626 00:24:22,080 --> 00:24:25,800 OF TRANSFORMATION A LOT, I THINK 627 00:24:25,800 --> 00:24:27,560 WE OVERUSE TRANSFORMATION. 628 00:24:27,560 --> 00:24:28,920 A LOT OF WHAT WE CALL 629 00:24:28,920 --> 00:24:30,320 TRANSFORMATION IS SIMPLY I WOULD 630 00:24:30,320 --> 00:24:32,000 CALL IMPROVEMENT, CONTINUOUS 631 00:24:32,000 --> 00:24:33,080 IMPROVEMENT OF THE CURRENT 632 00:24:33,080 --> 00:24:33,400 SYSTEM. 633 00:24:33,400 --> 00:24:35,120 BUT WHAT MAKES SOMETHING 634 00:24:35,120 --> 00:24:36,360 TRANSFORMATIONAL IN MY OPINION 635 00:24:36,360 --> 00:24:37,800 IS WHEN THE IF YOU WERE OF THE 636 00:24:37,800 --> 00:24:39,880 SYSTEM HAS CHANGED AND THIS 637 00:24:39,880 --> 00:24:42,520 PARALLELS THE RESEARCH, SO I 638 00:24:42,520 --> 00:24:45,600 WOULD SAY THAT IT SIMPLIFIED THE 639 00:24:45,600 --> 00:24:49,640 PRIMARY PURPOSE OF OUR CURRENT 640 00:24:49,640 --> 00:24:51,040 SYSTEM TO CURE IT WHEN WE CAN 641 00:24:51,040 --> 00:24:53,520 AND WHEN WE CAN'T CURE IT, 642 00:24:53,520 --> 00:24:54,160 MANAGE IT. 643 00:24:54,160 --> 00:24:57,080 I THINK THAT SIMPLY PUT IS THE 644 00:24:57,080 --> 00:24:58,560 DOMINANT PARADIGM OF OUR CURRENT 645 00:24:58,560 --> 00:24:59,920 SYSTEM AND WHEN WE TALK ABOUT 646 00:24:59,920 --> 00:25:01,520 WHOLE HEALTH AND YOU CAN GO TO 647 00:25:01,520 --> 00:25:04,720 THE NEXT SLIDE, WHAT DO WE MEAN 648 00:25:04,720 --> 00:25:05,520 BY WHOLE HEALTH. 649 00:25:05,520 --> 00:25:07,960 I THINK THAT THE PURPOSE OF 650 00:25:07,960 --> 00:25:09,480 WHOLE HEALTH VERY DIFFERENT 651 00:25:09,480 --> 00:25:12,200 PURPOSE, THAN THE PURPOSE OF THE 652 00:25:12,200 --> 00:25:14,560 HEALTH, THE DOMINANT HEALTH 653 00:25:14,560 --> 00:25:15,640 SYSTEM WE DESCRIBED. 654 00:25:15,640 --> 00:25:18,640 IT'S TO EMPOWER AND EQUIP. 655 00:25:18,640 --> 00:25:20,480 THOSE ARE TWO DIFFERENT ELEMENTS 656 00:25:20,480 --> 00:25:23,400 THAT ARE BOTH CRITICALLY 657 00:25:23,400 --> 00:25:23,960 IMPORTANT. 658 00:25:23,960 --> 00:25:25,520 EMPOWER PEOPLE AND THEN WHEN 659 00:25:25,520 --> 00:25:26,960 EMPOWERED, EQUIP THEM WITH THE 660 00:25:26,960 --> 00:25:28,800 SKILLS THAT THEY NEED AND THE 661 00:25:28,800 --> 00:25:30,120 SUPPORT THEY NEED SO THAT THEY 662 00:25:30,120 --> 00:25:32,160 CAN TAKE CHARGE OF THEIR 663 00:25:32,160 --> 00:25:33,760 PHYSICAL, MENTAL AND SPIRITUAL 664 00:25:33,760 --> 00:25:35,160 HEALTH FOR WHAT PURPOSE? 665 00:25:35,160 --> 00:25:37,320 SO THEY CAN LIVE A FULL AND 666 00:25:37,320 --> 00:25:38,280 MEANINGFUL LIFE. 667 00:25:38,280 --> 00:25:39,480 WHATEVER IS THAT MEANS FOR THEM. 668 00:25:39,480 --> 00:25:41,760 AND THIS DOESN'T -- LOTS OF TIME 669 00:25:41,760 --> 00:25:43,160 PEOPLE THINK WHOLE HEALTH IS 670 00:25:43,160 --> 00:25:43,440 PREVENTION. 671 00:25:43,440 --> 00:25:44,160 IT'S NOT. 672 00:25:44,160 --> 00:25:45,520 PREVENTION IS AN IMPORTANT PIECE 673 00:25:45,520 --> 00:25:46,920 OF THIS BUT WHOLE HEALTH, THIS 674 00:25:46,920 --> 00:25:48,440 IS APPLICABLE AND THE LAST FEW 675 00:25:48,440 --> 00:25:54,240 DAYS OF LIFE AS IT IS AT THE 676 00:25:54,240 --> 00:25:55,440 BEGINNING OF HEALTH. 677 00:25:55,440 --> 00:25:56,520 I'M EMPHASIZING THIS BECAUSE AS 678 00:25:56,520 --> 00:25:58,360 YOU GO THROUGH THE NEXT TWO DAYS 679 00:25:58,360 --> 00:25:59,360 AND YOU ARE ENTERTAINING, WHAT 680 00:25:59,360 --> 00:26:01,280 DOES THIS MEAN FOR PAIN AND PAIN 681 00:26:01,280 --> 00:26:02,720 MANAGEMENT AND THE RESEARCH THAT 682 00:26:02,720 --> 00:26:06,440 WE'RE ADVANCING. 683 00:26:06,440 --> 00:26:09,000 IF THIS IS THE PARADIGM AND TO 684 00:26:09,000 --> 00:26:11,600 EMPOWER PEOPLE AND EQUIP PEOPLE 685 00:26:11,600 --> 00:26:14,400 TO TAKE CHARGE OF ALL ASPECTS OF 686 00:26:14,400 --> 00:26:18,160 THEIR HEALTH FOR THE INTENTION 687 00:26:18,160 --> 00:26:20,480 AND PURPOSE OF LIVING THEIR FULL 688 00:26:20,480 --> 00:26:22,680 TIME YOUR QUESTION AND RESEARCH 689 00:26:22,680 --> 00:26:27,760 CHANGED DRAMATICALLY AND NEXT 690 00:26:27,760 --> 00:26:28,080 SLIDE. 691 00:26:28,080 --> 00:26:29,520 THIS IS GREAT. 692 00:26:29,520 --> 00:26:32,200 NO INTENT SHOULD BE MADE TO CURE 693 00:26:32,200 --> 00:26:33,600 THE WE'D WITHOUT THE SOUL. 694 00:26:33,600 --> 00:26:37,800 LET NO ONE PERSUADE YOU TO CURE 695 00:26:37,800 --> 00:26:39,480 CURE THE HEAD UNTIL HE HAS GIVEN 696 00:26:39,480 --> 00:26:40,000 HIS SOUL TO BE CURED. 697 00:26:40,000 --> 00:26:47,360 THIS IS THE GREATER OR OF OUR 698 00:26:47,360 --> 00:26:48,200 DAY. 699 00:26:48,200 --> 00:26:49,440 IT'S A LITTLE DISCOURAGING THAT 700 00:26:49,440 --> 00:26:51,560 WAS THE GREATER OR OF THE DAY 701 00:26:51,560 --> 00:26:52,920 WHEN PLATEAU WAS ALIVE BECAUSE I 702 00:26:52,920 --> 00:26:54,400 WOULD SAY IT'S ONE OF THE 703 00:26:54,400 --> 00:27:01,320 GREATERRGREAT ERRORSOF THE DAY . 704 00:27:01,320 --> 00:27:05,680 SO VERY SIMPLY PUT, I REFERENCED 705 00:27:05,680 --> 00:27:06,720 REDUCTIONISTIC APPROACH AND 706 00:27:06,720 --> 00:27:08,120 SYSTEMS APPROACH AND WHEN I 707 00:27:08,120 --> 00:27:10,160 THINK WE'VE COME FROM A 708 00:27:10,160 --> 00:27:11,560 REDUCTIONISTIC PARADIGM AND I 709 00:27:11,560 --> 00:27:13,720 HOPE WE'RE MOVING INTO A SYSTEMS 710 00:27:13,720 --> 00:27:16,440 APPROACH AND WHAT DO WE MEAN BY 711 00:27:16,440 --> 00:27:26,720 THAT CONCRETELY? 712 00:27:28,800 --> 00:27:30,520 IT'S OFTEN REACTION TIVE AND WE 713 00:27:30,520 --> 00:27:33,240 WAIT WELL THERE'S A PROBLEM AND 714 00:27:33,240 --> 00:27:34,920 WE RESPOND. 715 00:27:34,920 --> 00:27:36,880 SPORADIC INTERVENTIONS AND 716 00:27:36,880 --> 00:27:38,720 BIOMEDICAL INTERVENTIONS AND WE 717 00:27:38,720 --> 00:27:40,000 LET THE INDIVIDUAL ON THEIR OWN 718 00:27:40,000 --> 00:27:44,440 TO HOPEFULLY ENACT THE 719 00:27:44,440 --> 00:27:52,360 RECOMMENDATIONS. 720 00:27:52,360 --> 00:27:53,960 WINDOW DOES A SYSTEM APPROACH 721 00:27:53,960 --> 00:27:54,600 LOOK LIKE? 722 00:27:54,600 --> 00:27:56,160 WELL, WE'RE FOCUSED ON THE 723 00:27:56,160 --> 00:27:57,080 PERSON AND THEIR SENSE OF 724 00:27:57,080 --> 00:27:58,520 MEANING AND PURPOSE IN THEIR 725 00:27:58,520 --> 00:27:58,920 LIFE. 726 00:27:58,920 --> 00:28:00,560 IT'S NOT JUST ADDRESSING THE 727 00:28:00,560 --> 00:28:02,200 PROBLEMS, IT'S HELPING PEOPLE 728 00:28:02,200 --> 00:28:04,200 REALIZE THAT THEIR ASPIRATION 729 00:28:04,200 --> 00:28:06,840 AND HOW THEY CAN PARTNER WITH 730 00:28:06,840 --> 00:28:08,320 THE TEAM TO REALIZE THAT IN 731 00:28:08,320 --> 00:28:09,320 THEIR LIFE. 732 00:28:09,320 --> 00:28:11,680 IT'S MUCH MORE LIFE-FOCUSED THAN 733 00:28:11,680 --> 00:28:13,160 PROBLEM FOCUSED. 734 00:28:13,160 --> 00:28:14,720 IT'S NOT ONLY MANAGING DISEASE 735 00:28:14,720 --> 00:28:16,480 BUT OPTIMIZING HEALTH AND IT'S 736 00:28:16,480 --> 00:28:18,280 NOT ONLY FINDING AND FIXING 737 00:28:18,280 --> 00:28:19,800 PROBLEMS BUT IDENTIFYING THE 738 00:28:19,800 --> 00:28:20,960 RISK AND MINIMIZING IT. 739 00:28:20,960 --> 00:28:23,960 MUCH MORE PROACTIVE ACROSS THE 740 00:28:23,960 --> 00:28:25,560 LIFESPAN AND ENGAGING WHOLE 741 00:28:25,560 --> 00:28:26,840 HEALTH APPROACHES AND I'LL SHOW 742 00:28:26,840 --> 00:28:30,160 YOU A GRAPHIC OF HOW WE THINK 743 00:28:30,160 --> 00:28:33,840 ABOUT THAT IN A MOMENT AND VERY 744 00:28:33,840 --> 00:28:35,560 IMPORTANTLY, NOT SAYING, HAVE AT 745 00:28:35,560 --> 00:28:37,000 IT, HOPE IT TURNS OUT WELL, 746 00:28:37,000 --> 00:28:38,840 LET'S SEE HOW IT GOES. 747 00:28:38,840 --> 00:28:40,080 REALLY ADDRESSING THE SKILL 748 00:28:40,080 --> 00:28:42,240 BUILDING AND THE SUPPORT THAT 749 00:28:42,240 --> 00:28:43,080 PEOPLE NEED. 750 00:28:43,080 --> 00:28:44,640 NOT ONLY IN THE HEALTH-CARE 751 00:28:44,640 --> 00:28:46,200 SYSTEM BUT WHERE THEY WORK AND 752 00:28:46,200 --> 00:28:49,400 WHERE THEY LIVE TO REALLY HELP 753 00:28:49,400 --> 00:28:51,280 THEM OWN THEIR SELF-CARE AND 754 00:28:51,280 --> 00:28:53,720 THEIR PART OF THE HEALING 755 00:28:53,720 --> 00:28:56,760 PROCESS. 756 00:28:56,760 --> 00:28:59,160 NEXT SLIDE. 757 00:28:59,160 --> 00:29:01,240 MANY PEOPLE HAVE VERY SIMILAR 758 00:29:01,240 --> 00:29:01,640 GRAPHICS. 759 00:29:01,640 --> 00:29:03,440 THIS IS EVOLVED FROM DUKE TO THE 760 00:29:03,440 --> 00:29:05,000 V.A. TO THE HEALTH INSTITUTE. 761 00:29:05,000 --> 00:29:07,000 YOU CAN SEE THAT THE ELEMENTS 762 00:29:07,000 --> 00:29:09,080 HERE, THE CARE TEAM AND THE 763 00:29:09,080 --> 00:29:12,240 CLINICAL PIECE IS ONE PIECE THAT 764 00:29:12,240 --> 00:29:14,400 A PRETTY -- ONE PIECE OF A WHOLE 765 00:29:14,400 --> 00:29:15,600 WHERE WE START FIRST WITH THE 766 00:29:15,600 --> 00:29:17,040 PERSON THEMSELVES AND WHAT 767 00:29:17,040 --> 00:29:18,040 MATTERS MOST TO THEM. 768 00:29:18,040 --> 00:29:19,720 THAT'S A REAL SHIFT. 769 00:29:19,720 --> 00:29:22,400 AND YOU CAN SEE THAT IN THE PAIN 770 00:29:22,400 --> 00:29:23,480 COMMUNITY AND I'LL TALK MORE 771 00:29:23,480 --> 00:29:25,000 ABOUT THAT IN A MOMENT. 772 00:29:25,000 --> 00:29:27,640 THE MIDDLE CIRCLE, THE SELF-CARE 773 00:29:27,640 --> 00:29:30,240 CIRCLE ARE DIFFERENT DIFFERENT 774 00:29:30,240 --> 00:29:31,520 ELEMENTS OF SELF-CARE. 775 00:29:31,520 --> 00:29:33,560 MOST OF US ADDRESS VERY, VERY 776 00:29:33,560 --> 00:29:36,000 SIMILAR ASPECTS AND WE MIGHT 777 00:29:36,000 --> 00:29:36,960 LABEL THEM DIFFERENTLY BUT OF 778 00:29:36,960 --> 00:29:37,920 COURSE IT'S THINGS LIKE 779 00:29:37,920 --> 00:29:39,840 NUTRITION AND MOVING YOUR BODY 780 00:29:39,840 --> 00:29:42,840 AND ALSO THE POWER OF YOUR MIND 781 00:29:42,840 --> 00:29:44,080 AND SPIRITUALITY AND YOUR 782 00:29:44,080 --> 00:29:45,520 RELATIONSHIPS AND YOUR SLEEP, 783 00:29:45,520 --> 00:29:47,360 ALL OF THESE ASPECTS EFFECT 784 00:29:47,360 --> 00:29:48,840 PEOPLE PARTICULARLY WHEN DEALING 785 00:29:48,840 --> 00:29:51,480 WITH COMPLEX CHRONIC ISSUES LIKE 786 00:29:51,480 --> 00:29:52,000 PAIN. 787 00:29:52,000 --> 00:29:54,440 SO, THIS IS KIND OF THE VISION 788 00:29:54,440 --> 00:29:56,200 OF, WELL, THIS IS WHOLE HEALTH. 789 00:29:56,200 --> 00:29:57,080 IT STARTS WITH THE INDIVIDUAL 790 00:29:57,080 --> 00:29:59,680 AND THEIR PURPOSE AND A BIG 791 00:29:59,680 --> 00:30:00,760 EMPHASIS ON SELF-CARE. 792 00:30:00,760 --> 00:30:02,400 YES THE CARE TEAM AND YES IN 793 00:30:02,400 --> 00:30:04,080 COMMUNITIES BUT HOW DO YOU 794 00:30:04,080 --> 00:30:05,200 ACTUALLY OPERATIONALIZE THAT 795 00:30:05,200 --> 00:30:06,160 BECAUSE IF WE'RE GOING TO 796 00:30:06,160 --> 00:30:08,440 RESEARCH THAT, WE HAVE TO HAVE A 797 00:30:08,440 --> 00:30:10,320 SYSTEM AND APPROACH THAT SAY OK, 798 00:30:10,320 --> 00:30:11,760 WELL THAT LOOKS NICE AND CONCEPT 799 00:30:11,760 --> 00:30:13,440 AND THEORY, HOW DO YOU ACTUALLY 800 00:30:13,440 --> 00:30:14,600 MAKE IT HAPPEN? 801 00:30:14,600 --> 00:30:18,600 SO NEXT SLIDE. 802 00:30:18,600 --> 00:30:20,000 LET'S THE QUESTION I JUST ASKED, 803 00:30:20,000 --> 00:30:21,840 YOU CAN ADVANCE. 804 00:30:21,840 --> 00:30:23,440 SO THIS IS OUT OF THE WORK IN 805 00:30:23,440 --> 00:30:25,640 THE V.A. WHICH IS ON GOING AND 806 00:30:25,640 --> 00:30:27,920 QUITE AMAZING UNDER THE 807 00:30:27,920 --> 00:30:31,480 LEADERSHIP OF Dr. KIGLER AND 808 00:30:31,480 --> 00:30:32,800 WE REALIZE THROUGH A LOT OF WORK 809 00:30:32,800 --> 00:30:35,000 IN THE FACILITIES AND WITH 810 00:30:35,000 --> 00:30:36,400 CLINICIANS AND RESEARCHERS 811 00:30:36,400 --> 00:30:40,080 ACROSS THE NATION, THAT THIS IS 812 00:30:40,080 --> 00:30:42,560 NOT ALL DONE IN THE CLINICAL 813 00:30:42,560 --> 00:30:44,360 ENVIRONMENT IDEALLY THAT THE 814 00:30:44,360 --> 00:30:45,760 CLINICAL ENVIRONMENT IS 815 00:30:45,760 --> 00:30:47,480 INCREDIBLY IMPORTANT BUT THIS 816 00:30:47,480 --> 00:30:48,680 QUESTION OF HELPING PEOPLE 817 00:30:48,680 --> 00:30:50,760 UNDERSTAND WHAT MATTERS TO THEM 818 00:30:50,760 --> 00:30:52,400 AND ENGAGING THEM IN THEIR 819 00:30:52,400 --> 00:30:54,880 HEALTH IS A HUGE ISSUE THAT THE 820 00:30:54,880 --> 00:31:00,160 HEALTH SYSTEM ISN'T DESIGNED TO 821 00:31:00,160 --> 00:31:01,920 DO SO THE ABILITY TO USE PEER 822 00:31:01,920 --> 00:31:03,400 PROGRAMS TO HELP EXPLORE THESE 823 00:31:03,400 --> 00:31:05,240 NON CLINICAL QUESTIONS OF WHAT 824 00:31:05,240 --> 00:31:06,720 MATTERS MOST TO YOU, WHAT DO YOU 825 00:31:06,720 --> 00:31:10,680 WANT YOUR HEALTH FOR, THAT 826 00:31:10,680 --> 00:31:17,560 EMPOWER PIECE IS IT DOESN'T TAKE 827 00:31:17,560 --> 00:31:19,600 A CLINICAL TEAM IT'S 828 00:31:19,600 --> 00:31:26,120 SKILL-BUILDING AND SUPPORT AND 829 00:31:26,120 --> 00:31:28,400 WHEN THESE ARE ALIGNED AND 830 00:31:28,400 --> 00:31:29,280 PEOPLE ARE CONNECTED WITH EACH 831 00:31:29,280 --> 00:31:35,720 OTHER, THIS CAN HAVE AMAZING 832 00:31:35,720 --> 00:31:36,000 IMPACT. 833 00:31:36,000 --> 00:31:37,360 SO I'LL GO THROUGH THESE 834 00:31:37,360 --> 00:31:37,600 BRIEFLY. 835 00:31:37,600 --> 00:31:39,200 THE EMPOWER PIECE, AS I 836 00:31:39,200 --> 00:31:40,640 MENTIONED, IS ABOUT HELPING 837 00:31:40,640 --> 00:31:41,960 PEOPLE FIND WHAT MATTERS MOST TO 838 00:31:41,960 --> 00:31:43,920 THEM IN THEIR LIFE AND GIVE THEM 839 00:31:43,920 --> 00:31:45,640 A SENSE OF HOPE AND THERE'S A 840 00:31:45,640 --> 00:31:47,560 REASON TO ENGAGE IN THEIR LIFE 841 00:31:47,560 --> 00:31:47,920 AGAIN. 842 00:31:47,920 --> 00:31:51,960 AND THIS IS BEST LED BY PEERS IN 843 00:31:51,960 --> 00:31:53,600 OUR EXPERIENCE AND THE V.A. HAS 844 00:31:53,600 --> 00:31:54,800 GREAT MATERIALS AND COURSES THAT 845 00:31:54,800 --> 00:32:01,840 ARE OPEN SOURCE AND AVAILABLE TO 846 00:32:01,840 --> 00:32:11,880 ALL. 847 00:32:12,480 --> 00:32:14,720 MOVED YOUR BODY AND YOU NEED TO 848 00:32:14,720 --> 00:32:17,000 KNOW HOW TO DO IT DIFFERENTLY 849 00:32:17,000 --> 00:32:19,920 AND SUPPORT FOR REALLY ENGAGING 850 00:32:19,920 --> 00:32:21,560 AND BEHAVIOR CHANGE SO THE GREAT 851 00:32:21,560 --> 00:32:30,640 THINGS ABOUT THIS IS THESE 852 00:32:30,640 --> 00:32:32,040 SELF-CARE APPROACHES ARE 853 00:32:32,040 --> 00:32:34,120 CONSISTENT ACROSS BECAUSE AGAIN 854 00:32:34,120 --> 00:32:35,880 THE PARADIGM IS DIFFERENT AND 855 00:32:35,880 --> 00:32:37,840 WE'RE OPTIMIZING THE BODY'S 856 00:32:37,840 --> 00:32:43,160 ABILITY TO HEAL AND SO WE 857 00:32:43,160 --> 00:32:44,080 OPTIMIZE SELF-CARE AND IT'S THE 858 00:32:44,080 --> 00:32:46,040 SAME WITH A FEW TWEAKS WHETHER 859 00:32:46,040 --> 00:32:47,680 WHATEVER YOUR CONDITIONS IS AND 860 00:32:47,680 --> 00:32:49,720 THIS IS DONE THROUGH INSTRUCTORS 861 00:32:49,720 --> 00:32:52,400 AND COACHES AND ACROSS THIS 862 00:32:52,400 --> 00:32:58,720 DIFFERENT AREA AND NEXT SLIDE. 863 00:32:58,720 --> 00:32:59,960 IT MAKES A HUGE DIFFERENCE WHEN 864 00:32:59,960 --> 00:33:03,200 THE CLINICIANS ARE UNDERSTANDING 865 00:33:03,200 --> 00:33:06,000 THE CONCEPT OF THIS PARADIGM AND 866 00:33:06,000 --> 00:33:09,480 SUPPORT IT AND I'LL JUST TELL 867 00:33:09,480 --> 00:33:13,200 YOU A GREAT ILLUSTRATION OF THAT 868 00:33:13,200 --> 00:33:20,120 APPROACH FROM THE V.A. IN LITTLE 869 00:33:20,120 --> 00:33:21,960 ROCK. 870 00:33:21,960 --> 00:33:23,320 AND THE CARE TEAM, THIS IS MY 871 00:33:23,320 --> 00:33:25,520 STORY SO IF I GET IT WRONG I 872 00:33:25,520 --> 00:33:25,880 APOLOGIZE. 873 00:33:25,880 --> 00:33:27,200 THE CARE TEAM, AS I UNDERSTAND, 874 00:33:27,200 --> 00:33:29,080 WAS NOT REAL EXCITED ABOUT THIS 875 00:33:29,080 --> 00:33:30,400 NEW APPROACH AND REALLY LIKE 876 00:33:30,400 --> 00:33:31,640 THEY HAVE ENOUGH ON THEIR PLATES 877 00:33:31,640 --> 00:33:33,560 AND THEY'RE OVERWHELMED AND SO 878 00:33:33,560 --> 00:33:36,360 WHAT THEY DID AND THEY CREATED 879 00:33:36,360 --> 00:33:39,600 THE SELF-CARE PROGRAM TO WORK 880 00:33:39,600 --> 00:33:41,600 WITH THE CLINICIANS AND THE PAIN 881 00:33:41,600 --> 00:33:43,040 PATIENTS GOT SO ENGAGE FROM 882 00:33:43,040 --> 00:33:47,320 THEIR OWN LIFE AND HEALTH AND 883 00:33:47,320 --> 00:33:57,880 WERE GETTING THE OPPORTUNITY TO 884 00:34:11,120 --> 00:34:13,240 ENGAGE WORKPLACES IS A HUGE 885 00:34:13,240 --> 00:34:14,840 OPPORTUNITY THAT WILL SAVE FOR 886 00:34:14,840 --> 00:34:15,560 ANOTHER TALK. 887 00:34:15,560 --> 00:34:17,920 AND NEXT SLIDE. 888 00:34:17,920 --> 00:34:20,040 SO DOES IT WORK ANY WANT TO 889 00:34:20,040 --> 00:34:21,480 HIGHLIGHT A BIT OF THE RESEARCH 890 00:34:21,480 --> 00:34:23,400 AND THERE WAS AN ARTICLE 891 00:34:23,400 --> 00:34:24,520 PUBLISHED CAN YOU GO TO THE NEXT 892 00:34:24,520 --> 00:34:25,880 SLIDE FROM ALL THE V.A. WORK 893 00:34:25,880 --> 00:34:28,360 WHICH THIS IS JUST THE SUMMATION 894 00:34:28,360 --> 00:34:29,960 BUT I THINK WE'RE TALKING ABOUT 895 00:34:29,960 --> 00:34:31,680 PAIN AND I DID WANT TO HIGHLIGHT 896 00:34:31,680 --> 00:34:33,400 THAT WHOLE HEALTH HAD A POSITIVE 897 00:34:33,400 --> 00:34:38,000 IMPACT ON REDUCING OPIOID USE 898 00:34:38,000 --> 00:34:39,960 AND IN THE VETERANS USING WHOLE 899 00:34:39,960 --> 00:34:42,160 HEALTH AND THOSE WITHIN A 900 00:34:42,160 --> 00:34:42,920 THREEFOLD REDUCTION IN THOSE 901 00:34:42,920 --> 00:34:44,200 PATIENTS WHO ARE USING WHOLE 902 00:34:44,200 --> 00:34:45,440 HEALTH APPROACHES VERSUS THOSE 903 00:34:45,440 --> 00:34:48,360 WHO WERE NOT AND LOTS OF OTHER 904 00:34:48,360 --> 00:34:54,840 BENEFITS FROM THIS APPROACH 905 00:34:54,840 --> 00:35:05,320 INCLUDING THIS IS THE GRAPHIC 906 00:35:11,360 --> 00:35:13,480 AND YOU CAN SEE THERE'S A DOSE 907 00:35:13,480 --> 00:35:16,720 RESPONSE CURVE AND BETWEEN OPEN 908 00:35:16,720 --> 00:35:19,520 REDUCTION AND THE DIFFERENT 909 00:35:19,520 --> 00:35:21,400 LEVELS OF WHOLE HEALTH 910 00:35:21,400 --> 00:35:23,240 APPROACHES SO THEY'RE DEFINED ON 911 00:35:23,240 --> 00:35:25,920 THE SIDE AND THE INTENSIVE AND 912 00:35:25,920 --> 00:35:29,440 MIDDLE GROWN POWER IS 913 00:35:29,440 --> 00:35:30,720 COMPREHENSIVE INTEGRATION TIVE 914 00:35:30,720 --> 00:35:32,680 APPROACH ONLY AND THE CORE WHOLE 915 00:35:32,680 --> 00:35:35,440 HEALTH INTENSE AND CORE INCLUDES 916 00:35:35,440 --> 00:35:37,000 THE PEER PIECE AND THE SUPPORT 917 00:35:37,000 --> 00:35:39,200 AND THE COMPREHENSIVE INCLUDES 918 00:35:39,200 --> 00:35:44,560 BOTH SO VERY INTERESTING DATA. 919 00:35:44,560 --> 00:35:46,760 AND I'M NOT GOING TO GO INTO 920 00:35:46,760 --> 00:35:48,280 DEPTH ON THIS BUFFET TALK ON 921 00:35:48,280 --> 00:35:54,560 THIS LATER AND THIS IS WORK 922 00:35:54,560 --> 00:35:58,040 WITH A SIGNIFICANT REDUCTION OF 923 00:35:58,040 --> 00:35:59,720 SPINE PROCEDURES WITH VETERANS 924 00:35:59,720 --> 00:36:01,080 USING WHOLE HEALTH VERSUS THOSE 925 00:36:01,080 --> 00:36:02,880 WHO ARE NOT AND JUST TO LET YOUR 926 00:36:02,880 --> 00:36:06,520 APPETITE THAT THIS ISN'T JUST 927 00:36:06,520 --> 00:36:08,720 GREAT IDEAS, THERE'S REAL 928 00:36:08,720 --> 00:36:09,920 OUTCOMES AND HAVING LOOKED AT 929 00:36:09,920 --> 00:36:13,320 THE DATA LIKE THAT, I SHARE THIS 930 00:36:13,320 --> 00:36:15,760 SLIDE OFTEN AND I THINK ONE OF 931 00:36:15,760 --> 00:36:18,360 THE THINGS THAT WE'RE HERE TO 932 00:36:18,360 --> 00:36:22,360 REALIZE IS THAT IT'S SO MUCH 933 00:36:22,360 --> 00:36:23,800 MORE THAN JUST HOW MANY 934 00:36:23,800 --> 00:36:25,440 OWNERSHIPS ARE TAKEN ALTHOUGH 935 00:36:25,440 --> 00:36:27,480 IT'S CRITICAL AND HOW MANY 936 00:36:27,480 --> 00:36:28,120 PROCEDURES ARE DONE. 937 00:36:28,120 --> 00:36:29,240 THIS IS ABOUT PEOPLE'S LIVES. 938 00:36:29,240 --> 00:36:31,240 THIS IS WHAT CHANGES WITH THIS 939 00:36:31,240 --> 00:36:32,840 PARADIGM AND I WILL TAKE A 940 00:36:32,840 --> 00:36:34,960 MOMENT TO READ THESE. 941 00:36:34,960 --> 00:36:38,080 THESE NOT SPECIFIC TO PAIN 942 00:36:38,080 --> 00:36:39,440 PATIENTS BUT THEY'RE THREE 943 00:36:39,440 --> 00:36:40,960 PATIENTS WHO WE'RE NOT HAND 944 00:36:40,960 --> 00:36:45,560 SELECTED OUT OF THE NATION AND 945 00:36:45,560 --> 00:36:47,560 THE TOP IS THE 52-YEAR-OLD 946 00:36:47,560 --> 00:36:50,360 GENTLEMAN AND IT'S A GOOD THE 947 00:36:50,360 --> 00:36:52,360 CHANGE IN THIS APPROACH, THE 948 00:36:52,360 --> 00:36:54,200 CHANGE IN THIS LENS AND PAUL 949 00:36:54,200 --> 00:36:59,160 HEALTH HE SAYS BEGAN BY JOURNEY 950 00:36:59,160 --> 00:37:05,360 TO JOY AND WHO SAYS IT WILL A 951 00:37:05,360 --> 00:37:08,080 BEGAN BY I'M A CHANGE PERSON AND 952 00:37:08,080 --> 00:37:09,880 NO LONGER NEED MY CANE. 953 00:37:09,880 --> 00:37:12,080 SO THERE ARE CLINICAL IMPACT AND 954 00:37:12,080 --> 00:37:14,400 THE WHOLE HEALTH GROUP HAS 955 00:37:14,400 --> 00:37:18,720 BECOME MY FAMILY. 956 00:37:18,720 --> 00:37:22,160 MY NEUROLOGY DOESN'T NEED TO SEE 957 00:37:22,160 --> 00:37:22,760 ME. 958 00:37:22,760 --> 00:37:25,360 YES, GREAT CLINICAL OUTCOMES. 959 00:37:25,360 --> 00:37:26,640 AND 71-YEAR-OLD GENTLEMAN, I 960 00:37:26,640 --> 00:37:28,640 HAVE LOST 33 POUNDS, I GO TO FIT 961 00:37:28,640 --> 00:37:30,560 CLASS WHICH IS A MOVEMENT CLASS, 962 00:37:30,560 --> 00:37:35,960 NUTRITION CLASS, BATTLED FIELD, 963 00:37:35,960 --> 00:37:36,400 ACUPUNCTURE. 964 00:37:36,400 --> 00:37:38,080 MY WIFE SAYS, I HAVE A POSITIVE 965 00:37:38,080 --> 00:37:39,240 ATTITUDE NOW. 966 00:37:39,240 --> 00:37:39,640 [LAUGHTER] 967 00:37:39,640 --> 00:37:41,800 I LOVE IT SO MUCH. 968 00:37:41,800 --> 00:37:43,360 AND MY DIABETES IS UNDER CONTROL 969 00:37:43,360 --> 00:37:44,400 AND MY BLOOD PRESSURE IS DOWN 970 00:37:44,400 --> 00:37:46,400 AND MY LIPIDS ARE GOOD AND I SEE 971 00:37:46,400 --> 00:37:49,800 MY PRIMARY CARE DOCTOR MUCH 972 00:37:49,800 --> 00:37:50,080 LESS. 973 00:37:50,080 --> 00:37:52,040 AND A 37-YEAR-OLD WOMAN, I USED 974 00:37:52,040 --> 00:37:53,960 TO DRIVE OVER THE MISSISSIPPI 975 00:37:53,960 --> 00:37:56,320 RIVER BRIDGE TO THE JEFFERSON 976 00:37:56,320 --> 00:38:00,960 V.A. AND THINK ABOUT JUMPING 977 00:38:00,960 --> 00:38:11,160 EVERY TIME. 978 00:39:17,640 --> 00:39:20,560 I WANT TO SHARE WITH YOU AS YOU 979 00:39:20,560 --> 00:39:22,240 ASK YOURSELF THOSE QUESTIONS. 980 00:39:22,240 --> 00:39:24,080 WHAT DOES IT LOOK LIKE WHEN YOU 981 00:39:24,080 --> 00:39:26,280 APPROACH IT FROM A 982 00:39:26,280 --> 00:39:29,840 REDUCTIONISTIC PARADIGM AND WHAT 983 00:39:29,840 --> 00:39:30,960 CHANGES WHEN YOU THINK ABOUT IT 984 00:39:30,960 --> 00:39:32,480 THROUGH A SYSTEMS' LENS. 985 00:39:32,480 --> 00:39:34,680 I WOULD ENCOURAGE YOU TO 986 00:39:34,680 --> 00:39:36,960 REMEMBER THAT WHAT MATTERS MOST 987 00:39:36,960 --> 00:39:40,240 TO US, AS CLINICIANS, AND WHAT 988 00:39:40,240 --> 00:39:43,680 MATTERS MOST TO US AS 989 00:39:43,680 --> 00:39:44,920 RESEARCHERS, MAYBE NOT BE WHAT 990 00:39:44,920 --> 00:39:47,840 MATTERS MOST TO THE PERSON. 991 00:39:47,840 --> 00:39:50,920 AND I WANT TO SHARE A STORY 992 00:39:50,920 --> 00:39:54,520 ACTUALLY THAT Dr. TOM INSUL 993 00:39:54,520 --> 00:39:57,560 THE FORMER DIRECTOR OF NIMH AND 994 00:39:57,560 --> 00:40:00,680 SHARED IN A BOOK AND I'LL 995 00:40:00,680 --> 00:40:02,480 PARAPHRASE HIS STORY BUT IT'S 996 00:40:02,480 --> 00:40:03,520 REALLY SIGNIFICANT AND HE WAS 997 00:40:03,520 --> 00:40:05,560 TALKING ABOUT HOW HE WAS 998 00:40:05,560 --> 00:40:07,240 SOMEWHERE GIVING A COMMUNITY 999 00:40:07,240 --> 00:40:08,600 LECTURE ON ALL OF THE GREAT 1000 00:40:08,600 --> 00:40:09,600 WORK, THIS IS WHEN HE WAS STILL 1001 00:40:09,600 --> 00:40:10,360 WITH THE NIH. 1002 00:40:10,360 --> 00:40:12,400 ALL THE OF THE GREAT ADVANCES OF 1003 00:40:12,400 --> 00:40:15,560 THE RESEARCH OF NIMH AROUND 1004 00:40:15,560 --> 00:40:17,040 MENTAL HEALTH AND HOW AMAZING 1005 00:40:17,040 --> 00:40:20,920 THEIR ADVANCES ARE AND WHAT THEY 1006 00:40:20,920 --> 00:40:22,600 WERE LEARNING AND VERY PROUD OF 1007 00:40:22,600 --> 00:40:27,040 THIS AMAZING WORK AS HE SHOULD 1008 00:40:27,040 --> 00:40:29,680 HAVE BEEN. 1009 00:40:29,680 --> 00:40:30,960 FROM RACE ITSING AND WHEN IT 1010 00:40:30,960 --> 00:40:32,640 WENT AND HE WAS THE FIRST ONE AT 1011 00:40:32,640 --> 00:40:35,160 THE MICROPHONE AND SCHEER WHAT 1012 00:40:35,160 --> 00:40:37,840 THAT MEAN SAID TO HIM. 1013 00:40:37,840 --> 00:40:40,320 YOU REALLY DON'T GET IT. 1014 00:40:40,320 --> 00:40:43,040 MY 23-YEAR-OLD SON HAS 1015 00:40:43,040 --> 00:40:43,560 SCHIZOPHRENIA. 1016 00:40:43,560 --> 00:40:46,160 HE IS HOSPITALIZED FIVE TIMES 1017 00:40:46,160 --> 00:40:47,920 AND HAS MADE THREE SUICIDE 1018 00:40:47,920 --> 00:40:51,800 ATTEMPTS AND HE IS NOW HOMELESS. 1019 00:40:51,800 --> 00:41:02,200 OUR HOUSE IS ON FIRE. 1020 00:41:06,760 --> 00:41:08,200 OUR HOUSE IS ON FIRE AND YOU ARE 1021 00:41:08,200 --> 00:41:09,120 TALKING ABOUT THE CHEM IS TEE OF 1022 00:41:09,120 --> 00:41:09,800 THE PAINT. 1023 00:41:09,800 --> 00:41:11,000 WHAT ARE YOU GOING TO DO TO PUT 1024 00:41:11,000 --> 00:41:12,240 OUT THIS FIRE? 1025 00:41:12,240 --> 00:41:14,560 I THINK IT'S SUCH A POIGNANT 1026 00:41:14,560 --> 00:41:14,840 QUESTION. 1027 00:41:14,840 --> 00:41:16,440 I THINK THAT'S THE CHALLENGE FOR 1028 00:41:16,440 --> 00:41:18,880 US AS WE THINK ABOUT THIS IN THE 1029 00:41:18,880 --> 00:41:20,240 CONTEXT OF PAIN. 1030 00:41:20,240 --> 00:41:22,640 THE REDUCTIONISTIC RESEARCH IS 1031 00:41:22,640 --> 00:41:24,280 CRITICALLY IMPORTANT BUT IT'S 1032 00:41:24,280 --> 00:41:25,200 NOT ENOUGH. 1033 00:41:25,200 --> 00:41:28,920 SO WHAT CAN WE DO AND WHAT 1034 00:41:28,920 --> 00:41:29,640 CHANGES? 1035 00:41:29,640 --> 00:41:31,880 WHAT IS POSSIBLE WHEN WE LOOK AT 1036 00:41:31,880 --> 00:41:34,360 PAIN AND PAIN MANAGEMENT THROUGH 1037 00:41:34,360 --> 00:41:35,080 THIS DIFFERENT LENS. 1038 00:41:35,080 --> 00:41:37,680 I THINK FIRST OF ALL WE'LL ASK 1039 00:41:37,680 --> 00:41:39,080 DIFFERENT QUESTIONS AND SECOND 1040 00:41:39,080 --> 00:41:41,400 OF ALL WE ARE GOING TO SEE AND 1041 00:41:41,400 --> 00:41:42,720 EXPLORE NEW POSSIBILITIES THAT 1042 00:41:42,720 --> 00:41:45,640 WE OTHERWISE JUST WOULD NOT SEE 1043 00:41:45,640 --> 00:41:47,280 BECAUSE WE'RE LOOKING THROUGH A 1044 00:41:47,280 --> 00:41:48,040 DIFFERENT LENS. 1045 00:41:48,040 --> 00:41:53,680 SO NEXT SLIDE, PLEASE. 1046 00:41:53,680 --> 00:41:57,000 I'M SURE MANY OF YOU KNOW HIS 1047 00:41:57,000 --> 00:41:57,200 WRITING. 1048 00:41:57,200 --> 00:41:58,000 WE HAVE BEEN WRONG ABOUT WHAT 1049 00:41:58,000 --> 00:42:00,000 OUR JOB IS IN MEDICINE. 1050 00:42:00,000 --> 00:42:02,440 WE THINK OUR JOB IS TO ENSURE 1051 00:42:02,440 --> 00:42:04,480 HEALTH AND SURVIVAL BUT REALLY, 1052 00:42:04,480 --> 00:42:07,280 IT'S LARGER THAN THAT. 1053 00:42:07,280 --> 00:42:10,440 IT'S TO ENABLE WELLBEING AND 1054 00:42:10,440 --> 00:42:12,480 WELLBEING IS ABOUT THE REASONS 1055 00:42:12,480 --> 00:42:14,680 ONE WISHES TO BE ALIVE. 1056 00:42:14,680 --> 00:42:16,400 I LOVE THAT. 1057 00:42:16,400 --> 00:42:19,120 WELLBEING IS ABOUT THE REASONS 1058 00:42:19,120 --> 00:42:20,320 ONE WISHES TO BE A LIVE AND 1059 00:42:20,320 --> 00:42:21,960 THOSE REASONS MATTER NOT JUST AT 1060 00:42:21,960 --> 00:42:24,120 THE END-OF-LIFE, OR WHEN 1061 00:42:24,120 --> 00:42:26,440 DISABILITY COMES, BUT ALL ALONG 1062 00:42:26,440 --> 00:42:31,280 THE WAY. 1063 00:42:31,280 --> 00:42:35,720 NEXT SLIDE. 1064 00:42:35,720 --> 00:42:38,000 AND THE COST DECREASE SO IT'S 1065 00:42:38,000 --> 00:42:42,680 NOT AS IF WE'RE ABANDONING WHAT 1066 00:42:42,680 --> 00:42:44,240 THE OUTCOMES THAT WE NEED. 1067 00:42:44,240 --> 00:42:46,000 IT'S QUITE THE OPPOSITE. 1068 00:42:46,000 --> 00:42:47,720 IT'S THAT DOING MORE OF THE SAME 1069 00:42:47,720 --> 00:42:49,120 ISN'T GETTING US WHERE WE NEED 1070 00:42:49,120 --> 00:42:50,240 TO BE. 1071 00:42:50,240 --> 00:42:52,320 AND IN THIS WAY, WE CAN. 1072 00:42:52,320 --> 00:42:53,720 SO, IN CONCLUSION, I THINK 1073 00:42:53,720 --> 00:42:55,160 THAT'S MY LAST SLIDE, I JUST 1074 00:42:55,160 --> 00:42:56,640 WANTED TO SAY TO YOU ALL BEFORE 1075 00:42:56,640 --> 00:43:01,200 WE MOVED TO Q&A THAT I THINK 1076 00:43:01,200 --> 00:43:04,200 THAT YOU ALL HAVE A TREMENDOUS 1077 00:43:04,200 --> 00:43:05,760 OPPORTUNITY TO LEAD THE NATION 1078 00:43:05,760 --> 00:43:09,440 IN AN ENTIRELY NEW APPROACH TO 1079 00:43:09,440 --> 00:43:11,320 THINKING, TO TRAITING, AND TO 1080 00:43:11,320 --> 00:43:13,440 RESEARCHING THE ISSUES AROUND 1081 00:43:13,440 --> 00:43:14,040 PAIN. 1082 00:43:14,040 --> 00:43:15,960 AND I THINK THAT THE NUMBER OF 1083 00:43:15,960 --> 00:43:18,720 LIVES THAT YOU CAN IMPACT, THE 1084 00:43:18,720 --> 00:43:22,720 AMOUNT OF SUFFERING THAT YOU CAN 1085 00:43:22,720 --> 00:43:24,120 SOOTHE IS PHENOMENAL. 1086 00:43:24,120 --> 00:43:25,520 REALLY IT'S PHENOMENAL AND I 1087 00:43:25,520 --> 00:43:29,040 WANT TO A EMPLOYED THE ENTIRE 1088 00:43:29,040 --> 00:43:30,560 COMMITTEE AND THE ENTIRETY OF 1089 00:43:30,560 --> 00:43:32,160 NIH AND THE COP AGO RACE THAT 1090 00:43:32,160 --> 00:43:34,400 HAS FOCUSED AND TAKEN COURAGE, 1091 00:43:34,400 --> 00:43:44,920 IN MY OPINION, TO MAKE THIS WITH 1092 00:43:48,880 --> 00:43:50,840 THAT I'LL TURN IT OVER TO Q&A. 1093 00:43:50,840 --> 00:43:51,880 >> THANK YOU. 1094 00:43:51,880 --> 00:43:55,680 THANK YOU SO MUCH Dr. GAUDET. 1095 00:43:55,680 --> 00:43:58,360 THIS WAS EXCELLENT AND SO NEEDED 1096 00:43:58,360 --> 00:43:59,400 FOR THE FACE. 1097 00:43:59,400 --> 00:44:01,680 YOU REALLY SET UP THE SPACE FORT 1098 00:44:01,680 --> 00:44:02,480 NEXT TWO DAYS. 1099 00:44:02,480 --> 00:44:04,960 SO WE GOT QUESTIONS FROM THE 1100 00:44:04,960 --> 00:44:08,480 AUDIENCE AND I'D LIKE TO BRING A 1101 00:44:08,480 --> 00:44:09,800 COUPLE TO YOUR ATTENTION. 1102 00:44:09,800 --> 00:44:12,160 THE FIRST QUESTION, WHOLE HEALTH 1103 00:44:12,160 --> 00:44:15,880 IS LIMITED TO PATIENTS WHO HAVE 1104 00:44:15,880 --> 00:44:19,960 BEEN AT A CARE FACILITY AND 1105 00:44:19,960 --> 00:44:26,040 CONSTRUCT REQUCONNED BY PATIENTN 1106 00:44:26,040 --> 00:44:26,680 SPECIALISTS. 1107 00:44:26,680 --> 00:44:29,000 >> SO, I'M SORRY, SO THE 1108 00:44:29,000 --> 00:44:31,680 QUESTION IS -- 1109 00:44:31,680 --> 00:44:35,960 >> THE WHOLE APPROACH IS IT 1110 00:44:35,960 --> 00:44:37,840 APPLICABLE OR A CARE FACILITIES 1111 00:44:37,840 --> 00:44:38,720 OR OUT PATIENT? 1112 00:44:38,720 --> 00:44:39,320 >> THANK YOU. 1113 00:44:39,320 --> 00:44:40,840 THANK YOU FOR THE SUMMARY OF 1114 00:44:40,840 --> 00:44:42,960 THAT, I APPRECIATE THAT. 1115 00:44:42,960 --> 00:44:44,560 NO, ABSOLUTELY. 1116 00:44:44,560 --> 00:44:46,800 IT IS VERY INTERESTING THAT IT 1117 00:44:46,800 --> 00:44:51,920 IS APPLICABLE ACROSS ALL 1118 00:44:51,920 --> 00:44:55,360 SEVERITY OF WHETHER IT'S PAIN OR 1119 00:44:55,360 --> 00:44:56,800 OTHER CONDITIONS AND ACROSS 1120 00:44:56,800 --> 00:44:58,320 SETTINGS SO IN A LARGE DEGREE, 1121 00:44:58,320 --> 00:45:00,840 BECAUSE SO MUCH OF THIS IS NOT 1122 00:45:00,840 --> 00:45:04,040 JUST CLINICAL, IT'S VERY, VERY 1123 00:45:04,040 --> 00:45:05,520 ADAPTABLE AND OFTEN OPTIMAL, 1124 00:45:05,520 --> 00:45:08,280 EVEN THE EXAMPLE I GAVE LIKE THE 1125 00:45:08,280 --> 00:45:09,520 LITTLE ROCK CLINIC WHERE THERE 1126 00:45:09,520 --> 00:45:12,320 WAS WELL BEING WHOLE HEALTH, YOU 1127 00:45:12,320 --> 00:45:13,760 KNOW, SELF-CARE APPROACH AND IN 1128 00:45:13,760 --> 00:45:14,960 COLLABORATION WITH THE CLINICAL 1129 00:45:14,960 --> 00:45:17,240 SO IT'S NOT IN ANYWAY LIMITED TO 1130 00:45:17,240 --> 00:45:20,120 INPATIENT AND IT'S OFTEN MOST 1131 00:45:20,120 --> 00:45:21,720 EFFECTIVE IN THE COMMUNITIES AND 1132 00:45:21,720 --> 00:45:27,800 IN THE PLACE WHERE PEOPLE LIVE. 1133 00:45:27,800 --> 00:45:29,000 >> GREAT. 1134 00:45:29,000 --> 00:45:30,760 THANK YOU. 1135 00:45:30,760 --> 00:45:32,800 TO WHAT DEGREE THIS APPROACH USE 1136 00:45:32,800 --> 00:45:34,240 COMPARED TO CONSCIOUS PRESENTED 1137 00:45:34,240 --> 00:45:37,200 UP FRONT IS THERE EVIDENCE THAT 1138 00:45:37,200 --> 00:45:39,120 THEY IMPROVE HEALTH OUTCOMES AND 1139 00:45:39,120 --> 00:45:41,560 COSTS AT THE POPULATION LEVEL? 1140 00:45:41,560 --> 00:45:44,360 >> SO, I WISH I WERE MORE OF AN 1141 00:45:44,360 --> 00:45:46,400 EXPERT ON THE POPULATION SIDE OF 1142 00:45:46,400 --> 00:45:48,040 THIS BECAUSE THOSE ARE 1143 00:45:48,040 --> 00:45:48,680 TREMENDOUSLY IMPORTANT QUESTIONS 1144 00:45:48,680 --> 00:45:52,000 AND I DO THINK THAT WHAT WE WERE 1145 00:45:52,000 --> 00:45:53,320 SEEING -- ONE OF THE THINGS I 1146 00:45:53,320 --> 00:45:55,640 VALUE ABOUT THIS V.A. WORK, MANY 1147 00:45:55,640 --> 00:45:58,920 THINGS, THAT YOU KNOW THERE'S 1148 00:45:58,920 --> 00:46:02,080 BEEN, LET'S SAY 20 YEARS AGO, A 1149 00:46:02,080 --> 00:46:03,680 PRESUMPTION THAT THESE KINDS OF 1150 00:46:03,680 --> 00:46:05,520 PHILOSOPHIES AND APPROACHES WERE 1151 00:46:05,520 --> 00:46:08,840 FOR PEOPLE WHO WERE PRIVILEGED. 1152 00:46:08,840 --> 00:46:11,560 LIKE PEOPLE WHO HAD ACCESS AND 1153 00:46:11,560 --> 00:46:13,640 HAD AVAILABILITY AND SERVICES 1154 00:46:13,640 --> 00:46:14,640 AND HAD BEEN QUITE HONESTLY 1155 00:46:14,640 --> 00:46:16,080 PEOPLE HAD THE PERCEPTION THAT 1156 00:46:16,080 --> 00:46:18,120 WELL, SURE, THAT'S GREAT TO 1157 00:46:18,120 --> 00:46:18,760 THINK ABOUT. 1158 00:46:18,760 --> 00:46:19,760 YOUR SENSE OF MEANING AND 1159 00:46:19,760 --> 00:46:21,480 PURPOSE IN YOUR LIFE IF YOU ARE 1160 00:46:21,480 --> 00:46:23,600 AFFLUENT AND YOU CAN DO THAT. 1161 00:46:23,600 --> 00:46:26,040 WELL, WHAT IS SHOWN OVER THE 1162 00:46:26,040 --> 00:46:27,560 LAST 10 YEARS OR SO THIS IS 1163 00:46:27,560 --> 00:46:30,040 EVERY BIT IS APPLICABLE IF NOT 1164 00:46:30,040 --> 00:46:31,840 MORE FOR THE HOMELESS 1165 00:46:31,840 --> 00:46:33,480 POPULATION, FOR PEOPLE WHO ARE 1166 00:46:33,480 --> 00:46:35,880 JUST TRYING TO GET THROUGH THE 1167 00:46:35,880 --> 00:46:38,000 DAY THAT ACTUALLY, AND AGAIN, 1168 00:46:38,000 --> 00:46:41,640 USING THE V.A., EXPERIENCE, WHEN 1169 00:46:41,640 --> 00:46:44,280 THIS APPROACH WAS OPEN TO ALL 1170 00:46:44,280 --> 00:46:46,120 VETERANS AND THE PRIMARY PEOPLE 1171 00:46:46,120 --> 00:46:47,280 COMING WERE PEOPLE STRUGGLING 1172 00:46:47,280 --> 00:46:50,320 WITH MENTAL HEALTH AND OR PAIN. 1173 00:46:50,320 --> 00:46:53,560 YOU KNOW, ACROSS THE NATION. 1174 00:46:53,560 --> 00:46:55,600 SO I THINK THE IMPACT AT THE 1175 00:46:55,600 --> 00:46:56,600 POPULATION LEVEL IS SIGNIFICANT. 1176 00:46:56,600 --> 00:46:59,080 I THINK IT'S ACTUALLY MORE OF A 1177 00:46:59,080 --> 00:47:01,440 POPULATION BASED APPROACH AND A 1178 00:47:01,440 --> 00:47:04,600 MOVEMENT IF YOU WILL. 1179 00:47:04,600 --> 00:47:05,600 THIS IS OUT OF THE SCOPE FOR 1180 00:47:05,600 --> 00:47:06,720 THIS MEETING TODAY AND TOMORROW 1181 00:47:06,720 --> 00:47:08,080 I WOULD LIKE TO SEE THE DAY 1182 00:47:08,080 --> 00:47:18,640 WHERE THIS APPROACHES TO EMBRACE 1183 00:47:43,080 --> 00:47:43,840 WHOLE HEALTH. 1184 00:47:43,840 --> 00:47:46,280 WHAT LINES OF EFFORT SHOULD WE 1185 00:47:46,280 --> 00:47:48,120 PRIORITIZE TO KEEP THING HEADED 1186 00:47:48,120 --> 00:47:51,240 IN THE RIGHT DIRECTION? 1187 00:47:51,240 --> 00:47:53,520 >> I ACTUALLY THINK THE CRISIS 1188 00:47:53,520 --> 00:47:57,800 IS A GOOD THING FOR THIS 1189 00:47:57,800 --> 00:48:00,160 TRANSFORMATION, RIGHT. 1190 00:48:00,160 --> 00:48:02,000 BECAUSE, LIKE WE STARTED AT THE 1191 00:48:02,000 --> 00:48:02,880 BEGINNING, WHAT WE'RE DOING IS 1192 00:48:02,880 --> 00:48:06,800 NOT WORKING AND IT'S EXPENSIVE 1193 00:48:06,800 --> 00:48:08,560 AND WE CAN'T SUSTAIN IT. 1194 00:48:08,560 --> 00:48:10,000 THE NATION CANNOT SUSTAIN THAT 1195 00:48:10,000 --> 00:48:11,960 LEVEL OF EXPENDITURES FOR 1196 00:48:11,960 --> 00:48:12,240 HEALTHCARE. 1197 00:48:12,240 --> 00:48:13,840 WE WILL FAIL TO BE COMPETITIVE 1198 00:48:13,840 --> 00:48:15,120 AND THE GLOBAL MARKETS. 1199 00:48:15,120 --> 00:48:17,080 I MEAN, IT'S JUST NOT 1200 00:48:17,080 --> 00:48:18,440 SUSTAINABLE SO THAT CREATES A 1201 00:48:18,440 --> 00:48:21,240 PRESSURE THAT I THINK IS GOOD 1202 00:48:21,240 --> 00:48:22,880 FOR US TO DRIVE TO WHOLE HEALTH 1203 00:48:22,880 --> 00:48:24,120 BECAUSE THE GREAT THING IS, YOU 1204 00:48:24,120 --> 00:48:26,120 KNOW, A LOT OF PEOPLE, WHEN THEY 1205 00:48:26,120 --> 00:48:27,800 START TO SEE THE DATA THAT OH, 1206 00:48:27,800 --> 00:48:30,720 OUTCOMES ARE BETTER AND COST 1207 00:48:30,720 --> 00:48:31,000 DECREASE. 1208 00:48:31,000 --> 00:48:32,760 WHAT DO WE NOT LIKE ABOUT THAT? 1209 00:48:32,760 --> 00:48:33,760 THAT'S FABULOUS. 1210 00:48:33,760 --> 00:48:35,640 THE CHALLENGE THAT WE HAVE IS 1211 00:48:35,640 --> 00:48:37,320 THE PAYMENT SYSTEM HAS TO CATCH 1212 00:48:37,320 --> 00:48:38,040 UP, RIGHT. 1213 00:48:38,040 --> 00:48:39,800 SO AS LONG AS WE STILL HAVE FEE 1214 00:48:39,800 --> 00:48:41,440 FOR SERVICE PAYMENTS, WHERE 1215 00:48:41,440 --> 00:48:42,840 THERE'S PAIN CLINICS AND THEY'RE 1216 00:48:42,840 --> 00:48:44,040 GETTING PAID FOR THEIR 1217 00:48:44,040 --> 00:48:48,160 INTERVENTIONS AND NOT FOR ANY OF 1218 00:48:48,160 --> 00:48:49,680 THIS, IT'S NOT SUSTAINABLE. 1219 00:48:49,680 --> 00:48:52,400 THE GOOD NEWS IS AND I DON'T 1220 00:48:52,400 --> 00:48:54,920 MEAN TO MAKE IT SIMPLE. 1221 00:48:54,920 --> 00:48:56,520 IT'S COMPLEX AND DIFFICULT OR IT 1222 00:48:56,520 --> 00:48:57,160 WOULD HAVE ALREADY HAPPENED. 1223 00:48:57,160 --> 00:48:59,200 THE GOOD NEWS IS AS WE SHIFT 1224 00:48:59,200 --> 00:49:02,120 MORE IN THIS NATION TO 1225 00:49:02,120 --> 00:49:04,320 VALUE-BASED PAYMENTS, THAT WILL 1226 00:49:04,320 --> 00:49:07,360 DRIVE THE NEED FOR VALUE-BASED 1227 00:49:07,360 --> 00:49:08,440 CARE, RIGHT. 1228 00:49:08,440 --> 00:49:09,600 SO, VALUE BASED PAYMENT WHERE 1229 00:49:09,600 --> 00:49:12,880 WE'RE PAYING FOR OUTCOMES, NOW 1230 00:49:12,880 --> 00:49:15,320 INCENTIVIZES SYSTEMS TO SAY OH I 1231 00:49:15,320 --> 00:49:16,840 NEED THAT WHOLE HEALTH APPROACH 1232 00:49:16,840 --> 00:49:17,280 ACTUALLY. 1233 00:49:17,280 --> 00:49:18,640 WE'RE NOT GOING TO SUCCEED IF WE 1234 00:49:18,640 --> 00:49:19,720 DON'T HAVE A APPROACH THAT 1235 00:49:19,720 --> 00:49:21,640 ADDRESSES HEALTH AND WELLBEING 1236 00:49:21,640 --> 00:49:23,400 AND EVERYTHING WE HAVE RIGHT 1237 00:49:23,400 --> 00:49:25,680 NOW, IS FEE FOR SERVICE BASED SO 1238 00:49:25,680 --> 00:49:27,520 THE PAYMENT AND THE POLICY SIDE 1239 00:49:27,520 --> 00:49:33,520 OF ALL OF THIS IS CRITICAL. 1240 00:49:33,520 --> 00:49:34,760 >> THANK YOU. 1241 00:49:34,760 --> 00:49:37,120 DO YOU CONSIDER THE WHOLE HEALTH 1242 00:49:37,120 --> 00:49:41,920 FRAMEWORK AS CONSISTENT WITH THE 1243 00:49:41,920 --> 00:49:44,200 SOCIAL MODEL OR FUNDAMENTALLY 1244 00:49:44,200 --> 00:49:46,000 DIFFERENT IN IMPORTANT WAYS? 1245 00:49:46,000 --> 00:49:49,240 >> GREAT QUESTION. 1246 00:49:49,240 --> 00:49:52,440 AND I THINK THIS IS VERY, VERY 1247 00:49:52,440 --> 00:49:58,880 CONSISTENT WITH THE BY OWE BIO-L 1248 00:49:58,880 --> 00:49:59,160 MODEL. 1249 00:49:59,160 --> 00:50:01,280 THE BIG SHIFT IN THIS APPROACH 1250 00:50:01,280 --> 00:50:03,280 IS ACTUALLY WHAT I WOULD SAY 1251 00:50:03,280 --> 00:50:10,240 STARTING FROM A DIFFERENT PLACE 1252 00:50:10,240 --> 00:50:18,280 SO CAN YOU DO A SHIFT OF A MODEL 1253 00:50:18,280 --> 00:50:19,800 OR HOLE IS TICK APPROACH AND NOT 1254 00:50:19,800 --> 00:50:21,000 SHIFT IS THAT PARADIGM AND I 1255 00:50:21,000 --> 00:50:22,800 HAVE FOUND AND I THINK THE 1256 00:50:22,800 --> 00:50:26,400 RESEARCH IS BEARING OUT, THAT 1257 00:50:26,400 --> 00:50:28,680 THAT SHIFT IS CRITICAL AND THERE 1258 00:50:28,680 --> 00:50:31,160 ARE MANY OF THESE CIRCUMSTANCES 1259 00:50:31,160 --> 00:50:34,880 AND OFFERINGS AT AVAILABLE TO 1260 00:50:34,880 --> 00:50:39,240 PEOPLE AND THEY'RE GOING TO TAKE 1261 00:50:39,240 --> 00:50:40,520 ADVANTAGE OF IT. 1262 00:50:40,520 --> 00:50:41,720 THE REAL SHIFT IS USING ALL THE 1263 00:50:41,720 --> 00:50:43,960 TOOLS AND APPROACH AND BIO 1264 00:50:43,960 --> 00:50:47,800 PSYCHOSOCIAL MODEL THAT'S IT BUT 1265 00:50:47,800 --> 00:50:55,440 STARTING FROM A THE QUESTIONS WE 1266 00:50:55,440 --> 00:50:59,440 DON'T ASK OURSELVES CANCER 1267 00:50:59,440 --> 00:51:10,000 DIAGNOSIS BUT WHAT BUT ALIGNING 1268 00:51:10,520 --> 00:51:11,280 THOSE APPROACH THAT PERSON CAN 1269 00:51:11,280 --> 00:51:13,120 HAVE A MORE FULFILLING LIFE AND 1270 00:51:13,120 --> 00:51:16,280 THEN IT'S OH, BY THE WAY, THEIR 1271 00:51:16,280 --> 00:51:21,240 PAIN SCORES COME DOWN AND THE 1272 00:51:21,240 --> 00:51:31,800 BIG SHIFT AND ALL THAT HAVE IS. 1273 00:51:41,880 --> 00:51:43,120 >> HOW CAN WE MAKE THEM OPTION 1274 00:51:43,120 --> 00:51:47,720 IN THE PROGRAMS AND ASSESS IS 1275 00:51:47,720 --> 00:51:49,240 STILL TOO LOW. 1276 00:51:49,240 --> 00:51:51,960 >> THE LAST PART, I'M SORRY, MY 1277 00:51:51,960 --> 00:51:54,520 AUDIO IS NOT GREAT. 1278 00:51:54,520 --> 00:51:56,160 >> SO, I'M STRUGGLE TO GO HEAR 1279 00:51:56,160 --> 00:51:59,160 JUST A LITTLE BIT, I APOLOGIZE. 1280 00:51:59,160 --> 00:52:00,680 >> NO PROBLEM. 1281 00:52:00,680 --> 00:52:06,840 THE QUESTION OF HOW WE CAN MAKE 1282 00:52:06,840 --> 00:52:09,720 NON DRUG OPTION FORCE PAIN MORE 1283 00:52:09,720 --> 00:52:11,560 AVAILABLE BECAUSE THE NUMBERS OF 1284 00:52:11,560 --> 00:52:14,120 THOSE WHO CAN ASSESS THE IS 1285 00:52:14,120 --> 00:52:22,960 STILL VERY LOW. 1286 00:52:22,960 --> 00:52:24,520 >> IT IS LOWER THAN IT NEEDS TO 1287 00:52:24,520 --> 00:52:24,680 BE. 1288 00:52:24,680 --> 00:52:27,360 THE V.A. HAS MADE ADVANCES 1289 00:52:27,360 --> 00:52:31,960 BECAUSE THEY HAVE GOTTEN 1290 00:52:31,960 --> 00:52:33,600 REGULATIONS CHANGED SO THESE 1291 00:52:33,600 --> 00:52:35,360 APPROACHES ARE INCLUDED IN THE 1292 00:52:35,360 --> 00:52:37,280 MEDICAL BENEFITS PACKAGE FOR 1293 00:52:37,280 --> 00:52:39,080 VETERANS AND IT'S CLINICALLY 1294 00:52:39,080 --> 00:52:40,240 INDICATE AND CERTAINLY PAIN 1295 00:52:40,240 --> 00:52:41,080 PATIENTS IT WOULD BE. 1296 00:52:41,080 --> 00:52:43,480 SO THAT IS A HUGE STEP AND THE 1297 00:52:43,480 --> 00:52:47,880 ONLY REASON I'M REFERENCING THAT 1298 00:52:47,880 --> 00:52:50,320 AS THE V.A. SHIFTS AND THE 1299 00:52:50,320 --> 00:52:51,680 SERVICES ARE COVERED AND WE'RE 1300 00:52:51,680 --> 00:52:53,880 ON THE RIGHT PATH, IT'S TOO SLOW 1301 00:52:53,880 --> 00:52:56,360 FOR SURE, BUT WE'RE ON THE RIGHT 1302 00:52:56,360 --> 00:52:57,560 PATH WE GET MORE OF THE DATA 1303 00:52:57,560 --> 00:52:59,720 THAT CAN SUPPORT THIS MORE 1304 00:52:59,720 --> 00:53:01,560 BROADLY A CROSS THE NATION SO I 1305 00:53:01,560 --> 00:53:03,320 THINK WE'RE ON THE RIGHT PATH OF 1306 00:53:03,320 --> 00:53:04,600 THE INCLUSION OF THOSE 1307 00:53:04,600 --> 00:53:05,960 APPROACHES IN THE MEDICAL 1308 00:53:05,960 --> 00:53:09,120 BENEFITS PACKAGE AND IT WAS A 1309 00:53:09,120 --> 00:53:12,080 HUGE STEP FORWARD AND THE 1310 00:53:12,080 --> 00:53:14,040 ABILITY TO ALSO FOR VETERANS TO 1311 00:53:14,040 --> 00:53:15,160 GET THE APPROACHES IN THE 1312 00:53:15,160 --> 00:53:16,120 COMMUNITY NOT JUST ONLY THROUGH 1313 00:53:16,120 --> 00:53:18,080 THE V.A. IS A HUGE ADVANCE AS 1314 00:53:18,080 --> 00:53:23,800 WELL AND AS EVERYBODY KNOWS, THE 1315 00:53:23,800 --> 00:53:26,760 V.A. IS A CHALLENGING 1316 00:53:26,760 --> 00:53:28,160 BUREAUCRACY TO WORK THROUGH AND 1317 00:53:28,160 --> 00:53:32,680 HOPEFULLY IT CAN LEAD THEM THE 1318 00:53:32,680 --> 00:53:34,040 NATION SAYING LOOK THIS IS 1319 00:53:34,040 --> 00:53:35,120 EFFECTIVE WHY IS IT NOT 1320 00:53:35,120 --> 00:53:38,600 AVAILABLE TO ALL PEOPLE? 1321 00:53:38,600 --> 00:53:40,600 >> 1322 00:53:40,600 --> 00:53:44,840 >> SO OUR HEALTH-CARE SYSTEM WAS 1323 00:53:44,840 --> 00:53:47,760 EXCEPTION OF THE V.A. AND MAYBE 1324 00:53:47,760 --> 00:53:48,720 KAISER. 1325 00:53:48,720 --> 00:53:52,200 FOCUS ON PROCESS RATHER THAN 1326 00:53:52,200 --> 00:53:54,440 COST SAVINGS. 1327 00:53:54,440 --> 00:53:56,760 IT SEEMS THE WHOLE CARE WILL 1328 00:53:56,760 --> 00:54:00,000 PRIOR PARADIGM SHAPE INCLUDING 1329 00:54:00,000 --> 00:54:01,760 WIDESPREAD HEALTHCARE QUALITY 1330 00:54:01,760 --> 00:54:02,320 CHANGES. 1331 00:54:02,320 --> 00:54:06,720 DO YOU HAVE AN IDEA ON HOW BEST 1332 00:54:06,720 --> 00:54:08,640 WE, AS RESEARCHERS, CAN ASSIST 1333 00:54:08,640 --> 00:54:10,400 IN MOVING THAT NEEDLE? 1334 00:54:10,400 --> 00:54:13,000 >> THAT IS A GREAT QUESTION. 1335 00:54:13,000 --> 00:54:15,520 I WOULD LOVE YOU ALL TO TELL ME. 1336 00:54:15,520 --> 00:54:15,960 [LAUGHTER] 1337 00:54:15,960 --> 00:54:23,680 BECAUSE I TOTAL TOTE TOTALLY AGF 1338 00:54:23,680 --> 00:54:26,480 WE DON'T ADVANCE HEALTH SECTOR 1339 00:54:26,480 --> 00:54:28,040 OF FINANCE AND POLICY, WE CAN 1340 00:54:28,040 --> 00:54:30,440 COME UP, AS YOU ALL KNOW, WE CAN 1341 00:54:30,440 --> 00:54:34,840 CAN COME UP WITH THE RESEARCH 1342 00:54:34,840 --> 00:54:36,000 AND DATA THEY'RE EFFECTIVE BUT 1343 00:54:36,000 --> 00:54:37,200 THEY WON'T BE EFFECTIVE. 1344 00:54:37,200 --> 00:54:40,000 SO I TOTALLY CONCUR THAT THE 1345 00:54:40,000 --> 00:54:43,840 POLICY SIDE, THE FINANCE POLICY 1346 00:54:43,840 --> 00:54:46,400 IS ABSOLUTELY PIVOTAL TO THIS 1347 00:54:46,400 --> 00:54:49,840 ACTUALLY GOING FROM THE RESEARCH 1348 00:54:49,840 --> 00:54:51,240 TO REAL IMPLEMENTATION 1349 00:54:51,240 --> 00:54:52,000 CONNECTING PEOPLE'S LIVES AND I 1350 00:54:52,000 --> 00:54:53,240 THINK IT'S A GREAT QUESTION THAT 1351 00:54:53,240 --> 00:55:00,960 I WOULD KIND OF THROWBACK AT THE 1352 00:55:00,960 --> 00:55:04,720 GROUP THE NIH CAN PLAY IN 1353 00:55:04,720 --> 00:55:05,480 ADVANCING THE CONVERSATION 1354 00:55:05,480 --> 00:55:06,160 AROUND POLICY CHANGE. 1355 00:55:06,160 --> 00:55:08,680 I ALSO DO THINK IT'S A PLACE 1356 00:55:08,680 --> 00:55:11,160 WHERE -- AT THE PANDEMIC, HAS 1357 00:55:11,160 --> 00:55:15,520 HELPED TO SOME DEGREE THAT WE 1358 00:55:15,520 --> 00:55:18,840 ARE RETHINKING HOW DO WE DELIVER 1359 00:55:18,840 --> 00:55:19,640 HEALTHCARE AND ADDRESS THE 1360 00:55:19,640 --> 00:55:23,920 POLICY SIDE OF THIS SO THERE'S 1361 00:55:23,920 --> 00:55:26,400 AN OPENING AND IT'S HARD AND 1362 00:55:26,400 --> 00:55:26,680 COMPLICATED. 1363 00:55:26,680 --> 00:55:29,960 >> THANK YOU. 1364 00:55:29,960 --> 00:55:31,640 CAN YOU DISCUSS HOW YOU 1365 00:55:31,640 --> 00:55:34,880 DETERMINE THE DOSE OF EACH 1366 00:55:34,880 --> 00:55:36,320 COMPONENT FROM THE COMPONENT 1367 00:55:36,320 --> 00:55:38,720 APPROACHES SO THAT YOU 1368 00:55:38,720 --> 00:55:40,120 UNDERSTAND WHAT IS THE EFFECT? 1369 00:55:40,120 --> 00:55:41,640 >> AH! 1370 00:55:41,640 --> 00:55:42,880 THAT'S A GRAY QUESTION TO END 1371 00:55:42,880 --> 00:55:43,160 ON. 1372 00:55:43,160 --> 00:55:44,920 BECAUSE I FAILED TO EXPLAIN, AND 1373 00:55:44,920 --> 00:55:49,040 THIS IS A REALLY IMPORTANT 1374 00:55:49,040 --> 00:55:50,800 THING, PARTICULARLY FUR A 1375 00:55:50,800 --> 00:55:52,400 RESEARCHER, THAT ONE OF THE 1376 00:55:52,400 --> 00:55:54,400 SHIFTS AROUND THIS IS IT'S 1377 00:55:54,400 --> 00:55:55,080 PERSON-DRIVEN. 1378 00:55:55,080 --> 00:55:56,400 SO, IF YOU ARE A PAIN PATIENT, 1379 00:55:56,400 --> 00:55:57,720 WE GO WHERE THE PERSON IS DRAWN 1380 00:55:57,720 --> 00:56:00,320 WHICH IS A HUGE SHIFT THAT I 1381 00:56:00,320 --> 00:56:00,680 DIDN'T CLARIFY. 1382 00:56:00,680 --> 00:56:02,200 WHICH IS KIND OF CRAZY MAKING IF 1383 00:56:02,200 --> 00:56:04,680 YOU ARE TRYING TO RESEARCH A 1384 00:56:04,680 --> 00:56:05,560 SPECIFIC APPROACH BECAUSE REALLY 1385 00:56:05,560 --> 00:56:07,000 WHAT WE'RE SEEING IS THAT 1386 00:56:07,000 --> 00:56:08,320 APPROACH IS DRIVEN BY THE 1387 00:56:08,320 --> 00:56:08,640 PERSON. 1388 00:56:08,640 --> 00:56:11,880 THAT'S PART OF THE MODEL THAT IF 1389 00:56:11,880 --> 00:56:13,160 IT'S AVAILABLE AND THERE'S 1390 00:56:13,160 --> 00:56:14,840 EVIDENCE THAT IT COULD BE 1391 00:56:14,840 --> 00:56:16,720 EFFECTIVE FOR THEM, THEY'RE 1392 00:56:16,720 --> 00:56:18,360 GIVEN THE OPTION AND WHAT THEY 1393 00:56:18,360 --> 00:56:20,560 ARE DRAWN TO IS WHERE THEY 1394 00:56:20,560 --> 00:56:20,800 START. 1395 00:56:20,800 --> 00:56:23,720 AND THAT IS A DIFFERENT SHIFT 1396 00:56:23,720 --> 00:56:25,600 BUT WE FIND THAT OH, IF THEY GO 1397 00:56:25,600 --> 00:56:26,880 WHERE THEY'RE DRAWN, NOW THEY 1398 00:56:26,880 --> 00:56:29,000 STAY ENGAGE AND THEY'RE READY, 1399 00:56:29,000 --> 00:56:30,400 IF THEY FOR EXAMPLE, IF THEY ALL 1400 00:56:30,400 --> 00:56:32,440 WANT TO TAKE ON NUTRITION BUT 1401 00:56:32,440 --> 00:56:35,800 THEY'RE INTERESTED IN 1402 00:56:35,800 --> 00:56:37,760 ACCUPAUNCHTURE, GREAT, WHEN THEY 1403 00:56:37,760 --> 00:56:40,280 GET PROGRESS THEY TAKE ON OTHER 1404 00:56:40,280 --> 00:56:42,280 ASPECTS SO IT'S CHALLENGING AS A 1405 00:56:42,280 --> 00:56:43,320 RESEARCHER BECAUSE IT DOESN'T 1406 00:56:43,320 --> 00:56:45,120 FIT THE TYPICAL RANDOMIZED 1407 00:56:45,120 --> 00:56:49,160 CONTROL TRIAL BECAUSE YOU HAVE A 1408 00:56:49,160 --> 00:56:57,880 BLACK BOX. 1409 00:56:57,880 --> 00:56:59,440 THAT IS INTEGRAL TO THIS 1410 00:56:59,440 --> 00:57:02,880 APPROACH AND CREATES RESEARCH 1411 00:57:02,880 --> 00:57:03,600 CHALLENGES I KNOW. 1412 00:57:03,600 --> 00:57:06,840 >> THIS IS GREAT. 1413 00:57:06,840 --> 00:57:07,200 THANK YOU. 1414 00:57:07,200 --> 00:57:09,880 MAYBE ONE MORE QUESTION JUST TO 1415 00:57:09,880 --> 00:57:11,200 START MAYBE CONVERSATIONS THAT 1416 00:57:11,200 --> 00:57:15,520 WE CAN HAVE LATER MAYBE ON THE 1417 00:57:15,520 --> 00:57:16,440 NETWORK TOMORROW. 1418 00:57:16,440 --> 00:57:23,360 CAN YOU DISCUSS THE COST OF THE 1419 00:57:23,360 --> 00:57:25,960 APPROACH TO THE SOCIETY AND TO 1420 00:57:25,960 --> 00:57:26,720 THE HEALTH-CARE SYSTEM? 1421 00:57:26,720 --> 00:57:30,840 >> YEAH, THAT'S A HUGE QUESTION. 1422 00:57:30,840 --> 00:57:34,800 I DO THINK BEN, WHO IS RUNNING 1423 00:57:34,800 --> 00:57:36,120 THE V.A. WORK AND HIS TEAM HE 1424 00:57:36,120 --> 00:57:37,640 HAS EXCELLENT RESEARCHER TEAMS 1425 00:57:37,640 --> 00:57:38,920 WORKING WITH HIM ARE VERY MUCH 1426 00:57:38,920 --> 00:57:40,480 LOOKING AT THE COST AND THE 1427 00:57:40,480 --> 00:57:41,240 IMPACT OF COST. 1428 00:57:41,240 --> 00:57:44,600 SO THAT IS A -- I WILL JUST SAY 1429 00:57:44,600 --> 00:57:48,200 TO END US, I KNOW THIS SESSION 1430 00:57:48,200 --> 00:57:50,240 IS OVER THAT WHAT IS REALLY 1431 00:57:50,240 --> 00:57:51,400 ENCOURAGING IS IT'S NOT -- IT 1432 00:57:51,400 --> 00:57:53,920 DOES NOT APPEAR TO BE COST 1433 00:57:53,920 --> 00:57:55,840 NEUTRAL BUT COST SAVINGS, NOT 1434 00:57:55,840 --> 00:57:57,360 JUST IN PAIN BUT IN OTHER AREAS 1435 00:57:57,360 --> 00:58:02,920 OF HEALTHCARE AS WELL WHICH 1436 00:58:02,920 --> 00:58:03,880 MAKES SENSE. 1437 00:58:03,880 --> 00:58:05,280 THESE ARE NOT HIGH COST 1438 00:58:05,280 --> 00:58:07,320 INTERVENTIONS SO IT MAKES SENSE 1439 00:58:07,320 --> 00:58:09,240 THAT, AND EVEN USING PEERS FOR 1440 00:58:09,240 --> 00:58:10,600 EXAMPLE, TO DELIVER A LOT OF 1441 00:58:10,600 --> 00:58:12,400 THESE APPROACHES, TO DELIVER THE 1442 00:58:12,400 --> 00:58:13,880 CONVERSATIONS AND THE ENGAGEMENT 1443 00:58:13,880 --> 00:58:15,560 RATHER THAN CLINICIANS AND YOU 1444 00:58:15,560 --> 00:58:18,120 CAN SEE PRACTICALLY WHERE THAT 1445 00:58:18,120 --> 00:58:19,760 WOULD BE SCALABLE AND COST 1446 00:58:19,760 --> 00:58:21,720 EFFECTIVE AND SO NA IS WHAT WE 1447 00:58:21,720 --> 00:58:22,440 ARE DISCOVERING AND THERE NEEDS 1448 00:58:22,440 --> 00:58:24,000 TO BE A LOT MORE RESEARCH ON 1449 00:58:24,000 --> 00:58:29,000 THAT AND THAT IS ON GOING AND 1450 00:58:29,000 --> 00:58:31,600 IT'S WE WOULD BE A BIGGER UPHILL 1451 00:58:31,600 --> 00:58:38,600 BATTLE IF IT WORKS MORE AND IT 1452 00:58:38,600 --> 00:58:42,840 DOESN'T. 1453 00:58:42,840 --> 00:58:45,360 >> THANK YOU FOR THIS VERY, VERY 1454 00:58:45,360 --> 00:58:47,760 CONVERSATION AND FOR THE 1455 00:58:47,760 --> 00:58:49,120 EXCELLENCE PRESENTATION AND 1456 00:58:49,120 --> 00:58:54,720 THERE ARE SO MANY QUESTIONS AND 1457 00:58:54,720 --> 00:58:56,560 AND THE QUESTIONS WE CAN'T POINT 1458 00:58:56,560 --> 00:58:58,920 TO DURING THIS Q&A, WHAT ARE THE 1459 00:58:58,920 --> 00:59:01,600 BIGGEST BARRIERS TO INCREASING 1460 00:59:01,600 --> 00:59:02,560 IMPLEMENTED WHOLE POSITIVE 1461 00:59:02,560 --> 00:59:05,760 APPROACH AND HOW CAN WE OVERCOME 1462 00:59:05,760 --> 00:59:07,160 THOSE BARRIERS SO HOPEFULLY THE 1463 00:59:07,160 --> 00:59:11,680 REST OF THESE TWO DAYS SYMPOSIUM 1464 00:59:11,680 --> 00:59:13,000 WILL RESPONSE TO THESE QUESTIONS 1465 00:59:13,000 --> 00:59:17,000 AND HOPEFULLY WE HAVE ANOTHER 1466 00:59:17,000 --> 00:59:18,840 CONVERSATION ON THESE QUESTIONS 1467 00:59:18,840 --> 00:59:22,680 THE NETWORK TOMORROW AND THANK 1468 00:59:22,680 --> 00:59:22,960 YOU AGAIN. 1469 00:59:22,960 --> 00:59:28,520 YOU GO AGAIN SO MUCH. 1470 00:59:28,520 --> 00:59:30,080 >> WE ARE NOW MOVING TO THE 1471 00:59:30,080 --> 00:59:31,360 SESSION AND I'M PLEASED TO 1472 00:59:31,360 --> 00:59:34,920 INVITE MY COLLEAGUES Dr. ALEX 1473 00:59:34,920 --> 00:59:37,560 TUTTLE WHO WILL WILL MODERATE 1474 00:59:37,560 --> 00:59:38,520 THIS SESSION. 1475 00:59:38,520 --> 00:59:40,160 HE IS THE PROGRAM DIRECTOR IN 1476 00:59:40,160 --> 00:59:42,320 THE MECHANISTIC BRANCH AS THE 1477 00:59:42,320 --> 00:59:43,880 NATIONAL CENTER FOR 1478 00:59:43,880 --> 00:59:45,400 COMPLIMENTARY AND INGRAY TIVE 1479 00:59:45,400 --> 00:59:48,560 HELP WHERE HE MANAGED THE MANUAL 1480 00:59:48,560 --> 00:59:51,040 THERAPY AND BASIC PORTFOLIOS. 1481 00:59:51,040 --> 00:59:52,920 Dr. TUTTLE OVERSEES SEVERAL 1482 00:59:52,920 --> 00:59:55,520 PROBLEMS IN THE HELPING TO END 1483 00:59:55,520 --> 00:59:57,960 ADDICTION LONG-TERM, HEAL 1484 00:59:57,960 --> 01:00:00,720 INITIATIVE INCLUDING THE 1485 01:00:00,720 --> 01:00:04,120 BIOMARKERS PROGRAM AND AS WELL 1486 01:00:04,120 --> 01:00:05,720 AS (INAUDIBLE). 1487 01:00:05,720 --> 01:00:07,720 Dr. TUSSLE OBTAINED HIS PH.D 1488 01:00:07,720 --> 01:00:09,840 IN PSYCHOLOGY FROM THE 1489 01:00:09,840 --> 01:00:12,960 UNIVERSITY OF MCGILL AND A 1490 01:00:12,960 --> 01:00:15,800 SPECIALIST AS A NATIONAL INNS 1491 01:00:15,800 --> 01:00:19,600 FOR NEUROLOGICAL DISORDERS. 1492 01:00:19,600 --> 01:00:22,320 WITH THIS, Dr. TUSSLE, PLEASE 1493 01:00:22,320 --> 01:00:23,000 CARRY AWAY. 1494 01:00:23,000 --> 01:00:24,160 >> THANK YOU. 1495 01:00:24,160 --> 01:00:24,760 I APPRECIATE THE INTRODUCTION 1496 01:00:24,760 --> 01:00:26,480 AND GOOD AFTERNOON, EVERYONE. 1497 01:00:26,480 --> 01:00:27,960 I AM DELIGHT TODAY MODERATE THE 1498 01:00:27,960 --> 01:00:30,440 FIRST PANEL SESSION OF THIS 1499 01:00:30,440 --> 01:00:31,400 YEAR'S SYMPOSIUM. 1500 01:00:31,400 --> 01:00:35,320 WE'LL BEGIN WITH AN OVERVIEW OF 1501 01:00:35,320 --> 01:00:37,640 THE COMPLEX OVERVIEW OF THE PAIN 1502 01:00:37,640 --> 01:00:39,200 AND CO MORBID TEASE PRESENTED BY 1503 01:00:39,200 --> 01:00:47,920 Dr. TRACY PEREZ KOEHLMOOS AS 1504 01:00:47,920 --> 01:00:54,600 WELL AS SUBSTANCE USE DISORDERS 1505 01:00:54,600 --> 01:01:03,040 FROM Dr. ILGEN AND Dr. 1506 01:01:03,040 --> 01:01:06,040 PATRICK FINAN AND SAWSAN 1507 01:01:06,040 --> 01:01:06,880 AS-SANIE WE WILL POSE YOUR 1508 01:01:06,880 --> 01:01:08,760 QUESTIONS TO THE PANELISTS, 1509 01:01:08,760 --> 01:01:09,920 PLEASE SUBMIT YOUR QUESTIONS 1510 01:01:09,920 --> 01:01:12,800 USING THE Q&A BOX. 1511 01:01:12,800 --> 01:01:15,040 IT IS NOW MY DISTINCT PLEASURE 1512 01:01:15,040 --> 01:01:18,840 TO INTRODUCE Dr. KOEHLMOOS THE 1513 01:01:18,840 --> 01:01:20,720 DIRECTOR OF HEALTH SERVICES 1514 01:01:20,720 --> 01:01:22,520 RESEARCH AND DIRECTOR OF 1515 01:01:22,520 --> 01:01:23,920 DOCTORAL PROGRAMS IN 1516 01:01:23,920 --> 01:01:24,840 PUBLIC-HEALTH AT THE UNIVERSITY 1517 01:01:24,840 --> 01:01:26,560 OF THE HEALTH SCIENCES. 1518 01:01:26,560 --> 01:01:27,760 WHICH SHE LEADS THE DEVELOPMENT 1519 01:01:27,760 --> 01:01:29,760 OF ROBUST HEALTH SERVICES, 1520 01:01:29,760 --> 01:01:33,920 POLICY RESEARCH, AND GRADUATE 1521 01:01:33,920 --> 01:01:35,000 PROGRAMS. 1522 01:01:35,000 --> 01:01:38,640 WITH 200 PUBLICATIONS SHE'S A 1523 01:01:38,640 --> 01:01:39,720 DISTINGUISHED HEALTH SYSTEMS AND 1524 01:01:39,720 --> 01:01:41,160 POLICY EXPERT AND SHE'S THE 1525 01:01:41,160 --> 01:01:43,520 NATIONAL SECRETARY OF GOLD STAR 1526 01:01:43,520 --> 01:01:44,720 WIVES OF AMERICA AND AS THE 1527 01:01:44,720 --> 01:01:46,120 DEPUTY CHAIR OF THE COCHRAN 1528 01:01:46,120 --> 01:01:47,720 LIBRARY OVERSIGHT COMMITTEE. 1529 01:01:47,720 --> 01:01:51,760 PRIOR TO JOINING USUHS IN 2015, 1530 01:01:51,760 --> 01:01:53,400 SHE SERVED AS THE SPECIAL THE 1531 01:01:53,400 --> 01:01:54,680 ASSISTANT TO THE ASSISTANT 1532 01:01:54,680 --> 01:01:56,480 COMMAND ANT OF THE MARINE CORE. 1533 01:01:56,480 --> 01:01:59,040 A FORMER ARMY AIR DEFENSE 1534 01:01:59,040 --> 01:02:00,600 ARTILLERY OFFICER SHE'S THE 1535 01:02:00,600 --> 01:02:05,240 WIDOW OF CORNUAL RANDEL 1536 01:02:05,240 --> 01:02:06,960 KOEHLMOOS AND A MOTHER OF THREE 1537 01:02:06,960 --> 01:02:08,040 MILITARY MEMBERS. 1538 01:02:08,040 --> 01:02:09,080 THANK YOU FOR JOINING US TODAY. 1539 01:02:09,080 --> 01:02:10,520 >> THANK YOU FOR THAT KIND 1540 01:02:10,520 --> 01:02:11,680 INTRODUCTION, ALEX. 1541 01:02:11,680 --> 01:02:14,040 SO WELCOME, EVERYBODY. 1542 01:02:14,040 --> 01:02:16,320 I HAVE ABOUT 40 SLIDES AND 20 1543 01:02:16,320 --> 01:02:17,880 MINUTES SO I DO HOPE TO MOVE 1544 01:02:17,880 --> 01:02:19,680 THROUGH THIS QUICKLY BECAUSE I'M 1545 01:02:19,680 --> 01:02:21,520 A TEACHER IN MY DAY JOB, I'M 1546 01:02:21,520 --> 01:02:23,960 GOING TO START MY TIMER SO THAT 1547 01:02:23,960 --> 01:02:26,360 I CAN STAY ON TRACK AND I DO 1548 01:02:26,360 --> 01:02:27,360 HOPE PEOPLE WILL ADD THEIR 1549 01:02:27,360 --> 01:02:29,120 QUESTIONS TO THE END AND FOR 1550 01:02:29,120 --> 01:02:30,600 EVERYONE WHO IS DIALED IN YOUR 1551 01:02:30,600 --> 01:02:31,560 IN FOR A TREAT. 1552 01:02:31,560 --> 01:02:32,800 IT'S RARE THAT ANYBODY GETS TO 1553 01:02:32,800 --> 01:02:34,400 BE ON THE CALL WITH MORE THAN 1554 01:02:34,400 --> 01:02:36,400 ONE TRACY AND WE JUST HEARD FROM 1555 01:02:36,400 --> 01:02:39,480 MY COLLEAGUE TRACY GAUDET AND 1556 01:02:39,480 --> 01:02:41,240 NOW YOU'VE GOT ME, WE'RE GOING 1557 01:02:41,240 --> 01:02:43,440 TO TALK ABOUT THIS ISSUE OF PAIN 1558 01:02:43,440 --> 01:02:45,720 AND COMPLEXITY AND CO-MORBIDITY 1559 01:02:45,720 --> 01:02:47,560 THROUGH THE LENS OF THE U.S. 1560 01:02:47,560 --> 01:02:52,720 MILITARY HEALTH SYSTEM. 1561 01:02:52,720 --> 01:02:53,520 IT'S THE STAND AR DISCLAIMER, I 1562 01:02:53,520 --> 01:02:54,760 AM A FEDERAL GOVERNMENT EMPLOYEE 1563 01:02:54,760 --> 01:02:58,200 AND ANYTHING THAT I SAY DOES NOT 1564 01:02:58,200 --> 01:03:03,280 REFLECT THE VIEWS OF ANY AGENCY. 1565 01:03:03,280 --> 01:03:05,160 THAT WAS TO SHOW YOU WHERE WE'RE 1566 01:03:05,160 --> 01:03:05,720 GOING. 1567 01:03:05,720 --> 01:03:06,560 LET'S TALK ABOUT PAIN. 1568 01:03:06,560 --> 01:03:10,760 I THINK THE AUDIENCE AND THE 1569 01:03:10,760 --> 01:03:12,760 PARTICIPANTS IN THIS PANEL DON'T 1570 01:03:12,760 --> 01:03:18,840 NEED ANY REMINDERS ABOUT WHAT 1571 01:03:18,840 --> 01:03:21,560 PAIN IS OR HOW IT IMPACTS OUR 1572 01:03:21,560 --> 01:03:22,560 ENVIRONMENT AND THERE'S 1573 01:03:22,560 --> 01:03:26,160 ENVIRONMENTAL FEELINGS, 1574 01:03:26,160 --> 01:03:29,960 BEHAVIORS ALL THAT TAKE PLACE 1575 01:03:29,960 --> 01:03:32,440 AND I WILL PACT OUR EXPERIENCE 1576 01:03:32,440 --> 01:03:34,640 OF PAIN. 1577 01:03:34,640 --> 01:03:35,880 THERE'S STANDARD ONES THAT COME 1578 01:03:35,880 --> 01:03:37,160 WITH CHRONIC PAIN WHEN WE'RE IN 1579 01:03:37,160 --> 01:03:39,120 PAIN AND OUR FOODS ARE ALTERED 1580 01:03:39,120 --> 01:03:44,720 AND WE CAN'T SLEEP AND WE MAY 1581 01:03:44,720 --> 01:03:48,080 HAVE DYSFUNCTION WHILE WE TRY TO 1582 01:03:48,080 --> 01:03:51,760 MANAGE THE THESE THINGS SO THEY 1583 01:03:51,760 --> 01:03:52,640 TREMENDOUSLY REDUCE THE QUALITY 1584 01:03:52,640 --> 01:03:54,480 OF LIFE FOR PATIENTS, FOR OUR 1585 01:03:54,480 --> 01:03:56,120 FRIENDS, OUR FAMILIES, OUR 1586 01:03:56,120 --> 01:04:00,840 LEVELS AND NEXT SLIDE, PLEASE. 1587 01:04:00,840 --> 01:04:02,000 WE TALK A LOT IF WE'RE GOING TO 1588 01:04:02,000 --> 01:04:04,160 TALK ABOUT WHOLE PERSONNEL 1589 01:04:04,160 --> 01:04:05,920 HEALTH, HOW WE CAN ASSESS TREAT 1590 01:04:05,920 --> 01:04:08,560 AND MANAGE PAIN AND CHRONIC PAIN 1591 01:04:08,560 --> 01:04:10,600 PARTICULARLY IN A HOLISTIC 1592 01:04:10,600 --> 01:04:12,800 PLANNER THAT BRINGS PEOPLE BACK 1593 01:04:12,800 --> 01:04:14,800 TO BOTH FEELING BETTER AND 1594 01:04:14,800 --> 01:04:23,400 BETTER FUNCTIONING. 1595 01:04:23,400 --> 01:04:24,880 I DO TALK ABOUT RESEARCH AND 1596 01:04:24,880 --> 01:04:33,560 WORK THAT WE'VE DONE AND YOU 1597 01:04:33,560 --> 01:04:35,480 MIGHT THINK IT'S BEING ACTIVE 1598 01:04:35,480 --> 01:04:36,960 DUTIES AND YOU WOULD BE 1599 01:04:36,960 --> 01:04:41,640 INCORRECT ONLY ABOUT 18% OF OUR 1600 01:04:41,640 --> 01:04:43,440 9.6 MILLION FIN FISH ARY ARE ON 1601 01:04:43,440 --> 01:04:45,200 ACTIVE DUTIES AND EVERYONE ELSE 1602 01:04:45,200 --> 01:04:46,280 COMES TO US AS GOD MADE THEM. 1603 01:04:46,280 --> 01:04:51,320 IT'S THE SPOUSES, THE CHILDREN 1604 01:04:51,320 --> 01:04:56,240 AND 2 MILLION CHILDREN WHO ARE 1605 01:04:56,240 --> 01:04:58,320 POPULATION OF THE CHILDREN IT'S 1606 01:04:58,320 --> 01:05:02,120 OUR RETIREES AND THEY OFTEN STAY 1607 01:05:02,120 --> 01:05:05,280 ON AND THEY ARE 9.6 MILLION 1608 01:05:05,280 --> 01:05:06,120 BENEFICIARIES SPREAD OUT ACROSS 1609 01:05:06,120 --> 01:05:11,920 THE COUNTRY. 1610 01:05:11,920 --> 01:05:13,960 DOB A RETIREE IN OUR SYSTEM 1611 01:05:13,960 --> 01:05:14,800 DOESN'T NECESSARILY MEAN THAT 1612 01:05:14,800 --> 01:05:16,000 YOU ARE AGE 65. 1613 01:05:16,000 --> 01:05:18,320 WE HAVE RETIREES WHO CAN BE AS 1614 01:05:18,320 --> 01:05:22,840 YOUNG AS PAGE 38 WHO SERVED 1615 01:05:22,840 --> 01:05:24,240 THEIR FULL 20 YEARS AND KEEP 1616 01:05:24,240 --> 01:05:26,360 THIS MILITARY TRY-CARE BENEFIT 1617 01:05:26,360 --> 01:05:27,760 INTO THEIR PERSONAL RETIREMENT 1618 01:05:27,760 --> 01:05:30,480 IN ADDITION TO PERHAPS SEEKING 1619 01:05:30,480 --> 01:05:33,760 CARE INSIDE THE VETERAN'S HEALTH 1620 01:05:33,760 --> 01:05:34,280 ADMINISTRATION. 1621 01:05:34,280 --> 01:05:36,920 AND THE SYSTEM ITSELF COST THE 1622 01:05:36,920 --> 01:05:39,080 U.S. GOVERNMENT A $53 BILLION A 1623 01:05:39,080 --> 01:05:41,240 YEAR WHICH IS A VERY SMALL 10% 1624 01:05:41,240 --> 01:05:45,200 OF THE ENTIRE BUDGET WHEN WE 1625 01:05:45,200 --> 01:05:46,320 TALK ABOUT HEALTH INSURANCE AND 1626 01:05:46,320 --> 01:05:48,560 EVERYBODY ON THIS CALL HAS SOME 1627 01:05:48,560 --> 01:05:49,800 FORM OF HEALTH INSURANCE AND 1628 01:05:49,800 --> 01:05:53,520 THIS IS HEALTH INSURANCE WITH NO 1629 01:05:53,520 --> 01:05:55,640 OR LOCO PAYMENTS NEW YORK CITY 1630 01:05:55,640 --> 01:05:57,440 PREMIUMS AND IT'S AN INCLUSIVE 1631 01:05:57,440 --> 01:06:05,200 WITH A TREMENDOUS BENEFITS SO 1632 01:06:05,200 --> 01:06:15,680 THERE'S HOWEVER, IN ORDER TO 1633 01:06:17,560 --> 01:06:18,960 HELP MEET THE SECURITY NEEDS OF 1634 01:06:18,960 --> 01:06:22,880 THE U.S. ARMED FORCES, WE 1635 01:06:22,880 --> 01:06:24,040 MAINTAIN AND OPERATE OUR 1636 01:06:24,040 --> 01:06:27,480 GLOBALLY REPRESENT TEN AND 1637 01:06:27,480 --> 01:06:28,200 GEOGRAPHICALLY DISBURSE THE 1638 01:06:28,200 --> 01:06:30,240 HEALTH-CARE SYSTEM WITH MORE 1639 01:06:30,240 --> 01:06:35,600 THAN 375 DIFFERENT CLINICS. 1640 01:06:35,600 --> 01:06:37,480 MAJOR MEDICAL HOSPITALS ACROSS 1641 01:06:37,480 --> 01:06:42,080 THE U.S. IN GUAM, JAPAN AND 1642 01:06:42,080 --> 01:06:44,560 OTHER PLACES, WE SET UP DEPLOYED 1643 01:06:44,560 --> 01:06:45,840 FACILITIES WHERE OUR ARMED 1644 01:06:45,840 --> 01:06:47,520 FORCES MEMBERS AND SOLDIERS, 1645 01:06:47,520 --> 01:06:50,960 SAILORS AND MARINES GO TO 1646 01:06:50,960 --> 01:06:54,360 NATIONAL SECURITY OBJECTIVES FOR 1647 01:06:54,360 --> 01:06:55,880 THE UNITED STATES SO WE CAN SET 1648 01:06:55,880 --> 01:07:00,840 UP A HOSPITAL AND STATION AND 1649 01:07:00,840 --> 01:07:05,040 DELIVER HEALTHCARE ON THE DROP 1650 01:07:05,040 --> 01:07:06,480 OF A DIME WE JUST HEARD FROM THE 1651 01:07:06,480 --> 01:07:08,320 OTHER TRACY WHO SPOKE ABOUT THE 1652 01:07:08,320 --> 01:07:10,200 VETERAN'S HEALTH ADMINISTRATION. 1653 01:07:10,200 --> 01:07:11,240 VETERANS HEALTH AND HEALTHCARE 1654 01:07:11,240 --> 01:07:12,560 AND IT'S IMPORTANT TO KNOW THESE 1655 01:07:12,560 --> 01:07:14,240 ARE TWO SEPARATE SYSTEMS WHEN WE 1656 01:07:14,240 --> 01:07:15,600 TALK ABOUT THE V.A. WE'RE 1657 01:07:15,600 --> 01:07:18,040 TALKING ABOUT INDIVIDUALS WITH 1658 01:07:18,040 --> 01:07:19,960 PRIOR ACTIVE DUTY MILITARY 1659 01:07:19,960 --> 01:07:21,840 SERVICE AND IT DOESN'T 1660 01:07:21,840 --> 01:07:24,760 NECESSARILY INCLUDE THE ACTIVE 1661 01:07:24,760 --> 01:07:26,760 DUTY SERVICE MEMBERS OR INCLUDE 1662 01:07:26,760 --> 01:07:28,720 THE DEPENDENCE OF SPOUSES FOR 1663 01:07:28,720 --> 01:07:30,200 THE CHILDREN AND IT CERTAINLY 1664 01:07:30,200 --> 01:07:33,400 DOESN'T INCLUDE ALL OF THE 1665 01:07:33,400 --> 01:07:35,680 PEOPLE WHO RETIRE OR LEAVE THE 1666 01:07:35,680 --> 01:07:36,160 MILITARY. 1667 01:07:36,160 --> 01:07:38,640 DON NECESSARILY QUALIFY FOR 1668 01:07:38,640 --> 01:07:40,720 HEALTHCARE IN THE V.A. 1669 01:07:40,720 --> 01:07:45,880 WE HAVE 9.6 MILLION 1670 01:07:45,880 --> 01:07:47,720 BENEFICIARIES AND WE TREAT OUR 1671 01:07:47,720 --> 01:07:48,960 PROVIDERS AND IT'S A DIFFERENT 1672 01:07:48,960 --> 01:07:51,040 STRUCTURE AND THE IMPORTANT 1673 01:07:51,040 --> 01:07:53,080 TAKEAWAY IS THAT THESE TWO 1674 01:07:53,080 --> 01:07:54,400 ELECTRONIC HEALTH RECORDS DO NOT 1675 01:07:54,400 --> 01:07:56,400 TALK TO EACH OTHER AND THEY'RE 1676 01:07:56,400 --> 01:07:57,880 TWO SEPARATE SYSTEMS AND IT'S 1677 01:07:57,880 --> 01:08:01,000 HELPFUL FOR PEOPLE TO REMEMBER 1678 01:08:01,000 --> 01:08:01,480 THAT. 1679 01:08:01,480 --> 01:08:06,000 WE'RE WORKING ON GETTING A 1680 01:08:06,000 --> 01:08:08,440 SINGLE ELECTRONIC HEALTH RECORD 1681 01:08:08,440 --> 01:08:10,840 SO IT'S NOT IN THE PROCESS OF 1682 01:08:10,840 --> 01:08:15,600 HAPPENING NOW BUT IT'S MORE OF A 1683 01:08:15,600 --> 01:08:25,920 LONG-TERM VISION. 1684 01:08:27,800 --> 01:08:29,240 AND THE CURRENT 20 YEARS OR I 1685 01:08:29,240 --> 01:08:34,280 GUESS WE JUST WRAPPED UP AND TRY 1686 01:08:34,280 --> 01:08:36,160 ADDS AND OUR NEXT SLIDE PLEASE. 1687 01:08:36,160 --> 01:08:41,800 THIS CONSIST OF TRAIN INJURIES 1688 01:08:41,800 --> 01:08:44,760 POST TRAUMATIC STRESS DISORDER 1689 01:08:44,760 --> 01:08:51,000 AND OFTEN FOR SOMETHING LESS AND 1690 01:08:51,000 --> 01:09:01,320 WE LOOKED INSIDE. 1691 01:09:42,720 --> 01:09:44,720 >> A CARE DOCTOR DEALING WITH 1692 01:09:44,720 --> 01:09:47,880 THE PAIN ISSUES AND SO WE SAW 1693 01:09:47,880 --> 01:09:49,760 DIFFERENT PROVIDERS. 1694 01:09:49,760 --> 01:09:51,960 IT WAS DISJOINTED. 1695 01:09:51,960 --> 01:09:53,840 SO, WE WENT OUT AND REALLY THE 1696 01:09:53,840 --> 01:09:54,800 FIRST STEP WHEN YOU HAVE A 1697 01:09:54,800 --> 01:09:56,040 PROBLEM IS IDENTIFYING THAT YOU 1698 01:09:56,040 --> 01:10:02,600 HAVE A PROBLEM AND IT'S LIKE A 1699 01:10:02,600 --> 01:10:03,240 12-STEP PROBLEM. 1700 01:10:03,240 --> 01:10:05,920 OVER A FIVE-YEAR PERIOD FROM 1701 01:10:05,920 --> 01:10:07,240 2010 TO 2015 COMING OFF THE 1702 01:10:07,240 --> 01:10:09,760 HEIGHT OF THE THE SURGE IN 1703 01:10:09,760 --> 01:10:15,040 AFGHANISTAN, WE IDENTIFIED 1704 01:10:15,040 --> 01:10:17,200 15,000PCT PATIENTS WHO SHOWED 1705 01:10:17,200 --> 01:10:20,240 THE SYMPTOMS USING OUR MILITARY 1706 01:10:20,240 --> 01:10:22,640 HEALTH SYSTEM REPOSITORY. 1707 01:10:22,640 --> 01:10:24,320 THIS IS THE GROUP OF PATIENTS WE 1708 01:10:24,320 --> 01:10:25,800 IDENTIFIED AND THIS IN DEED WAS 1709 01:10:25,800 --> 01:10:30,160 THE LARGEST GROUP WITH THE POLY 1710 01:10:30,160 --> 01:10:31,560 TRAUMA MEDICAL TRIAD AND THERE 1711 01:10:31,560 --> 01:10:33,680 WERE VETERANS THAT ARE STUDIED 1712 01:10:33,680 --> 01:10:41,720 IN SOME DETAIL AND ON THE 1713 01:10:41,720 --> 01:10:42,760 SURVIVORS IS IT ON GOING NOW BUT 1714 01:10:42,760 --> 01:10:44,040 OF COURSE THE FIRST STEP IS 1715 01:10:44,040 --> 01:10:45,920 ALWAYS TRYING TO FIGURE OUT WHO 1716 01:10:45,920 --> 01:10:48,840 DO YOU HAVE IN THIS POPULATION. 1717 01:10:48,840 --> 01:10:49,480 WHERE ARE THEY? 1718 01:10:49,480 --> 01:10:50,960 WHAT'S GOING ON WITH THEM? 1719 01:10:50,960 --> 01:10:52,440 WHAT ARE THEY DOING? 1720 01:10:52,440 --> 01:10:57,760 WHY DO THEY HAVE MUSS CUE TAL 1721 01:10:57,760 --> 01:10:58,040 PAIN. 1722 01:10:58,040 --> 01:11:00,320 ALL OF THAT WORK IS GOING ON NOW 1723 01:11:00,320 --> 01:11:02,280 ACROSS DIFFERENT VENUES IN THE 1724 01:11:02,280 --> 01:11:03,760 DEPARTMENT OF DEFENSE AND THE 1725 01:11:03,760 --> 01:11:09,640 MILITARY HEALTH SYSTEMS. 1726 01:11:09,640 --> 01:11:13,000 SO THE CORNER STONE OF THESE 1727 01:11:13,000 --> 01:11:14,920 LAST 20 YEARS OF COMBAT IN 1728 01:11:14,920 --> 01:11:17,160 AFGHANISTAN AND IRAQ. 1729 01:11:17,160 --> 01:11:19,400 IT WOULD BE TRAUMATIC BRAIN 1730 01:11:19,400 --> 01:11:20,960 INJURY, WHICH OF COURSE, WE 1731 01:11:20,960 --> 01:11:27,760 OFTEN THINK OF IT AS CONCUSSION, 1732 01:11:27,760 --> 01:11:29,480 CONTUSION, PENETRATING INJURIES 1733 01:11:29,480 --> 01:11:31,840 AND IT'S DIS ACT AND DEATH IN 1734 01:11:31,840 --> 01:11:34,760 ADULTS IN GENERAL AND YOU WILL 1735 01:11:34,760 --> 01:11:35,840 SEE THAT DURING AFGHANISTAN, WE 1736 01:11:35,840 --> 01:11:37,880 HAD A TREMENDOUSLY HIGHER RATE 1737 01:11:37,880 --> 01:11:42,680 OF HEAD INJURIES THAN ANY OTHER 1738 01:11:42,680 --> 01:11:45,120 TIME, HALF A MILLION TRAUMATIC 1739 01:11:45,120 --> 01:11:47,320 BRAIN INJURIES DURING THE OEF, 1740 01:11:47,320 --> 01:11:51,240 OPERATION ENDURING FREEDOM AND 1741 01:11:51,240 --> 01:11:53,880 SO THE SHARE OF WHICH WERE MILD 1742 01:11:53,880 --> 01:11:58,600 BUT NOT NEGLIGIBLE SO THIS WAS 1743 01:11:58,600 --> 01:12:02,840 REALLY THE TAKE-HOME THING WE 1744 01:12:02,840 --> 01:12:04,240 HAD TO DEAL WITH BOTH IN WAYS 1745 01:12:04,240 --> 01:12:06,840 WHERE THE CONCLUSION WE KNOW 1746 01:12:06,840 --> 01:12:07,920 FROM HIGH SCHOOL FOOTBALL OR 1747 01:12:07,920 --> 01:12:10,480 SPORTS, BUT ALSO THE SQUEEZE, 1748 01:12:10,480 --> 01:12:11,840 THE COMPRESSION INJURIES THAT 1749 01:12:11,840 --> 01:12:13,440 CAUSED A TRAUMATIC BRAIN INJURY 1750 01:12:13,440 --> 01:12:16,400 IN THE SENSE THAT THE SQUEEZING 1751 01:12:16,400 --> 01:12:18,720 MIGHT SOMEHOW BE DIFFERENT OR 1752 01:12:18,720 --> 01:12:24,400 MORE DAMAGING THAN OTHER TYPES 1753 01:12:24,400 --> 01:12:26,840 OF CONCUSSIVE EVENTS. 1754 01:12:26,840 --> 01:12:28,800 WE WENT OUT AND WE LOOKED 1755 01:12:28,800 --> 01:12:36,160 BETWEEN 2016 AND 2019 AT WHERE 1756 01:12:36,160 --> 01:12:42,120 ACTIVE NATIONAL GUARD YOU CAN 1757 01:12:42,120 --> 01:12:48,520 SEE IN THE MOUNTAIN AND TEXAS 1758 01:12:48,520 --> 01:12:50,120 AND WE LOOKED AT THE ESTABLISH 1759 01:12:50,120 --> 01:12:51,640 OF ESTABLISHING WHERE WE MIGHT 1760 01:12:51,640 --> 01:12:54,520 DEVELOP SERVICES BETWEEN THE 1761 01:12:54,520 --> 01:12:55,720 DEPARTMENT OF DEFENSE AND THE 1762 01:12:55,720 --> 01:12:59,040 V.A. AND IT MIGHT TREAT AND HELP 1763 01:12:59,040 --> 01:13:01,040 THESE PATIENTS LIVE AND MANAGE 1764 01:13:01,040 --> 01:13:03,560 THEIR CONDITIONS GOING FORWARD. 1765 01:13:03,560 --> 01:13:05,760 AS THEY REINTEGRATE INTO 1766 01:13:05,760 --> 01:13:07,080 POPULATION AND TRY TO ENJOY THE 1767 01:13:07,080 --> 01:13:12,440 REST OF THEIR HAPPY LIVES THE 1768 01:13:12,440 --> 01:13:15,520 OTHER THING THAT IS IMPORTANT 1769 01:13:15,520 --> 01:13:17,760 ABOUT TRAUMATIC BRAIN INJURY IS 1770 01:13:17,760 --> 01:13:20,520 MILD AND MODERATE IT HAS A 1771 01:13:20,520 --> 01:13:22,840 LONG-TERM IMPACT ON A PATIENT 1772 01:13:22,840 --> 01:13:26,080 AND THERE ARE MORE EXPENSIVE TO 1773 01:13:26,080 --> 01:13:28,200 TREAT SO FROM A HEALTH SYSTEMS 1774 01:13:28,200 --> 01:13:29,120 PERSPECTIVE, PEOPLE TALK ABOUT 1775 01:13:29,120 --> 01:13:31,280 THE MILITARY HEALTH SYSTEM OR 1776 01:13:31,280 --> 01:13:33,120 THE V.A. HEALTH SYSTEM BECAUSE 1777 01:13:33,120 --> 01:13:36,440 THERE'S NO PREMIUM DEDUCTIBLE 1778 01:13:36,440 --> 01:13:37,840 FOR ACTIVE DUTY INDIVIDUALS, NO 1779 01:13:37,840 --> 01:13:41,000 CO PAYMENT, THERE'S A SENSE OF 1780 01:13:41,000 --> 01:13:42,320 WE DON'T THINK ABOUT MONEY BUT 1781 01:13:42,320 --> 01:13:45,040 WE DO BECAUSE EVERY PENNY AT 1782 01:13:45,040 --> 01:13:47,160 LEAST IN THE DOD THAT GOES TO 1783 01:13:47,160 --> 01:13:51,080 HEALTHCARE, IS ONE THAT US 1784 01:13:51,080 --> 01:13:53,160 DOESN'T GO FOR AIRPLANES, TANKS, 1785 01:13:53,160 --> 01:13:54,600 WEAPONS, SHIPS AT SEA DURING 1786 01:13:54,600 --> 01:13:56,280 POWER PROJECTION FOR THE UNITED 1787 01:13:56,280 --> 01:13:58,840 STATES AND SO WE ACTUALLY CARE A 1788 01:13:58,840 --> 01:14:00,480 GREAT DEAL ABOUT COST. 1789 01:14:00,480 --> 01:14:03,440 AS WE MOVE FROM MILD TO MODERATE 1790 01:14:03,440 --> 01:14:06,640 AND SEVERE WE SEE HOW EXPENSIVE 1791 01:14:06,640 --> 01:14:08,800 THIS IS FOR THE PATIENT 1792 01:14:08,800 --> 01:14:10,160 POPULATION AND THE HEALTH SYSTEM 1793 01:14:10,160 --> 01:14:17,680 IN HEALTH SO NEXT SLIDE, PLEASE. 1794 01:14:17,680 --> 01:14:18,720 SO IDENTIFYING WE ARE HAVING A 1795 01:14:18,720 --> 01:14:20,440 MONSTER PROBLEM WITH THE CROP I 1796 01:14:20,440 --> 01:14:22,840 CAN ISSUES OF T BYE THE 1797 01:14:22,840 --> 01:14:23,840 DEPARTMENT OF STINTS STOOD UP 1798 01:14:23,840 --> 01:14:27,680 THE NATIONAL INTREPID CENTER 1799 01:14:27,680 --> 01:14:29,560 WHERE WORKING ON THE CAMPUS 1800 01:14:29,560 --> 01:14:31,160 ACROSS THE STREET FROM THE NIH 1801 01:14:31,160 --> 01:14:34,520 SO MAYBE NEXT YEAR, WHEN WE'RE 1802 01:14:34,520 --> 01:14:36,240 ALL TOGETHER AT THE NIH IT'S SO 1803 01:14:36,240 --> 01:14:40,160 NICE AND WE'LL BE RIGHT ACROSS 1804 01:14:40,160 --> 01:14:45,400 FROM THE STOOD UP IN 2010 AND 1805 01:14:45,400 --> 01:14:48,800 THEN THEIR SATELLITE SPIRIT 1806 01:14:48,800 --> 01:14:52,000 CENTERS ACROSS THE NATION 1807 01:14:52,000 --> 01:14:53,040 THERE'S 13 PARTNER SITES AND 1808 01:14:53,040 --> 01:14:55,680 RATHER THAN HAVING THIS PRAG 1809 01:14:55,680 --> 01:14:57,640 INVESTMENTED CARE WHERE WE TREAT 1810 01:14:57,640 --> 01:15:01,360 T BYE OR HEADACHES IN ONE PLACE, 1811 01:15:01,360 --> 01:15:05,200 DIFFERENT PROVIDERS AND MANAGING 1812 01:15:05,200 --> 01:15:07,200 THOSE SLEEP DISTURBANCES BALANCE 1813 01:15:07,200 --> 01:15:08,640 DISTURBANCE AND EYE DISTURBANCES 1814 01:15:08,640 --> 01:15:12,120 AND ALL IN DIFFERENT PLACES, 1815 01:15:12,120 --> 01:15:13,760 THESE WERE PRACTICE UNITS AND 1816 01:15:13,760 --> 01:15:15,120 MODELS THAT HAVE BEEN STOOD UP 1817 01:15:15,120 --> 01:15:19,200 AND REPEATEDLY SORT OF TEST SOD 1818 01:15:19,200 --> 01:15:20,880 SEE HOW THEY'RE WORKING IN 1819 01:15:20,880 --> 01:15:23,240 THROUGH THEIR INTENSIVE OUT 1820 01:15:23,240 --> 01:15:26,000 PATIENT AND THE THEY HAVE NICO 1821 01:15:26,000 --> 01:15:29,920 HAS A INTENSIVE MONTH-LONG 1822 01:15:29,920 --> 01:15:32,920 PROGRAM AS WELL WHERE ALL OF THE 1823 01:15:32,920 --> 01:15:34,600 SERVICES ARE COAL LATED AND ALL 1824 01:15:34,600 --> 01:15:37,640 THE PATIENTS SCREENING RESULTS 1825 01:15:37,640 --> 01:15:39,280 THAT ARE SHARED ACROSS THE 1826 01:15:39,280 --> 01:15:42,120 PROVIDERS AS THAT INDIVIDUAL 1827 01:15:42,120 --> 01:15:45,200 MOVES THROUGH THE PRACTICE UNITS 1828 01:15:45,200 --> 01:15:46,240 AND RECEIVES REALLY THE TAILORED 1829 01:15:46,240 --> 01:15:48,280 CARE THAT THEY NEED. 1830 01:15:48,280 --> 01:15:53,440 SOME OF WHICH IS STANDARD 1831 01:15:53,440 --> 01:15:54,480 PRACTICE OF CARE AND HEARING 1832 01:15:54,480 --> 01:15:57,440 AIDS VISION AND EYEGLASSES, PAIN 1833 01:15:57,440 --> 01:16:00,480 AND PAIN MANAGEMENT BUT IT'S 1834 01:16:00,480 --> 01:16:02,880 ALSO THINGS LIKE ENTA RATE IS 1835 01:16:02,880 --> 01:16:03,520 TIVE MEDICINE WHICH I'M GOING TO 1836 01:16:03,520 --> 01:16:05,280 TALK ABOUT THE NEXT FEW MINUTES 1837 01:16:05,280 --> 01:16:09,440 BEFORE MY TALK COMES TO A RAPID 1838 01:16:09,440 --> 01:16:09,640 CLOSE. 1839 01:16:09,640 --> 01:16:12,680 LET'S TALK ABOUT INGRAY TIVE 1840 01:16:12,680 --> 01:16:14,360 MEDICINE AND IN THE DEPARTMENT 1841 01:16:14,360 --> 01:16:17,360 OF DEFENSE WE ARE FANS OF ENTA 1842 01:16:17,360 --> 01:16:18,320 GREAT TIVE MEDICINE OUR 1843 01:16:18,320 --> 01:16:19,480 PROVIDERS, PATIENTS AND FAMILY 1844 01:16:19,480 --> 01:16:22,320 MEMBERS AND WE'RE MONSTER FANS 1845 01:16:22,320 --> 01:16:25,000 OF MEDICINE AND WE OFTEN TO OUR 1846 01:16:25,000 --> 01:16:27,600 DISMAY, GET UP SET WITH THE IDEA 1847 01:16:27,600 --> 01:16:29,160 THAT ACTIVE DUTY SERVICE MEMBERS 1848 01:16:29,160 --> 01:16:33,240 WOULD PREFER TO HANG UPSIDE DOWN 1849 01:16:33,240 --> 01:16:36,120 BY BOOTS OR WEAR A HAT WITH 1850 01:16:36,120 --> 01:16:37,520 ELECTRODES AND WATCH A CERTAIN 1851 01:16:37,520 --> 01:16:39,680 TYPE OF PROGRAMMING OR DRINK A 1852 01:16:39,680 --> 01:16:40,960 POSITION IN THEIR GLASS AND TAKE 1853 01:16:40,960 --> 01:16:43,960 AN FDA APPROVED PILL TO HELP 1854 01:16:43,960 --> 01:16:46,840 MANAGE THEIR PAIN OR CONDITION. 1855 01:16:46,840 --> 01:16:48,400 WHEN WE TALK ABOUT IM IT'S 1856 01:16:48,400 --> 01:16:50,320 THROUGH THE LENS OF ACTUALLY 1857 01:16:50,320 --> 01:16:52,920 TRYING TO MEET THE NEEDS OF A 1858 01:16:52,920 --> 01:16:57,040 POPULATION THAT IS DEMANDING 1859 01:16:57,040 --> 01:16:58,200 THINGS OTHER THAN OVER THE 1860 01:16:58,200 --> 01:17:00,840 COUNTER MEDICATIONS, OR 1861 01:17:00,840 --> 01:17:01,400 PRESCRIPTION MEDICATIONS AND 1862 01:17:01,400 --> 01:17:04,160 THERE'S A REAL BIAS TOWARDS NOT 1863 01:17:04,160 --> 01:17:05,840 BEING MEDICATED ON ACTIVE DUTY 1864 01:17:05,840 --> 01:17:07,520 EVEN IF IT'S REALLY SOMETHING 1865 01:17:07,520 --> 01:17:10,880 THAT WE MAKE INDIVIDUALS FEEL 1866 01:17:10,880 --> 01:17:13,960 BETTER AND BE MORE WHOLE AND 1867 01:17:13,960 --> 01:17:14,360 HEALED. 1868 01:17:14,360 --> 01:17:15,480 SO YOU CAN UNDERSTAND WHERE WORE 1869 01:17:15,480 --> 01:17:17,520 COMING FROM AND AGAIN, IT'S 1870 01:17:17,520 --> 01:17:20,360 REALLY, IT'S THIS WHOLE PERSON 1871 01:17:20,360 --> 01:17:22,600 APPROACH TO ACHIEVE OPTIMAL, 1872 01:17:22,600 --> 01:17:24,120 MENTAL, PHYSICAL, AND 1873 01:17:24,120 --> 01:17:27,120 ENVIRONMENTAL HEALTH AND SOME OF 1874 01:17:27,120 --> 01:17:30,600 THESE ARE QUITE CONVENTIONAL AND 1875 01:17:30,600 --> 01:17:33,160 OTHERS ARE LESS CONVENTIONAL AND 1876 01:17:33,160 --> 01:17:37,120 OF COURSE THE GOAL IS WHERE 1877 01:17:37,120 --> 01:17:41,520 THINGS ARE NOT CONVENTIONAL, TO 1878 01:17:41,520 --> 01:17:44,160 DEVELOP THE EVIDENCE ABOUT 1879 01:17:44,160 --> 01:17:45,240 WHETHER THEY SHOULD BE INCLUDED 1880 01:17:45,240 --> 01:17:48,280 IN PRACTICE OR NOT AND ALL OF 1881 01:17:48,280 --> 01:17:51,240 THIS CENTER WE COME TO THIS 1882 01:17:51,240 --> 01:17:52,600 EXPERIENCE WITH THE SAME DESIRE, 1883 01:17:52,600 --> 01:17:56,600 AT LEAST THE SCIENTISTS DO, NEXT 1884 01:17:56,600 --> 01:17:57,520 SLIDE, PLEASE. 1885 01:17:57,520 --> 01:17:58,840 SO THERE'S A NUMBER OF DIFFERENT 1886 01:17:58,840 --> 01:18:00,160 THINGS THAT CAN TOWARDS HEALTH 1887 01:18:00,160 --> 01:18:04,360 AND MUCH OF THIS IS 1888 01:18:04,360 --> 01:18:05,040 EVIDENCE-BASED. 1889 01:18:05,040 --> 01:18:06,680 THINGS LIKE YOGA OR MEDICATION, 1890 01:18:06,680 --> 01:18:10,480 RIGHT, FOR PAIN MANAGEMENT AND 1891 01:18:10,480 --> 01:18:12,720 CHIROPRACTORS, COGNITIVE 1892 01:18:12,720 --> 01:18:15,200 BEHAVIORAL THERAPY IS A NORM BUT 1893 01:18:15,200 --> 01:18:17,040 IT'S ENTA GREAT TIVE MEDICINE 1894 01:18:17,040 --> 01:18:20,040 AND WE'RE MONSTER FANS OF 1895 01:18:20,040 --> 01:18:21,200 AFTERNOON YOU PUNCTURE IN THE 1896 01:18:21,200 --> 01:18:23,280 MILITARY HEALTH SYSTEMS SO THESE 1897 01:18:23,280 --> 01:18:27,120 ARE JUST ONCE THAT WE USE AND 1898 01:18:27,120 --> 01:18:28,440 SERVICE MEMBERS USE MILITARY 1899 01:18:28,440 --> 01:18:30,600 MEMBERS AND FAMILIES USE NON 1900 01:18:30,600 --> 01:18:32,480 CONVENTIONAL THERAPIES AT A MUCH 1901 01:18:32,480 --> 01:18:37,240 HIGHER RATE THAN CIVILIANS EARLY 1902 01:18:37,240 --> 01:18:38,920 SURVEYS OF SERVICE MEMBERS SHOW 1903 01:18:38,920 --> 01:18:42,400 THEY WANT MORE OF THIS SO IT'S 1904 01:18:42,400 --> 01:18:43,640 OUR CENTER ALIGN WITH THE 1905 01:18:43,640 --> 01:18:45,240 INTEREST OF GROUPS AT THE NIH 1906 01:18:45,240 --> 01:18:48,000 AND NEXT SLIDE, PLEASE. 1907 01:18:48,000 --> 01:18:49,800 I'VE GOT ABOUT THROW AND A HALF 1908 01:18:49,800 --> 01:18:53,560 MINUTES LEFT AND THERE'S SOME 1909 01:18:53,560 --> 01:18:58,200 THAT ARE EFFECTIVE CLEANING THE 1910 01:18:58,200 --> 01:19:02,120 POLY TRAUMA AND ACUPUNCTURE AND 1911 01:19:02,120 --> 01:19:04,840 I HAVE SLIDES I HOPE I CAN GET 1912 01:19:04,840 --> 01:19:08,160 TO AND YOGA NEXT SLIDE. 1913 01:19:08,160 --> 01:19:12,400 LET'S KEEP GOING. 1914 01:19:12,400 --> 01:19:13,600 AFTERNOON YOU PUNCTURE WE WENT 1915 01:19:13,600 --> 01:19:17,640 OUT AND WE LOOKED AT WHAT WAS 1916 01:19:17,640 --> 01:19:22,160 GOING ON IN THE MILITARY HEALTH 1917 01:19:22,160 --> 01:19:29,280 SYSTEM AND YOU WILL SEE A LOT OF 1918 01:19:29,280 --> 01:19:31,520 SERVICE MEMBERS WALKING AROUND 1919 01:19:31,520 --> 01:19:33,200 WITH THE RANK YOU PUNCTURE 1920 01:19:33,200 --> 01:19:43,720 TREATMENT AND WE KNOW THAT FOR 1921 01:19:46,280 --> 01:19:50,840 PAIN OPINIONS AND MORE THAN 83 1922 01:19:50,840 --> 01:19:51,840 MILITARY TREATMENT FACILITIES 1923 01:19:51,840 --> 01:19:55,760 ACROSS THE COUNTRY, OFTEN IS 1924 01:19:55,760 --> 01:19:57,880 THAT BUT WE ALSO TEACH OUR 1925 01:19:57,880 --> 01:20:01,400 PROVIDERS A DIFFERENT SCHOOLS 1926 01:20:01,400 --> 01:20:09,440 HOW TO DO ORAL ACU PUNK TIER SO 1927 01:20:09,440 --> 01:20:13,800 THEY CAN BRING IT TO THE SHIFT. 1928 01:20:13,800 --> 01:20:16,240 WHEN WE LOOKED AT THE DATA ON 1929 01:20:16,240 --> 01:20:17,920 RANK YOU PURETURE USE USING THE 1930 01:20:17,920 --> 01:20:20,160 MILITARY DATA REPOSITORY SO THIS 1931 01:20:20,160 --> 01:20:22,600 ISN'T SELF-REPORTED ACUPUNCTURE 1932 01:20:22,600 --> 01:20:25,520 USE THIS IS THE LOOKING AT THE 1933 01:20:25,520 --> 01:20:29,480 HEALTH RECORDS OF OUR 1934 01:20:29,480 --> 01:20:35,880 9.6 MILLION BENEFICIARY AND IN 1935 01:20:35,880 --> 01:20:37,760 2014, WE HAD 15,000 PATIENTS AND 1936 01:20:37,760 --> 01:20:39,600 THE MAJORITY WERE CAUCASIAN AND 1937 01:20:39,600 --> 01:20:41,360 MEN AND THE MAJORITY WERE IN THE 1938 01:20:41,360 --> 01:20:43,920 ARMY AND NOT A SURPRISE GIVING 1939 01:20:43,920 --> 01:20:47,960 THE DEMOGRAPHIC BREAKDOWN AND OF 1940 01:20:47,960 --> 01:20:49,840 THE MILITARY THE SAME WITH BLACK 1941 01:20:49,840 --> 01:20:52,480 RACE AND THERE IS OVER REPRESENT 1942 01:20:52,480 --> 01:20:54,120 IN THE MILITARY HEALTH SYSTEM SO 1943 01:20:54,120 --> 01:20:57,560 FOR US THIS IS ACTUALLY A VERY 1944 01:20:57,560 --> 01:21:02,840 THIS IS A VERY EQUITABLE RACE 1945 01:21:02,840 --> 01:21:09,680 WISE DISTRIBUTION OF ACUPUNC 1946 01:21:09,680 --> 01:21:15,720 ACUPUNCTURE.MILITARY HEALTH 1947 01:21:15,720 --> 01:21:20,440 SYSTEM. 1948 01:21:20,440 --> 01:21:23,520 A LITTLE BIT THROUGH NERVES AND 1949 01:21:23,520 --> 01:21:27,160 SENSES AND WE PUBLISHED A PAPER 1950 01:21:27,160 --> 01:21:32,400 LOOKING AT THE USE OF 1951 01:21:32,400 --> 01:21:33,440 ACUPUNCTURE AND I DON'T THINK 1952 01:21:33,440 --> 01:21:35,920 THIS RESULTS MADE IT IN HERE BUT 1953 01:21:35,920 --> 01:21:39,080 THAT PAPER IS OUT AND AVAILABLE 1954 01:21:39,080 --> 01:21:40,480 ON THE WESTBOUND YOU CAN FIND IT 1955 01:21:40,480 --> 01:21:46,080 NEXT SLIDE, PLEASE. 1956 01:21:46,080 --> 01:21:47,760 WE HAVE FIFTH DEMAND FROM OUR 1957 01:21:47,760 --> 01:21:49,280 PROVIDERS TO BE TRAINED IN THIS 1958 01:21:49,280 --> 01:21:50,520 SER ADVERTISE AND FROM OUR 1959 01:21:50,520 --> 01:21:51,960 PATIENTS, ESPECIALLY OUR ACTIVE 1960 01:21:51,960 --> 01:21:56,400 DUTY SERVICE MEMBERS FANS AND 1961 01:21:56,400 --> 01:21:59,040 NEXT SLIDE. 1962 01:21:59,040 --> 01:22:01,000 PAIN AS ALL OF YOU KNOW IS 1963 01:22:01,000 --> 01:22:02,400 MULTIFACETED AND COMPLICATED AND 1964 01:22:02,400 --> 01:22:05,640 WE STRUGGLE WITH THE POLY TRAUMA 1965 01:22:05,640 --> 01:22:06,800 CLINICAL TRIAD AND TRYING TO 1966 01:22:06,800 --> 01:22:09,320 FIGURE OUT HOW TO HELP BRING 1967 01:22:09,320 --> 01:22:12,960 ACTIVE DUTY SERVICE MEMBERS BACK 1968 01:22:12,960 --> 01:22:14,680 TO FULL HEALTH OR ENOUGH HEALTH 1969 01:22:14,680 --> 01:22:19,040 AND WELL BEING THAT THEY CAN 1970 01:22:19,040 --> 01:22:20,200 PERFORM THEIR SCROLL HAVE A 1971 01:22:20,200 --> 01:22:26,680 HIGH-QUALITY OF LIFE WHETHER 1972 01:22:26,680 --> 01:22:34,160 THEY'RE IN THE FOR THE FUTURE 1973 01:22:34,160 --> 01:22:44,600 AGAIN WE HAVE THE THE NEXT 1974 01:22:48,760 --> 01:22:50,000 SERIES OF SPEAKERS ARE COMING 1975 01:22:50,000 --> 01:22:56,640 AFTER ME AND I'LL BE FOLLOWED BY 1976 01:22:56,640 --> 01:22:57,760 Dr. SAWSAN AS-SANIE AND SO I 1977 01:22:57,760 --> 01:22:59,240 THINK THE OTHER SPEAKERS WILL BE 1978 01:22:59,240 --> 01:23:05,680 MORE FOCUSED ON INDIVIDUAL AREAS 1979 01:23:05,680 --> 01:23:08,800 OF PAIN SO SO WE HAVE THESE 1980 01:23:08,800 --> 01:23:10,200 SLIDES ANY QUESTIONS, COMMENTS, 1981 01:23:10,200 --> 01:23:11,520 FEEDBACK YOU ARE WELCOME TO 1982 01:23:11,520 --> 01:23:16,360 SHARE THOSE WITH ME AND THANK 1983 01:23:16,360 --> 01:23:22,080 YOU ALL FOR GOING NEXT. 1984 01:23:22,080 --> 01:23:24,080 >> THANK YOU SO MUCH. 1985 01:23:24,080 --> 01:23:26,400 IT WAS SUCH -- THANK YOU FOR A 1986 01:23:26,400 --> 01:23:27,120 LOVELY INTRODUCTION AS WELL AS 1987 01:23:27,120 --> 01:23:30,120 AN EXCELLENT LECTURE TO FOLLOW 1988 01:23:30,120 --> 01:23:31,360 SO I HAVE BIG SHOES TO FEEL. 1989 01:23:31,360 --> 01:23:35,520 I WOULD LIKE TO THINK THAT PAIN 1990 01:23:35,520 --> 01:23:36,560 CONSORTIUM ORGANIZERS TO SHARE 1991 01:23:36,560 --> 01:23:45,880 THE WORK ON REFRAMING 1992 01:23:45,880 --> 01:23:47,080 ENDOMETRIOSIS. 1993 01:23:47,080 --> 01:23:47,640 NEXT SLIDE. 1994 01:23:47,640 --> 01:23:49,200 SO THE OBJECTIVE OF MY TALK 1995 01:23:49,200 --> 01:23:50,800 TODAY ARE TO DEFINE 1996 01:23:50,800 --> 01:23:52,400 ENDOMETRIOSIS AND REVIEW IT'S 1997 01:23:52,400 --> 01:23:53,680 MOST COMMON SYMPTOMS AND I'M 1998 01:23:53,680 --> 01:23:58,080 GOING TO PRESENT SOME EVIDENCE 1999 01:23:58,080 --> 01:23:59,720 THAT WOMEN ARE PATIENTS WITH 2000 01:23:59,720 --> 01:24:01,840 ENDOMETRIOSIS SHARE CLINICAL AND 2001 01:24:01,840 --> 01:24:03,160 PHYSIOLOGICAL CHARACTERISTICS TO 2002 01:24:03,160 --> 01:24:04,720 CHRONIC OVERLAPPING PAIN 2003 01:24:04,720 --> 01:24:05,960 CONDITIONS AND THEN REVIEW THE 2004 01:24:05,960 --> 01:24:08,840 CLINICAL AS WELL AS THE RESEARCH 2005 01:24:08,840 --> 01:24:10,240 IMPLICATIONS OF PAIN IN THE 2006 01:24:10,240 --> 01:24:11,840 EVALUATION AND TREATMENT OF 2007 01:24:11,840 --> 01:24:18,840 PATIENTS WITH ENDOMETRIOSIS OR 2008 01:24:18,840 --> 01:24:19,640 PELVIC PAIN. 2009 01:24:19,640 --> 01:24:20,320 DROUIN-ULYSSE DROUIN-ULYSSE IS A 2010 01:24:20,320 --> 01:24:23,600 CONTINUE DEFINED BY THE PRESENCE 2011 01:24:23,600 --> 01:24:28,400 OF GLANDS AND STROM A OUTSIDE OF 2012 01:24:28,400 --> 01:24:28,880 THE UTERUS. 2013 01:24:28,880 --> 01:24:31,120 ON THE LEFT SIDE OF THE SCREEN 2014 01:24:31,120 --> 01:24:34,440 IS AN EXAMPLE OF ENDOMETRIOSIS 2015 01:24:34,440 --> 01:24:37,000 WITH A GLANCE IN STROMA AND A 2016 01:24:37,000 --> 01:24:38,440 TYPICAL SURGICAL IMAGE THAT WE 2017 01:24:38,440 --> 01:24:40,560 WOULD SEE AT THE TIME OF 2018 01:24:40,560 --> 01:24:44,760 LAPAROSCOPY FOR A PATIENT WITH 2019 01:24:44,760 --> 01:24:45,080 ENDOMETRIOSIS. 2020 01:24:45,080 --> 01:24:48,080 SO ENDOMETRIOSIS EFFECTS 10% OF 2021 01:24:48,080 --> 01:24:48,680 REPRODUCTIVE AGE WOMEN. 2022 01:24:48,680 --> 01:24:51,240 I WANT TO CLARIFY THAT 2023 01:24:51,240 --> 01:24:51,960 ENDOMETRIOSIS DOES EFFECT TRANS 2024 01:24:51,960 --> 01:24:56,480 AND BINARY PATIENTS AND I'LL 2025 01:24:56,480 --> 01:24:57,920 HOPE THAT EVERYONE UNDERSTANDS 2026 01:24:57,920 --> 01:24:59,600 THAT THIS COVERS ALL OF THOSE 2027 01:24:59,600 --> 01:25:00,080 PATIENTS. 2028 01:25:00,080 --> 01:25:02,840 SO THIS REPRESENTS OVER 2029 01:25:02,840 --> 01:25:03,560 200 MILLION PEOPLE GLOBALLY 2030 01:25:03,560 --> 01:25:05,160 MAKING IT MORE COMMON THAN 2031 01:25:05,160 --> 01:25:08,000 ASTHMA AND DIABETES. 2032 01:25:08,000 --> 01:25:09,880 THE PREVALENCE OF ENDOMETRIOSIS 2033 01:25:09,880 --> 01:25:11,560 IS MUCH HIGHER IN SPECIFIC 2034 01:25:11,560 --> 01:25:14,800 POPULATIONS SO IT OCCURS IN 2035 01:25:14,800 --> 01:25:17,200 ABOUT 30% OF PERSONS WITH SUB 2036 01:25:17,200 --> 01:25:19,000 FERTILITY AND 60% TO 80% OF 2037 01:25:19,000 --> 01:25:20,600 ADULTS WITH CHRONIC PELVIC BAIN 2038 01:25:20,600 --> 01:25:23,840 AND 50% OF ADOLESCENTS OF 2039 01:25:23,840 --> 01:25:24,520 CHRONIC PELVIC PAIN. 2040 01:25:24,520 --> 01:25:26,040 THE MOST COMMON PRESENTING 2041 01:25:26,040 --> 01:25:27,840 SYMPTOM OF ENDOMETRIOSIS IS 2042 01:25:27,840 --> 01:25:29,640 PELVIC PAIN AND THIS INCLUDES 2043 01:25:29,640 --> 01:25:33,040 DIS MEN ARIA DEFINED AS PAINFUL 2044 01:25:33,040 --> 01:25:38,520 PERIODS, NON MENSTRUAL PELVIC 2045 01:25:38,520 --> 01:25:40,040 PAIN AS WELL AS PAIN WITH SEXUAL 2046 01:25:40,040 --> 01:25:41,120 INTERNET ARE COURSE. 2047 01:25:41,120 --> 01:25:43,040 HOWEVER, PATIENTS ARE FREQUENTLY 2048 01:25:43,040 --> 01:25:43,960 REPORTING OTHER SYMPTOMS WHICH 2049 01:25:43,960 --> 01:25:46,320 ARE LISTED HERE. 2050 01:25:46,320 --> 01:25:47,520 ANY COMBINATION OF SYMPTOMS CAN 2051 01:25:47,520 --> 01:25:49,680 OCCUR, WHICH IS SHOWN IN THE 2052 01:25:49,680 --> 01:25:51,080 DIAGRAM AND IT'S ALSO IMPORTANT 2053 01:25:51,080 --> 01:25:55,240 TO NOTE THAT SOME PATIENTS HAVE 2054 01:25:55,240 --> 01:25:57,840 LITTLE TO NO SYMPTOMS AT ALL FOR 2055 01:25:57,840 --> 01:25:59,320 HAVING SIGNIFICANT DISEASE. 2056 01:25:59,320 --> 01:26:01,680 MUCH IS KNOWN ABOUT THE PATHO 2057 01:26:01,680 --> 01:26:02,720 PHYSIOLOGY OF ENDOMETRIOSIS AS 2058 01:26:02,720 --> 01:26:05,800 IT RELATES TO THE INFLAMMATORY 2059 01:26:05,800 --> 01:26:07,680 AND THE MECHANISMS THAT INITIATE 2060 01:26:07,680 --> 01:26:13,480 AND SUSTAIN THE PROLIFERATION OF 2061 01:26:13,480 --> 01:26:13,920 THESE ENDOMETRIOSIS. 2062 01:26:13,920 --> 01:26:14,520 REN TREE GRADE MENSTRUATION IS 2063 01:26:14,520 --> 01:26:17,360 THE MOST COMMON BUT NOT THE ONLY 2064 01:26:17,360 --> 01:26:18,560 INITIATING FACTOR AND 2065 01:26:18,560 --> 01:26:21,760 ALTERATIONS IN CELL ADHESION, 2066 01:26:21,760 --> 01:26:24,000 LOCAL PELVIC AND NERVE FIBER 2067 01:26:24,000 --> 01:26:25,600 FILTRATION AS WELL AS 2068 01:26:25,600 --> 01:26:27,040 VASCULARIZATION ARE NECESSARY 2069 01:26:27,040 --> 01:26:29,200 FOR THE ESTABLISHMENT OF THE 2070 01:26:29,200 --> 01:26:31,280 LESIONS AND WE KNOW THAT IT'S 2071 01:26:31,280 --> 01:26:33,880 NECESSARY TO STIM YOU LATE THIS 2072 01:26:33,880 --> 01:26:36,120 PROCESS AND THE SUPPRESSION OF 2073 01:26:36,120 --> 01:26:39,560 ESTROGEN IS IN SUPPRESSION AND 2074 01:26:39,560 --> 01:26:40,440 REGRESSION OF THESE IMPLANTS. 2075 01:26:40,440 --> 01:26:43,080 SO AS I PREVIOUSLY DESCRIBED, 2076 01:26:43,080 --> 01:26:45,560 THE MOST PROMINENT SYMPTOM IS 2077 01:26:45,560 --> 01:26:46,960 PELVIC PAIN AND THE TRADITIONAL 2078 01:26:46,960 --> 01:26:49,320 AND MOST WIDELY PREVIOUS HEALTH 2079 01:26:49,320 --> 01:26:52,400 VIEW IS ENDOMETRIOSIS IS A PAIN 2080 01:26:52,400 --> 01:26:53,560 CONDITION THAT OCCURS DUE TO 2081 01:26:53,560 --> 01:27:00,160 DIRECT ACTIVATION OF LESIONS. 2082 01:27:00,160 --> 01:27:02,360 THE OVERWHELMING MAJORITY OF 2083 01:27:02,360 --> 01:27:03,800 RESEARCH FUND TO GO DATE HAS 2084 01:27:03,800 --> 01:27:05,480 FOCUSED ON UNDERSTANDING THE 2085 01:27:05,480 --> 01:27:07,040 BIOLOGY OF ENDOMETRIOSIS LESIONS 2086 01:27:07,040 --> 01:27:09,080 AND CURRENTLY THE ONLY FDA 2087 01:27:09,080 --> 01:27:10,280 APPROVED TREATMENT ARE HOR 2088 01:27:10,280 --> 01:27:12,720 MONDAYAL MEDICATIONS THAT 2089 01:27:12,720 --> 01:27:15,800 SUPPRESSION PRODUCTION AND 2090 01:27:15,800 --> 01:27:16,920 SUPPRESSION THE LESIONS AS WELL 2091 01:27:16,920 --> 01:27:20,640 AS SURGERY OR DESTROYING 2092 01:27:20,640 --> 01:27:20,880 LESIONS. 2093 01:27:20,880 --> 01:27:21,880 IS IT THAT SIMPLE? 2094 01:27:21,880 --> 01:27:23,520 AS MOST OF US WOULD UNDERSTAND, 2095 01:27:23,520 --> 01:27:25,160 PARTICULARLY IN LIGHT OF THE 2096 01:27:25,160 --> 01:27:26,240 PREVIOUS LECTURES, IT REALLY 2097 01:27:26,240 --> 01:27:32,680 CANNOT BE THAT SIMPLE. 2098 01:27:32,680 --> 01:27:33,800 WHILE IT'S CLEAR THEY'RE 2099 01:27:33,800 --> 01:27:35,600 IMPORTANT THE RELATIONSHIP 2100 01:27:35,600 --> 01:27:36,200 BETWEEN DROUIN-ULYSSE 2101 01:27:36,200 --> 01:27:41,280 DROUIN-UENDOMETRIOSIS IS NOT EXD 2102 01:27:41,280 --> 01:27:42,600 SO THERE'S MINIMAL RELATIONSHIP 2103 01:27:42,600 --> 01:27:45,960 BETWEEN THE SEVERITY OF 2104 01:27:45,960 --> 01:27:47,920 ENDOMETRIOSIS AND IT THIS IS SIM 2105 01:27:47,920 --> 01:27:49,280 PAR TO PAIN CONDITIONS AND 2106 01:27:49,280 --> 01:27:51,560 DOCUMENTED THAT THERE ARE 2107 01:27:51,560 --> 01:27:54,280 PATIENTS WITH VERY ADVANCE 2108 01:27:54,280 --> 01:27:56,080 DISEASE WHO HAVE LITTLE OR NO 2109 01:27:56,080 --> 01:27:57,960 PAIN AND THAT ARE PATIENTS WITH 2110 01:27:57,960 --> 01:27:59,800 ONE OR TWO VERY SMALL DEPOSITS 2111 01:27:59,800 --> 01:28:02,240 THAT HAVE DEBILITATING 2112 01:28:02,240 --> 01:28:03,560 LIFE-ALTERING PAIN. 2113 01:28:03,560 --> 01:28:05,400 SECOND, TREATMENTS AIMED AT THE 2114 01:28:05,400 --> 01:28:08,640 LESIONS DO NOT CONSIST ENDLY A 2115 01:28:08,640 --> 01:28:09,760 MILLER' EIGHT SYMPTOMS SO PAIN 2116 01:28:09,760 --> 01:28:11,960 IS IN 25% OF PATIENTS WHO 2117 01:28:11,960 --> 01:28:13,440 UNDERGO MEDICAL AND SURGICAL 2118 01:28:13,440 --> 01:28:15,080 THERAPY SO THEY'RE UNRESPONSIVE 2119 01:28:15,080 --> 01:28:17,880 TO THAT AND PAIN RECURSE IN 50% 2120 01:28:17,880 --> 01:28:23,200 OF PATIENTS FOLLOWING INCISION. 2121 01:28:23,200 --> 01:28:25,240 THE PAIN COMES BACK AND IT 2122 01:28:25,240 --> 01:28:27,360 OCCURS UP TO 10 TO 25% OF 2123 01:28:27,360 --> 01:28:31,160 PATIENTS WHO UNDERGO 2124 01:28:31,160 --> 01:28:32,240 HYSTERECTOMY AND 450% OF THEM 2125 01:28:32,240 --> 01:28:35,920 THERE'S NO EVIDENCE OF RECURRENT 2126 01:28:35,920 --> 01:28:39,600 ENDOMETRIOSIS LESIONS SO WE NEED 2127 01:28:39,600 --> 01:28:40,920 TO REMEMBER THERE'S NO CHRONIC 2128 01:28:40,920 --> 01:28:43,280 PAIN CONDITION THAT IS EXPLAINED 2129 01:28:43,280 --> 01:28:45,320 BY PERIPHERAL PATHOLOGY BECAUSE 2130 01:28:45,320 --> 01:28:47,160 THE CENTRAL NERVOUS SYSTEM HAS A 2131 01:28:47,160 --> 01:28:50,200 POWERFUL ABILITY TO AMPLIFIED AS 2132 01:28:50,200 --> 01:28:52,680 WELL AS DAMPEN SIGNALS. 2133 01:28:52,680 --> 01:28:54,680 SO AS SUCH THE MODERN 2134 01:28:54,680 --> 01:28:55,520 UNDERSTANDING OF PAIN IS THAT 2135 01:28:55,520 --> 01:28:57,160 PAIN IS AN OUTPUT OF THE BRAIN 2136 01:28:57,160 --> 01:28:59,160 THAT IS A BALANCE BETWEEN THE 2137 01:28:59,160 --> 01:29:02,920 PERIPHERAL INPUT AND THE CENTRAL 2138 01:29:02,920 --> 01:29:07,360 NERVOUS SYSTEM VOLUME CONTROL. 2139 01:29:07,360 --> 01:29:11,480 SO PAIN IS DEFINED AS ANY NERVE 2140 01:29:11,480 --> 01:29:13,040 DYSFUNCTION THAT PLAYS A ROLE IN 2141 01:29:13,040 --> 01:29:16,000 MAINTAINING PAIN AND CAN LEAD TO 2142 01:29:16,000 --> 01:29:18,360 CRON INPAIN INDEPENDENT THE 2143 01:29:18,360 --> 01:29:21,360 SIGNALS. 2144 01:29:21,360 --> 01:29:31,960 NO SIS ACCEPTIVE CRON EASTBOUNDW 2145 01:29:40,080 --> 01:29:46,800 BACK PAIN AND -- AND THESE NO 2146 01:29:46,800 --> 01:29:51,640 SIM PLASTIC PAIN ARE BY 2147 01:29:51,640 --> 01:29:52,160 WIDESPREAD PAIN AND THESE 2148 01:29:52,160 --> 01:29:54,000 PATIENTS HAVE A PAIR LIFETIME 2149 01:29:54,000 --> 01:30:03,360 HISTORY -- PAIN IS 2150 01:30:03,360 --> 01:30:07,880 ASKER BATED BY STRESSORS. 2151 01:30:07,880 --> 01:30:16,840 AND THEN NOW NEXT SLIDE. 2152 01:30:16,840 --> 01:30:18,520 SO, IT'S VERY IMPORTANT TO KNOW 2153 01:30:18,520 --> 01:30:19,800 THESE CONDITIONS ARE NOT JUST 2154 01:30:19,800 --> 01:30:21,360 PAIN DISORDERS BUT THESE ARE 2155 01:30:21,360 --> 01:30:23,200 ALSO CHARACTERIZED BY GREATER 2156 01:30:23,200 --> 01:30:24,720 SENSITIVITY TO INTERNAL 2157 01:30:24,720 --> 01:30:26,000 SENSATIONS AS WELL AS GREATER 2158 01:30:26,000 --> 01:30:27,320 SENSITIVITY TO SOUND AND LIGHT 2159 01:30:27,320 --> 01:30:28,800 AND THESE PATIENTS ALSO 2160 01:30:28,800 --> 01:30:30,720 EXPERIENCE CHRONIC FATIGUE, POOR 2161 01:30:30,720 --> 01:30:34,240 OR NON RESTORATIVE SLEEP, MEMORY 2162 01:30:34,240 --> 01:30:35,440 DIFFICULTIES AS WELL AS HIGHER 2163 01:30:35,440 --> 01:30:40,000 PREVALENCE SUCH AS ANXIETY ASK 2164 01:30:40,000 --> 01:30:41,080 DEPRESSION. 2165 01:30:41,080 --> 01:30:43,680 SO THESE NOCIPLASTIC PAIN CO 2166 01:30:43,680 --> 01:30:45,800 OCCUR AND THE COEXISTING PAIN 2167 01:30:45,800 --> 01:30:47,360 CONDITIONS HAS BEEN RECOGNIZED 2168 01:30:47,360 --> 01:30:53,720 BY THE NIH PAIN COR SO MANYION O 2169 01:30:53,720 --> 01:30:55,480 ONE THANK THAT IS CLEAR IS THE 2170 01:30:55,480 --> 01:30:57,800 PAIN CONDITIONS CO AND YOU ARE 2171 01:30:57,800 --> 01:30:59,960 THIS IS A STUDY PUBLISHED BY 2172 01:30:59,960 --> 01:31:01,080 Dr. WILLIAMS WHO IS GOING TO 2173 01:31:01,080 --> 01:31:05,480 BE SPEAKING TOMORROW, AND USING 2174 01:31:05,480 --> 01:31:07,160 A LIST OF CODES AND THEY 2175 01:31:07,160 --> 01:31:08,560 DEMONSTRATED THAT ALL OF THESE 2176 01:31:08,560 --> 01:31:09,760 CHRONIC OVERLAPPING PAIN 2177 01:31:09,760 --> 01:31:10,880 CONDITIONS ARE ASSOCIATED WITH 2178 01:31:10,880 --> 01:31:12,960 HAVING AN INCREASE ODDS OF 2179 01:31:12,960 --> 01:31:16,080 HAVING AT LEAST ONE OTHER 2180 01:31:16,080 --> 01:31:16,640 CHRONIC OVERLAPPING PAIN 2181 01:31:16,640 --> 01:31:18,040 CONDITION SO THE STRONGEST 2182 01:31:18,040 --> 01:31:20,520 ASSOCIATIONS HERE ARE SHOWN IN 2183 01:31:20,520 --> 01:31:22,040 RED WHICH HAVE GREATER THAN FIVE 2184 01:31:22,040 --> 01:31:23,920 AND THOSE THAT ARE MODERATE AND 2185 01:31:23,920 --> 01:31:25,800 ODDS RATIO OF THROW TO FIVE AND 2186 01:31:25,800 --> 01:31:27,560 MILD ONE TO THREE AND SO WHAT 2187 01:31:27,560 --> 01:31:29,640 YOU CAN SEE HERE, FOR EXAMPLE, 2188 01:31:29,640 --> 01:31:32,840 IS THAT PATIENTS WITH DEGREE 2189 01:31:32,840 --> 01:31:38,040 TREMENDOMETRIOSISHAVE A 16 TIMES 2190 01:31:38,040 --> 01:31:39,760 AND FIVE TIMES THE ODDS OF 2191 01:31:39,760 --> 01:31:41,880 HAVING IRB AND FOUR TIMES THE 2192 01:31:41,880 --> 01:31:45,200 ODDS OF HAVING FIBER MYALGIA. 2193 01:31:45,200 --> 01:31:48,840 SO WHAT DO WE KNOW ABOUT 2194 01:31:48,840 --> 01:31:49,920 ENDOMETRIOSIS SO I WAS ASKED TO 2195 01:31:49,920 --> 01:31:51,240 TALK ABOUT THE RESEARCH THAT 2196 01:31:51,240 --> 01:31:52,280 WE'VE BEEN DOING HERE AT THE 2197 01:31:52,280 --> 01:31:54,520 UNIVERSITY OF MICHIGAN ON THIS 2198 01:31:54,520 --> 01:31:54,920 TOPIC. 2199 01:31:54,920 --> 01:31:56,720 AND WHAT OUR GROUP IS STUDIED 2200 01:31:56,720 --> 01:31:58,760 THIS QUESTION BY COMPARING WOMEN 2201 01:31:58,760 --> 01:32:00,360 OR PATIENTS WITH CHRONIC PELVIC 2202 01:32:00,360 --> 01:32:02,360 PAIN INCLUDING THOSE WITH AND 2203 01:32:02,360 --> 01:32:03,680 WITHOUT ENDOMETRIOSIS AND WE'VE 2204 01:32:03,680 --> 01:32:05,120 COMPARED THEM TO PAIN-FREE 2205 01:32:05,120 --> 01:32:06,320 HEALTHY CONTROLS AND WE FOUND 2206 01:32:06,320 --> 01:32:09,280 THROW MAIN FINDINGS. 2207 01:32:09,280 --> 01:32:13,480 FIRST, SO, NEXT, INCREASE 2208 01:32:13,480 --> 01:32:14,520 SENSITIVITY TO THESE PATIENTS 2209 01:32:14,520 --> 01:32:16,840 WITH CHRONIC PELVIC PAIN HAVE 2210 01:32:16,840 --> 01:32:18,200 INCREASED SENSITIVITY TO PAIN 2211 01:32:18,200 --> 01:32:20,000 AND SENSORY STIMULI AND THIS IS 2212 01:32:20,000 --> 01:32:21,400 FOUND IN THE PEL VISION AS WELL 2213 01:32:21,400 --> 01:32:23,080 AS A REGION DISTANT FROM THE 2214 01:32:23,080 --> 01:32:28,720 SITE OF CLINICAL PAIN. 2215 01:32:28,720 --> 01:32:31,080 CHANGES IN BRAIN STRUCTURE 2216 01:32:31,080 --> 01:32:32,200 SIMILAR TO PAIN CONDITIONS AND 2217 01:32:32,200 --> 01:32:35,000 WOMEN WITH CHRONIC PELVIC PAIN 2218 01:32:35,000 --> 01:32:36,400 DEMONSTRATE VOLUME IN PAY 2219 01:32:36,400 --> 01:32:40,840 REGULATORY REGIONS SUCH AS THE 2220 01:32:40,840 --> 01:32:44,440 THALAMUS, AND NEXT. 2221 01:32:44,440 --> 01:32:45,440 CHANGES IN BRAIN FUNCTION WITH 2222 01:32:45,440 --> 01:32:47,000 INCREASE LEVELS OF NEURO 2223 01:32:47,000 --> 01:32:48,960 TRANSMITTERS IN THE INSUL A AS 2224 01:32:48,960 --> 01:32:50,560 WELL AS INCREASE DETECTIVE TEE 2225 01:32:50,560 --> 01:32:54,080 BETWEEN PAIN REGULATORY REGIONS 2226 01:32:54,080 --> 01:33:04,560 SAYS THE PRE FRONTAL CORTEX. 2227 01:33:58,480 --> 01:33:59,520 SO THIS SUGGESTS THAT ONE 2228 01:33:59,520 --> 01:34:01,560 POSSIBLE REASON THAT WOMEN WITH 2229 01:34:01,560 --> 01:34:02,520 PAIN FREE ENDOMETRIOSIS 2230 01:34:02,520 --> 01:34:03,840 EXPERIENCE LITTLE TO NO PAIN IS 2231 01:34:03,840 --> 01:34:05,920 THEY MIGHT HAVE SOME ADAPTIVE 2232 01:34:05,920 --> 01:34:07,520 BRAIN CHANGES THAT OFFSET OR 2233 01:34:07,520 --> 01:34:12,360 DAMPEN THE INPUT. 2234 01:34:12,360 --> 01:34:13,560 SO, IT'S WELL ESTABLISHED THAT 2235 01:34:13,560 --> 01:34:15,160 ENDOMETRIOSIS IS AN ESTROGEN 2236 01:34:15,160 --> 01:34:17,720 DISEASE THAT IS CHARACTERIZED BY 2237 01:34:17,720 --> 01:34:19,080 PELVIC INFLAMMATION AS WELL AS 2238 01:34:19,080 --> 01:34:20,760 SYSTEMIC INFLAMMATION SO THIS 2239 01:34:20,760 --> 01:34:22,200 RAISES AN IMPORTANT QUESTION OF 2240 01:34:22,200 --> 01:34:25,000 WHETHER THERE'S A LINK BETWEEN 2241 01:34:25,000 --> 01:34:26,240 SYSTEMIC INFLAMMATION AND NO SIS 2242 01:34:26,240 --> 01:34:27,360 PLASTIC PAIN SO THIS IS A 2243 01:34:27,360 --> 01:34:29,120 COURTESY OF ONE OF MY COLLEAGUES 2244 01:34:29,120 --> 01:34:30,720 AND COLLABORATORS AT THE 2245 01:34:30,720 --> 01:34:37,240 UNIVERSITY OF MICHIGAN AND 2246 01:34:37,240 --> 01:34:44,720 ILLUSTRATES -- 2247 01:34:44,720 --> 01:34:47,560 SO THESE CELLS ARE KNOWN TO 2248 01:34:47,560 --> 01:34:49,520 MODULATE COMMUNICATION BETWEEN 2249 01:34:49,520 --> 01:34:51,360 NERVE FIBERS WHICH ARE STAINED 2250 01:34:51,360 --> 01:34:53,000 RED HERE AND THESE CELLS ARE 2251 01:34:53,000 --> 01:34:58,240 KNOWN TO EXPRESS RECEPTORS SO 2252 01:34:58,240 --> 01:34:59,600 STIMULATION OF THESE RECEPTOR 2253 01:34:59,600 --> 01:35:01,480 HAS BEEN SHOWN TO INDUCE RELEASE 2254 01:35:01,480 --> 01:35:04,200 OF PRO INFLAMMATORY CYTOKINES IN 2255 01:35:04,200 --> 01:35:05,600 THE SPINAL CORD. 2256 01:35:05,600 --> 01:35:09,040 AND THIS IS THOUGHT TO BE ONE 2257 01:35:09,040 --> 01:35:12,440 CONTRIBUTING MECHANISM FOR 2258 01:35:12,440 --> 01:35:14,000 NOCIPLASTIC PAIN CHARACTERIZED 2259 01:35:14,000 --> 01:35:16,760 BY THESE SYMPTOMS HERE. 2260 01:35:16,760 --> 01:35:19,000 SO LYPO POLICY AK OWE RIGHT IS A 2261 01:35:19,000 --> 01:35:20,760 WELL-KNOWN AGO A NICE AND USED 2262 01:35:20,760 --> 01:35:22,600 TO STUDY THE RELATIONSHIP 2263 01:35:22,600 --> 01:35:24,560 BETWEEN RECEPTOR STIMULATION 2264 01:35:24,560 --> 01:35:33,240 MARKERS FOR CENTRAL SENSATION. 2265 01:35:33,240 --> 01:35:35,440 SO, MEMBERS OF THE NIH FUNDED 2266 01:35:35,440 --> 01:35:36,760 NETWORK HAVE INVESTIGATED THIS 2267 01:35:36,760 --> 01:35:39,680 RELATIONSHIP IN FEMALE PATIENTS, 2268 01:35:39,680 --> 01:35:41,680 AND IN THIS PAPER THAT WAS 2269 01:35:41,680 --> 01:35:43,680 PUBLISHED IN 2015 THEY EXAM THE 2270 01:35:43,680 --> 01:35:45,560 RELATIONSHIP BETWEEN THE SITE 2271 01:35:45,560 --> 01:35:47,080 OWE KEEN RESPONSE TO LPS 2272 01:35:47,080 --> 01:35:50,560 STIMULATION OF ISOLATED MONO 2273 01:35:50,560 --> 01:35:51,880 NUCLEAR CELLS AND THEY FOUND 2274 01:35:51,880 --> 01:35:54,120 THAT FOR EVERY ONE STANDARD 2275 01:35:54,120 --> 01:35:56,360 DEVIATION IN INCREASE IN THE 2276 01:35:56,360 --> 01:35:57,600 RECEPTOR FOR IN FLAM TORI 2277 01:35:57,600 --> 01:35:59,080 RESPONSE THERE WAS A 60% 2278 01:35:59,080 --> 01:36:01,800 INCREASE IN THE LIKELIHOOD OF 2279 01:36:01,800 --> 01:36:08,040 REPORTING WIDESPREAD PAIN. 2280 01:36:08,040 --> 01:36:10,200 AS SHOWN WHERE DARK COLOR 2281 01:36:10,200 --> 01:36:13,880 REPRESENT A PREPORTION THOSE 2282 01:36:13,880 --> 01:36:15,880 PATIENTS WITH THE LOW TAYLOR OF 2283 01:36:15,880 --> 01:36:20,080 FOUR RESPONSE GENERALLY HAD 2284 01:36:20,080 --> 01:36:22,320 LOCALIZED PAIN. 2285 01:36:22,320 --> 01:36:23,520 HOWEVER, THIS IS IN STARK CON 2286 01:36:23,520 --> 01:36:26,920 TCONTRAST WITH THOSE THAT ARE 2287 01:36:26,920 --> 01:36:29,040 CHARACTERIZED BY HAVING 2288 01:36:29,040 --> 01:36:33,760 WIDESPREAD PAIN WHICH IS NO SEE 2289 01:36:33,760 --> 01:36:42,360 PLASTIC PAIN. 2290 01:36:42,360 --> 01:36:44,720 SO THEY DETERMINE WHETHER A 2291 01:36:44,720 --> 01:36:45,720 SIMILAR RELATIONSHIP OCCURS IN 2292 01:36:45,720 --> 01:36:47,440 WOMEN WITH CHRONIC PELVIC PAIN 2293 01:36:47,440 --> 01:36:49,680 AND IT'S A PROSPECTIVE 2294 01:36:49,680 --> 01:36:52,120 OBSERVATIONAL COHORT STUDY 2295 01:36:52,120 --> 01:36:57,120 INVESTIGATING WHETHER PER I HAVE 2296 01:36:57,120 --> 01:37:00,840 PRO DICTIONARIORS ARE PRESENT 2297 01:37:00,840 --> 01:37:01,680 FOR PAIN. 2298 01:37:01,680 --> 01:37:03,760 SO, IN THOSE PRELIMINARY DATA, 2299 01:37:03,760 --> 01:37:07,480 WE EXAM 17 WOMEN AWAITING HISS 2300 01:37:07,480 --> 01:37:10,920 TERRECTOMY AND NOT USING 2301 01:37:10,920 --> 01:37:12,760 HORMONAL THERAPY AND THEY WERE 2302 01:37:12,760 --> 01:37:14,440 STIMULATED WITH LPS FOR 24 HOURS 2303 01:37:14,440 --> 01:37:16,160 AND WE SHOW A CORRELATION PLOT 2304 01:37:16,160 --> 01:37:18,600 AND WHAT WE FOUND WAS IS THAT 2305 01:37:18,600 --> 01:37:20,720 MID ONE ALPHA, ONE OF THE 2306 01:37:20,720 --> 01:37:21,560 CYTOKINES MEASURED WAS 2307 01:37:21,560 --> 01:37:25,560 ASSOCIATED WITH ALL SUB TYPES OF 2308 01:37:25,560 --> 01:37:29,880 PELVIC PAIN SYMPTOMS, AND NEXT 2309 01:37:29,880 --> 01:37:31,880 TO VALIDATE THESE FINDINGS IN A 2310 01:37:31,880 --> 01:37:34,480 SECOND COHORT THERE WAS A 2311 01:37:34,480 --> 01:37:37,760 SIMILAR ANALYSIS IN 15 PRE 2312 01:37:37,760 --> 01:37:39,240 MENOPAUSAL WITH ENDOMETRIOSIS AS 2313 01:37:39,240 --> 01:37:41,080 WELL AS YOU'RE LOGIC PAIN OF THE 2314 01:37:41,080 --> 01:37:43,840 MAP NETWORK AND CONFIRMED THE 2315 01:37:43,840 --> 01:37:44,840 SAME RELATIONSHIP. 2316 01:37:44,840 --> 01:37:46,520 SO WE THEN EXAMINED THE 2317 01:37:46,520 --> 01:37:47,840 RELATIONSHIP BETWEEN THE 2318 01:37:47,840 --> 01:37:50,760 PROVOKED INFLAMMATION AS WELL AS 2319 01:37:50,760 --> 01:37:52,120 FUNCTIONAL BRAIN IMAGING AND WE 2320 01:37:52,120 --> 01:37:53,800 CONDUCTED A SEED REGION TO HOLD 2321 01:37:53,800 --> 01:37:56,040 BRAIN ANALYSIS IN THESE SAME 2322 01:37:56,040 --> 01:37:57,560 PATIENTS TO IDENTIFY WHETHER 2323 01:37:57,560 --> 01:37:58,680 THEY WERE BRAIN REGIONS THAT 2324 01:37:58,680 --> 01:38:01,040 WERE MODULATED BY SYSTEMIC 2325 01:38:01,040 --> 01:38:02,520 INFLAMMATION AND THE SEED WAS 2326 01:38:02,520 --> 01:38:05,000 PLACED IN THE PELVIC TRUNK IN 2327 01:38:05,000 --> 01:38:07,240 THE S1 CORTEX WHICH IS SHOWN IN 2328 01:38:07,240 --> 01:38:08,000 PANEL A. 2329 01:38:08,000 --> 01:38:11,200 AND WHAT WE FOUND WAS THAT AS 2330 01:38:11,200 --> 01:38:13,760 MID 1 ALPHA LEVELS SHOWN IN 2331 01:38:13,760 --> 01:38:20,000 PANEL C, THE CORRELATION BETWEEN 2332 01:38:20,000 --> 01:38:21,640 PELVIC S1 AND IT STRONGLY 2333 01:38:21,640 --> 01:38:23,240 SUGGESTS THAT THE RELATIONSHIP 2334 01:38:23,240 --> 01:38:28,800 BETWEEN SYSTEMIC INFLAMMATION IN 2335 01:38:28,800 --> 01:38:30,440 THE CENTRAL NERVOUS SYSTEM AND 2336 01:38:30,440 --> 01:38:32,040 THE PRO SIGHSLY EXPECTED BRAIN 2337 01:38:32,040 --> 01:38:36,400 REGION IS A PELVIC PAIN SAMPLE. 2338 01:38:36,400 --> 01:38:39,440 WE FEEL THIS IS UNLIKELY TO BE 2339 01:38:39,440 --> 01:38:42,440 FINDING SINCE THE CORTEX WAS 2340 01:38:42,440 --> 01:38:45,400 IMPLICATED AND SYSTEMIC 2341 01:38:45,400 --> 01:38:47,200 INFLAMMATION AND BRAIN 2342 01:38:47,200 --> 01:38:50,600 CONNECTIVE TIE AND THAT WAS 2343 01:38:50,600 --> 01:38:54,600 PUBLISHED IN 2018. 2344 01:38:54,600 --> 01:38:55,800 SO WHY DOES THIS MATTER? 2345 01:38:55,800 --> 01:38:57,880 I AM A CLINICIAN AND I SPEND MY 2346 01:38:57,880 --> 01:38:59,520 TIME ACTUALLY SEEING PATIENT IN 2347 01:38:59,520 --> 01:39:01,120 CLINIC SO HOW DO WE APPLY THIS 2348 01:39:01,120 --> 01:39:04,440 TO CLINICAL CARE AS WELL AS 2349 01:39:04,440 --> 01:39:05,520 RESEARCH? 2350 01:39:05,520 --> 01:39:08,400 SO FIRST AND FOREMOST, 2351 01:39:08,400 --> 01:39:10,360 IDENTIFYING RELEVANT BIOLOGICAL 2352 01:39:10,360 --> 01:39:11,720 MARK OFFICERS IMPORTANT FOR 2353 01:39:11,720 --> 01:39:13,920 DECISION MAKING AND WE NEED TO 2354 01:39:13,920 --> 01:39:16,360 MAKE OUR DEXES BASED ON THE 2355 01:39:16,360 --> 01:39:26,840 UNDERLINE PAIN MECHANISM. 2356 01:39:27,320 --> 01:39:29,440 SO WHILE ENDOMETRIOSIS IS A 2357 01:39:29,440 --> 01:39:30,760 PATHWAY THERE ARE MANY OTHER 2358 01:39:30,760 --> 01:39:37,160 PATHWAYS INCLUDING SENSE 2359 01:39:37,160 --> 01:39:37,480 TAIZATION. 2360 01:39:37,480 --> 01:39:38,360 AND AS WELL AS ALL OF THESE 2361 01:39:38,360 --> 01:39:40,680 THINGS CAN BE MODIFIED BY 2362 01:39:40,680 --> 01:39:42,880 INFLUENCED BY GENETIC 2363 01:39:42,880 --> 01:39:45,160 VARIABILITY AS WELL AS TRAUMA. 2364 01:39:45,160 --> 01:39:46,960 WE ALSO NEED TO RECOGNIZE THAT 2365 01:39:46,960 --> 01:39:51,800 THESE PATIENTS ARE HETEROGENEOUS 2366 01:39:51,800 --> 01:39:55,600 AND THEY CAN BE DIFFERENT FROM 2367 01:39:55,600 --> 01:39:57,600 EACH SO MIGHT HAVE NO SUN 2368 01:39:57,600 --> 01:39:58,720 ACCEPTIVE PAIN LIKE ON THE 2369 01:39:58,720 --> 01:40:01,360 FAR-LEFT AS WELL AS SOME 2370 01:40:01,360 --> 01:40:04,760 PATIENTS YOU HAVE NOCIPLASTIC 2371 01:40:04,760 --> 01:40:06,160 PAIN IN THE LEFT AND THE MIDDLE 2372 01:40:06,160 --> 01:40:07,880 WHO HAVE MIXED PAIN CONDITION. 2373 01:40:07,880 --> 01:40:09,080 >> WE NODE TO MOVE ON TO THE 2374 01:40:09,080 --> 01:40:10,440 NEXT SPEAKER, PLEASE. 2375 01:40:10,440 --> 01:40:14,720 GIVE A CONCLUDING SENTENCE, 2376 01:40:14,720 --> 01:40:15,000 THANK YOU. 2377 01:40:15,000 --> 01:40:17,160 >> SO, I APOLOGIZE. 2378 01:40:17,160 --> 01:40:19,200 IN CONCLUSION, I THINK THAT IT'S 2379 01:40:19,200 --> 01:40:22,120 JUST CRITICAL TO UNDERSTAND THAT 2380 01:40:22,120 --> 01:40:24,160 REALLY ENDOMETRIOSIS WE NEED TO 2381 01:40:24,160 --> 01:40:26,120 MOVE BEYOND THE LESION AND THINK 2382 01:40:26,120 --> 01:40:30,800 OF IT AS A SYSTEMIC DISEASE. 2383 01:40:30,800 --> 01:40:35,160 THANK YOU. 2384 01:40:35,160 --> 01:40:37,840 >> THANK YOU. 2385 01:40:37,840 --> 01:40:44,000 WE HAVE Dr. FINAN NEXT. 2386 01:40:44,000 --> 01:40:44,120 >> 2387 01:40:44,120 --> 01:40:45,440 >> FANTASTIC. 2388 01:40:45,440 --> 01:40:46,880 THANK YOU SO MUCH FOR THAT TALK. 2389 01:40:46,880 --> 01:40:49,480 THAT WAS REALLY ENLIGHTENING. 2390 01:40:49,480 --> 01:40:51,520 AND THANK YOU ALL FOR ATTENDING 2391 01:40:51,520 --> 01:40:52,280 OUR SESSION TODAY. 2392 01:40:52,280 --> 01:40:54,880 MY NAME IS PATRICK FINAN FROM 2393 01:40:54,880 --> 01:40:57,240 THE DEPARTMENT OF PSYCHIATRY AND 2394 01:40:57,240 --> 01:40:59,000 BEHAVIORAL SCIENCES AT JOHNS 2395 01:40:59,000 --> 01:41:00,720 HOPKINS SCHOOL OF MEDICINE. 2396 01:41:00,720 --> 01:41:02,360 FIRST OF ALL, THANK YOU TO THE 2397 01:41:02,360 --> 01:41:04,000 PAIN CONSORTIUM FOR THE 2398 01:41:04,000 --> 01:41:05,680 INVITATION TO SPEAK HERE TODAY. 2399 01:41:05,680 --> 01:41:09,280 IT'S AN HONOR TO BE HERE. 2400 01:41:09,280 --> 01:41:10,440 TODAY I'M GOING TO TALK ABOUT 2401 01:41:10,440 --> 01:41:12,320 THE ASSOCIATION OF SLEEP AND 2402 01:41:12,320 --> 01:41:14,080 PAIN BUT IN THE SPIRIT OF 2403 01:41:14,080 --> 01:41:15,760 TACKLING THIS ISSUE FROM A WHOLE 2404 01:41:15,760 --> 01:41:18,680 PERSON PERSPECTIVE, I'M GOING TO 2405 01:41:18,680 --> 01:41:21,200 FOCUS THE DISCUSSION BY 2406 01:41:21,200 --> 01:41:21,640 CONTEXTUALIZING THAT 2407 01:41:21,640 --> 01:41:23,120 RELATIONSHIP IN TERMS OF 2408 01:41:23,120 --> 01:41:24,320 EFFECTIVE FUNCTION WHICH I THINK 2409 01:41:24,320 --> 01:41:26,320 IS A CRITICAL FOCAL POINT IN 2410 01:41:26,320 --> 01:41:29,120 UNDERSTANDING HOW THESE TWO 2411 01:41:29,120 --> 01:41:32,200 MAJOR BIO PSYCHOSOCIAL SYSTEM 2412 01:41:32,200 --> 01:41:32,480 INTERACT. 2413 01:41:32,480 --> 01:41:35,920 NEXT SLIDE, PLEASE. 2414 01:41:35,920 --> 01:41:39,120 SO, I SHOULD NOTE I'M ON THE 2415 01:41:39,120 --> 01:41:40,800 SCIENTIFIC ADVISORY BOARD ON A 2416 01:41:40,800 --> 01:41:44,320 COMPANY NOT RELATED WHAT I'M 2417 01:41:44,320 --> 01:41:45,640 GOING TO TALK TO YOU ABOUT 2418 01:41:45,640 --> 01:41:46,080 TODAY. 2419 01:41:46,080 --> 01:41:48,560 SO, THE EFFECTS OF SLEEP ON PAIN 2420 01:41:48,560 --> 01:41:50,880 ARE NOW QUITE WELL ESTABLISHED. 2421 01:41:50,880 --> 01:41:53,280 WE KNOW FOR EXAMPLE THAT UPWARDS 2422 01:41:53,280 --> 01:41:56,960 OF 50% OR MORE OF PATIENTS WITH 2423 01:41:56,960 --> 01:42:00,000 CHRONIC PAIN, REPORT SLEEP 2424 01:42:00,000 --> 01:42:03,880 DISTURBANCES WHICH IS INSOMNIA 2425 01:42:03,880 --> 01:42:07,960 OR DIFFICULTY FALLING OR STAYING 2426 01:42:07,960 --> 01:42:09,600 ALI WITH ACCOMPANIES DAYTIME 2427 01:42:09,600 --> 01:42:09,920 IMPAIRMENTS. 2428 01:42:09,920 --> 01:42:16,240 MANY PATIENTS WHO MAY NOT MEET 2429 01:42:16,240 --> 01:42:26,720 CRYIA AND AND STUDIES HAVE 2430 01:42:30,200 --> 01:42:31,560 INCORPORATED PROSPECT OF DESIGNS 2431 01:42:31,560 --> 01:42:33,240 A TREND IN THE DATA IS EMERGED 2432 01:42:33,240 --> 01:42:35,680 AND SUPPORTING THE HYPOTHESIS 2433 01:42:35,680 --> 01:42:37,840 THAT SLEEP PROBLEMS MAY CAUSE 2434 01:42:37,840 --> 01:42:39,000 INCREASE PAIN PER EXPERIENCE AND 2435 01:42:39,000 --> 01:42:45,240 THE INCIDENTS OF CHRONIC PAIN 2436 01:42:45,240 --> 01:42:47,840 AND THEY SUPPORT INCREASES PAIN 2437 01:42:47,840 --> 01:42:49,560 SENSE ACTIVITY AND SO HOW DOES 2438 01:42:49,560 --> 01:42:50,400 THIS HAPPEN? 2439 01:42:50,400 --> 01:42:53,880 THERE ARE OF COURSE A NUMBER OF 2440 01:42:53,880 --> 01:42:54,520 PLAUSIBLE MECHANISM TO CONSIDER 2441 01:42:54,520 --> 01:42:57,720 LIKE INFLAMMATION, OR NEURO 2442 01:42:57,720 --> 01:42:59,880 ENDOCRINE FUNCTION, DIRECTION 2443 01:42:59,880 --> 01:43:03,000 BUT THE WORK HAS CENTERED 2444 01:43:03,000 --> 01:43:03,800 PRINCIPALLY AROUND EFFECTIVE 2445 01:43:03,800 --> 01:43:06,320 FUNCTION AND POSITIVE EFFECT AND 2446 01:43:06,320 --> 01:43:16,800 THE SO-CALLED REWARDS SYSTEM. 2447 01:43:18,320 --> 01:43:20,120 WE HAVE TO EFFECT MODELS OF 2448 01:43:20,120 --> 01:43:24,480 EITHER SLEEP OR PAIN FOCUSED ON 2449 01:43:24,480 --> 01:43:27,720 NEGATIVE AFFECT AND AND AS THIS 2450 01:43:27,720 --> 01:43:30,040 STARTED TO CHANGE WHICH OCCURRED 2451 01:43:30,040 --> 01:43:33,120 WITH INFLUENTIAL NUDGING BY MY 2452 01:43:33,120 --> 01:43:36,920 LATE, GREAT, ALEX SALTRA AND 2453 01:43:36,920 --> 01:43:40,600 MARY DAVIS AMONG OTHERS IN THE 2454 01:43:40,600 --> 01:43:51,120 PAIN SPACE AND IN POSITIVE AND 2455 01:44:07,960 --> 01:44:10,240 TO SLEEP LOSS THAN NEGATIVE 2456 01:44:10,240 --> 01:44:14,960 EMOTIONAL RESPONSES. 2457 01:44:14,960 --> 01:44:16,560 THIS WAS WORK I'VE BEEN DOING 2458 01:44:16,560 --> 01:44:18,600 FROM THE EARLY SLEEP DISRUPTION 2459 01:44:18,600 --> 01:44:19,960 EXPERIMENTS SO WE SET OUT TO 2460 01:44:19,960 --> 01:44:27,040 BUILD A MODEL THAT INCORPORATED 2461 01:44:27,040 --> 01:44:36,320 EFFECT THERE ARE COMPONENTS OF 2462 01:44:36,320 --> 01:44:38,920 COGNITIVE THERAPIES CRUX LIKE 2463 01:44:38,920 --> 01:44:40,880 POSITIVE REAPPRAISAL, PRO SOCIAL 2464 01:44:40,880 --> 01:44:42,880 COPING, STATE MINDFULNESS AND 2465 01:44:42,880 --> 01:44:45,760 OTHERS THAT MAY BE 2466 01:44:45,760 --> 01:44:47,560 THERAPEUTICALLY HARNESSES TO 2467 01:44:47,560 --> 01:44:50,720 ENGENDER A STATE OF RESILIENT 2468 01:44:50,720 --> 01:44:53,280 PAIN SELF-MANAGEMENT AND THAT 2469 01:44:53,280 --> 01:44:55,240 THEY MAY DO SO BY OPTIMIZING FOR 2470 01:44:55,240 --> 01:44:58,840 ENHANCED POSITIVE EFFECT AND 2471 01:44:58,840 --> 01:45:00,240 OTHER POSITIVE STATES IN AN 2472 01:45:00,240 --> 01:45:04,440 EFFORT TO DIMINISH THE MAGNITUDE 2473 01:45:04,440 --> 01:45:06,080 OF COUPLING BETWEEN PAIN AND 2474 01:45:06,080 --> 01:45:08,760 EFFECT NIH AFFECT OR NEGATIVE 2475 01:45:08,760 --> 01:45:10,520 AFFECTIVE OF REACTIVITY TO PAIN. 2476 01:45:10,520 --> 01:45:13,400 SO OUR SLEEP WORK IS REALLY AN N 2477 01:45:13,400 --> 01:45:14,720 EXTENSION OF THIS MODEL AND 2478 01:45:14,720 --> 01:45:15,880 WE'RE INTERESTED IN 2479 01:45:15,880 --> 01:45:17,680 UNDERSTANDING TO WHAT EXTENT DO 2480 01:45:17,680 --> 01:45:19,960 SLEEP PROBLEMS OPERATE UPSTREAM 2481 01:45:19,960 --> 01:45:21,200 OF THESE PROCESSES. 2482 01:45:21,200 --> 01:45:25,000 AND CAN WE MODIFIED SLEEP 2483 01:45:25,000 --> 01:45:25,840 THERAPEUTICALLY OR 2484 01:45:25,840 --> 01:45:28,480 EXPERIMENTALLY IN A WAY THAT 2485 01:45:28,480 --> 01:45:35,640 INVESTIGSTRENGTHENS THESE EFFEC. 2486 01:45:35,640 --> 01:45:37,440 WE FOUND DIRECT EXPERIMENTAL 2487 01:45:37,440 --> 01:45:40,800 SUPPORT FOR THE OBSERVATION FOR 2488 01:45:40,800 --> 01:45:42,400 PALMER ANDAL FAN OWE LITERATURE 2489 01:45:42,400 --> 01:45:44,240 REVIEW THAT SLEEP LOSS, UNDER 2490 01:45:44,240 --> 01:45:46,760 CERTAIN CONDITIONS, TARGETS 2491 01:45:46,760 --> 01:45:48,200 POSITIVE EFFECT OVER NEGATIVE 2492 01:45:48,200 --> 01:45:50,720 AND IN THIS STUDY 45 HEALTHY 2493 01:45:50,720 --> 01:45:51,800 PARTICIPANTS WERE ENROLLED 2494 01:45:51,800 --> 01:45:54,720 WITHIN SUBJECT AND 2495 01:45:54,720 --> 01:45:55,880 COUNTERBALANCED EXPERIMENT WHERE 2496 01:45:55,880 --> 01:45:57,120 EVERYONE RECEIVED ONE NIGHT OF 2497 01:45:57,120 --> 01:46:00,360 NORMAL SLEEP AND ONE NIGHT OF 2498 01:46:00,360 --> 01:46:02,240 SLEEP DISRUPTION FORCED 2499 01:46:02,240 --> 01:46:06,400 NOCTURNAL AWAKENINGS. 2500 01:46:06,400 --> 01:46:08,640 SO, JUST REMEMBER THAT GENERAL 2501 01:46:08,640 --> 01:46:09,960 EXPERIMENTAL PARADIGM THAT I'M 2502 01:46:09,960 --> 01:46:11,920 GOING TO COME BACK TO SEVERAL 2503 01:46:11,920 --> 01:46:13,320 TIMES THROUGHOUT THIS TALK. 2504 01:46:13,320 --> 01:46:15,520 WE ADMINISTERED A NUMBER OF 2505 01:46:15,520 --> 01:46:18,280 MEASURES IN TASKS RELEVANT HERE. 2506 01:46:18,280 --> 01:46:20,520 IN THIS CASE WE SAW A 2507 01:46:20,520 --> 01:46:22,520 SIGNIFICANT REDUCTION IN 2508 01:46:22,520 --> 01:46:24,000 POSITIVE EFFECT FOLLOWING FORCED 2509 01:46:24,000 --> 01:46:25,800 AWAKENINGS BUT NO INCREASE IN 2510 01:46:25,800 --> 01:46:26,480 NEGATIVE EFFECT. 2511 01:46:26,480 --> 01:46:30,480 AND IMPORTANTLY, THIS APPEARED 2512 01:46:30,480 --> 01:46:32,200 TO GENERALIZE TO BOTH HIGH AK 2513 01:46:32,200 --> 01:46:36,400 TAIZATION POSITIVE EMOTIONAL 2514 01:46:36,400 --> 01:46:38,800 STATES LIKE JOVIALITY AND LOW 2515 01:46:38,800 --> 01:46:44,840 STATES LIKE SERENITY. 2516 01:46:44,840 --> 01:46:47,320 NOW ASSISTANT PROFESSOR AT 2517 01:46:47,320 --> 01:46:48,840 ARIZONA STATE UNIVERSITY 2518 01:46:48,840 --> 01:46:50,160 EXTENDED THESE EXPERIMENTAL 2519 01:46:50,160 --> 01:46:55,320 FINDINGS INTO THE CLINICAL REAL. 2520 01:46:55,320 --> 01:46:58,840 THIS WAS ANALYSIS OF TWO WEEKS 2521 01:46:58,840 --> 01:47:00,880 IN MORNING AND EVENING ELECTRIC 2522 01:47:00,880 --> 01:47:04,720 I DO A REIN PATIENTS WITH CO 2523 01:47:04,720 --> 01:47:06,960 MORBID INSOMNIA WHICH I SHOULD 2524 01:47:06,960 --> 01:47:09,200 MENTION DERIVES FROM A LARGER 2525 01:47:09,200 --> 01:47:12,960 CLINICAL RILE LED BY MICHAEL 2526 01:47:12,960 --> 01:47:17,480 SMITH AND HERE WE OBSERVED THAT 2527 01:47:17,480 --> 01:47:18,480 BOTH LOWER TOTE SLEEP TIME AND 2528 01:47:18,480 --> 01:47:19,960 HIGHER NUMBER OF MINUTES SPENT 2529 01:47:19,960 --> 01:47:22,160 AWAKE AFTER SLEEP ONSET OR WHAT 2530 01:47:22,160 --> 01:47:27,720 WE CALL LASO PREDICTED LOWER 2531 01:47:27,720 --> 01:47:29,320 POSITIVE EFFECT THE NEXT MORNING 2532 01:47:29,320 --> 01:47:31,960 AND THAT LED TO HIRE DAILY PAIN 2533 01:47:31,960 --> 01:47:34,560 SEVERITY RATED IN THE EVENING 2534 01:47:34,560 --> 01:47:39,600 AND A SIMILAR EFFECT FOR PAIN 2535 01:47:39,600 --> 01:47:43,000 EXACT AROUNDLY AND THEY SHARE 2536 01:47:43,000 --> 01:47:46,000 VARIANTS AND NOTABLY HERE, WE 2537 01:47:46,000 --> 01:47:47,640 SEE ALTHOUGH THE SLEEP MEASURES 2538 01:47:47,640 --> 01:47:48,560 WERE PRO DICK TIVE OF NEXT 2539 01:47:48,560 --> 01:47:49,960 MORNING NEGATIVE AFFECT OF 2540 01:47:49,960 --> 01:47:52,560 STATES, THOSE ASSOCIATIONS 2541 01:47:52,560 --> 01:47:59,720 DIDN'T TRANSLATE INTO HIGHER 2542 01:47:59,720 --> 01:48:01,200 PAIN SO IT WAS THROUGH POSITIVE 2543 01:48:01,200 --> 01:48:11,600 BUT NOT NEGATIVE EFFECT. 2544 01:48:13,440 --> 01:48:16,000 IN THIS ANALYSIS, THEY FLIPPED 2545 01:48:16,000 --> 01:48:16,800 THE QUESTION AROUND A BIT. 2546 01:48:16,800 --> 01:48:19,200 INSTEAD OF LOOKING AT SLEEP ON 2547 01:48:19,200 --> 01:48:20,520 AFFECT, SHE ASKED WHETHER TRAIT 2548 01:48:20,520 --> 01:48:23,400 LEVELS OF POSITIVE EFFECT WERE 2549 01:48:23,400 --> 01:48:26,120 PROTECTIVE AGAINST THE EFFECT OF 2550 01:48:26,120 --> 01:48:28,040 SLEEP DIS RISK ON NEXT DAY 2551 01:48:28,040 --> 01:48:30,960 INFLAMMATION WHICH AS Dr. 2552 01:48:30,960 --> 01:48:32,280 SAWSAN AS-SANIE JUST EXPLAINED 2553 01:48:32,280 --> 01:48:36,360 IS ANOTHER RISK FACTOR FOR PAIN. 2554 01:48:36,360 --> 01:48:37,920 AND AGAIN THESE WERE OTHERWISE 2555 01:48:37,920 --> 01:48:39,320 HEALTHY PARTICIPANTS UNDERGOING 2556 01:48:39,320 --> 01:48:41,000 A NIGHT OF NORMAL SLEEP AND A 2557 01:48:41,000 --> 01:48:45,000 NIGHT OF FORCED AWAKENINGS AND 2558 01:48:45,000 --> 01:48:46,720 WE SEE THAT SLEEP DISRUPTION LED 2559 01:48:46,720 --> 01:48:50,200 TO INCREASED CELLULAR EXPRESSION 2560 01:48:50,200 --> 01:48:53,960 OF THE CYTOKINES IL6 AND TNF 2561 01:48:53,960 --> 01:48:54,960 ALPHA AS WELL AS THEIR CO 2562 01:48:54,960 --> 01:48:56,440 EXPRESSION BUT IT HAPPENED ONLY 2563 01:48:56,440 --> 01:48:57,640 AMONG PARTICIPANTS WITH LOW 2564 01:48:57,640 --> 01:48:59,360 LEVELS OF POSITIVE AFFECT. 2565 01:48:59,360 --> 01:49:01,960 SO IN THIS CASE, HAVING HIGHER 2566 01:49:01,960 --> 01:49:03,480 TRAIT POSITIVE EFFECT WAS 2567 01:49:03,480 --> 01:49:04,600 PROTECTED AND IT BUFFERED 2568 01:49:04,600 --> 01:49:06,400 AGAINST THE EFFECT OF SLEEP 2569 01:49:06,400 --> 01:49:08,120 DISRUPTION ON INFLAMMATION AND 2570 01:49:08,120 --> 01:49:10,280 THIS PERHAPS REPRESENTS ANOTHER 2571 01:49:10,280 --> 01:49:12,880 MECHANISTIC PATHWAY TO CON 2572 01:49:12,880 --> 01:49:16,000 ACCEPT TYPEACTUALIZE IN THE BROT 2573 01:49:16,000 --> 01:49:18,760 OF SLEEP AND PAIN. 2574 01:49:18,760 --> 01:49:20,320 SO ANOTHER RELATED MECHANISM 2575 01:49:20,320 --> 01:49:22,720 WE'VE BEEN INTERESTED IN IS 2576 01:49:22,720 --> 01:49:24,640 AFFECTIVE PAIN MODULATION OR THE 2577 01:49:24,640 --> 01:49:26,640 DEGREE TO WHICH AFFECTIVE 2578 01:49:26,640 --> 01:49:28,400 STIMULI ALTER PAIN PROCESSING 2579 01:49:28,400 --> 01:49:33,560 THAT BEHAVIORAL AND NEURO 2580 01:49:33,560 --> 01:49:36,920 BIOLOGICAL LEVELS. 2581 01:49:36,920 --> 01:49:39,160 IN OUR STUDY, WE ASKED WHETHER 2582 01:49:39,160 --> 01:49:40,920 FORCED AWAKENINGS ALTERED THE 2583 01:49:40,920 --> 01:49:43,160 BUILT OF POSITIVE EFFECT TO 2584 01:49:43,160 --> 01:49:44,600 INHIBIT PAIN SO WE EXPOSED 2585 01:49:44,600 --> 01:49:47,240 PARTICIPANTS TO A STANDARD 2586 01:49:47,240 --> 01:49:48,920 AFFECTIVE PAIN MODULATION TASK 2587 01:49:48,920 --> 01:49:53,000 IN WHICH THEY VIEWED POSITIVE 2588 01:49:53,000 --> 01:49:56,120 AND NEGATIVE OR NEUTRAL SLIDES 2589 01:49:56,120 --> 01:49:56,920 THAT WERE PAIRED WITH STIMULI 2590 01:49:56,920 --> 01:49:58,240 AND THEY RAIDED THE PAIN 2591 01:49:58,240 --> 01:50:00,320 ASSOCIATED WITH THE STIMULI. 2592 01:50:00,320 --> 01:50:03,240 AND UNDER NORMAL SLEEP, WE SEE 2593 01:50:03,240 --> 01:50:06,040 THE CLASSIC EFFECTIVE PAIN 2594 01:50:06,040 --> 01:50:07,440 MODULATION OCCUR AND IN THIS 2595 01:50:07,440 --> 01:50:09,840 CASE, PAIN IS LOWER UNDER 2596 01:50:09,840 --> 01:50:12,280 CONDITIONS OF POSITIVE RELATIVE 2597 01:50:12,280 --> 01:50:16,080 TO NEUTRAL OR NEGATIVE EFFECT OF 2598 01:50:16,080 --> 01:50:18,560 STIMULI AND FOLLOWING FORCED 2599 01:50:18,560 --> 01:50:19,760 AWAKENINGS, THAT CURVE FLATTENS 2600 01:50:19,760 --> 01:50:26,400 SO WE SEE ESSENTIALLY ANNA 2601 01:50:26,400 --> 01:50:27,960 ABOLISHMENT. 2602 01:50:27,960 --> 01:50:28,560 NEXT SLIDE. 2603 01:50:28,560 --> 01:50:29,920 I THINK IT'S IMPORTANT TO NOTE 2604 01:50:29,920 --> 01:50:32,040 THAT THIS PATTERN FINDINGS THAT 2605 01:50:32,040 --> 01:50:33,680 WE OBSERVED UNDER CONTROLLED 2606 01:50:33,680 --> 01:50:35,040 CONDITIONS ALMOST DIRECTLY 2607 01:50:35,040 --> 01:50:37,440 MIRRORS EFFECTS THAT JAMIE 2608 01:50:37,440 --> 01:50:39,760 RUDY'S GROUP OBSERVED IN BETWEEN 2609 01:50:39,760 --> 01:50:41,920 GROUP ANALYSIS OF HEALTHY 2610 01:50:41,920 --> 01:50:43,080 SUBJECTS AND INDIVIDUALS WITH 2611 01:50:43,080 --> 01:50:45,880 MODERATE TO HIGH INSOMNIA SO 2612 01:50:45,880 --> 01:50:47,840 THESE DATA TELL US THAT SLEEP 2613 01:50:47,840 --> 01:50:49,720 DISTURBANCES NOT ONLY ATTENUATE 2614 01:50:49,720 --> 01:50:52,160 POSITIVE EFFECT LEVELS BUT ALSO 2615 01:50:52,160 --> 01:50:53,520 THE FUNCTION OF POSITIVE AFFECT 2616 01:50:53,520 --> 01:50:58,800 TO INHIBIT PAIN. 2617 01:50:58,800 --> 01:51:01,800 SO FINALLY, I'D LIKE TO 2618 01:51:01,800 --> 01:51:03,480 HIGHLIGHT THAT THE AFFECTS THAT 2619 01:51:03,480 --> 01:51:05,640 HAVE JUST BEEN TALKED ABOUT, 2620 01:51:05,640 --> 01:51:06,840 APPEAR TO BE TIED TO FUNCTIONING 2621 01:51:06,840 --> 01:51:09,240 WITHIN THE MESS OWE CORTICAL 2622 01:51:09,240 --> 01:51:12,720 REWARDS SYSTEM. 2623 01:51:12,720 --> 01:51:14,760 AND IN OUR EXPERIMENTAL WORK 2624 01:51:14,760 --> 01:51:18,360 AGAIN, FOR EXAMPLE, WE'VE 2625 01:51:18,360 --> 01:51:19,240 EXAMINED SLEEP DISRUPTION ON 2626 01:51:19,240 --> 01:51:26,760 REWARD RESPONSIVENESS AND IN 2627 01:51:26,760 --> 01:51:28,600 THIS TASK, WE KNOW IT TO BE 2628 01:51:28,600 --> 01:51:30,640 QUITE SENSITIVE TO VARIATION IN 2629 01:51:30,640 --> 01:51:34,720 REWARD SYSTEMS FUNCTION AND 2630 01:51:34,720 --> 01:51:36,160 PARTICULARLY CHANGES IN DOPAMINE 2631 01:51:36,160 --> 01:51:37,800 ACTIVITY AND IT'S BEEN SHOWN TO 2632 01:51:37,800 --> 01:51:39,720 DIFFERENTIATE PATIENTS WITH 2633 01:51:39,720 --> 01:51:41,840 DEPRESSION FROM CONTROLS. 2634 01:51:41,840 --> 01:51:43,200 ESSENTIALLY PARTICIPANTS ARE 2635 01:51:43,200 --> 01:51:44,440 TASKED WITH DISCRIMINATING 2636 01:51:44,440 --> 01:51:47,760 BETWEEN TWO NEARLY IDENTICAL 2637 01:51:47,760 --> 01:51:49,360 STIMULI BUT THEIR 2638 01:51:49,360 --> 01:51:50,480 DISPROPORTIONATELY REWARDED FOR 2639 01:51:50,480 --> 01:51:51,840 CORRECT RESPONSES ATTRIBUTED TO 2640 01:51:51,840 --> 01:51:53,720 ONE OF THE STIMULI. 2641 01:51:53,720 --> 01:51:55,680 OVER TIME, PEOPLE WILL DEVELOP A 2642 01:51:55,680 --> 01:51:57,160 BUY AS TOWARDS THE STIMULUS 2643 01:51:57,160 --> 01:51:59,320 THAT'S REWARDED MORE FREQUENTLY. 2644 01:51:59,320 --> 01:52:00,760 PATIENTS CAN DEPRESSION, FOR 2645 01:52:00,760 --> 01:52:04,960 EXAMPLE, SHOW DIMINISHED REWARD 2646 01:52:04,960 --> 01:52:05,800 RESPONSIVENESS AND THIS PRESENTS 2647 01:52:05,800 --> 01:52:08,680 AS A FLATTER SLOPE OF CHANGE IN 2648 01:52:08,680 --> 01:52:11,000 REWARD RESPONSE BIAS OVER BLOCKS 2649 01:52:11,000 --> 01:52:12,440 OF THE TASK. 2650 01:52:12,440 --> 01:52:14,080 SO, IN OUR SLEEP DISRUPTION 2651 01:52:14,080 --> 01:52:16,800 STUDY WE SHOWED THAT POSITIVE 2652 01:52:16,800 --> 01:52:17,640 EFFECTIVE CHANGES FOLLOWING 2653 01:52:17,640 --> 01:52:20,120 SLEEP DISRUPTIONS, ESSENTIALLY 2654 01:52:20,120 --> 01:52:22,880 DICTATED THE PATTERNS OF REWARD 2655 01:52:22,880 --> 01:52:25,760 RESPONSIVENESS THAT WE ZO OBSER. 2656 01:52:25,760 --> 01:52:27,880 THOSE WHO HAVE POSITIVE 2657 01:52:27,880 --> 01:52:29,280 EFFECTIVE DEFICITS SHOWED IN 2658 01:52:29,280 --> 01:52:31,680 REWARD RESPONSIVENESS FOLLOWING 2659 01:52:31,680 --> 01:52:33,120 SLEEP DISRUPTION BUT THOSE ABLE 2660 01:52:33,120 --> 01:52:35,080 TO MAINTAIN POSITIVE LEVELS 2661 01:52:35,080 --> 01:52:37,760 SHOWED AN INCREASE IN REWARD 2662 01:52:37,760 --> 01:52:38,760 RESPONSIVENESS FOLLOWING SLEEP 2663 01:52:38,760 --> 01:52:40,160 DISRUPTION AND THIS CAN BE 2664 01:52:40,160 --> 01:52:42,200 HIGHLIGHTS THE DEGREE OF 2665 01:52:42,200 --> 01:52:43,720 INTEGRATION BETWEEN SLEEP LOSS 2666 01:52:43,720 --> 01:52:46,560 AND EFFECTIVE FUNCTION AND THE 2667 01:52:46,560 --> 01:52:48,960 REWARDS SYSTEM. 2668 01:52:48,960 --> 01:52:50,280 NEXT SLIDE. 2669 01:52:50,280 --> 01:52:52,360 NOW, WE OBSERVED AN INCREASE 2670 01:52:52,360 --> 01:52:54,280 REWARD RESPONSIVENESS AFTER 2671 01:52:54,280 --> 01:52:55,440 SLEEP DISRUPTION AMONG THOSE WHO 2672 01:52:55,440 --> 01:52:57,760 RE MAY DESCRIBE AS RESILIENT 2673 01:52:57,760 --> 01:52:58,160 INDIVIDUALS. 2674 01:52:58,160 --> 01:53:00,280 THOSE WHO WERE ABLE TO PRESERVE 2675 01:53:00,280 --> 01:53:01,920 POSITIVE EFFECT IN THE FACE OF 2676 01:53:01,920 --> 01:53:03,880 ACUTE SLEEP LOSS. 2677 01:53:03,880 --> 01:53:05,960 PRIOR WORK HAS ALSO SHOWN THAT 2678 01:53:05,960 --> 01:53:07,520 SLEEP LOSS UNDER CERTAIN 2679 01:53:07,520 --> 01:53:09,040 CONDITIONS IS ASSOCIATED WITH AN 2680 01:53:09,040 --> 01:53:10,520 INCREASE IN FUNCTION AND 2681 01:53:10,520 --> 01:53:12,200 POSITIVE SYSTEMS. 2682 01:53:12,200 --> 01:53:13,800 AND FOR EXAMPLE, A STUDY BY 2683 01:53:13,800 --> 01:53:15,480 MATTHEW WALK ARE'S GROUP SHOWED 2684 01:53:15,480 --> 01:53:17,120 THAT HEALTHY INDIVIDUALS 2685 01:53:17,120 --> 01:53:19,760 INTENDED TO SHOW A BUY AS FOR 2686 01:53:19,760 --> 01:53:22,520 POSITIVE EMOTION APPRAISALS 2687 01:53:22,520 --> 01:53:24,440 FOLLOWING TOTAL SLEEP 2688 01:53:24,440 --> 01:53:25,560 DEPRIVATION WHICH THEN 2689 01:53:25,560 --> 01:53:28,000 CORRESPONDED TO VARIATION IN 2690 01:53:28,000 --> 01:53:29,480 CORTICAL BRAIN REGIONS THAT 2691 01:53:29,480 --> 01:53:31,880 BROADLY FALL INTO A REWARD 2692 01:53:31,880 --> 01:53:32,840 NETWORK. 2693 01:53:32,840 --> 01:53:34,560 GETS THE BACKDROP OF WORK IT'S 2694 01:53:34,560 --> 01:53:36,000 IMPORTANT TO CONTEXTUALIZE THESE 2695 01:53:36,000 --> 01:53:37,960 TYPES OF FINDINGS WITH 2696 01:53:37,960 --> 01:53:40,600 INDIVIDUAL DIFFERENCES IN LEVELS 2697 01:53:40,600 --> 01:53:42,560 AND THE STABILITY OF POSITIVE 2698 01:53:42,560 --> 01:53:43,000 EMOTIONS. 2699 01:53:43,000 --> 01:53:44,920 WHICH IN OUR STUDY REVEALED 2700 01:53:44,920 --> 01:53:49,560 IMPORTANT SUBGROUPS OF 2701 01:53:49,560 --> 01:53:50,000 RESPONDERS. 2702 01:53:50,000 --> 01:53:53,560 SO, FINALLY, HOW DO THESE REWARD 2703 01:53:53,560 --> 01:53:55,000 RELATED FINDINGS INFORM OUR 2704 01:53:55,000 --> 01:53:57,000 UNDERSTANDING OF SLEEP AND PAIN? 2705 01:53:57,000 --> 01:53:59,520 SO TO ADDRESS THAT QUESTION, IN 2706 01:53:59,520 --> 01:54:00,240 COLLABORATION WITH MY GOOD 2707 01:54:00,240 --> 01:54:02,600 FRIEND AND COLLEAGUE DAVID, WE 2708 01:54:02,600 --> 01:54:05,200 DEVELOPED A REWARDING MUSIC TASK 2709 01:54:05,200 --> 01:54:06,960 AND WHICH PARTICIPANTS WERE 2710 01:54:06,960 --> 01:54:08,560 EXPOSED TO A SERIES OF 2711 01:54:08,560 --> 01:54:11,280 PERSONALLY MEANINGFUL SONG CLIPS 2712 01:54:11,280 --> 01:54:15,400 THAT HAD HIGH LEVELS OF POSITIVE 2713 01:54:15,400 --> 01:54:16,880 EFFECTIVE OR SONG CLIPS RATED 2714 01:54:16,880 --> 01:54:18,920 NEUTRAL WITH NO PERSONAL 2715 01:54:18,920 --> 01:54:19,240 SIGNIFICANCE. 2716 01:54:19,240 --> 01:54:20,600 WE PAIRED THESE SONGS WITH A 2717 01:54:20,600 --> 01:54:23,480 RAMP AND HOLD NOXIOUS TERMAL 2718 01:54:23,480 --> 01:54:26,960 STIMULATION PARADIGM RAMPING 2719 01:54:26,960 --> 01:54:28,480 TEMPERATURES UP TO A PAINFUL 2720 01:54:28,480 --> 01:54:28,760 LEVEL. 2721 01:54:28,760 --> 01:54:33,080 WE DID THIS IN A MRI MACHINE AND 2722 01:54:33,080 --> 01:54:33,920 OBTAINED SCANS WHILE THEY WERE 2723 01:54:33,920 --> 01:54:35,520 EXPOSED TO THESE REWARDING OR 2724 01:54:35,520 --> 01:54:38,200 NEUTRAL STIMULI AND PAIN. 2725 01:54:38,200 --> 01:54:40,000 >> TWO MINUTE WARNING. 2726 01:54:40,000 --> 01:54:42,320 >> AND FURTHER PARTICIPANTS DID 2727 01:54:42,320 --> 01:54:43,760 THIS TASK AFTER A NIGHT OF 2728 01:54:43,760 --> 01:54:45,080 NORMAL SLEEP AND AFTER A NIGHT 2729 01:54:45,080 --> 01:54:49,760 OF SLEEP DISRUPTION. 2730 01:54:49,760 --> 01:54:55,480 WE FOUND FIRST THAT THE SUB WAS 2731 01:54:55,480 --> 01:54:58,480 AK TA RATE IS BID REWARDING 2732 01:54:58,480 --> 01:55:00,040 MUSIC AND IT WAS STRONGLY AK TA 2733 01:55:00,040 --> 01:55:02,080 RATE ISED BY THE ONSET OF 2734 01:55:02,080 --> 01:55:04,800 PAINFUL THERMAL STIMULI AND 2735 01:55:04,800 --> 01:55:06,880 REWARDING MUSIC A LOT ERT 2736 01:55:06,880 --> 01:55:09,480 NUCLEUS ACTIVITY WITH KEY NODES 2737 01:55:09,480 --> 01:55:11,440 OF THE CIRCUITS AND ALSO DURING 2738 01:55:11,440 --> 01:55:16,920 PAIN ONSET AND SLEEP DISRUPTION 2739 01:55:16,920 --> 01:55:23,000 ATTENUATED THE ACTIVATION AND 2740 01:55:23,000 --> 01:55:25,360 THE ANTERIOR MID SINGULAR CORTEX 2741 01:55:25,360 --> 01:55:30,600 ALSO A PAIN ONSET. 2742 01:55:30,600 --> 01:55:32,120 WE WERE INTERPRET THIS, ONE 2743 01:55:32,120 --> 01:55:33,360 POSSIBLE INTERPRETATION OF THE 2744 01:55:33,360 --> 01:55:34,960 INCREASED REWARD RELATED 2745 01:55:34,960 --> 01:55:36,440 CONNECTIVITY BETWEEN THE NAC AND 2746 01:55:36,440 --> 01:55:38,440 THE AMCC COULD BE THAT IT'S 2747 01:55:38,440 --> 01:55:40,120 REFLECTIVE OF A RECRUITMENT OF 2748 01:55:40,120 --> 01:55:42,840 THIS REGISTER ON TO RECOVER 2749 01:55:42,840 --> 01:55:44,680 COGNITIVE CONTROL OF PAIN 2750 01:55:44,680 --> 01:55:48,360 FOLLOWING SLEEP DISRUPTION. 2751 01:55:48,360 --> 01:55:51,360 SO, TO SUMMARIZE, WE SEE THAT 2752 01:55:51,360 --> 01:55:53,160 SLEEP DISRUPTION MODULATES 2753 01:55:53,160 --> 01:55:55,360 POSITIVE EFFECT AND POSITIVE 2754 01:55:55,360 --> 01:55:57,560 EFFECT OF PAIN AND NOT JUST AT 2755 01:55:57,560 --> 01:55:59,600 BEHAVIORAL LEVEL BUT ALSO 2756 01:55:59,600 --> 01:56:01,400 OBSERVABLE VIA CHANGES IN 2757 01:56:01,400 --> 01:56:04,200 ACTIVITY WITHIN THE CIRCUITS. 2758 01:56:04,200 --> 01:56:06,600 THESE FINDINGS SUPPORT THE MULTI 2759 01:56:06,600 --> 01:56:10,000 SYSTEM VIEW OF THE SLEEP AFFECT 2760 01:56:10,000 --> 01:56:11,320 AND PAIN DYNAMIC AND POINT TO 2761 01:56:11,320 --> 01:56:13,200 POSSIBLE AREAS FOR FURTHER WORK 2762 01:56:13,200 --> 01:56:15,320 TO INFORM FOR EXAMPLE NEURO 2763 01:56:15,320 --> 01:56:17,480 MODULATORY THERAPEUTICS OR 2764 01:56:17,480 --> 01:56:18,560 PSYCHOSOCIAL INTERVENTION TO 2765 01:56:18,560 --> 01:56:20,080 BOOST POSITIVE EFFECT AND THE 2766 01:56:20,080 --> 01:56:24,920 FACE OF SLEEP LOSS. 2767 01:56:24,920 --> 01:56:27,160 AND WE COMPLETED A STUDY OF A 2768 01:56:27,160 --> 01:56:30,000 BRIEF POSITIVE EMOTION SAVORING 2769 01:56:30,000 --> 01:56:31,160 MEDICATION THAT I'D LIKE TO TALK 2770 01:56:31,160 --> 01:56:32,440 ABOUT IF WE HAD MORE TIME BUT 2771 01:56:32,440 --> 01:56:35,880 THERE ARE OF COURSE NUMEROUS AVS 2772 01:56:35,880 --> 01:56:37,760 TO TRAVEL AND IT'S MY BELIEVE 2773 01:56:37,760 --> 01:56:40,200 AND WE MAINTAIN A FRAMEWORK FOR 2774 01:56:40,200 --> 01:56:43,160 UNRATTLING THE ASSOCIATION 2775 01:56:43,160 --> 01:56:45,240 BETWEEN SLEEP AND PAIN WE'LL 2776 01:56:45,240 --> 01:56:46,000 DRAW CLOSER TO DISCOVERING AN 2777 01:56:46,000 --> 01:56:48,360 INTERVENTION THAT OPTIMIZES THE 2778 01:56:48,360 --> 01:56:50,080 WHOLE PERSON AND TARGETS 2779 01:56:50,080 --> 01:56:51,280 OUTCOMES BEYOND PAIN SEVERITY. 2780 01:56:51,280 --> 01:56:54,400 >> TIME HAS EXPIRED. 2781 01:56:54,400 --> 01:56:55,760 >> SO, THAT'S ALL I HAVE FOR 2782 01:56:55,760 --> 01:56:55,920 YOU. 2783 01:56:55,920 --> 01:56:59,800 THANK YOU SO MUCH. 2784 01:56:59,800 --> 01:57:01,200 AND I CAN'T WITHOUT 2785 01:57:01,200 --> 01:57:02,800 ACKNOWLEDGING THE POSTDOC TO BAL 2786 01:57:02,800 --> 01:57:04,560 FELLOWS AND THE COORDINATORS WHO 2787 01:57:04,560 --> 01:57:06,320 MAKE THIS WORK AND OF COURSE THE 2788 01:57:06,320 --> 01:57:07,600 SUPPORT WE'VE FROM THE NIH 2789 01:57:07,600 --> 01:57:13,040 PARTICULARLY NCCIH, NIADA. 2790 01:57:13,040 --> 01:57:14,240 THANK YOU FOR YOUR TIME AND I 2791 01:57:14,240 --> 01:57:21,160 WILL TRANSITION NOW TO Dr. 2792 01:57:21,160 --> 01:57:22,080 ILGEN WHO IS NEXT. 2793 01:57:22,080 --> 01:57:23,240 >> GREAT. 2794 01:57:23,240 --> 01:57:26,240 THANK YOU. 2795 01:57:26,240 --> 01:57:30,560 AND THANK YOU TO THE PAIN CON 2796 01:57:30,560 --> 01:57:31,600 COR SLUM TO PRESENT TODAY. 2797 01:57:31,600 --> 01:57:32,840 I'M GOING TO TALK ABOUT THE 2798 01:57:32,840 --> 01:57:34,360 OVERLAP BETWEEN CHRONIC PAIN AND 2799 01:57:34,360 --> 01:57:36,760 SUBSTANCE USE DISORDERS AS WELL 2800 01:57:36,760 --> 01:57:47,200 AS RESOLVED FROM -- MAYBE 2801 01:57:58,480 --> 01:57:59,360 SUBSTANCE USE DISORDERS AND 2802 01:57:59,360 --> 01:58:02,240 SUBSTANCE RELATED ADVERSE EVENTS 2803 01:58:02,240 --> 01:58:05,480 AMONG THOSE WITH CHRONIC PAIN. 2804 01:58:05,480 --> 01:58:06,760 FOR TODAY'S TALK, WE'RE GOING TO 2805 01:58:06,760 --> 01:58:08,680 KIND OF FLIP THAT A LITTLE BIT 2806 01:58:08,680 --> 01:58:10,760 AND TALK ABOUT INDIVIDUALS WHO 2807 01:58:10,760 --> 01:58:12,800 HAVE ESTABLISHED SUBSTANCE USE 2808 01:58:12,800 --> 01:58:14,520 DISORDERS AND WHAT CAN BE DONE 2809 01:58:14,520 --> 01:58:16,960 ABOUT THE LARGE GROUP OF FOLKS 2810 01:58:16,960 --> 01:58:20,680 WHO HAVE CHRONIC PAIN AND COULD 2811 01:58:20,680 --> 01:58:22,280 BENEFIT FROM SOME ADDITIONAL 2812 01:58:22,280 --> 01:58:23,800 TREATMENT. 2813 01:58:23,800 --> 01:58:25,480 UNFORTUNATELY, ESPECIALLY WITHIN 2814 01:58:25,480 --> 01:58:27,600 SPECIALTY SUBSTANCE USE DISORDER 2815 01:58:27,600 --> 01:58:29,240 TREATMENT PROGRAMS, THOSE WITH 2816 01:58:29,240 --> 01:58:39,760 CHRONIC PAIN ARE OFTEN THEY ARE 2817 01:58:44,640 --> 01:58:46,160 OFTEN GIVEN LITTLE IN TERMS OF 2818 01:58:46,160 --> 01:58:47,600 GATE AN ABOUT HOW TO BERMAN AGE 2819 01:58:47,600 --> 01:58:51,200 THEIR PAIN AND SO THAT IS 2820 01:58:51,200 --> 01:58:52,520 SOMETHING WE'VE BEEN LOOKING AT 2821 01:58:52,520 --> 01:58:54,400 AND I'LL TALK ABOUT OUR RESEARCH 2822 01:58:54,400 --> 01:58:59,400 ON INTERVENTIONS TO EMIGRATED 2823 01:58:59,400 --> 01:59:03,000 DISCUSSIONS OF PAIN AND 2824 01:59:03,000 --> 01:59:04,320 SUBSTANCE ABUSE DISORDERS. 2825 01:59:04,320 --> 01:59:08,600 IN ELSE TERMS OF ACKNOWLEDGMEND 2826 01:59:08,600 --> 01:59:09,920 DISCLOSURE I WILL FOCUS ON OUR 2827 01:59:09,920 --> 01:59:11,720 RESEARCH FUNDED BIT V.A. AND AS 2828 01:59:11,720 --> 01:59:14,400 WELL AS NIADA AND I'LL TOUCH ON 2829 01:59:14,400 --> 01:59:20,440 AN ONGOING STUDY FROM NCCIH AND 2830 01:59:20,440 --> 01:59:22,040 I'M A PART OF A SMALL COMPANY 2831 01:59:22,040 --> 01:59:23,600 AND I DON'T THINK IT'S RELATE 2832 01:59:23,600 --> 01:59:25,120 TODAY THIS CONTENT BUT I WANT TO 2833 01:59:25,120 --> 01:59:30,840 MAKE SURE THAT OTHERS ARE AWARE. 2834 01:59:30,840 --> 01:59:38,080 SO, YOU CAN GO AHEAD AND 2835 01:59:38,080 --> 01:59:40,800 ADVANCE. 2836 01:59:40,800 --> 01:59:45,440 >> CHRONIC PAIN IS HIGHLY COMMON 2837 01:59:45,440 --> 01:59:46,880 IN ADDICTION SETTINGS. 2838 01:59:46,880 --> 01:59:50,360 50% TO 80% SHOWING UP TO DRUG 2839 01:59:50,360 --> 01:59:52,640 AND ALCOHOL TREATMENT REPORT 2840 01:59:52,640 --> 01:59:56,040 SOME TYPE OF PERSISTENT AND 2841 01:59:56,040 --> 01:59:56,840 DEBILITATING PAIN. 2842 01:59:56,840 --> 01:59:58,960 THE GENERAL RULE OF THUMB IS 2843 01:59:58,960 --> 02:00:00,720 THAT THE MORE THAT THE SUBSTANCE 2844 02:00:00,720 --> 02:00:04,360 USE DISORDER TREATMENT SETTING 2845 02:00:04,360 --> 02:00:05,800 FOCUSES ON OPIOID USE DISORDERS 2846 02:00:05,800 --> 02:00:07,680 THE MORE COMMON THE CHRONIC PAIN 2847 02:00:07,680 --> 02:00:11,600 CONDITION IS SO FUR LOOKING AT 2848 02:00:11,600 --> 02:00:12,680 MAINTENANCE PROGRAMS OR 2849 02:00:12,680 --> 02:00:14,600 MEDICATION TREATMENTS FOR OPIOID 2850 02:00:14,600 --> 02:00:20,360 USE DISORDERS, YOU CAN SEE RATES 2851 02:00:20,360 --> 02:00:22,160 OF CO OCCURRING PAIN THAT 2852 02:00:22,160 --> 02:00:23,080 APPROACH 80%. 2853 02:00:23,080 --> 02:00:25,400 AND WHEN PAIN IS PRESENT, 2854 02:00:25,400 --> 02:00:26,240 OBSERVATIONAL DATA INDICATES 2855 02:00:26,240 --> 02:00:28,920 THAT IT IS ASSOCIATED WITH 2856 02:00:28,920 --> 02:00:30,200 POORER TREATMENT OUTCOMES, NOT 2857 02:00:30,200 --> 02:00:31,760 JUST IN TERMS OF PAIN AND 2858 02:00:31,760 --> 02:00:36,320 FUNCTIONING BUT ALSO IN TERMS OF 2859 02:00:36,320 --> 02:00:37,400 GREATER LIKELY HOOD OF POOR 2860 02:00:37,400 --> 02:00:39,320 SUBSTANCE RELATED OUTCOMES UP TO 2861 02:00:39,320 --> 02:00:42,080 ONE YEAR OF POST TREATMENT. 2862 02:00:42,080 --> 02:00:44,280 UNFORTUNATELY, PAIN IS RARELY 2863 02:00:44,280 --> 02:00:47,160 COMPREHENSIVELY ADDRESSED DURING 2864 02:00:47,160 --> 02:00:47,880 STANDARD S.U.V. TREATMENT WHICH 2865 02:00:47,880 --> 02:00:49,840 RAISES THE POSSIBILITY THAT 2866 02:00:49,840 --> 02:00:53,280 POTENTIALLY IMPROVING PAIN 2867 02:00:53,280 --> 02:00:55,400 TREATMENT DURING SUD TREATMENT 2868 02:00:55,400 --> 02:00:57,080 COULD LEAD TO BETTER OUTCOMES TO 2869 02:00:57,080 --> 02:01:01,080 PAIN AND SUBSTANCE USE DISORDERS 2870 02:01:01,080 --> 02:01:02,400 AND THERE'S SOME RESEARCH ON 2871 02:01:02,400 --> 02:01:05,840 THIS TOPIC INCLUDING PROBABLY 2872 02:01:05,840 --> 02:01:09,280 MOST DIS BLEE ERIC GARLAND AND 2873 02:01:09,280 --> 02:01:12,040 COLLEAGUES WORK ON MINDFULNESS 2874 02:01:12,040 --> 02:01:14,040 BASED INTERVENTIONS AND THESE 2875 02:01:14,040 --> 02:01:17,600 ARE CONDUCTED IN AN SUD SETTINGS 2876 02:01:17,600 --> 02:01:20,400 BUT IN GENERAL FOR THEIR 2877 02:01:20,400 --> 02:01:24,240 PATIENTS WHO HAVE CHRONIC PAIN 2878 02:01:24,240 --> 02:01:25,960 AND EMERGING SUBSTANCES THERE'S 2879 02:01:25,960 --> 02:01:28,520 A SENSE THAT INTERVENTION CAN 2880 02:01:28,520 --> 02:01:29,960 IMPROVE OUTCOMES IN BOTH OF 2881 02:01:29,960 --> 02:01:31,760 THOSE DOMAINS AND I'LL TALK 2882 02:01:31,760 --> 02:01:34,280 ABOUT A FEW TRIALS THAT WE'VE 2883 02:01:34,280 --> 02:01:37,800 DONE IN A SIMILAR VANE. 2884 02:01:37,800 --> 02:01:38,720 NEXT SLIDE, PLEASE. 2885 02:01:38,720 --> 02:01:43,200 OUR WORK USES A COMBINATION OF A 2886 02:01:43,200 --> 02:01:46,280 COGNITIVE BEHAVIORAL MODEL FOR 2887 02:01:46,280 --> 02:01:51,400 THINKING ABOUT CHRONIC PAIN AND 2888 02:01:51,400 --> 02:01:53,160 FOR THINK WE THINK OF SUBSTANCE 2889 02:01:53,160 --> 02:01:54,720 USE AND THOUGHTS AND PERCEPTIONS 2890 02:01:54,720 --> 02:02:00,280 OF SUBSTANCE USE FIGHTING NICELY 2891 02:02:00,280 --> 02:02:02,080 IN A CHRONIC PAIN FOR A LONG 2892 02:02:02,080 --> 02:02:05,800 TIME LIKE THE FEAR AVOIDANCE 2893 02:02:05,800 --> 02:02:06,440 MODEL. 2894 02:02:06,440 --> 02:02:07,680 FEARS ABOUT PAIN CONCERNS ABOUT 2895 02:02:07,680 --> 02:02:12,000 THE INABILITY TO MANAGE PAIN AND 2896 02:02:12,000 --> 02:02:14,600 EXPECTANCY AROUND SUBSTANCE USE 2897 02:02:14,600 --> 02:02:18,480 CAN PERPETUATE AVOIDANCE OF 2898 02:02:18,480 --> 02:02:20,320 POTENTIALLY PAINFUL STIMULI AS 2899 02:02:20,320 --> 02:02:23,240 WELL AS THE USE OF SUBSTANCES TO 2900 02:02:23,240 --> 02:02:25,480 COPE AS AVOIDANCE COPING 2901 02:02:25,480 --> 02:02:27,720 MECHANISM AND THIS CAN KIND OF 2902 02:02:27,720 --> 02:02:30,760 LEAD TO A SPIRAL OF NEGATIVE 2903 02:02:30,760 --> 02:02:32,320 OUTCOMES THAT CHARACTERIZE 2904 02:02:32,320 --> 02:02:33,800 CHRONIC PAIN AND FROM AN 2905 02:02:33,800 --> 02:02:34,840 INTERVENTION PERSPECTIVE, YOU 2906 02:02:34,840 --> 02:02:38,280 ARE LOOKING TO HELP SHAPE 2907 02:02:38,280 --> 02:02:39,600 PERCEPTIONS OF PAIN AND 2908 02:02:39,600 --> 02:02:41,760 SUBSTANCE OF USE AS WELL AS 2909 02:02:41,760 --> 02:02:43,960 ENGAGEMENT IN FEWER AVOIDANCE 2910 02:02:43,960 --> 02:02:47,320 RELATED BEHAVIORS INCLUDING 2911 02:02:47,320 --> 02:02:49,360 SUBSTANCE USE AND MISUSE AS A 2912 02:02:49,360 --> 02:02:53,040 WAY TO BREAK OUT OF THAT CYCLE. 2913 02:02:53,040 --> 02:02:54,600 NEXT SLIDE. 2914 02:02:54,600 --> 02:02:54,920 PLEASE. 2915 02:02:54,920 --> 02:02:59,920 WE DEVELOPED THIS INTERVENTION 2916 02:02:59,920 --> 02:03:01,800 AND WE CALL IT IMPACT AND IT'S 2917 02:03:01,800 --> 02:03:03,440 THE BASIS OF WHAT I'LL DESCRIBE 2918 02:03:03,440 --> 02:03:08,240 HERE TODAY AND THIS IS SOMETHING 2919 02:03:08,240 --> 02:03:10,720 THAT CAN BE OVER LAID ON TO AN 2920 02:03:10,720 --> 02:03:12,080 EPISODE OF EXISTING SUBSTANCE 2921 02:03:12,080 --> 02:03:13,840 USE DISORDER TREATMENT AND IT'S 2922 02:03:13,840 --> 02:03:15,240 MEANT TO BE COMPLIMENTARY TO A 2923 02:03:15,240 --> 02:03:17,480 LOT OF MESSAGES THAT WE WILL 2924 02:03:17,480 --> 02:03:18,600 RECEIVE IN STAND AR ADDICTION 2925 02:03:18,600 --> 02:03:23,840 TREATMENT AND IT HIGHLIGHTS 2926 02:03:23,840 --> 02:03:24,760 THOSE LINKS BETWEEN SUBSTANCE 2927 02:03:24,760 --> 02:03:26,680 USE AND CHRONIC PAIN THROUGHOUT 2928 02:03:26,680 --> 02:03:30,200 AND ENCOURAGES DIFFERENT COPES 2929 02:03:30,200 --> 02:03:31,280 OF COPING WITH NEGATIVE THOUGHTS 2930 02:03:31,280 --> 02:03:35,280 OF PAIN AND NEGATIVE EXPERIENCES 2931 02:03:35,280 --> 02:03:38,880 SUCH AS SPIKES IN PAIN. 2932 02:03:38,880 --> 02:03:40,840 SO, FOR TODAY, I AM GOING TO 2933 02:03:40,840 --> 02:03:43,040 DESCRIBE THE RESULTS OF TWO 2934 02:03:43,040 --> 02:03:44,520 RANDOMIZED TRIALS BOTH OF THE 2935 02:03:44,520 --> 02:03:45,160 SAME INTERVENTION. 2936 02:03:45,160 --> 02:03:46,680 THE FIRST OF WHICH WAS CONDUCTED 2937 02:03:46,680 --> 02:03:49,080 IN THE V.A. AND IN AN OUT 2938 02:03:49,080 --> 02:03:51,760 PATIENT SETTING, THE OTHER WAS 2939 02:03:51,760 --> 02:03:53,560 CONDUCTED IN A COMMUNITY 2940 02:03:53,560 --> 02:03:55,200 RESIDENTIAL DRUG AND ALCOHOL 2941 02:03:55,200 --> 02:03:55,840 TREATMENT PROGRAM. 2942 02:03:55,840 --> 02:03:57,840 NEXT SLIDE, PLEASE. 2943 02:03:57,840 --> 02:04:01,960 SO FOR THE V.A. STUDY, WE 2944 02:04:01,960 --> 02:04:02,960 RECRUITED 130 PATIENTS STARTING 2945 02:04:02,960 --> 02:04:06,120 AN EPISODE OF VA TREATMENT THEY 2946 02:04:06,120 --> 02:04:10,400 WERE RANDOMIZED TO ONE OF TWO 2947 02:04:10,400 --> 02:04:11,880 12-WEEK GROUPS AND IN THIS 2948 02:04:11,880 --> 02:04:15,600 IMPACT INTERCEPTIONS AND OR ANNA 2949 02:04:15,600 --> 02:04:17,520 TENSION MATCH CONTROL CONDITION 2950 02:04:17,520 --> 02:04:19,600 THIS WAS REALLY JUST KIND OF A 2951 02:04:19,600 --> 02:04:21,680 PSYCHO EDUCATIONAL CONTROL WHERE 2952 02:04:21,680 --> 02:04:23,440 THEY MET WITH A THERAPIST AND 2953 02:04:23,440 --> 02:04:24,800 OTHER PATIENTS FROM THE SAME 2954 02:04:24,800 --> 02:04:26,880 LENGTH OF TIME AS THE 2955 02:04:26,880 --> 02:04:28,160 INTERVENTION AND IT DID NOT 2956 02:04:28,160 --> 02:04:37,440 OVERLAP IN TERMS OF THE SPECIFIC 2957 02:04:37,440 --> 02:04:39,640 CONTENT AND OUR FOLLOW-UP RATES 2958 02:04:39,640 --> 02:04:41,400 WERE HIGH FOR THIS PATIENT 2959 02:04:41,400 --> 02:04:41,720 POPULATION. 2960 02:04:41,720 --> 02:04:52,040 NEXT SLIDE, PLEASE. 2961 02:04:59,320 --> 02:05:01,320 NET CONSISTENTLY LOWER PAIN OVER 2962 02:05:01,320 --> 02:05:02,960 THE FOLLOW-UP INTERVAL COMPARED 2963 02:05:02,960 --> 02:05:08,040 TO THOSE RANDOMIZED TO THE 2964 02:05:08,040 --> 02:05:13,000 CONTROL CONDITIONS AND YOU SEE 2965 02:05:13,000 --> 02:05:14,840 THAT IN TERMS OF FUNCTIONING 2966 02:05:14,840 --> 02:05:17,760 THEY REPORTED HIGHER FUNCTIONING 2967 02:05:17,760 --> 02:05:21,160 ON AVERAGE AND DID THOSE IN THE 2968 02:05:21,160 --> 02:05:23,320 LOCAL CONDITION OVER THE 2969 02:05:23,320 --> 02:05:24,360 12-MONTH FOLLOW-UP. 2970 02:05:24,360 --> 02:05:25,680 NEXT SLIDE, PLEASE. 2971 02:05:25,680 --> 02:05:27,920 TURNING TO SUBSTANCE RELATED 2972 02:05:27,920 --> 02:05:34,040 OUTCOMES, THE UPPER LAST CORNER 2973 02:05:34,040 --> 02:05:37,200 AND WE LOOKED AT ALCOHOL AND 2974 02:05:37,200 --> 02:05:38,800 OTHER DRUG USE SEPARATELY FOR 2975 02:05:38,800 --> 02:05:41,720 THIS STUDY AND IN TERMS OF COL 2976 02:05:41,720 --> 02:05:43,640 USE YOU SEE THE NATIONAL 2977 02:05:43,640 --> 02:05:44,720 FOLLOW-UP THE TWO CONDITIONS 2978 02:05:44,720 --> 02:05:46,920 LOOK SIMILAR AND THERE'S NO 2979 02:05:46,920 --> 02:05:48,800 DIFFERENCE THERE AND THEN OVER 2980 02:05:48,800 --> 02:05:50,320 TIME, A DIFFERENCE EMERGES WHERE 2981 02:05:50,320 --> 02:05:52,160 THOSE IN THE CONTROL CONDITIONS 2982 02:05:52,160 --> 02:05:54,600 AND RETURNED TO MORE REGULAR 2983 02:05:54,600 --> 02:06:04,640 ALCOHOL USE WHERE THOSE IN THE 2984 02:06:04,640 --> 02:06:05,480 INITIALLY FOLLOWING TREATMENT. 2985 02:06:05,480 --> 02:06:08,000 AND IN THE BOTTOM RIGHT-HAND 2986 02:06:08,000 --> 02:06:12,680 CORNER LOOKING AT YOU SEE THE 2987 02:06:12,680 --> 02:06:14,480 WIDER OR BARS AND WE HAD A LOT 2988 02:06:14,480 --> 02:06:15,520 OF OVER HAPPEN BETWEEN 2989 02:06:15,520 --> 02:06:25,160 CONDITIONS AND NO REAL VERSUS 2990 02:06:25,160 --> 02:06:26,160 THE CONTROL CONDITION. 2991 02:06:26,160 --> 02:06:36,720 AS THE LAST SLIDE OF THIS TRIAL, 2992 02:06:41,040 --> 02:06:42,640 THIS IS A KEY MECHANISM OF THE 2993 02:06:42,640 --> 02:06:45,880 INTERVENTION AND YOU CAN SEE 2994 02:06:45,880 --> 02:06:46,680 CONSISTENCES FOR CONDITIONS FOR 2995 02:06:46,680 --> 02:06:51,280 THOSE IN THE CBT OR IMPACT 2996 02:06:51,280 --> 02:07:01,760 CONDITION AND NEXT SLIDE, 2997 02:07:03,240 --> 02:07:06,880 PLEASE, SO TURNING TO THE NON 2998 02:07:06,880 --> 02:07:08,200 V.A. STUDY THEY WERE CREATED 2999 02:07:08,200 --> 02:07:10,520 DURING AN EPISODE OF COMMUNITY 3000 02:07:10,520 --> 02:07:15,160 RESIDENTIAL DRUG AND ALCOHOL 3001 02:07:15,160 --> 02:07:16,480 TREATMENT IN LARGE TREATMENT 3002 02:07:16,480 --> 02:07:22,120 UNIT IN THE DETROIT AREA 3003 02:07:22,120 --> 02:07:24,880 MICHIGAN AND WE TRIED TO RECRUIT 3004 02:07:24,880 --> 02:07:31,560 MEN AND WOMEN INTO THIS TRIAL 3005 02:07:31,560 --> 02:07:34,000 AND THEY WERE RANDOMIZED TO THE 3006 02:07:34,000 --> 02:07:35,000 SAME CAN'T WE SHORT END THE 3007 02:07:35,000 --> 02:07:42,000 CONDITIONS AND MET MORE 3008 02:07:42,000 --> 02:07:44,920 FREQUENTLY WHERE WE DELIVERED 3009 02:07:44,920 --> 02:07:46,800 THEM TWICE A WEEK AND WE 3010 02:07:46,800 --> 02:07:48,240 FOLLOWED FOLKS FOR THREE, SIX 3011 02:07:48,240 --> 02:07:51,240 AND 12 MONTHS AND AGAIN YOU CAN 3012 02:07:51,240 --> 02:07:55,880 SEE THE FOLLOW-UP RATES. 3013 02:07:55,880 --> 02:07:57,560 ADDITION TO THE PAIN LEVEL 3014 02:07:57,560 --> 02:08:02,360 FUNCTIONING ALCOHOL USE AND DRUG 3015 02:08:02,360 --> 02:08:04,240 USE FREQUENCY, WE HAVE A MEASURE 3016 02:08:04,240 --> 02:08:11,160 OF PAIN TASK AND WE LOOKED AT 3017 02:08:11,160 --> 02:08:12,920 PAIN TOLLENNANCE IN THIS STUFF. 3018 02:08:12,920 --> 02:08:23,240 NEXT SLIDE, PLEASE. 3019 02:08:27,080 --> 02:08:29,480 THE RESULTS ARE LESS IMPRESSIVE. 3020 02:08:29,480 --> 02:08:30,800 WE SEE DIFFERENCES ON TWO OF 3021 02:08:30,800 --> 02:08:37,200 THEM AND THOSE WOULD BE ENTA 3022 02:08:37,200 --> 02:08:38,120 INDICATION OF HIGHER PAIN 3023 02:08:38,120 --> 02:08:41,960 FUNCTIONING OVER THE FOLLOW-UP 3024 02:08:41,960 --> 02:08:45,440 INTERVAL AND HIGHER PAIN DOLL 3025 02:08:45,440 --> 02:08:46,760 ORANCE AND THERE WAS NO 3026 02:08:46,760 --> 02:08:47,680 DIFFERENCES ON SELF-REPORTED 3027 02:08:47,680 --> 02:08:55,400 PAIN LEVEL AND ALCOHOL USE AND 3028 02:08:55,400 --> 02:08:56,280 DRUG USE. 3029 02:08:56,280 --> 02:08:59,800 AS A ANALYSIS GETTING OUR HEAD 3030 02:08:59,800 --> 02:09:00,800 AROUND WHAT IS MAYBE DIFFERENT 3031 02:09:00,800 --> 02:09:08,960 BETWEEN THIS STUDY AND THE PRIOR 3032 02:09:08,960 --> 02:09:10,840 STUDY WE EXAMINED SELF-EFFICACY 3033 02:09:10,840 --> 02:09:15,200 YOU SAW IN ONE OF THE LAST 3034 02:09:15,200 --> 02:09:21,240 SLIDES ON IT DOES DIFFER BY 3035 02:09:21,240 --> 02:09:25,080 CONDITION AND WE SEE THAT THE 3036 02:09:25,080 --> 02:09:26,560 ASSOCIATION BETWEEN 3037 02:09:26,560 --> 02:09:28,000 SELF-EFFICACY AND PAIN LEVEL AND 3038 02:09:28,000 --> 02:09:29,720 PAIN LEVEL FUNCTIONING OVER THE 3039 02:09:29,720 --> 02:09:35,800 FOLLOW-UP INTERVAL BUT NO LINK 3040 02:09:35,800 --> 02:09:36,640 BETWEEN THAT MEASURE AND THE 3041 02:09:36,640 --> 02:09:39,520 ALCOHOL AND DRUG RELATED OUTCOME 3042 02:09:39,520 --> 02:09:43,640 SHOWING THERE'S POPULATION OF 3043 02:09:43,640 --> 02:09:45,080 PATIENTS AND EVEN THOUGH THEY 3044 02:09:45,080 --> 02:09:47,120 FEEL BETTER THEY GET THE 3045 02:09:47,120 --> 02:09:48,320 BEHAVIORAL PAIN MANAGEMENT 3046 02:09:48,320 --> 02:09:49,520 INVENTION AND THEY'RE NOT 3047 02:09:49,520 --> 02:09:50,320 NECESSARILY BEHAVING DIFFERENTLY 3048 02:09:50,320 --> 02:09:55,400 IN TERMS OF THEIR SUBSTANCE USE 3049 02:09:55,400 --> 02:09:57,920 AND ONE FINAL POINT IS THAT OUR 3050 02:09:57,920 --> 02:09:59,440 FINDINGS WERE GENERALLY LARGER 3051 02:09:59,440 --> 02:10:03,960 IN THOSE NOT IN THE CONTROLLED 3052 02:10:03,960 --> 02:10:04,440 ENVIRONMENT. 3053 02:10:04,440 --> 02:10:05,840 ONE, CHALLENGE IN THE PATIENT 3054 02:10:05,840 --> 02:10:07,440 POPULATION WE WERE FOCUSING ON 3055 02:10:07,440 --> 02:10:09,120 IS THAT MANY OF THE PEOPLE 3056 02:10:09,120 --> 02:10:13,560 RECRUITED INTO THE STUDY WERE 3057 02:10:13,560 --> 02:10:15,160 HOMELESS AND HAD UNSTABLE 3058 02:10:15,160 --> 02:10:16,920 HOUSING FOLLOWING TREATMENT AND 3059 02:10:16,920 --> 02:10:25,880 OFTEN THEY ENDED UP IN ENDED UP 3060 02:10:25,880 --> 02:10:27,600 IN JAIL OR PRISON SO IT WAS 3061 02:10:27,600 --> 02:10:34,040 DIFFICULT TO DETECT EFFECTS WITH 3062 02:10:34,040 --> 02:10:37,600 THEY WERE NOT OUT IN THE 3063 02:10:37,600 --> 02:10:38,840 COMMUNITY AND IF WE LIMIT 3064 02:10:38,840 --> 02:10:44,560 OURSELVES TO THOSE PARTICIPANTS 3065 02:10:44,560 --> 02:10:45,920 WHO WHEN THEY LEFT TREATMENT, 3066 02:10:45,920 --> 02:10:46,920 SOME OF THE FINDINGS WERE A 3067 02:10:46,920 --> 02:10:51,880 LITTLE MORE CONSISTENT AND 3068 02:10:51,880 --> 02:10:52,160 ENCOURAGING. 3069 02:10:52,160 --> 02:10:53,560 >> TWO MINUTES REMAINING. 3070 02:10:53,560 --> 02:10:54,240 >> THANK YOU. 3071 02:10:54,240 --> 02:10:58,560 SO AS A WRAP-UP, WE BELIEVE THAT 3072 02:10:58,560 --> 02:11:00,000 NON MEDICATION TREATMENT HAVE A 3073 02:11:00,000 --> 02:11:01,000 ROLE TO REPLY IN ADDRESSING PAIN 3074 02:11:01,000 --> 02:11:05,160 IN THOSE WITH SUBSTANCE USE 3075 02:11:05,160 --> 02:11:09,000 DISORDERS AND THOSE IN 3076 02:11:09,000 --> 02:11:09,400 TREATMENT. 3077 02:11:09,400 --> 02:11:11,640 I DIDN'T TALK ABOUT THE INFORMAL 3078 02:11:11,640 --> 02:11:15,480 TREATMENT BUT THEY WERE REALLY 3079 02:11:15,480 --> 02:11:18,520 APPRECIATIVE AND WE WERE ASKING 3080 02:11:18,520 --> 02:11:23,320 ABOUT THEIR PAIN AND VALIDATING 3081 02:11:23,320 --> 02:11:24,520 THE IMPORTANCE AND WORKING WITH 3082 02:11:24,520 --> 02:11:25,880 THEM TO DEVELOP SOLUTIONS TO 3083 02:11:25,880 --> 02:11:31,000 THEIR PAIN THAT WAS VERY 3084 02:11:31,000 --> 02:11:31,960 DIFFERENT FROM WHAT MIGHT BE 3085 02:11:31,960 --> 02:11:33,600 DRUG AND ALCOHOL AND THEY ATTEND 3086 02:11:33,600 --> 02:11:34,920 RATES WERE VERY GOOD FOR OUR 3087 02:11:34,920 --> 02:11:36,640 GROUPS AND THEY SEEMED REALLY 3088 02:11:36,640 --> 02:11:42,240 ENGLISH GAGEDREAL --ENGAGE IN T. 3089 02:11:42,240 --> 02:11:43,240 RESULTS WERE ENCOURAGING 3090 02:11:43,240 --> 02:11:46,880 ESPECIALLY AROUND THE PAIN 3091 02:11:46,880 --> 02:11:57,360 OUTCOMES AND THEY WERE LESSEN 3092 02:11:58,120 --> 02:12:00,080 COURAGING AND WE DID SEE 3093 02:12:00,080 --> 02:12:01,400 EVIDENCE THE MECHANISMS OF 3094 02:12:01,400 --> 02:12:05,880 ACTION OF THE INTERVENTIONS WERE 3095 02:12:05,880 --> 02:12:09,280 CHANGING IN THE CONDITION AND 3096 02:12:09,280 --> 02:12:11,560 THESE FACTORS RELATED TO 3097 02:12:11,560 --> 02:12:12,680 SELF-ADVOCACY AND THE GENERAL 3098 02:12:12,680 --> 02:12:17,160 ABILITY TO COPE WITH PAIN ARE 3099 02:12:17,160 --> 02:12:19,040 IMPORTANT AND THEY ARE CLOSELY 3100 02:12:19,040 --> 02:12:24,280 LINKED WITH THE PAIN OUTCOMES 3101 02:12:24,280 --> 02:12:25,880 THAN THE SUBSTANCE ELATED 3102 02:12:25,880 --> 02:12:30,320 OUTCOMES SO WHAT IS THAT LINK 3103 02:12:30,320 --> 02:12:33,680 BETWEEN PAIN AND WHAT CAN BE 3104 02:12:33,680 --> 02:12:35,560 DONE TO HELP PATIENTS HAVE 3105 02:12:35,560 --> 02:12:44,960 BETTER OUTCOMES. 3106 02:12:44,960 --> 02:12:53,480 AND BOTH OF THESE STUDIES DID 3107 02:12:53,480 --> 02:12:55,080 AND NA IS PROBABLY PARTICULARLY 3108 02:12:55,080 --> 02:13:03,040 TRUE FOR THOSE WITH OPIOID USE 3109 02:13:03,040 --> 02:13:05,160 DISORDERS SO WE ARE DOING FOLLOW 3110 02:13:05,160 --> 02:13:06,760 UM TREATMENT TO SEE IF THAT TYPE 3111 02:13:06,760 --> 02:13:08,800 OF INTERVENTION CAN HELP IMPROVE 3112 02:13:08,800 --> 02:13:10,560 OUTCOMES IN THAT GROUP. 3113 02:13:10,560 --> 02:13:15,480 NEXT SLIDE, PLEASE. 3114 02:13:15,480 --> 02:13:17,080 THAT'S IT FOR MY PRESENTATION. 3115 02:13:17,080 --> 02:13:19,120 WE'LL GO AHEAD AND HAND OFF TO 3116 02:13:19,120 --> 02:13:27,720 THE NEXT PRESENTER. 3117 02:13:27,720 --> 02:13:32,480 >> THANK YOU FOR HAVING ME HERE 3118 02:13:32,480 --> 02:13:33,080 TODAY. 3119 02:13:33,080 --> 02:13:40,120 MESH SLIDE, PLEASE. 3120 02:13:40,120 --> 02:13:42,760 I HAVE PREVIOUS RESEARCH BUT NOT 3121 02:13:42,760 --> 02:13:45,320 RELATED TO THIS PRESENTATION. 3122 02:13:45,320 --> 02:13:48,000 WHEN WE THINK ABOUT CHRONIC 3123 02:13:48,000 --> 02:13:50,000 OROFACIAL PAIN YOU THINK ABOUT 3124 02:13:50,000 --> 02:13:52,960 DISORDERS BUT THEY CAN BE 3125 02:13:52,960 --> 02:13:55,320 SUBDIVIDED TO NEURO VASCULAR 3126 02:13:55,320 --> 02:13:58,240 PAIN AND IT'S A TERM EMBRACING A 3127 02:13:58,240 --> 02:14:01,480 GROUP OF MUSCULAR SKILL TAP AND 3128 02:14:01,480 --> 02:14:03,800 JOINT PAIN INFLAMMATORY OR A 3129 02:14:03,800 --> 02:14:05,680 COMBINATION THEY MAY HAVE 3130 02:14:05,680 --> 02:14:16,000 DIFFERENT DIRECTORY. 3131 02:14:28,760 --> 02:14:31,640 THEY LOOKED AT FOUR OTHER PAIN 3132 02:14:31,640 --> 02:14:32,800 CONDITIONS. 3133 02:14:32,800 --> 02:14:35,920 FIBROMYALGIA, LOW BACK PAIN, IBR 3134 02:14:35,920 --> 02:14:37,040 AND HEADACHES. 3135 02:14:37,040 --> 02:14:39,320 YOU SEE THIS IN 2020 AND SHOWING 3136 02:14:39,320 --> 02:14:41,520 IN RED PAINFUL AREAS AND IN BLUE 3137 02:14:41,520 --> 02:14:44,680 AREAS THAT ARE NOT PAINFUL AND 3138 02:14:44,680 --> 02:14:46,520 PATIENT WITH FINAL MYALGIA, LOW 3139 02:14:46,520 --> 02:14:49,360 BACK PAIN, IRB AND HEADACHE AND 3140 02:14:49,360 --> 02:14:51,640 YOU CAN SEE THAT THE RED PAINFUL 3141 02:14:51,640 --> 02:14:55,000 AREAS EXTEND IN THE PATIENT 3142 02:14:55,000 --> 02:14:56,960 BEYOND THE OROFACIAL REGION AND 3143 02:14:56,960 --> 02:14:59,240 THE PATIENT WITHOUT THE CHRONIC 3144 02:14:59,240 --> 02:15:02,280 PAIN CONDITION REPORT PAIN IN 3145 02:15:02,280 --> 02:15:07,960 THE REGIS REGION AS WELL. 3146 02:15:07,960 --> 02:15:11,400 AND NOW THE VERY COMMON PAIN OR 3147 02:15:11,400 --> 02:15:12,960 CHRONIC PAIN THAT WE SEE IN THE 3148 02:15:12,960 --> 02:15:15,360 OR OFFICIAL PAIN CLINICS IS 3149 02:15:15,360 --> 02:15:19,240 PAINFUL POST DRAMATIC NEWER ON 3150 02:15:19,240 --> 02:15:21,200 THEE AND IT'S TO THE OROFACIAL 3151 02:15:21,200 --> 02:15:24,680 REGION AND IT CAN FOLLOW A 3152 02:15:24,680 --> 02:15:27,400 DENTAL PROCEDURE LIKE SURGERY, 3153 02:15:27,400 --> 02:15:28,800 IMPLANTS BUT IN CERTAIN PATIENTS 3154 02:15:28,800 --> 02:15:30,400 IN SOME PATIENTS IT MAY FOLLOW 3155 02:15:30,400 --> 02:15:32,400 WITH DENTAL PROCEDURES SUCH AS 3156 02:15:32,400 --> 02:15:35,880 CROWN PREPARATION, EVEN 3157 02:15:35,880 --> 02:15:37,280 CLEANING, SCALING AND MORE THAN 3158 02:15:37,280 --> 02:15:38,920 ANOTHER CONDITIONS IN THERAPY A 3159 02:15:38,920 --> 02:15:41,560 ROOT CANAL TREATMENT. 3160 02:15:41,560 --> 02:15:46,760 AND IT'S SURPRISING THAT FIVE TO 3161 02:15:46,760 --> 02:15:48,920 SEVEN HAVE SUCCESSFUL ROOT CANAL 3162 02:15:48,920 --> 02:15:53,800 TREATMENT WITH NO COMPLICATION 3163 02:15:53,800 --> 02:15:55,960 AND THIS IS A MILD PAIN AND IT 3164 02:15:55,960 --> 02:15:58,880 MAY LAST SEVERAL YEARS FOLLOWING 3165 02:15:58,880 --> 02:16:01,240 THE COMPLETION. 3166 02:16:01,240 --> 02:16:01,600 NEXT. 3167 02:16:01,600 --> 02:16:03,920 THE GOOD NEWS THAT OVER ALL 3168 02:16:03,920 --> 02:16:06,400 PERSISTENT PAINFUL AND AREAS IS 3169 02:16:06,400 --> 02:16:08,800 SIGNIFICANT LESS COMMON THAN 3170 02:16:08,800 --> 02:16:10,720 PAIN FALLING SPINAL NERVE 3171 02:16:10,720 --> 02:16:11,080 INJURY. 3172 02:16:11,080 --> 02:16:12,880 IT'S GO AHEAD NEWS BECAUSE IT'S 3173 02:16:12,880 --> 02:16:14,240 DENTIST MOST PROCEDURES THAT WE 3174 02:16:14,240 --> 02:16:16,920 DO CAN CAUSE TRAUMA TO THE AREA 3175 02:16:16,920 --> 02:16:21,080 AND THE QUESTION THAT HE WAS 3176 02:16:21,080 --> 02:16:26,680 ASKED, WHY SOME IS MORE 3177 02:16:26,680 --> 02:16:27,760 RESISTANT AND ONE THING WE TALK 3178 02:16:27,760 --> 02:16:30,360 ABOUT IS THE ONLY AREA THAT IS 3179 02:16:30,360 --> 02:16:32,560 PROGRAM FOR THE INNOVATION AND 3180 02:16:32,560 --> 02:16:34,000 ONE SET OF REPLACING THE OTHER 3181 02:16:34,000 --> 02:16:36,280 AND ANOTHER POINT IS RELATED TO 3182 02:16:36,280 --> 02:16:37,200 THE INJURY BARRAGE AND IT'S BEEN 3183 02:16:37,200 --> 02:16:42,240 SHOWN THAT THE INJURY BARRAGE 3184 02:16:42,240 --> 02:16:44,960 INCIDENTS IS MUCH LOWER COMPARED 3185 02:16:44,960 --> 02:16:46,240 TO THE CONSUMPTION AND IN 3186 02:16:46,240 --> 02:16:48,080 ADDITION, MOST OF THE PROCEDURES 3187 02:16:48,080 --> 02:16:55,080 IN THE OFFICE OF THE LOCAL 3188 02:16:55,080 --> 02:16:57,520 ANESTHESIAIA THAT AND IT 3189 02:16:57,520 --> 02:16:59,320 REPORTED THAT THIS SPROUT THAT 3190 02:16:59,320 --> 02:17:02,600 ARE FOUND FOLLOWING NERVE 3191 02:17:02,600 --> 02:17:03,760 INJURIES IS NERVE SECTION ARE 3192 02:17:03,760 --> 02:17:06,480 HARDLY PRESENT OR NOT PRESENT AT 3193 02:17:06,480 --> 02:17:10,800 ALL FOLLOWING THE TRANCE 3194 02:17:10,800 --> 02:17:11,120 SECTION. 3195 02:17:11,120 --> 02:17:15,440 AND A RECENT STUDY FROM OUR 3196 02:17:15,440 --> 02:17:18,040 GROUP, DEMONSTRATED DIFFERENT 3197 02:17:18,040 --> 02:17:22,080 GENE EXPRESSION IN THE DOSAL 3198 02:17:22,080 --> 02:17:23,400 ROOT GANGLION AND THIS IS 3199 02:17:23,400 --> 02:17:25,360 IMPORTANT BECAUSE IF WE SAY THAT 3200 02:17:25,360 --> 02:17:28,520 THE SYSTEM IS MORE RESISTANT TO 3201 02:17:28,520 --> 02:17:30,200 CHRONIC PAIN, FINDING MAY HELP 3202 02:17:30,200 --> 02:17:35,360 AND DOWN THE ROAD EVEN POTENTIAL 3203 02:17:35,360 --> 02:17:35,600 TREATMENT. 3204 02:17:35,600 --> 02:17:37,400 OF COURSE, THE VERY INTERESTING 3205 02:17:37,400 --> 02:17:40,440 QUESTION IS, WHAT IS MAKING SOME 3206 02:17:40,440 --> 02:17:42,040 PATIENTS DEVELOP CHRONIC PAIN 3207 02:17:42,040 --> 02:17:43,640 FOLLOWING INJURY AND SOME TO 3208 02:17:43,640 --> 02:17:46,640 DEVELOP ONLY ACUTE PAIN THAT 3209 02:17:46,640 --> 02:17:46,840 HEALS? 3210 02:17:46,840 --> 02:17:48,720 OF COURSE, IT'S AN IMPORTANT 3211 02:17:48,720 --> 02:17:50,640 ROLE IS GENETICS AND 3212 02:17:50,640 --> 02:17:51,640 PSYCHOLOGICAL FACTORS ARE 3213 02:17:51,640 --> 02:17:52,720 SIGNIFICANT AND WE MENTIONED 3214 02:17:52,720 --> 02:17:54,880 ALREADY THE SYMPATHETIC NERVOUS 3215 02:17:54,880 --> 02:17:56,840 SYSTEM AND INFLAMMATION WE'VE 3216 02:17:56,840 --> 02:17:58,120 ZONE IN STUDIES AND I WOULD LIKE 3217 02:17:58,120 --> 02:18:05,400 TO FOCUS ON THE ROLE OF PAIN 3218 02:18:05,400 --> 02:18:05,720 MODULATION. 3219 02:18:05,720 --> 02:18:11,800 TO TRY TO DEFINE IT IS DIFFICULT 3220 02:18:11,800 --> 02:18:16,000 AND WE WILL SUMMARIZE AND SAY 3221 02:18:16,000 --> 02:18:17,600 THAT THE CENTRAL NERVOUS SYSTEM 3222 02:18:17,600 --> 02:18:20,240 WILL MODULATE PAIN THROUGH EX 3223 02:18:20,240 --> 02:18:26,400 CITATION AND WE CAN TEST IT WITH 3224 02:18:26,400 --> 02:18:36,920 SUMMATION AND IT'S A TEST HOW DO 3225 02:18:42,640 --> 02:18:45,200 WE DO THAT WE APPLY A PAINFUL 3226 02:18:45,200 --> 02:18:46,760 STIMULUS AND REPORT THE 3227 02:18:46,760 --> 02:18:48,960 INTENSITY AS CAN YOU SEE ON THE 3228 02:18:48,960 --> 02:18:59,280 RED BARON THE RIGHT. 3229 02:19:08,080 --> 02:19:09,080 AND SYSTEMS WE WILL NOT SEE THE 3230 02:19:09,080 --> 02:19:11,400 SAME REDUCTION IN PAIN 3231 02:19:11,400 --> 02:19:12,880 SENSITIVITY AND THERE'S ARE A 3232 02:19:12,880 --> 02:19:17,040 LOT OF STUDIES TO SHOW IS THAT 3233 02:19:17,040 --> 02:19:22,600 LESS EFFICIENT THEY ARE ON 3234 02:19:22,600 --> 02:19:24,480 LIMITED TO A NUMBER OF STUDY 3235 02:19:24,480 --> 02:19:27,760 FOCUSES ON THE OROFACIAL REGION. 3236 02:19:27,760 --> 02:19:29,640 IN THAT ALL, WE COMBINED 3237 02:19:29,640 --> 02:19:33,240 SUMMATION AND CTM AND WE USE 30 3238 02:19:33,240 --> 02:19:34,880 REPEATED MECHANICAL STINZIANO 3239 02:19:34,880 --> 02:19:36,160 YOU EYE AND THEN WE SECRETARY 3240 02:19:36,160 --> 02:19:37,520 PATIENT TO REPORT AGAIN 3241 02:19:37,520 --> 02:19:39,480 INTENSITY FOLLOWING THE FIRST 3242 02:19:39,480 --> 02:19:44,240 10, 20 OR 30 STIMULI THAT CAN BE 3243 02:19:44,240 --> 02:19:47,160 DONE OBVIOUSLY WE GET SUMMATION 3244 02:19:47,160 --> 02:19:49,960 AND THE CONTINUING PAIN FALL 3245 02:19:49,960 --> 02:19:51,080 STIMULATION CAN SEE HERE AND 3246 02:19:51,080 --> 02:20:00,600 REDUCE THE PAINENS TENSE TEE AND 3247 02:20:00,600 --> 02:20:02,400 WE TESTED PAIN FOLLOWING ROOT 3248 02:20:02,400 --> 02:20:05,200 CANAL AND THE MOST COMMON DENTAL 3249 02:20:05,200 --> 02:20:10,440 PROCEDURE AND IN BLUE AND WE CAN 3250 02:20:10,440 --> 02:20:17,960 SEE THE PAIN AND MINIMUM PESK O 3251 02:20:17,960 --> 02:20:22,520 AND WE CAN STEL THE STUDY AND 3252 02:20:22,520 --> 02:20:23,960 THE PATIENTS THAT DEVELOPED 3253 02:20:23,960 --> 02:20:26,320 CHRONIC PAIN TO BEGIN WITH AND 3254 02:20:26,320 --> 02:20:27,760 LESS EFFICIENT PAIN POPULATION 3255 02:20:27,760 --> 02:20:29,080 AND WE CAN CONCLUDE THAT SIMILAR 3256 02:20:29,080 --> 02:20:31,040 TO OTHER CHRONIC PAIN CONTINUES, 3257 02:20:31,040 --> 02:20:32,320 PATIENTS SUFFERING FROM CHRONIC 3258 02:20:32,320 --> 02:20:34,640 PAIN FROM A ROOT CANAL HAVE LESS 3259 02:20:34,640 --> 02:20:37,880 SUFFICIENT PAIN MODULATION. 3260 02:20:37,880 --> 02:20:42,880 AND AS I MENTIONED EARLIER, 3261 02:20:42,880 --> 02:20:53,400 EXERCISE IN HOWEVER, IT EFFECT 3262 02:20:56,360 --> 02:20:58,600 IS LIMITED TO THE TIME OF THE 3263 02:20:58,600 --> 02:21:00,320 CONDITIONING PAINFUL STIMULUS 3264 02:21:00,320 --> 02:21:02,600 AND WHILE EXERCISE EFFECT CAN 3265 02:21:02,600 --> 02:21:03,520 LAST BEYOND AND AFTER THE 3266 02:21:03,520 --> 02:21:05,520 EXERCISE ENDED. 3267 02:21:05,520 --> 02:21:07,760 AND IN OTHER STUDIES TO SHOW 3268 02:21:07,760 --> 02:21:09,160 THAT THERE'S NOT A CORRELATION 3269 02:21:09,160 --> 02:21:10,440 BETWEEN THE TWO PATIENTS WOULD 3270 02:21:10,440 --> 02:21:15,440 HAVE EXCELLENT EXERCISE AND NOT 3271 02:21:15,440 --> 02:21:17,000 NECESSARILY HAVE GOOD. 3272 02:21:17,000 --> 02:21:17,200 NEXT. 3273 02:21:17,200 --> 02:21:21,560 HERE IN THIS STUDY, WE USED 3274 02:21:21,560 --> 02:21:23,560 EXERCISE TO COMPARE THE 3275 02:21:23,560 --> 02:21:26,320 INHIBITOR SYSTEM OF PATIENT WITH 3276 02:21:26,320 --> 02:21:28,640 CHRONIC MYALGIA WHICH IS SUBTYPE 3277 02:21:28,640 --> 02:21:30,960 AND THEY CREATED TO PAIN AND 3278 02:21:30,960 --> 02:21:31,800 HEALTHY CONTROLS. 3279 02:21:31,800 --> 02:21:37,320 AND TO ACHIEVE EXERCISE IN 3280 02:21:37,320 --> 02:21:38,520 HYPOAGLESIA THEY 50% OF THE 3281 02:21:38,520 --> 02:21:39,920 MAXIMUM NUMBER OF STEPS THEY CAN 3282 02:21:39,920 --> 02:21:41,840 HAVE IN ONE MINUTE AND SUB 3283 02:21:41,840 --> 02:21:44,120 STUDIES ARE USING MORE INTENSE 3284 02:21:44,120 --> 02:21:46,200 EXERCISES AND WE FOUND THAT MORE 3285 02:21:46,200 --> 02:21:47,880 INTENSE EXERCISE REDUCED THE 3286 02:21:47,880 --> 02:21:49,680 COMPLIANCE OF PATIENT THAT 3287 02:21:49,680 --> 02:21:54,760 ALREADY HAVE CHRONIC PAIN. 3288 02:21:54,760 --> 02:22:05,520 SO SIMILAR TO THE R ROOT CANAL - 3289 02:23:18,200 --> 02:23:19,760 >> WE CAN CONCLUDE FROM THIS 3290 02:23:19,760 --> 02:23:23,680 STUDY THAT PATIENTS HAVE LESS 3291 02:23:23,680 --> 02:23:25,240 EFFICIENT PAIN AND EXERCISE AND 3292 02:23:25,240 --> 02:23:26,320 HOWEVER THEY HAVE A DELAYED 3293 02:23:26,320 --> 02:23:29,840 RESPONSE AND THE RESPONSE IS 3294 02:23:29,840 --> 02:23:31,520 STILL EXISTING WE CAN USE THE 3295 02:23:31,520 --> 02:23:35,360 TREATMENT IN THE FUTURE. 3296 02:23:35,360 --> 02:23:37,200 NEXT, PLEASE. 3297 02:23:37,200 --> 02:23:39,320 TO FURTHER STUDY EXERCISE AND WE 3298 02:23:39,320 --> 02:23:41,400 WILL ANIMAL MODEL WHERE WE 3299 02:23:41,400 --> 02:23:45,000 TESTED RODENTS SENSITIVITY TO 3300 02:23:45,000 --> 02:23:45,720 MECHANICAL STIMULATION BEFORE 3301 02:23:45,720 --> 02:23:47,080 AND AFTER THREE MINUTES ON A 3302 02:23:47,080 --> 02:23:51,720 ROTATING ROLL AND YOU CAN SEE ON 3303 02:23:51,720 --> 02:24:02,320 THE DRAFT, SOME DEVELOP SIGNIFIT 3304 02:24:06,240 --> 02:24:08,560 AND SOME WERE MEANINGFUL AND 3305 02:24:08,560 --> 02:24:11,720 THEY HAD MORE THAN 70% REDUCTION 3306 02:24:11,720 --> 02:24:14,280 IN AT LEAST THREE REPEATED TESTS 3307 02:24:14,280 --> 02:24:15,960 AND THEY HAVE VERY MINOR ARE 3308 02:24:15,960 --> 02:24:18,080 LOWER THAN 30% REDUCTION IN AT 3309 02:24:18,080 --> 02:24:21,880 LEAST REPEATED TESTS AND THOSE 3310 02:24:21,880 --> 02:24:23,000 ARE THE SIGNIFICANT RATES THAT 3311 02:24:23,000 --> 02:24:27,000 WE CONCEDED AND BY EXERCISING 3312 02:24:27,000 --> 02:24:29,640 AND THOSE WITH MINUTE YUM AS LOW 3313 02:24:29,640 --> 02:24:36,360 THAT HAVE LESS SUFFICIENT. 3314 02:24:36,360 --> 02:24:37,040 NEXT. 3315 02:24:37,040 --> 02:24:39,480 LOW AND HIGH IN PAIN POPULATION 3316 02:24:39,480 --> 02:24:44,080 AND THE SIGH ATTIC AND TO 3317 02:24:44,080 --> 02:24:49,520 SUMMARIZE THE RESULTS, LOW RATES 3318 02:24:49,520 --> 02:24:51,680 DEVELOP SIGNIFICANTLY MORE 3319 02:24:51,680 --> 02:24:53,840 PAINFUL NERVE INJURY AND THAT 3320 02:24:53,840 --> 02:24:55,320 MEANS LOW LESS PAIN AND DEVELOP 3321 02:24:55,320 --> 02:24:56,040 MORE PAIN. 3322 02:24:56,040 --> 02:25:00,000 IN ADDICTION, LOW EIH RATS 3323 02:25:00,000 --> 02:25:02,200 DEVELOPED PAIN IN THE CONTRA 3324 02:25:02,200 --> 02:25:03,440 LATERAL UNEFFECTED NERVE 3325 02:25:03,440 --> 02:25:05,240 TERRITORY BUT THAT WAS ONLY FOR 3326 02:25:05,240 --> 02:25:09,800 SIGH ATTIC NERVE INJURY AND NOT 3327 02:25:09,800 --> 02:25:20,160 THE, AND RELATION TO. 3328 02:25:26,920 --> 02:25:31,120 WE FOUND THE MIRROR IMAGE IN 3329 02:25:31,120 --> 02:25:32,720 HIGH EIH RATS ONLY IN THE 3330 02:25:32,720 --> 02:25:34,720 SCIATIC NERVE THIS IS ANOTHER 3331 02:25:34,720 --> 02:25:36,880 EXAMPLE OF THE SYSTEM RELATIVE 3332 02:25:36,880 --> 02:25:38,760 RESISTANCE TO CHRONIC PAIN 3333 02:25:38,760 --> 02:25:39,560 FOLLOWING INJURY. 3334 02:25:39,560 --> 02:25:40,720 AND NEXT SLIDE. 3335 02:25:40,720 --> 02:25:42,840 I THINK TO RESPECT THE TIME 3336 02:25:42,840 --> 02:25:46,080 WE'LL SKIP THIS ONE. 3337 02:25:46,080 --> 02:25:48,800 SKIP THIS SLIDE. 3338 02:25:48,800 --> 02:25:50,320 ONE OF THE PROBLEMS WE HAVE IN 3339 02:25:50,320 --> 02:25:53,160 THE OWE OFFICIAL PAIN CLINICS IN 3340 02:25:53,160 --> 02:25:55,480 AND AND OUR TREATMENT IS TRIAL 3341 02:25:55,480 --> 02:26:05,640 AND ERROR. 3342 02:26:07,520 --> 02:26:09,480 PATIENTS WILL BENEFIT MORE FROM 3343 02:26:09,480 --> 02:26:11,080 TREATMENT AND SO WHAT WE DID IS 3344 02:26:11,080 --> 02:26:13,920 WE TREATED LOW AND HIGH EIH RATS 3345 02:26:13,920 --> 02:26:17,120 STRONG AND WEAK PAIN SYSTEMS AND 3346 02:26:17,120 --> 02:26:19,840 WITH A RANGE OF MEDICATION THAT 3347 02:26:19,840 --> 02:26:22,720 ARE USED IN THE PAIN CLINIC AND 3348 02:26:22,720 --> 02:26:28,360 WE DID IT AFTER FOLLOWING RAIN 3349 02:26:28,360 --> 02:26:36,960 -- TO SUMMARIZETHE FINDING WE D 3350 02:26:36,960 --> 02:26:38,600 LESS SUFFICIENT PAIN RELATED 3351 02:26:38,600 --> 02:26:43,280 SYSTEM THEY HAD BENEFITED MORE 3352 02:26:43,280 --> 02:26:45,120 FROM -- NEXT LIED, PLEASE. 3353 02:26:45,120 --> 02:26:47,040 SO THE NEXT QUESTION THAT WE HAD 3354 02:26:47,040 --> 02:26:49,120 WAS TO ASK OURSELVES, ARE THOSE 3355 02:26:49,120 --> 02:26:50,160 MEDICATIONS THAT ARE 3356 02:26:50,160 --> 02:26:51,200 SPECIFICALLY BETTER WITH 3357 02:26:51,200 --> 02:26:53,440 PATIENTS AND THE REST THAT IT 3358 02:26:53,440 --> 02:26:55,440 HAS LESS EFFICIENT PAIN, DO 3359 02:26:55,440 --> 02:26:57,960 SOMETHING TO THEIR CLAIM OF 3360 02:26:57,960 --> 02:26:58,280 RELATION -- 3361 02:26:58,280 --> 02:26:59,000 >> A MINUTE WARNING. 3362 02:26:59,000 --> 02:27:01,760 >> WE GAVE THOSE MEDICATIONS TO 3363 02:27:01,760 --> 02:27:04,080 THE RATS TO LOW AND HIGH EIH 3364 02:27:04,080 --> 02:27:07,240 RATS AND WE FOUND THAT FOUR DAYS 3365 02:27:07,240 --> 02:27:09,680 OF TREATMENT TURNS FORM 70% OF 3366 02:27:09,680 --> 02:27:12,600 THE LOW RATS THAT HAD LOW PAIN 3367 02:27:12,600 --> 02:27:15,400 AND LOW EXERCISE INTO HIGH OR 3368 02:27:15,400 --> 02:27:17,080 MEDIUM AND IT IMPROVES THAT PAIN 3369 02:27:17,080 --> 02:27:18,640 OF RELATION SYSTEM AND THIS MAY 3370 02:27:18,640 --> 02:27:21,880 HAVE A CLINICAL RELEVANCE. 3371 02:27:21,880 --> 02:27:22,720 NEXT, PLEASE. 3372 02:27:22,720 --> 02:27:25,120 MODEL THAT WAS DEVELOPED BY 3373 02:27:25,120 --> 02:27:27,560 DAVID SUGGESTED THAT PATIENTS 3374 02:27:27,560 --> 02:27:28,160 WITH LESS EFFICIENT PAIN OF 3375 02:27:28,160 --> 02:27:30,320 RELATION RED IN THIS SLIDE AND 3376 02:27:30,320 --> 02:27:34,560 ARE AT HIGH-RISK OF DEVELOPING 3377 02:27:34,560 --> 02:27:38,360 CHRONIC PAIN AND BLUE IS REDUCED 3378 02:27:38,360 --> 02:27:41,240 RATES OF CHRONIC PAIN SO IF 3379 02:27:41,240 --> 02:27:44,920 PATIENTS ARE HAVING INJURY IN 3380 02:27:44,920 --> 02:27:55,480 RED THEY WILL DEVELOP PERSISTENT 3381 02:27:57,280 --> 02:27:57,680 PAIN. 3382 02:27:57,680 --> 02:27:58,720 >> YOU ARE MUTED. 3383 02:27:58,720 --> 02:28:03,960 >> YOU HAVE MUTED YOURSELF. 3384 02:28:03,960 --> 02:28:07,440 HOW DID I DO THAT? 3385 02:28:07,440 --> 02:28:08,160 NEXT, PLEASE. 3386 02:28:08,160 --> 02:28:10,560 SO IF A PATIENT IS IN THE RED 3387 02:28:10,560 --> 02:28:12,240 AREA, AND HE IS A PIE RISK OR 3388 02:28:12,240 --> 02:28:13,960 SHE IS AT HIGH-RISK TO DEVELOP 3389 02:28:13,960 --> 02:28:17,800 CHRONIC PAIN IF WE CAN IMPROVE 3390 02:28:17,800 --> 02:28:21,000 BY THEY WERE PEE AND OR EXERCISE 3391 02:28:21,000 --> 02:28:22,880 PROTOCOL, THE HOPE IS THAT THOSE 3392 02:28:22,880 --> 02:28:24,800 PATIENTS WILL DEVELOP ACUTE PAIN 3393 02:28:24,800 --> 02:28:29,600 BUT NOT A PERSIST APARTMENT PAI. 3394 02:28:29,600 --> 02:28:31,880 TO SUMMARIZE WE CAN SAY THAT 3395 02:28:31,880 --> 02:28:34,160 CHRONIC OR OFFICIAL PAIN ARE 3396 02:28:34,160 --> 02:28:36,520 COMMON AND OPEN LAP WITH OTHER 3397 02:28:36,520 --> 02:28:37,680 PAIN AND THE GENERAL SYSTEM IS 3398 02:28:37,680 --> 02:28:39,560 MORE RESISTANT TO PAIN FOLLOWING 3399 02:28:39,560 --> 02:28:41,280 INJURY AND INEFFICIENT PAIN 3400 02:28:41,280 --> 02:28:42,960 MODULATION SYSTEM IS ASSOCIATED 3401 02:28:42,960 --> 02:28:46,560 WITH CHRONIC PAIN AND IT MAY 3402 02:28:46,560 --> 02:28:47,880 IMPROVE THE PAIN POPULATION 3403 02:28:47,880 --> 02:28:50,360 SYSTEM. 3404 02:28:50,360 --> 02:28:50,800 THANK YOU, VERY MUCH. 3405 02:28:50,800 --> 02:28:54,760 >> THANK YOU. 3406 02:28:54,760 --> 02:28:56,040 I BELIEVE WE ARE NOW GOING TO 3407 02:28:56,040 --> 02:28:58,480 MOVE TO THE Q&A SESSION FOR THIS 3408 02:28:58,480 --> 02:29:04,480 FIRST PANEL. 3409 02:29:04,480 --> 02:29:05,960 THANK YOU WHO SUBMITTED 3410 02:29:05,960 --> 02:29:06,240 QUESTIONS. 3411 02:29:06,240 --> 02:29:07,840 I HAVE ONE FOR EVERYBODY. 3412 02:29:07,840 --> 02:29:09,240 AND THEN WE'LL SEE HOW WE'RE 3413 02:29:09,240 --> 02:29:12,720 DOING ON TIME. 3414 02:29:12,720 --> 02:29:15,720 SO, Dr. KOEHLOMOOS. 3415 02:29:15,720 --> 02:29:18,160 PAIN WITH MILITARY MEMBERS WITH 3416 02:29:18,160 --> 02:29:19,760 POLYTRAUMA YOU DESCRIBED, IT 3417 02:29:19,760 --> 02:29:22,160 APPEARS YOU ARE USING CBT OR 3418 02:29:22,160 --> 02:29:24,520 MINDFUL LESS FOR THERAPY, HAS 3419 02:29:24,520 --> 02:29:25,760 ANYONE ALREADY USED ACT 3420 02:29:25,760 --> 02:29:26,720 ACCEPTANCE AND COMMITMENT 3421 02:29:26,720 --> 02:29:28,560 THERAPY AS PART OF THE CARE 3422 02:29:28,560 --> 02:29:28,840 PLAN? 3423 02:29:28,840 --> 02:29:29,400 >> GREAT. 3424 02:29:29,400 --> 02:29:30,680 THANK YOU FOR ASKING THAT 3425 02:29:30,680 --> 02:29:30,960 QUESTION. 3426 02:29:30,960 --> 02:29:32,120 I WAS ACTUALLY HOPING THAT WE 3427 02:29:32,120 --> 02:29:33,640 WOULD GET TO TALK A LITTLE BIT 3428 02:29:33,640 --> 02:29:41,880 ABOUT THE OR I ORLICULA AR ACUPO 3429 02:29:41,880 --> 02:29:43,800 I WRITE THE ANONYMOUS POSTER OF 3430 02:29:43,800 --> 02:29:44,960 THOSE QUESTIONS TO KNOW I'M 3431 02:29:44,960 --> 02:29:48,480 HAPPY TO ADDRESS THAT LATER. 3432 02:29:48,480 --> 02:29:51,720 I AM LESS CLEAR ON THE 3433 02:29:51,720 --> 02:29:53,240 INTERVENTION THAT YOU MENTIONED. 3434 02:29:53,240 --> 02:29:54,400 IT MIGHT BE BEING TESTED. 3435 02:29:54,400 --> 02:29:57,800 WE DO A LOT OF EXPERIMENTATION. 3436 02:29:57,800 --> 02:29:58,920 CLINICAL TRIALS OF DIFFERENT 3437 02:29:58,920 --> 02:30:00,920 METHODS BOTH FUNDED BY THE DOD 3438 02:30:00,920 --> 02:30:03,400 AND ALSO IN PARTNERSHIP WITH THE 3439 02:30:03,400 --> 02:30:06,160 V.A. 3440 02:30:06,160 --> 02:30:07,680 SO I'M NOT AWARE OF ANY TRIALS 3441 02:30:07,680 --> 02:30:09,800 OF THAT BUT I WOULDN'T BE 3442 02:30:09,800 --> 02:30:10,280 SURPRISED. 3443 02:30:10,280 --> 02:30:11,240 THERE'S A LOT OF DIFFERENT -- 3444 02:30:11,240 --> 02:30:12,800 FOR ANY OF YOU, FOR THOSE OF YOU 3445 02:30:12,800 --> 02:30:14,920 WHO ARE ON THE CALL, IF YOU ARE 3446 02:30:14,920 --> 02:30:15,880 RESEARCHERS, YOU KNOW, IF YOU 3447 02:30:15,880 --> 02:30:17,320 DON'T KNOW THIS, I KNOW THAT 3448 02:30:17,320 --> 02:30:23,440 MOST YOU LOOK TO THE NIH FOR 3449 02:30:23,440 --> 02:30:25,600 FUNDING BUT YOU MIGHT LOOK TO 3450 02:30:25,600 --> 02:30:36,080 CDMRP THE CONGRESSIONAL AND 3451 02:30:36,640 --> 02:30:38,960 MEDICAL RESEARCH AND MATERIALS 3452 02:30:38,960 --> 02:30:39,360 MRMC. 3453 02:30:39,360 --> 02:30:41,400 WRITE TO ME AND I'LL LET YOU 3454 02:30:41,400 --> 02:30:41,600 KNOW. 3455 02:30:41,600 --> 02:30:43,400 WE HAVE FUNDING FOR A LOT OF 3456 02:30:43,400 --> 02:30:44,280 THESE DIFFERENT THINGS. 3457 02:30:44,280 --> 02:30:45,960 YOU DON'T NECESSARILY HAVE TO DO 3458 02:30:45,960 --> 02:30:48,000 YOUR WORK ON A MILITARY 3459 02:30:48,000 --> 02:30:49,520 POPULATION, ALTHOUGH IT'S NICE. 3460 02:30:49,520 --> 02:30:53,280 BUT DO LET ME USE THIS AS AN 3461 02:30:53,280 --> 02:30:54,600 OPPORTUNITY TO ATTRACT MORE 3462 02:30:54,600 --> 02:30:55,680 TALENT TO ISSUES THAT ARE 3463 02:30:55,680 --> 02:30:58,280 IMPORTANT TO THE DOD LIKE WHOLE 3464 02:30:58,280 --> 02:30:59,520 PERSON HEALTH AND PAIN 3465 02:30:59,520 --> 02:31:00,800 MANAGEMENT AND DIFFERENT 3466 02:31:00,800 --> 02:31:03,000 INTERVENTIONS FOR BEHAVIORAL 3467 02:31:03,000 --> 02:31:04,240 HEALTH DISORDERS SO THANK YOU. 3468 02:31:04,240 --> 02:31:07,240 >> THANK YOU. 3469 02:31:07,240 --> 02:31:08,080 Dr. SAWSAN AS-SANIE. 3470 02:31:08,080 --> 02:31:09,720 WHAT ARE SOME CAUSES FOR 3471 02:31:09,720 --> 02:31:11,320 SYSTEMATIC OR SYSTEMIC 3472 02:31:11,320 --> 02:31:13,360 INFLAMMATION IN THE CONTEXT OF 3473 02:31:13,360 --> 02:31:16,000 ENDOMETRIOSIS OR CHRONIC PELVIC 3474 02:31:16,000 --> 02:31:16,280 PAIN? 3475 02:31:16,280 --> 02:31:18,040 THERE WAS ANOTHER QUESTION ABOUT 3476 02:31:18,040 --> 02:31:20,160 INVOLVEMENT OF A PATHOGENIC 3477 02:31:20,160 --> 02:31:20,680 MICROBIOME? 3478 02:31:20,680 --> 02:31:22,120 IS THERE ANYTHING CAN YOU SAY 3479 02:31:22,120 --> 02:31:24,200 ABOUT THAT AND FOR A GIVEN 3480 02:31:24,200 --> 02:31:25,440 PATIENT, IS THERE A SIMPLE WAY 3481 02:31:25,440 --> 02:31:29,560 TO TELL IF THE PAIN IS 3482 02:31:29,560 --> 02:31:30,120 NOCIPLASTIC. 3483 02:31:30,120 --> 02:31:31,800 >> THOSE ARE ALL EXCELLENT 3484 02:31:31,800 --> 02:31:33,560 QUESTIONS AND IN TERMS OF 3485 02:31:33,560 --> 02:31:35,000 SYSTEMIC INFLAMMATION THERE'S 3486 02:31:35,000 --> 02:31:36,400 ACTUALLY NOT A TREMENDOUS AMOUNT 3487 02:31:36,400 --> 02:31:37,800 OF WORK THAT HAS BEEN DONE IN 3488 02:31:37,800 --> 02:31:39,400 THAT AREA OF ENDOMETRIOSIS. 3489 02:31:39,400 --> 02:31:43,720 MOST OF WHAT WE KNOW IS THAT A 3490 02:31:43,720 --> 02:31:45,440 VERY STRONG LOCAL LEVELS OF 3491 02:31:45,440 --> 02:31:47,240 LOCAL PELVIC INFLAMMATION AND 3492 02:31:47,240 --> 02:31:49,000 THERE'S SOME DATA THAT SUGGESTS 3493 02:31:49,000 --> 02:31:51,480 THIS EXTENDS TO A SYSTEMIC LEVEL 3494 02:31:51,480 --> 02:31:53,160 BUT THE AMOUNT OF BODY OF 3495 02:31:53,160 --> 02:31:55,200 EVIDENCE IN THAT IS A BIT MORE 3496 02:31:55,200 --> 02:31:59,320 LIMITED AND THE RELATIONSHIP 3497 02:31:59,320 --> 02:32:00,760 BETWEEN THE INFORMATION IS 3498 02:32:00,760 --> 02:32:03,320 COMPLETELY UNKNOWN. 3499 02:32:03,320 --> 02:32:04,520 WITH REGARDS -- I'M SORRY, THERE 3500 02:32:04,520 --> 02:32:05,400 WERE THREE QUESTIONS. 3501 02:32:05,400 --> 02:32:08,000 I FORGOT ALREADY THE SECOND ONE. 3502 02:32:08,000 --> 02:32:10,160 >> PATHOGENIC MICROBIOME. 3503 02:32:10,160 --> 02:32:12,120 >> AND YES, THERE'S VERY EARLY 3504 02:32:12,120 --> 02:32:15,880 WORK LOOKING AT PATHOGENIC 3505 02:32:15,880 --> 02:32:18,960 MICROBIOME BUT AGAIN, YOU KNOW, 3506 02:32:18,960 --> 02:32:19,880 ITS RELATIONSHIP BETWEEN THESE 3507 02:32:19,880 --> 02:32:24,000 OTHER FACTORS STILL REMAINS 3508 02:32:24,000 --> 02:32:27,680 UNKNOWN AND SO IT'S WHERE WE ARE 3509 02:32:27,680 --> 02:32:29,720 WITH RESEARCH AND REALLY JUST 3510 02:32:29,720 --> 02:32:32,240 VERY SMALL MICROSCOPES IN 3511 02:32:32,240 --> 02:32:33,800 DIFFERENT, YOU KNOW, AREAS OF 3512 02:32:33,800 --> 02:32:36,000 DISEASE BUT NONE OF REALLY BEEN 3513 02:32:36,000 --> 02:32:36,680 INTERCONNECTED YET. 3514 02:32:36,680 --> 02:32:39,640 AND THEN THE THIRD QUESTION WAS, 3515 02:32:39,640 --> 02:32:42,920 HOW DO WE MEASURE NOCIPLASTIC 3516 02:32:42,920 --> 02:32:44,680 PAIN AND I WOULD SAY WHILE 3517 02:32:44,680 --> 02:32:45,800 THERE'S A LOT OF REALLY 3518 02:32:45,800 --> 02:32:47,200 EXCELLENT WORK THAT HAVE BEEN 3519 02:32:47,200 --> 02:32:49,240 SCRUBBED BY ALL OF THESE 3520 02:32:49,240 --> 02:32:50,440 INVESTIGATORS, ON WAYS TO 3521 02:32:50,440 --> 02:32:53,080 MEASURE IT IN THE LAB WHEN WE 3522 02:32:53,080 --> 02:32:55,040 ARE THINKING ABOUT IT CLINICALLY 3523 02:32:55,040 --> 02:32:57,520 THEY'RE REALLY AREN'T 3524 02:32:57,520 --> 02:32:59,080 STANDARDIZED WAYS OF PROBABLY I 3525 02:32:59,080 --> 02:33:01,680 WOULD SAY THE BEST WAY BASED ON 3526 02:33:01,680 --> 02:33:03,920 WHAT I HAVE LEARNED IF MY MEN 3527 02:33:03,920 --> 02:33:07,480 STORES IS LOOKING AT A BODY MAP 3528 02:33:07,480 --> 02:33:09,720 AND TRYING TO UNDERSTAND FROM A 3529 02:33:09,720 --> 02:33:10,320 PATIENT WHAT ARE THE OTHER 3530 02:33:10,320 --> 02:33:12,120 REGIONS IN THE BODY THAT THEY'VE 3531 02:33:12,120 --> 02:33:16,200 EXPERIENCED PAIN AND THAT SAY 3532 02:33:16,200 --> 02:33:18,040 PRETTY GOOD ROUGH ESTIMATE OF 3533 02:33:18,040 --> 02:33:21,440 WHERE THEY ARE IN THAT SCALE. 3534 02:33:21,440 --> 02:33:22,520 >> THANK YOU. 3535 02:33:22,520 --> 02:33:25,440 DO ANY OF THE OTHER PANELISTS 3536 02:33:25,440 --> 02:33:25,920 WANT TO CHIME IN. 3537 02:33:25,920 --> 02:33:30,720 A WAY TO TELL DIFFERENT TYPES OF 3538 02:33:30,720 --> 02:33:31,320 CHRONIC PAIN? 3539 02:33:31,320 --> 02:33:36,320 >> ANY OTHER VIEWPOINTS. 3540 02:33:36,320 --> 02:33:38,520 I'LL MOVE ON TO THE NEXT 3541 02:33:38,520 --> 02:33:39,120 QUESTION. 3542 02:33:39,120 --> 02:33:41,720 Dr. FINAN, HAVE YOU STUDIED AN 3543 02:33:41,720 --> 02:33:43,440 ASSOCIATION OF PAIN AND SLEEP 3544 02:33:43,440 --> 02:33:45,160 LOSS WITH COUPLES WHO HAVE YOUNG 3545 02:33:45,160 --> 02:33:48,280 CHILDREN OR BABIES THAT LEAD TO 3546 02:33:48,280 --> 02:33:52,240 SLEEP REDUCTION AND I'M ASKING 3547 02:33:52,240 --> 02:33:53,080 PERSONALLY. 3548 02:33:53,080 --> 02:33:56,000 DO POSTPARTUM CHANGES SEX 3549 02:33:56,000 --> 02:33:58,040 DIFFERENCES BETWEEN MALES AND 3550 02:33:58,040 --> 02:34:00,040 FEMALES AND IF SO DOES THIS SEX 3551 02:34:00,040 --> 02:34:03,800 DIFFERENCE NEUTRALIZE OR GO BACK 3552 02:34:03,800 --> 02:34:05,440 TO NO SIGNIFICANT DIFFERENCES 3553 02:34:05,440 --> 02:34:07,440 AFTER A CERTAIN AMOUNT OF TIME? 3554 02:34:07,440 --> 02:34:13,440 >> YEAH, SO, THAT'S A GREAT Q 3555 02:34:13,440 --> 02:34:17,960 THE MODEL THAT WE USE 3556 02:34:17,960 --> 02:34:20,680 EXPERIMENTALLY, ONE OF THE 3557 02:34:20,680 --> 02:34:23,400 REASONS WE LOOK AT THIS FORCED 3558 02:34:23,400 --> 02:34:26,840 NOCTURNAL AWAKENINGS PARADIGM IS 3559 02:34:26,840 --> 02:34:33,280 BECAUSE REPEATED A -- AWAKENNES 3560 02:34:33,280 --> 02:34:34,440 IS A HALLMARK OF SLEEP 3561 02:34:34,440 --> 02:34:36,280 MAINTENANCE INSOMNIA IN PATIENTS 3562 02:34:36,280 --> 02:34:38,080 WITH CHRONIC PAIN WHO MAY BE 3563 02:34:38,080 --> 02:34:39,240 AWAKENED THROUGHOUT THE NIGHT 3564 02:34:39,240 --> 02:34:41,160 BUT THEIR PAIN. 3565 02:34:41,160 --> 02:34:44,040 IN THE EXPERIMENTAL CONTEXT, 3566 02:34:44,040 --> 02:34:46,440 IT'S REALLY A GOOD BIT MORE 3567 02:34:46,440 --> 02:34:50,440 SEVERE FROM AN AWAKENING 3568 02:34:50,440 --> 02:34:51,840 STANDPOINT THAN PEOPLE WITH 3569 02:34:51,840 --> 02:34:57,360 INCOM SOMNIA EXPERIENCE. 3570 02:34:57,360 --> 02:34:59,600 IT'S OUR ABILITY TO KIND OF 3571 02:34:59,600 --> 02:35:00,400 GENERALIZE THE CLINICAL 3572 02:35:00,400 --> 02:35:02,160 POPULATIONS WITH ONE EXCEPTION, 3573 02:35:02,160 --> 02:35:05,200 AND THAT IS HAVING A BABY IN THE 3574 02:35:05,200 --> 02:35:07,680 HOUSE, PARTICULARLY IF YOU ARE A 3575 02:35:07,680 --> 02:35:09,200 MOTHER, OR FATHER WHO IS DOING 3576 02:35:09,200 --> 02:35:11,360 MIDDLE OF NIGHT CARE. 3577 02:35:11,360 --> 02:35:13,800 SO, I'VE GOT A COUPLE YOUNG KIDS 3578 02:35:13,800 --> 02:35:15,440 NOW AND SO I RECENTLY WENT 3579 02:35:15,440 --> 02:35:17,840 THROUGH ALL OF THAT AND CAN SAY 3580 02:35:17,840 --> 02:35:21,840 FOR SURE THAT OUR FORCED 3581 02:35:21,840 --> 02:35:23,120 AWAKENINGS PARADIGM IS SIMILAR 3582 02:35:23,120 --> 02:35:24,600 SO LOTS OF PEOPLE UNTIL THE REAL 3583 02:35:24,600 --> 02:35:26,200 WORLD GO THROUGH EXTENDED 3584 02:35:26,200 --> 02:35:27,640 PERIODS THAT ARE CONSIDER THEY 3585 02:35:27,640 --> 02:35:28,960 EXPERIENCE SIMILAR THINGS THAT 3586 02:35:28,960 --> 02:35:31,040 WE ARE DOING IN THE LAB. 3587 02:35:31,040 --> 02:35:34,640 WHEN WE LOOK AT THE DATA, WE 3588 02:35:34,640 --> 02:35:37,480 HAVE RECENTLY PUBLISHED SOME SEX 3589 02:35:37,480 --> 02:35:40,160 DIFFERENCES IN RESPONSE TO THE 3590 02:35:40,160 --> 02:35:42,160 FORCED AWAKENINGS PARADIGM AND 3591 02:35:42,160 --> 02:35:44,240 ONE THAT WAS PARTICULARLY 3592 02:35:44,240 --> 02:35:51,120 INTERESTING TO US WAS THAT 3593 02:35:51,120 --> 02:35:52,040 FEMALES WERE ABLE TO -- THEY 3594 02:35:52,040 --> 02:35:55,320 WERE MORE RESILIENT IN TERMS OF 3595 02:35:55,320 --> 02:35:57,320 THEIR STAGE N3 SLEEP. 3596 02:35:57,320 --> 02:35:58,560 THEIR SLOW WAVE SLEEP FOLLOWING 3597 02:35:58,560 --> 02:36:01,160 THE FORCED AWAKENINGS PARADIGM 3598 02:36:01,160 --> 02:36:04,520 AND IT'S SOMETHING THAT'S 3599 02:36:04,520 --> 02:36:07,000 DIFFICULT TO LOOK AT IN MANY 3600 02:36:07,000 --> 02:36:09,720 SLEEP DEPRIVATION PARADIGMS 3601 02:36:09,720 --> 02:36:11,560 PARTICULARLY TOTAL SLEEP 3602 02:36:11,560 --> 02:36:12,440 DEPRIVATION BECAUSE YOU DON'T 3603 02:36:12,440 --> 02:36:13,560 HAVE THE OPPORTUNITY TO SEE IN 3604 02:36:13,560 --> 02:36:15,720 THE COURSE OF THIS KIND OF SLEEP 3605 02:36:15,720 --> 02:36:17,080 DISTURBANCE, WHAT IS HAPPENING 3606 02:36:17,080 --> 02:36:18,680 IN YOUR SLEEP. 3607 02:36:18,680 --> 02:36:22,320 THEY'RE SLEEP DOUGH, WE ALLOW 3608 02:36:22,320 --> 02:36:24,000 PEOPLE TO FALL ASLEEP, WE WAKE 3609 02:36:24,000 --> 02:36:26,920 THEM UP, ALLOW THEM TO FALL BACK 3610 02:36:26,920 --> 02:36:30,960 ASLEEP OVER EIGHT HOURS SO WE 3611 02:36:30,960 --> 02:36:31,760 ESSENTIALLY DEPRIVE THEM OF FOUR 3612 02:36:31,760 --> 02:36:33,120 HOURS OF SLEEP AND WE CAN SEE 3613 02:36:33,120 --> 02:36:35,200 WHAT IS GOING ON AND IN TERMS OF 3614 02:36:35,200 --> 02:36:37,240 THEIR SLEEP EEG IN THE INTERIM 3615 02:36:37,240 --> 02:36:40,280 AND WE SAW THAT FEMALES WERE 3616 02:36:40,280 --> 02:36:42,120 BETTER ABLE TO PRESERVE SLOW 3617 02:36:42,120 --> 02:36:47,880 WAVE SLEEP FOLLOWING A SLEEP 3618 02:36:47,880 --> 02:36:48,080 LOSS. 3619 02:36:48,080 --> 02:36:50,120 WE HAVEN'T FOLLOWED UP IN TERMS 3620 02:36:50,120 --> 02:36:52,520 OF PAIN BUT IT'S A INITIAL 3621 02:36:52,520 --> 02:36:54,080 FOLLOWING WE CAN GO OFF. 3622 02:36:54,080 --> 02:36:56,680 >> VERY INTERESTING. 3623 02:36:56,680 --> 02:36:59,360 Dr. ILGEN, HAVE YOU EXAMINED 3624 02:36:59,360 --> 02:37:00,520 MODERATORS OF TREATMENT EFFICACY 3625 02:37:00,520 --> 02:37:03,400 IN YOUR CBT TRIAL? 3626 02:37:03,400 --> 02:37:04,840 PATIENT CHERER PHYSICS SUCH AS 3627 02:37:04,840 --> 02:37:15,120 SEX DIFFERENCES? 3628 02:37:17,280 --> 02:37:20,640 >> THEY LOOKED SOMEWHAT SIMILAR 3629 02:37:20,640 --> 02:37:25,280 BUT WEAKER WHEN SPLIT OUT BY 3630 02:37:25,280 --> 02:37:30,080 GENDER AND THEN, OUR BY SEX AND 3631 02:37:30,080 --> 02:37:32,480 THAT WE REALLY DIDN'T SEE AN 3632 02:37:32,480 --> 02:37:34,080 EMERGING PATTERN OF RESULTS THAT 3633 02:37:34,080 --> 02:37:38,240 WAS ALL THAT COMPELLING AND OUR 3634 02:37:38,240 --> 02:37:40,160 MAIN OUTCOME PAPER PRESENTED IT 3635 02:37:40,160 --> 02:37:41,720 SEPARATELY IN MEN AND WOMEN FOR 3636 02:37:41,720 --> 02:37:45,720 THE PRESENTATION TODAY. 3637 02:37:45,720 --> 02:37:46,360 I GROUPED EVERYONE TOGETHER. 3638 02:37:46,360 --> 02:37:47,840 WE'VE LOOKED AT A NUMBER OF 3639 02:37:47,840 --> 02:37:52,240 DIFFERENT MODERATORS AND MY 3640 02:37:52,240 --> 02:37:54,600 SENSE IS THAT THE DRIVERS OF 3641 02:37:54,600 --> 02:37:56,280 CLINICAL OUTCOMES IN THIS GROUP 3642 02:37:56,280 --> 02:37:58,880 HAVE A LOT TO DO WITH HOW PEOPLE 3643 02:37:58,880 --> 02:38:02,040 LEAVE RESIDENTIAL TREATMENT AND 3644 02:38:02,040 --> 02:38:03,520 MORE THAN HOW THEY LOOK WHEN 3645 02:38:03,520 --> 02:38:04,720 THEY SHOW UP AT TREATMENT. 3646 02:38:04,720 --> 02:38:06,520 THERE IS OBVIOUSLY RELATIONSHIP 3647 02:38:06,520 --> 02:38:08,480 THERE AND THAT SOMEONE IS 3648 02:38:08,480 --> 02:38:14,280 BASELINE CHARRER ADVE CHARACTERF 3649 02:38:14,280 --> 02:38:16,440 THEY LEAVE AND GO TO JAIL AND GO 3650 02:38:16,440 --> 02:38:21,920 IN THTHEY'RE HOMELESS, THEY HAVA 3651 02:38:21,920 --> 02:38:22,760 DIFFERENT COURSE THAN PEOPLE 3652 02:38:22,760 --> 02:38:26,240 THAT LEAVE AND GO TO A STABLE 3653 02:38:26,240 --> 02:38:27,520 HOME ENVIRONMENT AND EXAMINING 3654 02:38:27,520 --> 02:38:29,840 SUB GROUP DIFFERENCES WITHIN AN 3655 02:38:29,840 --> 02:38:32,160 INTENT TO TREAT ANALYSIS AND 3656 02:38:32,160 --> 02:38:33,360 RANDOMIZED TRIAL IS DIFFICULT 3657 02:38:33,360 --> 02:38:35,120 BECAUSE YOU ARE TALKING ABOUT 3658 02:38:35,120 --> 02:38:37,200 THINGS THAT HAPPENED POST 3659 02:38:37,200 --> 02:38:39,720 BASELINE AND SO YOU REALLY DON'T 3660 02:38:39,720 --> 02:38:43,240 KNOW THAT BASED ON HOW THEY LOOK 3661 02:38:43,240 --> 02:38:45,160 WHEN THEY SHOW UP TO TREATMENT 3662 02:38:45,160 --> 02:38:47,720 SO I THINK FOR US, YES, WE'VE 3663 02:38:47,720 --> 02:38:49,400 EXAMINED MODERATORS BY 3664 02:38:49,400 --> 02:38:50,400 IMPRESSIONIST THAT THE RESULTS 3665 02:38:50,400 --> 02:38:52,360 ARE NOT ALL THAT INFORMATIVE IN 3666 02:38:52,360 --> 02:39:00,680 ALL LICK LIKELIHOOD THEY HAVE HE 3667 02:39:00,680 --> 02:39:01,960 POSITIVE AND NEGATIVE OUTCOMES 3668 02:39:01,960 --> 02:39:05,680 IN IDENTIFYING WITCH FACTORS 3669 02:39:05,680 --> 02:39:10,160 MATTER IN WHICH GROUPS AS THEY 3670 02:39:10,160 --> 02:39:11,160 EXIT TREATMENT. 3671 02:39:11,160 --> 02:39:13,880 >> A QUICK FOLLOW-UP, HOW DO YOU 3672 02:39:13,880 --> 02:39:15,440 ATTRIBUTE YOUR EXCELLENT 3673 02:39:15,440 --> 02:39:17,520 RETENTION RATES IN YOUR V.A. AND 3674 02:39:17,520 --> 02:39:20,120 RESIDENTIAL STUDIES. 3675 02:39:20,120 --> 02:39:21,760 WHY DO SO MANY PEOPLE FINISH THE 3676 02:39:21,760 --> 02:39:25,000 TRIAL IN YOUR CASE? 3677 02:39:25,000 --> 02:39:26,680 >> IT HELPS TO DELIVER AN 3678 02:39:26,680 --> 02:39:28,520 INTERVENTION DURING RESIDENTIAL 3679 02:39:28,520 --> 02:39:29,240 TREATMENT BECAUSE PEOPLE ARE 3680 02:39:29,240 --> 02:39:31,440 THERE AND THEY'RE GOING TO DO 3681 02:39:31,440 --> 02:39:34,240 YOUR TREATMENT AND ADHERE TO 3682 02:39:34,240 --> 02:39:34,920 YOUR PROTOCOL. 3683 02:39:34,920 --> 02:39:37,600 IN TERMS OF POST TREATMENT 3684 02:39:37,600 --> 02:39:39,080 FOLLOW-UP RATES IN THE V.A. FOR 3685 02:39:39,080 --> 02:39:41,480 THOSE PEOPLE ON THE CALL WHO DO 3686 02:39:41,480 --> 02:39:43,640 V.A. RESEARCH YOU KNOW THAT THE 3687 02:39:43,640 --> 02:39:44,800 ELECTRONIC MEDICAL RECORDS IS A 3688 02:39:44,800 --> 02:39:49,000 GREAT RESOURCE AND WE'RE ABLE TO 3689 02:39:49,000 --> 02:39:59,240 TRACK PEOPLE. 3690 02:39:59,840 --> 02:40:01,800 THANK YOU TO ALL THE SPEAKERS 3691 02:40:01,800 --> 02:40:02,680 FROM THE FIRST SESSION. 3692 02:40:02,680 --> 02:40:03,880 I REALLY APPRECIATE THE CHANCE 3693 02:40:03,880 --> 02:40:09,040 TO MODERATE AND FEEL IS FREE TO 3694 02:40:09,040 --> 02:40:10,320 LEAVE THE QUESTIONS IN THE Q AND 3695 02:40:10,320 --> 02:40:11,960 A AND WE'LL GET THEM TO THE 3696 02:40:11,960 --> 02:40:12,200 SPEAKERS. 3697 02:40:12,200 --> 02:40:18,440 >>ON BEHALF OF THE ORGANIZERS, 3698 02:40:18,440 --> 02:40:21,400 I'D LIKE TO APOLOGIZE FOR THIS 3699 02:40:21,400 --> 02:40:22,760 TECHNICAL GLITCH AND HOPEFULLY 3700 02:40:22,760 --> 02:40:25,360 WE'LL RESOLVE ALL THE ISSUES 3701 02:40:25,360 --> 02:40:26,440 DURING THE BREAK. 3702 02:40:26,440 --> 02:40:27,880 THANK YOU VERY MUCH AND THANK 3703 02:40:27,880 --> 02:40:29,720 YOU TO ALL THE SPEAKERS OF THE 3704 02:40:29,720 --> 02:40:33,240 WONDERFUL PANEL AND WE STILL 3705 02:40:33,240 --> 02:40:36,360 HAVE UNANSWERED QUESTIONS SO WE 3706 02:40:36,360 --> 02:40:40,560 WILL BE GLAD TO REJOIN WITH OUR 3707 02:40:40,560 --> 02:40:44,000 SPEAKERS DURING THE NEXT WORKING 3708 02:40:44,000 --> 02:40:46,320 SESSION TOMORROW AT 3:45 AND NOW 3709 02:40:46,320 --> 02:40:47,080 WE'LL HAVE A 30-MINUTE BREAK 3710 02:40:47,080 --> 02:40:48,080 >>IT'S MY PLEASURE TO WELCOME 3711 02:40:48,080 --> 02:40:49,560 YOU BACK FROM THE BREAK. 3712 02:40:49,560 --> 02:40:50,960 FOR THOSE WHO GOT CUT OFF FROM 3713 02:40:50,960 --> 02:40:52,720 THE BREAK, ACCEPT OUR SINCERE 3714 02:40:52,720 --> 02:40:55,200 APOLOGIES FOR THE TECHNICAL 3715 02:40:55,200 --> 02:40:55,560 GLITCH. 3716 02:40:55,560 --> 02:40:56,600 HOPEFULLY THE REST OF THE 3717 02:40:56,600 --> 02:40:57,880 MEETING WILL GO SMOOTHLY. 3718 02:40:57,880 --> 02:40:58,720 "HOPE EVERYONE TOOK ADVANTAGE OF 3719 02:40:58,720 --> 02:41:01,080 THIS TIME TO STRETCH YOUR LEGS 3720 02:41:01,080 --> 02:41:02,160 AND GET NOURISHMENT. 3721 02:41:02,160 --> 02:41:08,200 WE HAVE A FULL AGENDA TODAY, WE 3722 02:41:08,200 --> 02:41:09,280 WILL GET STARTED. 3723 02:41:09,280 --> 02:41:11,400 NEXT IS LAURA WANDNER. 3724 02:41:11,400 --> 02:41:13,560 A PROGRAM DIRECTOR IN THE OFFICE 3725 02:41:13,560 --> 02:41:15,320 OF PAIN POLICY AND PLANNING AT 3726 02:41:15,320 --> 02:41:16,960 THE NATIONAL INSTITUTE OF 3727 02:41:16,960 --> 02:41:18,720 NEUROLOGICAL DISORDERS AND 3728 02:41:18,720 --> 02:41:19,040 STROKE. 3729 02:41:19,040 --> 02:41:21,280 SHE MANAGING PROGRAMS WITHIN THE 3730 02:41:21,280 --> 02:41:23,360 ACUTE TO CHRONIC PAIN PROGRAM 3731 02:41:23,360 --> 02:41:25,160 AND THE HELP TO END ADDICTION 3732 02:41:25,160 --> 02:41:28,720 LONG-TERM INITIATIVE OR HEAL 3733 02:41:28,720 --> 02:41:30,720 INITIATIVE AND SHE LEADS THE 3734 02:41:30,720 --> 02:41:36,560 HEAL COMMON DATA INITIATIVE AND 3735 02:41:36,560 --> 02:41:37,840 Dr. WANDA TREATS PAIN PATIENTS 3736 02:41:37,840 --> 02:41:42,120 AT THE MILITARY MEDICAL CENTER 3737 02:41:42,120 --> 02:41:51,240 AND SO PLEASE WELCOME Dr. 3738 02:41:51,240 --> 02:41:52,000 WANDNER. 3739 02:41:52,000 --> 02:41:54,320 >> WELCOME TO THE JUNIOR 3740 02:41:54,320 --> 02:41:55,640 INVESTIGATE POSTER SESSION THERE 3741 02:41:55,640 --> 02:41:57,920 WILL BE THREE INVESTIGATOR 3742 02:41:57,920 --> 02:41:59,480 SESSIONS DURING THE NIH 3743 02:41:59,480 --> 02:42:00,720 SYMPOSIUM AND THE TIMES OF THE 3744 02:42:00,720 --> 02:42:02,080 OTHER POSTER SESSIONS ARE LISTED 3745 02:42:02,080 --> 02:42:06,760 HERE ON THE SLIDE. 3746 02:42:06,760 --> 02:42:07,960 THE JUNIOR INVESTIGATORS WERE 3747 02:42:07,960 --> 02:42:09,080 SELECTED BY PROGRAM STAFF AND IN 3748 02:42:09,080 --> 02:42:11,200 ORDER TO QUALIFY AS A JUNIOR 3749 02:42:11,200 --> 02:42:12,920 INVESTIGATOR, WHO IS ELIGIBLE TO 3750 02:42:12,920 --> 02:42:23,440 PRESENT OF THIS SYMPOSIUM, ALL 3751 02:42:28,800 --> 02:42:30,800 OF THE PRE-RECORDED TALKS WILL 3752 02:42:30,800 --> 02:42:33,400 PLAY ONE AFTER ANOTHER AND THE 3753 02:42:33,400 --> 02:42:35,800 JUNIOR INVESTIGATORS WILL BE 3754 02:42:35,800 --> 02:42:36,680 AVAILABLE TO ANSWER QUESTIONS OF 3755 02:42:36,680 --> 02:42:39,760 THE END OF THE SESSION SO 3756 02:42:39,760 --> 02:42:40,840 ATTENDEES PLEASE SUBMIT YOUR 3757 02:42:40,840 --> 02:42:41,960 QUESTIONS OR THE JUNIOR 3758 02:42:41,960 --> 02:42:44,320 INVESTIGATORS IN THE Q&A BOX AND 3759 02:42:44,320 --> 02:42:46,560 THE MODERATORS OF THE POSTER 3760 02:42:46,560 --> 02:42:47,560 SESSIONS WILL REVIEW THE 3761 02:42:47,560 --> 02:42:51,560 QUESTIONS TO THE JUNIOR 3762 02:42:51,560 --> 02:42:51,880 INVESTIGATORS. 3763 02:42:51,880 --> 02:42:53,200 WITH THAT I'M HONORED THE 3764 02:42:53,200 --> 02:42:54,920 INTRODUCE THE FIRST GROUP OF 3765 02:42:54,920 --> 02:42:58,000 JUNIOR INVESTIGATORS. 3766 02:42:58,000 --> 02:43:03,880 THE FIRST SPEAKER IS A POSTDOC 3767 02:43:03,880 --> 02:43:06,080 TO BAL IRT FELLOW AT THE 3768 02:43:06,080 --> 02:43:07,560 NATIONAL CENTER OF COM TRAMENT 3769 02:43:07,560 --> 02:43:09,480 TREE AND INGRAY TIVE HEALTH AND 3770 02:43:09,480 --> 02:43:14,400 WILL PRESENT ON THE IMPACT OF 3771 02:43:14,400 --> 02:43:17,400 CRON I OBJECT PAIN CONDITIONS 3772 02:43:17,400 --> 02:43:21,600 AND AND Dr. TEEN POWELL THE 3773 02:43:21,600 --> 02:43:24,320 DIRECTOR OF BREAST ON COL TEE AT 3774 02:43:24,320 --> 02:43:28,200 CANCER CENTER AND WILL PRESENT 3775 02:43:28,200 --> 02:43:33,640 ON ACUPUNCTURE FOR CHEMOTHERAPY 3776 02:43:33,640 --> 02:43:37,560 INDUCED NUR ON AGENT' AND Dr. 3777 02:43:37,560 --> 02:43:40,120 JEFF' BOISSONEAULT FROM THE 3778 02:43:40,120 --> 02:43:42,240 DEPARTMENT OF CLINICAL AND 3779 02:43:42,240 --> 02:43:52,640 HEALTH SIGN SIGHEALTHPSYCHOLOGYY 3780 02:43:52,640 --> 02:43:56,160 DELDINE FROM THE JOINT GRADUATE 3781 02:43:56,160 --> 02:43:57,680 PROGRAM OF INSTITUTE AND THE 3782 02:43:57,680 --> 02:43:59,720 NATIONAL CENTER OF COPMENT TREE 3783 02:43:59,720 --> 02:44:01,160 AND INGRAY TIVE HEALTH AND HE 3784 02:44:01,160 --> 02:44:03,960 WILL PRESENT ON EVALUATING 3785 02:44:03,960 --> 02:44:05,800 POTENTIAL DISPARITIES AND 3786 02:44:05,800 --> 02:44:09,400 SOCIOCULTURAL FACTORS AND 3787 02:44:09,400 --> 02:44:14,040 ASSESSMENT AND Dr. MINHAUN AT 3788 02:44:14,040 --> 02:44:17,000 THE NATIONAL INSTITUTE OF DENTAL 3789 02:44:17,000 --> 02:44:19,040 AND CRANIAL FACIAL RESEARCH AND 3790 02:44:19,040 --> 02:44:29,560 WILL PRESENT ON VISUALIZATION. 3791 02:44:30,200 --> 02:44:31,560 WITH THAT, WE'LL GET STARTED 3792 02:44:31,560 --> 02:44:35,200 WITH THEPRE-RECORDED TALKS. 3793 02:44:35,200 --> 02:44:39,480 >> I'M A POSTBAC AT THE NCCIH 3794 02:44:39,480 --> 02:44:40,520 AND I'LL TALK ABOUT MENTAL 3795 02:44:40,520 --> 02:44:41,920 HEALTH OUTCOMES FOR DIFFERENT 3796 02:44:41,920 --> 02:44:42,760 CHRONIC PAIN CONDITIONS DURING 3797 02:44:42,760 --> 02:44:44,120 THE COVID-19 PANDEMIC. 3798 02:44:44,120 --> 02:44:45,840 SO, AS MANY OF YOU ARE AWARE THE 3799 02:44:45,840 --> 02:44:47,680 PANDEMIC HAS HAD EXPENSIVE 3800 02:44:47,680 --> 02:44:49,800 PHYSICAL AND PSYCHOSOCIAL 3801 02:44:49,800 --> 02:44:51,200 RAMIFICATIONS FOR THE GENERAL 3802 02:44:51,200 --> 02:44:52,960 PUBLIC AND STUDIES SHOW CHRONIC 3803 02:44:52,960 --> 02:44:54,600 PAIN PATIENT MAY BE VULNERABLE 3804 02:44:54,600 --> 02:44:57,640 TO THE IMPACT OF THE COVID-19 3805 02:44:57,640 --> 02:44:58,520 PANDEMIC. 3806 02:44:58,520 --> 02:44:59,960 EXISTING LITERATURE EXAMINING 3807 02:44:59,960 --> 02:45:02,160 CHRONIC PAIN PATIENTS, SHOW 3808 02:45:02,160 --> 02:45:03,680 CONFLICTING HEALTH AND PAIN 3809 02:45:03,680 --> 02:45:04,880 OUTCOMES SUGGESTING THAT THESE 3810 02:45:04,880 --> 02:45:06,280 OUTCOMES MAY ACTUALLY DEFER 3811 02:45:06,280 --> 02:45:09,560 BASED ON CHRONIC PAIN 3812 02:45:09,560 --> 02:45:09,880 CONDITIONS. 3813 02:45:09,880 --> 02:45:14,960 TO INVESTIGATE THIS WE WOULD 3814 02:45:14,960 --> 02:45:17,160 DISTRESS, LONELINESS AND ANXIETY 3815 02:45:17,160 --> 02:45:19,880 DIFFERENTIALLY AND WE ALSO HAVE 3816 02:45:19,880 --> 02:45:21,240 HYPOTHESIZED HAVE HAVING PAIN 3817 02:45:21,240 --> 02:45:22,640 CONDITIONS WOULD OUTCOME THESE 3818 02:45:22,640 --> 02:45:26,480 OUT COMES AND IT WAS 804 CHRONIC 3819 02:45:26,480 --> 02:45:29,520 PAIN PATIENTS FOCUS ON THE 481 3820 02:45:29,520 --> 02:45:32,920 PATIENTS AND WHO ENDORSED ONE 3821 02:45:32,920 --> 02:45:36,120 WON I CAN PAIN CONDITION ONLY. 3822 02:45:36,120 --> 02:45:37,480 MENTAL HEALTH OUTCOMES WERE 3823 02:45:37,480 --> 02:45:39,280 SELECTED OVER A SIX MONTH PERIOD 3824 02:45:39,280 --> 02:45:40,680 AND PAIN INTENSITY WAS COLLECTED 3825 02:45:40,680 --> 02:45:43,120 AT THE END OF THE STUDY AND 3826 02:45:43,120 --> 02:45:45,520 PRIOR MENTAL HEALTH STATUS WAS 3827 02:45:45,520 --> 02:45:46,680 EVALUATED AT BASELINE. 3828 02:45:46,680 --> 02:45:48,760 CHRONIC PAIN CONDITIONS WERE 3829 02:45:48,760 --> 02:45:49,880 CATEGORIZED USING THE 3830 02:45:49,880 --> 02:45:51,160 CLASSIFICATION OF DISEASE AND 3831 02:45:51,160 --> 02:45:52,800 BASED ON FREE RESPONSES INCLUDED 3832 02:45:52,800 --> 02:45:55,640 IN THE CHRONIC PAIN SCALE. 3833 02:45:55,640 --> 02:45:58,320 MOVING ON TO OUR RESULTS ARE 3834 02:45:58,320 --> 02:46:02,000 THEY SHOWED MAIN EFFECTS OF 3835 02:46:02,000 --> 02:46:02,880 CHRONIC PAIN CONDITIONS AND ONLY 3836 02:46:02,880 --> 02:46:04,040 TWO OUTCOMES ARE SHOWN IN THE 3837 02:46:04,040 --> 02:46:06,360 FIGURES ON THIS POSTER, SIMILAR 3838 02:46:06,360 --> 02:46:08,880 TRENDS WERE OBSERVED FOR ALL-OUT 3839 02:46:08,880 --> 02:46:09,400 COMES. 3840 02:46:09,400 --> 02:46:11,880 TO KEEP POST HOCKEY ANALYZE 3841 02:46:11,880 --> 02:46:13,840 REVEALED PARTICIPANTS OF CHRONIC 3842 02:46:13,840 --> 02:46:15,520 PRIMARY PAIN HAD GREATER LEVELS 3843 02:46:15,520 --> 02:46:17,840 OF DISTRESS DEPRESSION AND 3844 02:46:17,840 --> 02:46:19,600 SANITY AND LONELINESS AND THEN 3845 02:46:19,600 --> 02:46:23,200 THOSE WITH PATHIC PAIN, MUSCULAR 3846 02:46:23,200 --> 02:46:24,920 SKELETAL PAIN AND VISCERAL PAIN 3847 02:46:24,920 --> 02:46:27,160 AND THOSE WITH HEADACHE OR ORAL 3848 02:46:27,160 --> 02:46:29,560 FACIAL PAN HAD GREATER LEVELS OF 3849 02:46:29,560 --> 02:46:31,400 DISTRESS, LONELINESS THAN THOSE 3850 02:46:31,400 --> 02:46:33,480 WITH MESS CUE LALL SKELETAL 3851 02:46:33,480 --> 02:46:33,800 PAIN. 3852 02:46:33,800 --> 02:46:35,440 WE FOUND THAT PAIN INTENSITY AND 3853 02:46:35,440 --> 02:46:43,760 A NUMBER OF PAIN CONDITIONS OF 3854 02:46:43,760 --> 02:46:45,120 ANXIETY AND DISTRESS. 3855 02:46:45,120 --> 02:46:48,200 IT'S PAIN INTENSITY AND ON THE 3856 02:46:48,200 --> 02:46:49,040 FAR PLOT SHOWING THE ASSOCIATION 3857 02:46:49,040 --> 02:46:51,120 BETWEEN THE NUMBER OF PIN 3858 02:46:51,120 --> 02:46:52,560 CONDITIONS AND MAIN ANXIETY AND 3859 02:46:52,560 --> 02:46:54,040 HE WILL NOTE HERE, THAT THE 3860 02:46:54,040 --> 02:46:55,920 MAJORITY OF OUR PARTICIPANTS 3861 02:46:55,920 --> 02:46:59,360 HAVE EITHER ONE, TWO OR THREE 3862 02:46:59,360 --> 02:47:00,800 PAIN CONDITIONS WHERE WE SEE 3863 02:47:00,800 --> 02:47:01,920 THIS TREND. 3864 02:47:01,920 --> 02:47:03,400 SO THESE PROVIDE A POSSIBLE 3865 02:47:03,400 --> 02:47:05,000 EXPLANATION FOR THE VARIABILITY 3866 02:47:05,000 --> 02:47:06,840 WE SEE IN MENTAL HEALTH OUTCOMES 3867 02:47:06,840 --> 02:47:13,720 IN CHRONIC PAIN ANCIENT DURING N 3868 02:47:13,720 --> 02:47:17,480 MANAGEMENT MANY TO CONSIDER THE 3869 02:47:17,480 --> 02:47:25,120 UNIQUE NEEDS AND OUR STUDY 3870 02:47:25,120 --> 02:47:27,160 HAVE AND OUR MEASURES OF PAIN 3871 02:47:27,160 --> 02:47:28,800 ALSO ROW LIED ON THE 3872 02:47:28,800 --> 02:47:29,720 PARTICIPANTS RETROSPECTIVE 3873 02:47:29,720 --> 02:47:32,320 MEMORY OF PAIN, SO THAT'S 3874 02:47:32,320 --> 02:47:32,800 ANOTHER LIMITATION. 3875 02:47:32,800 --> 02:47:34,960 AND FOR FUTURE DIRECTIONS, WE'LL 3876 02:47:34,960 --> 02:47:36,840 INVESTIGATE HOW DIFFERENT 3877 02:47:36,840 --> 02:47:37,800 CHRONIC PAIN CONDITIONS 3878 02:47:37,800 --> 02:47:38,880 INFLUENCE VARIOUS OTHER MENTAL 3879 02:47:38,880 --> 02:47:40,920 HEALTH AND BEHAVIORAL OUTCOMES 3880 02:47:40,920 --> 02:47:43,240 AND WE'RE EXCITED TO CONTINUE 3881 02:47:43,240 --> 02:47:46,880 EXPLORING THESE QUESTIONS. 3882 02:47:46,880 --> 02:47:49,480 THANK YOU. 3883 02:47:49,480 --> 02:47:54,480 >> GOOD MORNING, MY NAME IS TIN 3884 02:47:54,480 --> 02:47:55,920 BELL AND THE TITLE OF OUR 3885 02:47:55,920 --> 02:48:00,080 PRESENTATION IS ACUPUNCTURE FOR 3886 02:48:00,080 --> 02:48:04,920 CHEMOTHERAPY INDUCED PERIPHERAL 3887 02:48:04,920 --> 02:48:07,160 NER ON AGENT' AND IT'S A PAINFUL 3888 02:48:07,160 --> 02:48:11,600 COMPLICATION OF NEURO TOXIC 3889 02:48:11,600 --> 02:48:14,440 CHEMOTHERAPY. 3890 02:48:14,440 --> 02:48:18,640 IT AFFECTS 68% OF CANCER 3891 02:48:18,640 --> 02:48:18,880 PATIENTS. 3892 02:48:18,880 --> 02:48:20,640 IT CAN LAST FOR YEARS AND 3893 02:48:20,640 --> 02:48:21,880 ASSOCIATE IN PAIN AND WORSEN 3894 02:48:21,880 --> 02:48:24,560 FUNCTION AND QUALITY OF LIFE. 3895 02:48:24,560 --> 02:48:26,280 CURRENTLY, THERE'S NO GOOD 3896 02:48:26,280 --> 02:48:29,320 TREATMENT FOR IT AND ACUPUNCTURE 3897 02:48:29,320 --> 02:48:31,920 IS A WIDELY USED, MINIMUMLY 3898 02:48:31,920 --> 02:48:33,760 INVASIVE AND SAFE TRADITIONAL 3899 02:48:33,760 --> 02:48:35,760 CHINESE MEDICINE TECHNIQUE 3900 02:48:35,760 --> 02:48:38,760 CURRENTLY AVAILABLE FOR PATIENTS 3901 02:48:38,760 --> 02:48:41,000 IN 75% OF ACADEMIC CANCER 3902 02:48:41,000 --> 02:48:44,640 CENTERS IN THE U.S. 3903 02:48:44,640 --> 02:48:46,800 EVEN THOUGH IT HAS BEEN 3904 02:48:46,800 --> 02:48:48,360 ESTABLISHED AS THE EFFECTIVE 3905 02:48:48,360 --> 02:48:53,320 TREATMENT FOR REDUCING CHRONIC 3906 02:48:53,320 --> 02:48:55,240 MUSCULAR SKELETAL PAIN IT'S 3907 02:48:55,240 --> 02:48:58,000 PATHIC PAIN HAS NOT BEEN 3908 02:48:58,000 --> 02:48:59,600 ESTABLISHED. 3909 02:48:59,600 --> 02:49:06,960 SO OUR GRO COMPLED A PILOT SHOWE 3910 02:49:06,960 --> 02:49:09,600 AMONG SOLID TUMOR PATIENTS WITH 3911 02:49:09,600 --> 02:49:12,600 MODERATE TO SEVERE CIPN 3912 02:49:12,600 --> 02:49:13,320 SYMPTOMS. 3913 02:49:13,320 --> 02:49:16,840 THE PATIENTS WERE RANDOMIZED TO 3914 02:49:16,840 --> 02:49:19,520 ELECTRO ACUPUNCTURE, SHAM 3915 02:49:19,520 --> 02:49:21,960 ACUPUNCTURE AND USUAL CARE FOR 3916 02:49:21,960 --> 02:49:25,120 EIGHT WEEKS AND THEN FOR FOUR 3917 02:49:25,120 --> 02:49:25,440 WEEKS. 3918 02:49:25,440 --> 02:49:30,600 SO AS YOU CAN SEE, AT THE END OF 3919 02:49:30,600 --> 02:49:41,120 WEEK EIGHT, THEY RECEIVED EIGHT 3920 02:50:05,680 --> 02:50:06,800 WEEKS INTERVENTION AND FOLLOW-UP 3921 02:50:06,800 --> 02:50:10,520 AT WEEK 12, WEEK 18 AND WEEK 24. 3922 02:50:10,520 --> 02:50:12,120 THE TRIAL IS ON GOING. 3923 02:50:12,120 --> 02:50:16,880 THE TARGET IS 250 PATIENTS. 3924 02:50:16,880 --> 02:50:20,640 RIGHT NOW, WE HAVE 39 PATIENTS. 3925 02:50:20,640 --> 02:50:22,760 THANKS FOR YOUR INTEREST. 3926 02:50:22,760 --> 02:50:24,480 >> HI, EVERYONE, I'VE JEFF 3927 02:50:24,480 --> 02:50:25,760 ASSISTANT PROFESSOR IN THE 3928 02:50:25,760 --> 02:50:26,800 DEPARTMENT OF CLINICAL AND 3929 02:50:26,800 --> 02:50:28,600 HEALTH PSYCHOLOGY AT THE 3930 02:50:28,600 --> 02:50:30,840 UNIVERSITY OF COLOR WHERE "HAVE 3931 02:50:30,840 --> 02:50:32,040 BEHAVIORAL HEALTH I'M GOING TO 3932 02:50:32,040 --> 02:50:34,440 TALK TO YOU TODAY ABOUT NEW 3933 02:50:34,440 --> 02:50:36,280 INSIGHTS INTO MECHANISMS 3934 02:50:36,280 --> 02:50:38,280 UNDERLINED ALCOHOL ANDAL GEESIA 3935 02:50:38,280 --> 02:50:43,080 AND WE HAVE COMBINED DATA FROM 3936 02:50:43,080 --> 02:50:50,400 TWO LABS IN THE CONTEXT OF 3937 02:50:50,400 --> 02:50:53,160 PAIN ALTHOUGH WE DO UNDERSTAND 3938 02:50:53,160 --> 02:50:54,360 FROM A LIMITED EXPERIMENTAL 3939 02:50:54,360 --> 02:50:56,400 LITERATURE ACUTE ALCOHOL INTAKE 3940 02:50:56,400 --> 02:50:58,120 DOES INCREASE PAIN THRESHOLD AND 3941 02:50:58,120 --> 02:51:01,480 REDUCE PAIN INTENSITY ACROSS 3942 02:51:01,480 --> 02:51:02,640 EXPERIMENTAL PAIN INDUCTION 3943 02:51:02,640 --> 02:51:03,600 MODALITIES IN PEOPLE WITHOUT 3944 02:51:03,600 --> 02:51:04,880 CHRONIC PAIN, THERE'S NEVER BEEN 3945 02:51:04,880 --> 02:51:10,120 STUDIES EXAMINING THE ACUTE 3946 02:51:10,120 --> 02:51:11,360 ANALOGY IN PEOPLE WITH CHRONIC 3947 02:51:11,360 --> 02:51:13,520 PAIN OR THE EXTENT TO WHICH 3948 02:51:13,520 --> 02:51:15,400 FACTORS OTHER THAN QUANTITIVE 3949 02:51:15,400 --> 02:51:19,760 CHANGES AND SENSORY FUNCTION BE 3950 02:51:19,760 --> 02:51:22,960 FROM PAIN THAT COMES WITH 3951 02:51:22,960 --> 02:51:23,360 CONSUMING ALCOHOL. 3952 02:51:23,360 --> 02:51:26,120 WE HAD A TOTAL SAMPLE OF 119 3953 02:51:26,120 --> 02:51:28,360 PEOPLE AND FROM TWO STUDIES AND 3954 02:51:28,360 --> 02:51:33,520 STUDY 2, 21 INDIVIDUALS OR 41% 3955 02:51:33,520 --> 02:51:36,600 HAD CHRONIC JAW PAIN. 3956 02:51:36,600 --> 02:51:39,040 WE ASSESSED PAIN THRESHOLD, 3957 02:51:39,040 --> 02:51:40,160 PAINEN TEES TEE AND PERCEIVED 3958 02:51:40,160 --> 02:51:43,240 RELIEF USING HEAT PAIN IN STUDY 3959 02:51:43,240 --> 02:51:46,200 ONE AND PRESSURE AT THE MASS IN 3960 02:51:46,200 --> 02:51:47,320 STUDY 2 AND WE EXAMINED CENTRAL 3961 02:51:47,320 --> 02:51:49,320 FACTORS CONTRIBUTING TO PAIN 3962 02:51:49,320 --> 02:51:51,320 RELIEF USING HIGHER AGGRESSION 3963 02:51:51,320 --> 02:51:53,040 WHICH WILL BE ON THE NEXT PAGE. 3964 02:51:53,040 --> 02:51:54,760 AS YOU CAN SEE FROM THE RESULTS, 3965 02:51:54,760 --> 02:51:57,160 WE DID FIND THAT CONSISTENT WITH 3966 02:51:57,160 --> 02:51:59,360 THE LITERATURE, ALCOHOL INTAKE 3967 02:51:59,360 --> 02:52:00,520 SIGNIFICANT INCREASE PAIN 3968 02:52:00,520 --> 02:52:03,040 THRESHOLD COMPARED TO PLACEBO. 3969 02:52:03,040 --> 02:52:06,520 THESE WERE LARGE EFFECTS. 3970 02:52:06,520 --> 02:52:07,960 AND HIGHER AGGRESSION DID 3971 02:52:07,960 --> 02:52:10,240 INDICATE THAT ALTHOUGH EXPECTED 3972 02:52:10,240 --> 02:52:13,000 OF ALCOHOL ANALOGY SEE YA AND IT 3973 02:52:13,000 --> 02:52:23,640 WOULD RELIEF PAIN -- AND PROBLEE 3974 02:52:27,320 --> 02:52:29,480 NOT SIGNIFICANTLY PREDICTORS. 3975 02:52:29,480 --> 02:52:31,320 FINALLY, ALTHOUGH WE FOUND THAT 3976 02:52:31,320 --> 02:52:32,800 ALCOHOL DID SIGNIFICANTLY REDUCE 3977 02:52:32,800 --> 02:52:37,600 PAIN INTENSITY, ESPECIALLY IN 3978 02:52:37,600 --> 02:52:40,000 STUDY 2, THESE EFFECTS DID NOT 3979 02:52:40,000 --> 02:52:40,800 DIFFER BETWEEN INDIVIDUALS WITH 3980 02:52:40,800 --> 02:52:42,840 AND WITHOUT CHRONIC JAW PAIN 3981 02:52:42,840 --> 02:52:45,200 ALTHOUGH PEOPLE WITH CHRONIC JAW 3982 02:52:45,200 --> 02:52:46,600 PAIN DID REPORT MORE PAIN. 3983 02:52:46,600 --> 02:52:48,400 SO TAKEN TOGETHER, THESE RESULTS 3984 02:52:48,400 --> 02:52:51,160 SUGGEST THAT ALCOHOL DOES HAVE 3985 02:52:51,160 --> 02:52:52,200 ANNAL GEESE I CAN EFFECTS IN TAB 3986 02:52:52,200 --> 02:53:02,760 LORI SETTINGS AND AND THEY HAVE 3987 02:53:05,960 --> 02:53:07,800 ANALGESIA AND INCLUDING 3988 02:53:07,800 --> 02:53:08,360 INTOXICATION. 3989 02:53:08,360 --> 02:53:10,120 THE MEASURES OF PAIN AND 3990 02:53:10,120 --> 02:53:14,400 THRESHOLD ARE INTENSITY PER SE. 3991 02:53:14,400 --> 02:53:15,720 >> PAIN ARE RAMPANT AND WOMEN 3992 02:53:15,720 --> 02:53:16,880 AND BLACK PATIENT EXPERIENCE 3993 02:53:16,880 --> 02:53:18,640 MORE PAIN, LESS PAIN ASSESSED 3994 02:53:18,640 --> 02:53:20,480 AND LESS PAIN IS TREATED IN THIS 3995 02:53:20,480 --> 02:53:21,560 GROUP TOO. 3996 02:53:21,560 --> 02:53:24,080 THIS LARGE LITERATURE IS ON 3997 02:53:24,080 --> 02:53:26,600 PURPOSE OF SUPPORT AND HOWEVER 3998 02:53:26,600 --> 02:53:27,760 THERE HAVE BEEN STUDIES LOOKING 3999 02:53:27,760 --> 02:53:32,120 AT THE ROLE OF PAIN EXPRESSION 4000 02:53:32,120 --> 02:53:34,360 AND RESULTS HAVE BEEN QUITE 4001 02:53:34,360 --> 02:53:35,440 INCONSISTENT AND THAT IS IN PART 4002 02:53:35,440 --> 02:53:39,040 BECAUSE THERE ARE NO DIVERSE 4003 02:53:39,040 --> 02:53:40,360 DATA OF PAIN. 4004 02:53:40,360 --> 02:53:41,920 OUR WORK IS DEVELOPING THOSE. 4005 02:53:41,920 --> 02:53:44,000 WE BELIEVE PARTICIPANTS RELATE 4006 02:53:44,000 --> 02:53:45,640 MORE PAIN WITH HIGHER INTENSITY 4007 02:53:45,640 --> 02:53:47,160 AND WHITE AND MEN TARGETS 4008 02:53:47,160 --> 02:53:49,800 COMPARED TO BLACK PERSPECTIVELY. 4009 02:53:49,800 --> 02:53:52,640 WE HAVE PARTICIPANTS WATCH VIDEO 4010 02:53:52,640 --> 02:53:55,920 OF PAIN SIMULATION AND BASED ON 4011 02:53:55,920 --> 02:53:58,480 THIS PERSON WAS IN PAIN OR NO 4012 02:53:58,480 --> 02:54:00,280 PAIN AND THEY VARY HOW INTENSE 4013 02:54:00,280 --> 02:54:02,320 THAT SENSATION WAS. 4014 02:54:02,320 --> 02:54:05,600 THEY ANSWERED A FEW QUESTIONS. 4015 02:54:05,600 --> 02:54:07,320 49% COMPLETED THIS TASK ON-LINE 4016 02:54:07,320 --> 02:54:10,960 OVER TELE CAST AND WE USED 4017 02:54:10,960 --> 02:54:13,000 MODELS AND TO ASSESS PAIN 4018 02:54:13,000 --> 02:54:15,320 COMPETITION AND INTENSITY. 4019 02:54:15,320 --> 02:54:16,760 THERE'S A PAIN CATEGORIZATION 4020 02:54:16,760 --> 02:54:19,440 AND WE SAW A TARGETED PATIENTS 4021 02:54:19,440 --> 02:54:22,440 BEING PAIN INCREASED THE ODDS OF 4022 02:54:22,440 --> 02:54:25,160 PAIN AND WE DO NOTE THE OVER ALL 4023 02:54:25,160 --> 02:54:28,440 PAIN WAS LOW AND ONLY 50% HERE 4024 02:54:28,440 --> 02:54:32,280 ON THIS GRAPH AND AS IT TARGETS 4025 02:54:32,280 --> 02:54:33,600 FABLE EXPRESSION TARGET TEE 4026 02:54:33,600 --> 02:54:35,040 INTEENSED THERE'S A GREATER 4027 02:54:35,040 --> 02:54:36,600 LIKELIHOOD OF THE PAIN AND WE 4028 02:54:36,600 --> 02:54:39,880 ALSO BIASES PRESENT SO WE SAW 4029 02:54:39,880 --> 02:54:41,920 THAT THEY ARE PAIN IN MEN 4030 02:54:41,920 --> 02:54:45,400 COMPARED TO AS WEL MEN. 4031 02:54:45,400 --> 02:54:47,520 WE DID SEE MODERATION HERE WITH 4032 02:54:47,520 --> 02:54:49,160 GREATER RACIAL BIAS ENDORSEMENT 4033 02:54:49,160 --> 02:54:51,360 IN GROWN LEADING TO GREATER ODDS 4034 02:54:51,360 --> 02:54:53,120 OF PAIN FOR WHITE TARGETS 4035 02:54:53,120 --> 02:54:59,080 COMPARED TO BLACK TARGETS 6789 E 4036 02:54:59,080 --> 02:55:01,960 TRIALERS HERE IN BLUE INCREASED 4037 02:55:01,960 --> 02:55:03,480 PERCEIVERS INTENSITY RATINGS. 4038 02:55:03,480 --> 02:55:05,600 WE SAW THERE WAS NO EFFECT ON 4039 02:55:05,600 --> 02:55:07,520 FACIAL EXPRESSION INTENSITY ON 4040 02:55:07,520 --> 02:55:12,600 RATINGS AND IT'S INTERESTING TO 4041 02:55:12,600 --> 02:55:15,560 US AND WE DID SEE BIAS FOR WHITE 4042 02:55:15,560 --> 02:55:19,280 TARGETS COMPARED TO BLACK 4043 02:55:19,280 --> 02:55:19,600 TARGETS. 4044 02:55:19,600 --> 02:55:21,760 WE DIDN'T SEE TARGET GENDER ON 4045 02:55:21,760 --> 02:55:22,960 PERCEIVED INTENSITY AND ONCE 4046 02:55:22,960 --> 02:55:31,120 AGAIN, WE DID SEE AN EFFECT OF 4047 02:55:31,120 --> 02:55:34,480 FOR WHITE COMPARED TO BLACK 4048 02:55:34,480 --> 02:55:36,560 TARGETS IT WAS A PAIN AND 4049 02:55:36,560 --> 02:55:38,480 RECEIVER PERCEIVED PAIN WITH A 4050 02:55:38,480 --> 02:55:41,960 TARGET RATED PAIN GREATER FACIAL 4051 02:55:41,960 --> 02:55:45,920 EXPRESSIONS AND FOR ANY OTHER 4052 02:55:45,920 --> 02:55:52,360 INTENSITY AND AND PAIN MORE IN 4053 02:55:52,360 --> 02:55:56,280 MEN AND AND WE BELIEVE IT'S 4054 02:55:56,280 --> 02:55:57,400 INCREASED TO OUTCOMES AND 4055 02:55:57,400 --> 02:55:58,800 ADDRESSING PROVIDING 4056 02:55:58,800 --> 02:56:01,000 INTERVENTIONS FOR RACIAL BIAS 4057 02:56:01,000 --> 02:56:03,640 WILL NEED TO DECREASE IN BIASES 4058 02:56:03,640 --> 02:56:14,000 FOR PAIN ASSESSMENTS. 4059 02:56:21,000 --> 02:56:22,640 >> I'M FROM NATIONAL INSTITUTE 4060 02:56:22,640 --> 02:56:25,680 OF DENTAL AND CRAN Y'ALL 4061 02:56:25,680 --> 02:56:27,280 RESEARCH AND TODAY I WOULD LIKE 4062 02:56:27,280 --> 02:56:37,760 TO TALK ABOUT REALIZATION OF 4063 02:57:05,840 --> 02:57:08,600 LABELED HERE WITH 6 TO 4064 02:57:08,600 --> 02:57:10,520 SIMULTANEOUSLY MONITOR NEURO 4065 02:57:10,520 --> 02:57:13,360 RESPONSE TO AND NOXIOUS STIMULI 4066 02:57:13,360 --> 02:57:17,600 INCLUDING MECHANICAL, THERMAL 4067 02:57:17,600 --> 02:57:20,480 AND ALL KINDS INDUCE DIFFERENT 4068 02:57:20,480 --> 02:57:23,920 ACTIVITIES TRANCE ANT AND SECOND 4069 02:57:23,920 --> 02:57:26,280 DEPENDING IS A KEY NEURO 4070 02:57:26,280 --> 02:57:28,840 INVOLVED IN PAIN SIGNALING AND 4071 02:57:28,840 --> 02:57:39,680 WE USE TRANS AGAIN WE CONDUCT F 4072 02:57:39,680 --> 02:57:41,920 IMAGING AND ACTIVITY ANYWAY AND 4073 02:57:41,920 --> 02:57:45,040 TO THE MICE THE TOTAL INTENSITY 4074 02:57:45,040 --> 02:57:46,440 INCREASED AS WELL AS THE NUMBER 4075 02:57:46,440 --> 02:57:48,360 OF AK TA RATE ISED NEURONS AND 4076 02:57:48,360 --> 02:57:59,000 WE ALSO FIND OUT THAT -- IT INCD 4077 02:58:01,600 --> 02:58:03,680 COMPARED WITH CONTROL. 4078 02:58:03,680 --> 02:58:08,600 THE DATA SHOWS INCREASING 4079 02:58:08,600 --> 02:58:12,400 ACTIVITY SHOWED SIGNIFICANT PAIN 4080 02:58:12,400 --> 02:58:16,000 PERCEPTIONS. 4081 02:58:16,000 --> 02:58:16,680 BETTER FACIAL INFORMATION PAIN 4082 02:58:16,680 --> 02:58:21,280 IN MICE COULD BE ALLEVIATED BY 4083 02:58:21,280 --> 02:58:22,840 BEHAVIOR TFP5. 4084 02:58:22,840 --> 02:58:25,280 AS YOU CAN SEE HERE, THE NEURO 4085 02:58:25,280 --> 02:58:28,480 RISK RESPONDS TO BOTH BRUSH AND 4086 02:58:28,480 --> 02:58:30,920 WITH WHITE IF SIGNIFICANTLY 4087 02:58:30,920 --> 02:58:33,520 DOUGH CREASED AFTER A 4088 02:58:33,520 --> 02:58:36,480 APPLICATION OF 5 AND 4089 02:58:36,480 --> 02:58:37,160 SPECIFICALLY DECREASED A TOTAL 4090 02:58:37,160 --> 02:58:39,600 COST OF INTENSITY IN RESPONSE 4091 02:58:39,600 --> 02:58:47,320 FOR STIMULI SO THE INHIBIT INHIR 4092 02:58:47,320 --> 02:58:51,800 INHIBITS AK TAIZATION OF SENSORY 4093 02:58:51,800 --> 02:59:02,320 NEURONS AND IT DEMONSTRATES WITH 4094 02:59:03,920 --> 02:59:06,880 A PATH WAY TO THERAPEUTICS. 4095 02:59:06,880 --> 02:59:08,320 THE ACTIVITY AT PARAMETER 4096 02:59:08,320 --> 02:59:09,520 SENSORY NEURONS COULD OFFER 4097 02:59:09,520 --> 02:59:11,800 BETTER AND SAFER TREATMENT FOR 4098 02:59:11,800 --> 02:59:12,160 FACIAL PAIN. 4099 02:59:12,160 --> 02:59:22,680 THANK YOU FOR YOUR ATTENTION. 4100 02:59:32,440 --> 02:59:33,760 >> THANK YOU FOR YOUR TALKS. 4101 02:59:33,760 --> 02:59:35,480 I'LL ASK YOU TO TURN ON YOUR 4102 02:59:35,480 --> 02:59:37,640 CAMERAS AND ATTENDEES FEEL FREE 4103 02:59:37,640 --> 02:59:41,720 TO SUBMIT QUESTIONS AND FOR THE 4104 02:59:41,720 --> 02:59:43,640 ATTENDEES TO ANSWER IN THE Q&A 4105 02:59:43,640 --> 02:59:45,160 SESSION AND YOU WILL GET STARTED 4106 02:59:45,160 --> 02:59:46,520 WITH SOME OF THE INITIAL 4107 02:59:46,520 --> 02:59:48,120 QUESTIONS THAT HAVE BEEN 4108 02:59:48,120 --> 02:59:48,840 SUBMITTED ALREADY. 4109 02:59:48,840 --> 02:59:53,000 SO THE FIRST QUESTION IS TO MYA, 4110 02:59:53,000 --> 02:59:55,680 ANY HYPOTISIESE WHY PRIMARY 4111 02:59:55,680 --> 02:59:57,200 CHRONIC PAIN HAS WORSE MENTAL 4112 02:59:57,200 --> 02:59:58,400 HEALTH OUTCOMES COMPARED TO 4113 02:59:58,400 --> 03:00:02,520 OTHER CHRONIC PAIN CONDITIONS? 4114 03:00:02,520 --> 03:00:06,000 >> YES, SO, ACTUALLY ONE OF THE 4115 03:00:06,000 --> 03:00:07,760 PAIN CONTINUES THAT IS 4116 03:00:07,760 --> 03:00:09,760 CATEGORIZED IN CHRONIC PRIMARY 4117 03:00:09,760 --> 03:00:11,760 PAIN IS FIBER HIGH GAL AND AS 4118 03:00:11,760 --> 03:00:14,720 MANY OF YOU NOW THE IDEOLOGY IS 4119 03:00:14,720 --> 03:00:16,760 UNKNOWN AND THERE'S NO LESION, 4120 03:00:16,760 --> 03:00:18,520 OR BLOOD WORK OR ANYTHING THAT 4121 03:00:18,520 --> 03:00:20,240 CAN BE DONE THAT COMES BACK AND 4122 03:00:20,240 --> 03:00:23,160 SAYS THIS IS FIBER MYALGIA AND 4123 03:00:23,160 --> 03:00:27,800 SO WE HYPOTHESIZE THAT SENSE OF 4124 03:00:27,800 --> 03:00:31,440 UNCERTAINTY AS WELL AS THE LACK 4125 03:00:31,440 --> 03:00:32,440 OF CONCRETE PLANNER AND 4126 03:00:32,440 --> 03:00:35,080 TREATMENT AROUND FIBER MYALGIA 4127 03:00:35,080 --> 03:00:36,880 MAY LEED TO ANXIETY AND 4128 03:00:36,880 --> 03:00:38,040 DEPRESSION AS OPPOSE TODAY SOME 4129 03:00:38,040 --> 03:00:41,360 OF THE OTHER CHRONIC CONDITIONS. 4130 03:00:41,360 --> 03:00:43,040 AND WE DID PREVIOUSLY RUN SOME 4131 03:00:43,040 --> 03:00:45,680 OTHER ANALYSIS USING A BROADER 4132 03:00:45,680 --> 03:00:47,440 CATEGORIZATION WHERE FIBER 4133 03:00:47,440 --> 03:00:50,480 MYALGIA WAS ITS OWN CATEGORY AND 4134 03:00:50,480 --> 03:00:52,480 WE DID SEE A DRASTIC DIFFERENCE 4135 03:00:52,480 --> 03:00:55,760 FOR THAT AS WELL. 4136 03:00:55,760 --> 03:00:56,960 >> GREAT THANK YOU SO MUCH FOR 4137 03:00:56,960 --> 03:00:57,480 THAT ANSWER. 4138 03:00:57,480 --> 03:01:02,000 I REALLY APPRECIATE IT. 4139 03:01:02,000 --> 03:01:03,360 THE NEXT QUESTION IS FOR YOU, 4140 03:01:03,360 --> 03:01:05,240 ARE CITATIONS OR WESTBOUND LINKS 4141 03:01:05,240 --> 03:01:06,640 AVAILABLE FOR YOUR WORK THAT YOU 4142 03:01:06,640 --> 03:01:07,760 CAN SHARE TODAY? 4143 03:01:07,760 --> 03:01:09,760 >> YEAH, I THINK THAT IT'S 4144 03:01:09,760 --> 03:01:12,480 ACTUALLY ON THE FIRST SLIDE. 4145 03:01:12,480 --> 03:01:15,160 SO, THE PILOT DATA WAS PUBLISHED 4146 03:01:15,160 --> 03:01:16,600 AT THE NETWORK AND I THINK IT 4147 03:01:16,600 --> 03:01:20,600 WAS LAST YEAR OR 2021 AND THAT 4148 03:01:20,600 --> 03:01:22,160 IS BASICALLY SUMMARIZING THE 4149 03:01:22,160 --> 03:01:22,560 RESULTS. 4150 03:01:22,560 --> 03:01:26,160 WE NOTICED THE ELECTRO 4151 03:01:26,160 --> 03:01:28,720 ACUPUNCTURE WAS BETTER THAN SHAM 4152 03:01:28,720 --> 03:01:30,120 ACUPUNCTURE IN TERMS OF REDUCING 4153 03:01:30,120 --> 03:01:32,800 PAIN BUT IN TERMS OF TINGLING 4154 03:01:32,800 --> 03:01:33,800 NUMBNESS, THEY ARE BOTH BETTER 4155 03:01:33,800 --> 03:01:35,280 WITH THE USUALLY CARE OF 4156 03:01:35,280 --> 03:01:38,600 ACTUALLY REAL ACUPUNCTURE IS NOT 4157 03:01:38,600 --> 03:01:40,480 THAT MUCH BETTER THAN SHAM 4158 03:01:40,480 --> 03:01:42,000 ACUPUNCTURE THAT'S WHY IT'S CIP 4159 03:01:42,000 --> 03:01:42,520 AND PAIN. 4160 03:01:42,520 --> 03:01:43,400 >> GREAT. 4161 03:01:43,400 --> 03:01:44,440 THANK YOU, THAT'S SO 4162 03:01:44,440 --> 03:01:46,960 INTERESTING, REALLY APPRECIATE 4163 03:01:46,960 --> 03:01:47,120 IT. 4164 03:01:47,120 --> 03:01:51,120 >> JEFF, THE NEXT QUESTION IS 4165 03:01:51,120 --> 03:01:52,280 FOR YOU. 4166 03:01:52,280 --> 03:01:54,080 THE QUESTIONS IS VERY 4167 03:01:54,080 --> 03:01:56,600 INTERESTING TALK AND THEY'RE NOT 4168 03:01:56,600 --> 03:01:59,960 SOCIOCULTURAL EFFECTS, ARE THERE 4169 03:01:59,960 --> 03:02:01,680 CURRENT EXPERIMENTAL MODEL TO 4170 03:02:01,680 --> 03:02:04,000 SIMULATE THE POTENTIAL SOCIAL 4171 03:02:04,000 --> 03:02:06,080 EFFECTS, TO REPLICATE LIKELY 4172 03:02:06,080 --> 03:02:07,960 SOCIAL SETTING FOR MANY DRINKING 4173 03:02:07,960 --> 03:02:13,320 IN REAL SETTINGS. 4174 03:02:13,320 --> 03:02:15,120 >> THAT'S A GOOD QUESTION, THERE 4175 03:02:15,120 --> 03:02:18,480 ARE NOT STUDIES OF ALCOHOL 4176 03:02:18,480 --> 03:02:19,680 ANALGESIA IN THE CONTEXT OF 4177 03:02:19,680 --> 03:02:20,680 SOCIAL INTERACTIONS. 4178 03:02:20,680 --> 03:02:22,320 THERE ARE STUDIES OF SOCIAL 4179 03:02:22,320 --> 03:02:24,400 EFFECTS OF DRINKING AND DIE ADDS 4180 03:02:24,400 --> 03:02:25,920 AND GROUPS IN LABORATORY 4181 03:02:25,920 --> 03:02:28,120 SETTINGS AND IN NATURALISTIC 4182 03:02:28,120 --> 03:02:28,760 SETTINGS AS WELL. 4183 03:02:28,760 --> 03:02:31,200 I HAVE NOT SEEN THEM COMBINED 4184 03:02:31,200 --> 03:02:32,520 WITH PAIN IN THAT WAY. 4185 03:02:32,520 --> 03:02:34,000 IT'S A REALLY INTERESTING THING 4186 03:02:34,000 --> 03:02:37,600 TO PURSUE MOVING FORWARD. 4187 03:02:37,600 --> 03:02:38,480 >> GREAT. 4188 03:02:38,480 --> 03:02:40,200 THANK YOU FOR ANSWERING THAT 4189 03:02:40,200 --> 03:02:40,600 QUESTION. 4190 03:02:40,600 --> 03:02:42,880 WE APPRECIATE IT. 4191 03:02:42,880 --> 03:02:45,000 >> Dr. DILDINE. 4192 03:02:45,000 --> 03:02:46,840 BASED ON YOUR RESULT, DO YOU 4193 03:02:46,840 --> 03:02:48,240 HAVE ANY RECOMMENDATIONS ON THE 4194 03:02:48,240 --> 03:02:50,360 TYPES OF INTERVENTIONS NEEDED TO 4195 03:02:50,360 --> 03:02:52,440 REDUCE BIASES WITHIN THE PAIN 4196 03:02:52,440 --> 03:02:53,800 MANAGEMENT FIELD? 4197 03:02:53,800 --> 03:02:57,200 >> THAT IS A BIG QUESTION. 4198 03:02:57,200 --> 03:02:57,600 [LAUGHTER] 4199 03:02:57,600 --> 03:02:59,360 >> IT'S A VERY BIG QUESTION. 4200 03:02:59,360 --> 03:03:01,840 >> I THINK ULTIMATELY I THINK 4201 03:03:01,840 --> 03:03:02,920 THERE'S BEEN A LOT OF GOOD DONE 4202 03:03:02,920 --> 03:03:10,480 IN RECENT YEARS AND THE FIRST 4203 03:03:10,480 --> 03:03:12,520 STEP IS AWARENESS ON THE 4204 03:03:12,520 --> 03:03:14,600 PROVIDER END BUT THERE ARE 4205 03:03:14,600 --> 03:03:17,000 POTENTIAL BIASES IN ASSESSMENTS. 4206 03:03:17,000 --> 03:03:19,160 NOT JUST RACIAL AND GENDER BUT 4207 03:03:19,160 --> 03:03:20,640 ALSO ACROSS ALL POPULATION AND 4208 03:03:20,640 --> 03:03:22,160 UNDER ASSESSING PAIN. 4209 03:03:22,160 --> 03:03:24,680 SO IT'S A BIG ONE TO CONSIDER. 4210 03:03:24,680 --> 03:03:27,680 AND I THINK BEYOND IT, THERE'S 4211 03:03:27,680 --> 03:03:29,520 BEEN SOME INITIAL WORKS SEEING 4212 03:03:29,520 --> 03:03:33,600 SOME BENEFITS AND PAINING THAT 4213 03:03:33,600 --> 03:03:35,720 CAN BE OFFICIAL IN TRAINING 4214 03:03:35,720 --> 03:03:38,440 MEDICAL WRITERS TO EMPHASIS AND 4215 03:03:38,440 --> 03:03:40,360 BE ABLE TO BETTER ASSESS THE 4216 03:03:40,360 --> 03:03:41,560 THEME AND SOMETHING THAT WE'RE 4217 03:03:41,560 --> 03:03:45,120 INTERESTED IN TRYING TO RUN THAT 4218 03:03:45,120 --> 03:03:48,040 CAN PROVIDE INTERVENTIONS WITH 4219 03:03:48,040 --> 03:03:49,520 FEEDBACK HELPING DOCTORS 4220 03:03:49,520 --> 03:03:51,160 UNDERSTAND HOW MUCH WE NEED 4221 03:03:51,160 --> 03:03:52,760 SOMEONE IN IF THAT WOULD IMPROVE 4222 03:03:52,760 --> 03:03:54,800 THEIR ABILITY TO SEE PAIN AND 4223 03:03:54,800 --> 03:03:56,880 THEN OBVIOUSLY WE SAW MODERATION 4224 03:03:56,880 --> 03:04:00,680 IN OUR TASK WITH RACIAL BIAS AND 4225 03:04:00,680 --> 03:04:03,120 THAT MAKING THOSE OUTCOMES 4226 03:04:03,120 --> 03:04:03,480 WORSE. 4227 03:04:03,480 --> 03:04:06,720 AND THAT CAN GET INTO SOME 4228 03:04:06,720 --> 03:04:08,200 CONTROVERSIAL TOPICS IN TERMS OF 4229 03:04:08,200 --> 03:04:09,320 WHAT IS THE BEST WAY TO DEAL 4230 03:04:09,320 --> 03:04:11,240 WITH THAT OBVIOUSLY, LOTS OF 4231 03:04:11,240 --> 03:04:13,600 ORGANIZATIONS HAVE TRIED TO DO 4232 03:04:13,600 --> 03:04:15,480 TRAININGS ON IMPLICIT BIAS AND 4233 03:04:15,480 --> 03:04:17,480 ALL OF THOSE THINGS AND I THINK 4234 03:04:17,480 --> 03:04:19,760 THEY'VE HAD KIND OF MINIMAL 4235 03:04:19,760 --> 03:04:22,840 POSITIVE OUTCOMES AT THIS POINT 4236 03:04:22,840 --> 03:04:26,040 SO I NEED RECOGNITION OF BIAS 4237 03:04:26,040 --> 03:04:28,720 IMPLICIT ON THEIR OWN AREN'T 4238 03:04:28,720 --> 03:04:30,200 MAKING THAT MUCH OF A DIFFERENCE 4239 03:04:30,200 --> 03:04:34,640 IN TERMS OF WORKFORCE CHANGE SO 4240 03:04:34,640 --> 03:04:35,920 THERE'S NO LOT FOR US TO 4241 03:04:35,920 --> 03:04:36,840 CONSIDER AND THERE'S A LOT TO BE 4242 03:04:36,840 --> 03:04:38,880 DONE IN THE FIELD AND BEYOND 4243 03:04:38,880 --> 03:04:41,360 THIS PAIN AND HEALTH AND HOW TO 4244 03:04:41,360 --> 03:04:42,800 MAKE INTERVENTIONS THAT ARE 4245 03:04:42,800 --> 03:04:50,320 ACTUALLY LONG LASTING AND CHANGE 4246 03:04:50,320 --> 03:04:50,920 BEHAVIORAL OUTCOMES. 4247 03:04:50,920 --> 03:04:52,800 >> IT'S SUCH AN IMPORTANT TOPIC 4248 03:04:52,800 --> 03:04:54,160 AND I'M GLAD TO SEE THAT YOU ARE 4249 03:04:54,160 --> 03:04:55,720 WORKING ON IT. 4250 03:04:55,720 --> 03:05:03,360 NEXT QUESTION, IS FOR Dr. HU. 4251 03:05:03,360 --> 03:05:05,400 DO THEY REGULATE ALL TIMES OF 4252 03:05:05,400 --> 03:05:07,640 PAIN, MECHANICAL, CHEMICAL AND 4253 03:05:07,640 --> 03:05:09,160 THERMAL OR ONLY CERTAIN TYPES OF 4254 03:05:09,160 --> 03:05:09,480 PAIN? 4255 03:05:09,480 --> 03:05:12,480 >> SO, THAT'S A GOOD QUESTION, 4256 03:05:12,480 --> 03:05:13,040 THANK YOU. 4257 03:05:13,040 --> 03:05:17,360 SO, IN MY EXPERIMENT I TRIED ALL 4258 03:05:17,360 --> 03:05:19,480 DIFFERENT KINDS OF STIMULATIONS 4259 03:05:19,480 --> 03:05:30,040 INCLUDING MECHANICAL, YEAH, AND 4260 03:05:35,240 --> 03:05:37,480 ALSO I TRIED HAIR STIMULATION 4261 03:05:37,480 --> 03:05:41,480 AND WHICH LIKE I ALSO CALL IT AS 4262 03:05:41,480 --> 03:06:09,800 PINCH SO REGULATED,. 4263 03:06:09,800 --> 03:06:13,480 I'D LIKE TO WELCOME YOU BACK, 4264 03:06:13,480 --> 03:06:13,960 AGAIN. 4265 03:06:13,960 --> 03:06:17,400 YOU STILL HAVE ANOTHER VERY 4266 03:06:17,400 --> 03:06:18,920 INTERESTING PANEL, WHICH FOCUSES 4267 03:06:18,920 --> 03:06:21,640 ON THE INTEGRATION OF 4268 03:06:21,640 --> 03:06:22,640 WHOLE-PERSON TOOLS AND 4269 03:06:22,640 --> 03:06:23,080 APPROACHES. 4270 03:06:23,080 --> 03:06:29,160 AND I'D LIKE TO INTRODUCE Dr. 4271 03:06:29,160 --> 03:06:29,400 LIN. 4272 03:06:29,400 --> 03:06:31,320 A PROGRAM DIRECTOR IN THE INTRA 4273 03:06:31,320 --> 03:06:32,960 GRAY TIVE NEUROSCIENCE BRANCH 4274 03:06:32,960 --> 03:06:34,600 WHERE HE MANAGED A PORTFOLIO ON 4275 03:06:34,600 --> 03:06:35,720 CLINICAL AND TRANCATIONAL 4276 03:06:35,720 --> 03:06:38,200 RESEARCH IN THE AREAS OF PAIN 4277 03:06:38,200 --> 03:06:39,360 AND HIV/AIDS. 4278 03:06:39,360 --> 03:06:40,760 THIS PARTICULAR AREA OF FOCUS 4279 03:06:40,760 --> 03:06:47,000 ARE ON CHRONIC PAIN AND -- ON 4280 03:06:47,000 --> 03:06:48,200 THE INTERACTIVE OF ADDICTIVE 4281 03:06:48,200 --> 03:06:52,120 DRUGS ON COGNITIVE FUNCTIONING 4282 03:06:52,120 --> 03:06:54,160 PATIENTS OF HIV/AIDS AND HE WAS 4283 03:06:54,160 --> 03:06:56,560 AN ANESTHESIOLOGIST AND A 4284 03:06:56,560 --> 03:06:59,360 PHYSICIAN SCIENTIST AND ENTA 4285 03:06:59,360 --> 03:07:02,240 GRAY TIVE HEALTH SO PLEASE 4286 03:07:02,240 --> 03:07:04,400 WELCOME Dr. LIN. 4287 03:07:04,400 --> 03:07:04,560 >> 4288 03:07:04,560 --> 03:07:08,280 >> HI, EVERYONE, GOOD AFTERNOON. 4289 03:07:08,280 --> 03:07:12,160 IT'S MY PLEASURE TO TEAM UP WITH 4290 03:07:12,160 --> 03:07:13,640 EXCELLENT INVESTIGATORS TO CARRY 4291 03:07:13,640 --> 03:07:15,440 OUT THIS PANEL AND THIS DECISION 4292 03:07:15,440 --> 03:07:25,920 WAS STARTED BY Dr. MARK PAIN 4293 03:07:27,320 --> 03:07:29,360 RESEARCH TO INTRODUCE AND 4294 03:07:29,360 --> 03:07:36,240 FOLLOWED BY Dr. LAUREN ATTARS 4295 03:07:36,240 --> 03:07:41,120 A PROCESAROUSAL OF THE FRONTAL X 4296 03:07:41,120 --> 03:07:44,480 AND THEN Dr. DANIEL BAUER WILL 4297 03:07:44,480 --> 03:07:54,240 TELL A PERSON ORIENTED APPROACH 4298 03:07:54,240 --> 03:07:57,360 AND ASSESSING CHRONIC CONDITIONS 4299 03:07:57,360 --> 03:07:58,800 WITH INDIVIDUALS DELIVERED BY 4300 03:07:58,800 --> 03:07:59,920 DAVID WILLIAMS. 4301 03:07:59,920 --> 03:08:03,600 Dr. MARK JASON IS A PROFESSOR 4302 03:08:03,600 --> 03:08:05,880 OF THE UNIVERSITY OF WASHINGTON. 4303 03:08:05,880 --> 03:08:08,440 HE IS THE CURRENT 4304 03:08:08,440 --> 03:08:13,440 EDITOR-IN-CHIEF FOR THE JOURNAL 4305 03:08:13,440 --> 03:08:15,440 OF PAIN WHO HAS EFFECT AND 4306 03:08:15,440 --> 03:08:17,520 MECHANISM FOR PAIN INTERVENTIONS 4307 03:08:17,520 --> 03:08:21,600 AND HE PUBLISHED OVER 600 4308 03:08:21,600 --> 03:08:24,080 ARTICLES IN PEER REVIEW 4309 03:08:24,080 --> 03:08:27,240 JOURNALISTS AND HIS CO-AUTHOR OF 4310 03:08:27,240 --> 03:08:30,840 OVER 40 BOOKS AND CHAPTERS AND 4311 03:08:30,840 --> 03:08:39,240 HAS ADDED BOOKS WITH THAT, Dr. 4312 03:08:39,240 --> 03:08:45,880 JANSSEN. 4313 03:08:45,880 --> 03:08:48,640 >> ARE THE SLIDES GOING TO BE UP 4314 03:08:48,640 --> 03:08:51,440 THERE THEY GO. 4315 03:08:51,440 --> 03:08:54,720 I'LL TALK AS Dr. ELLEN SAID 4316 03:08:54,720 --> 03:08:55,960 ABOUT THINKING OF PAIN RESEARCH 4317 03:08:55,960 --> 03:08:57,320 FROM THE WHOLE PERSON 4318 03:08:57,320 --> 03:09:00,400 PERSPECTIVE NEXT SLIDE, PLEASE. 4319 03:09:00,400 --> 03:09:01,880 AND I'M GOING TO TALK BRIEFLY 4320 03:09:01,880 --> 03:09:03,200 ABOUT THE STRENGTH AND 4321 03:09:03,200 --> 03:09:04,840 WEAKNESSES OF TRADITIONAL 4322 03:09:04,840 --> 03:09:07,800 APPROACHES TO STUDYING PAIN 4323 03:09:07,800 --> 03:09:10,280 TREATMENTS AND FOCUS ON LOOKING 4324 03:09:10,280 --> 03:09:11,520 ABOUT, TALKING ABOUT ALTERNATIVE 4325 03:09:11,520 --> 03:09:14,800 APPROACHES THAT ARE MORE PERSON 4326 03:09:14,800 --> 03:09:18,240 ORIENTED AND THE CENTRAL IDEA IS 4327 03:09:18,240 --> 03:09:19,840 THAT I'M THINKING THESE NEW 4328 03:09:19,840 --> 03:09:22,640 APPROACHES MIGHT BE MOST USEFUL 4329 03:09:22,640 --> 03:09:25,600 TO US FOR HELPING PEOPLE WITH 4330 03:09:25,600 --> 03:09:25,840 PAIN. 4331 03:09:25,840 --> 03:09:31,080 AND SO OF COURSE, THE 4332 03:09:31,080 --> 03:09:34,840 TRADITIONAL EXPLANATORY TRIAL 4333 03:09:34,840 --> 03:09:36,840 ARE TO TEST THE EFFICACY OF A 4334 03:09:36,840 --> 03:09:39,400 PARTICULAR TREATMENT AND TO DO 4335 03:09:39,400 --> 03:09:40,680 THAT WE DESIGN STUDIES THAT 4336 03:09:40,680 --> 03:09:42,560 CONTROL FOR THE VARIABLES EXCEPT 4337 03:09:42,560 --> 03:09:44,760 FOR THE TREATMENT CONDITION. 4338 03:09:44,760 --> 03:09:48,000 WE WANT TO REALLY MINIMIZE 4339 03:09:48,000 --> 03:09:49,280 PARTICIPANT HETEROGENEITY AND 4340 03:09:49,280 --> 03:09:50,600 LOOK AT SUBGROUPS OF PATIENTS 4341 03:09:50,600 --> 03:09:51,800 AND STANDARDIZE THE TREATMENTS 4342 03:09:51,800 --> 03:09:54,640 TO MAKE SURE THAT THEY'RE ALL 4343 03:09:54,640 --> 03:09:58,040 SIMILAR DONE IN THE SAME WAY AND 4344 03:09:58,040 --> 03:09:59,000 INCLUDE CONTROLLED CONDITIONS 4345 03:09:59,000 --> 03:10:00,640 THAT CONTROL FOR EVERYTHING 4346 03:10:00,640 --> 03:10:02,800 GIVEN IN THE ACTIVE TREATMENT WE 4347 03:10:02,800 --> 03:10:04,280 WANT TO TEST FOR WHAT WE THINK 4348 03:10:04,280 --> 03:10:08,520 IS THE ACTIVE COMPONENT, NEXT 4349 03:10:08,520 --> 03:10:09,880 SLIDE, PLEASE. 4350 03:10:09,880 --> 03:10:13,520 AND VERY STRONG APPROACH IT 4351 03:10:13,520 --> 03:10:15,080 MAXIMIZES POWER AND ALSO WE 4352 03:10:15,080 --> 03:10:16,800 ALMOST ALWAYS HAVE THIS ONE 4353 03:10:16,800 --> 03:10:20,760 OUTCOME VARIABLE BECAUSE WE WANT 4354 03:10:20,760 --> 03:10:24,000 TO MAXIMIZE AND WE JUST DO ONE 4355 03:10:24,000 --> 03:10:27,480 TEST, IS THIS STUDY TREATMENT 4356 03:10:27,480 --> 03:10:28,040 EFFECTIVE OR NOT? 4357 03:10:28,040 --> 03:10:30,560 NEXT SLIDE, PLEASE. 4358 03:10:30,560 --> 03:10:34,040 AND SO THIS APPROACH WE CAN DRAW 4359 03:10:34,040 --> 03:10:36,440 VERY FIRM CONCLUSIONS WHEN IT'S 4360 03:10:36,440 --> 03:10:37,560 DESIGNED REGARDING WHETHER OR 4361 03:10:37,560 --> 03:10:43,640 NOT THE TREATMENT IS EFFECTIVE. 4362 03:10:43,640 --> 03:10:47,040 AND THIS FOCUSES ON THE 4363 03:10:47,040 --> 03:10:47,440 TREATMENT. 4364 03:10:47,440 --> 03:10:50,000 AND SO IT'S A HIGHLY 4365 03:10:50,000 --> 03:10:51,520 STANDARDIZED TREATMENT USUALLY 4366 03:10:51,520 --> 03:10:54,840 IN THE STUT STUDIES. 4367 03:10:54,840 --> 03:10:56,480 IT'S NOT PROVIDED IN THE REAL 4368 03:10:56,480 --> 03:10:58,600 WORLD AND THE FOCUS IS ON THE 4369 03:10:58,600 --> 03:11:00,200 TREATMENT NOT THE PERSON OR EVEN 4370 03:11:00,200 --> 03:11:01,160 THE WHOLE PERSON. 4371 03:11:01,160 --> 03:11:02,680 NOT EVEN A PART OF THE PERSON, 4372 03:11:02,680 --> 03:11:03,640 IT'S ABOUT TREATMENT. 4373 03:11:03,640 --> 03:11:06,920 NEXT SLIDE, PLEASE. 4374 03:11:06,920 --> 03:11:08,880 AND IT ONLY LOOKS AT THE EFFECTS 4375 03:11:08,880 --> 03:11:11,120 FOR A HIGHLY SELECTED GROUP THAT 4376 03:11:11,120 --> 03:11:13,680 ARE NOT THE NORM SO NEXT SLIDE, 4377 03:11:13,680 --> 03:11:14,440 PLEASE. 4378 03:11:14,440 --> 03:11:17,760 AND SO, IN GENERAL, ALSO THE 4379 03:11:17,760 --> 03:11:19,120 EFFECTS TEND TO BE MODEST AT 4380 03:11:19,120 --> 03:11:25,040 BEST SO WE DON'T SEE OFTEN THESE 4381 03:11:25,040 --> 03:11:33,600 HUGE GROUND-BREAKING THESE ARE 4382 03:11:33,600 --> 03:11:34,400 POPULAR FOR GOOD REASON. 4383 03:11:34,400 --> 03:11:37,000 THEY ALLOW FOR TESTING OR 4384 03:11:37,000 --> 03:11:38,000 INTERVENTIONS IN REAL WORLD 4385 03:11:38,000 --> 03:11:39,480 CONDITIONS AND THEY ALLOW FOR 4386 03:11:39,480 --> 03:11:40,840 GREATER HETEROGENEITY IN THE 4387 03:11:40,840 --> 03:11:42,560 STUDY SAMPLE WHICH IS THE 4388 03:11:42,560 --> 03:11:43,680 PATIENTS THAT WE ACTUALLY SEE 4389 03:11:43,680 --> 03:11:45,480 AND IT ALSO GREATER 4390 03:11:45,480 --> 03:11:46,360 HETEROGENEITY IN THE TREATMENT 4391 03:11:46,360 --> 03:11:47,560 AS DELIVERED WHICH IS HOW 4392 03:11:47,560 --> 03:11:48,360 TREATMENTS ARE DELIVERED. 4393 03:11:48,360 --> 03:11:52,840 NEXT SLIDE, PLEASE. 4394 03:11:52,840 --> 03:11:54,320 AGAIN, THIS FAVORS EXTERNAL DATA 4395 03:11:54,320 --> 03:11:56,120 THAT WE CAN DRAW CONCLUSION 0 4396 03:11:56,120 --> 03:11:57,960 THESE TRIALS REGARDING TREATMENT 4397 03:11:57,960 --> 03:11:59,120 EFFECTS AS THAT YOU ARE 4398 03:11:59,120 --> 03:11:59,560 PROVIDED. 4399 03:11:59,560 --> 03:12:03,120 NEXT SLIDE, PLEASE, THE FOCUS IS 4400 03:12:03,120 --> 03:12:06,600 STILL ON THE TREATMENT AND NOT 4401 03:12:06,600 --> 03:12:07,360 THE PERSON. 4402 03:12:07,360 --> 03:12:11,520 AND AGAIN, THE EFFECTS TEND TO 4403 03:12:11,520 --> 03:12:13,280 BE EVEN MORE MODEST WHEN YOU ADD 4404 03:12:13,280 --> 03:12:19,720 THE NOISE OF A PRAGMATIC TRIAL 4405 03:12:19,720 --> 03:12:21,080 SO MY OWN BELIEVE IS WE DON'T 4406 03:12:21,080 --> 03:12:23,040 HAVE THE RESOURCES TO DESIGN 4407 03:12:23,040 --> 03:12:25,000 SUCH STUDIES FOR EVERY TREATMENT 4408 03:12:25,000 --> 03:12:26,720 WE WANT TO EXAM AND THEY MAY NOT 4409 03:12:26,720 --> 03:12:30,360 BE THE MOST EFFICIENT WAY FOR US 4410 03:12:30,360 --> 03:12:32,280 TO UNDERSTAND HOW TO DELIVER TO 4411 03:12:32,280 --> 03:12:35,360 PEOPLE SO THAT REDUCE OUR 4412 03:12:35,360 --> 03:12:36,440 SUFFERING AND A DIFFERENT 4413 03:12:36,440 --> 03:12:38,200 APPROACH IS TO EMBRACE 4414 03:12:38,200 --> 03:12:41,200 VARIABILITY RATHER THAN LIMIT IT 4415 03:12:41,200 --> 03:12:44,240 AND MEASURE THAT VARIABILITY AND 4416 03:12:44,240 --> 03:12:47,040 CONDUCT ANALYSIS TO UNDERSTAND 4417 03:12:47,040 --> 03:12:49,080 HOW THAT VARIABILITY IS RELATE 4418 03:12:49,080 --> 03:12:52,040 TODAY OUR OUTCOMES TO UNDERSTAND 4419 03:12:52,040 --> 03:12:53,000 TWO THINGS, WHY THE TREATMENT 4420 03:12:53,000 --> 03:12:55,720 WORKS AND FOR WHOM IT WORKS. 4421 03:12:55,720 --> 03:12:57,520 AND THIS SHIFTS THE FOCUS REALLY 4422 03:12:57,520 --> 03:12:58,920 TO THE PERSON. 4423 03:12:58,920 --> 03:13:01,440 NEXT SLIDE, PLEASE. 4424 03:13:01,440 --> 03:13:03,160 AND SO THREE EXAMPLES OF THESE 4425 03:13:03,160 --> 03:13:04,480 APPROACHES I WANT TO INTRODUCE 4426 03:13:04,480 --> 03:13:06,560 ARE THE MEDIATION, MODERATION 4427 03:13:06,560 --> 03:13:08,360 AND MODERATED MEDIATION 4428 03:13:08,360 --> 03:13:08,640 APPROACHES. 4429 03:13:08,640 --> 03:13:10,400 NEXT SLIDE, PLEASE. 4430 03:13:10,400 --> 03:13:12,960 AND IT MEDIATION ANALYSIS, NEXT 4431 03:13:12,960 --> 03:13:20,840 SLIDE, PLEASE, WE CAN ON AND A 4432 03:13:20,840 --> 03:13:22,320 ASSIGN AND WE CAN LOOK AT THE 4433 03:13:22,320 --> 03:13:24,200 EFFECTS OF THAT ON AN OUTCOME. 4434 03:13:24,200 --> 03:13:28,520 THIS IS A CLASSIC EXPLANATORY 4435 03:13:28,520 --> 03:13:30,120 TRIAL AND EFFICIENCY TRIAL. 4436 03:13:30,120 --> 03:13:31,480 NEXT SLIDE, PLEASE. 4437 03:13:31,480 --> 03:13:33,800 BUT WE CAN ALSO MEASURE AS PART 4438 03:13:33,800 --> 03:13:36,400 OF THAT, POTENTIAL MECHANISM 4439 03:13:36,400 --> 03:13:38,520 VARIABLES WE THINK THAT WILL 4440 03:13:38,520 --> 03:13:42,600 PLAIN HOW AND WHY THE TREATMENT 4441 03:13:42,600 --> 03:13:44,440 WORKS AND WE CAN COMPUTE THE 4442 03:13:44,440 --> 03:13:46,800 EFFECTS OF THE TREATMENT ON THAT 4443 03:13:46,800 --> 03:13:48,240 MECHANISM AND THEN STUDY HOW 4444 03:13:48,240 --> 03:13:51,960 CHANGES IN THAT MECHANISM EFFECT 4445 03:13:51,960 --> 03:13:55,680 OUTCOME AND THE CO EFFICIENT 4446 03:13:55,680 --> 03:13:58,760 THERE. 4447 03:13:58,760 --> 03:13:59,960 IT'S STRONG BECAUSE WE'RE ABLE 4448 03:13:59,960 --> 03:14:01,040 TO DRAW CONCLUSIONS ABOUT THE 4449 03:14:01,040 --> 03:14:02,320 TREATMENT ON THE MECHANISM 4450 03:14:02,320 --> 03:14:08,800 VARIABLE, NEXT SLIDE, PLEASE. 4451 03:14:08,800 --> 03:14:10,800 WE CAN UNDERSTAND THE EXTENT TO 4452 03:14:10,800 --> 03:14:12,800 WIT MECHANISM VARIABLE EXPLAINS 4453 03:14:12,800 --> 03:14:15,640 OUTCOMES AND IT CAN SUPPORT THIS 4454 03:14:15,640 --> 03:14:17,160 ANALYSIS IS NOT CAUSAL BUT IT 4455 03:14:17,160 --> 03:14:19,760 CAN HELP RULE OUT POTENTIAL 4456 03:14:19,760 --> 03:14:23,680 MECHANISMS THAT WE THINK ARE 4457 03:14:23,680 --> 03:14:25,000 VARIABLE AND YOU CUT AWAY FROM 4458 03:14:25,000 --> 03:14:26,040 WOOD ALL THE PIECES THAT AREN'T 4459 03:14:26,040 --> 03:14:31,240 A GUITAR AND WHAT IS LEFT, THE 4460 03:14:31,240 --> 03:14:32,280 MECHANISMS THAT ARE MOST LIKELY 4461 03:14:32,280 --> 03:14:34,800 PLAYING A ROLE AND WE CAN STUDY 4462 03:14:34,800 --> 03:14:36,080 MANY VARIABLE AND WE CAN STUT' 4463 03:14:36,080 --> 03:14:39,160 THE WHOLE PERSON BIOLOGICAL 4464 03:14:39,160 --> 03:14:41,040 VARIABLE, SOCIAL VARIABLE, 4465 03:14:41,040 --> 03:14:42,840 ENVIRONMENTAL VARIABLE AND WE 4466 03:14:42,840 --> 03:14:45,280 CAN UNDERSTAND ALL THE 4467 03:14:45,280 --> 03:14:47,000 MECHANISMS TA CAN PLAY A ROLE 4468 03:14:47,000 --> 03:14:47,360 HERE. 4469 03:14:47,360 --> 03:14:48,640 NEXT SLIDE, PLEASE. 4470 03:14:48,640 --> 03:14:50,600 SO AGAIN, THIS IS UNDERSTANDING 4471 03:14:50,600 --> 03:14:54,200 WHY THE TREATMENT WORKS AND IT'S 4472 03:14:54,200 --> 03:14:58,360 NOT ABOUT IF IT DOESN'T WORK BUT 4473 03:14:58,360 --> 03:14:58,520 WHY. 4474 03:14:58,520 --> 03:15:02,240 AND ANOTHER APPROACH IS A 4475 03:15:02,240 --> 03:15:02,680 MODERATION ANALYSIS. 4476 03:15:02,680 --> 03:15:04,880 AND THIS CASE AGAIN WE CAN 4477 03:15:04,880 --> 03:15:08,200 DESIGN A STUDY COULD CAM PAIR 4478 03:15:08,200 --> 03:15:12,920 TWO TREATMENTS AS A PRAGMATIC 4479 03:15:12,920 --> 03:15:14,680 TRIAL WE PRESSURE A PERSON 4480 03:15:14,680 --> 03:15:16,080 VARIABLES TO UNDERSTAND WHAT IT 4481 03:15:16,080 --> 03:15:17,920 IS ABOUT THE PERSON THAT 4482 03:15:17,920 --> 03:15:20,880 INTERACTS WITH THIS OUTCOMES AND 4483 03:15:20,880 --> 03:15:25,480 TO EXPLAIN HOW, FOR WHOM THE 4484 03:15:25,480 --> 03:15:26,320 TREATMENT WORKS. 4485 03:15:26,320 --> 03:15:29,360 BECAUSE WE MEASURE THE PERSON 4486 03:15:29,360 --> 03:15:30,240 VARIABLES THEY HAPPEN BEFORE THE 4487 03:15:30,240 --> 03:15:31,560 TREATMENT IS GIVEN WE GET 4488 03:15:31,560 --> 03:15:34,720 PRECEDENT SO IT'S A PREDICTIVE 4489 03:15:34,720 --> 03:15:35,280 ANALYSIS. 4490 03:15:35,280 --> 03:15:36,040 NEXT SLIDE, PLEASE. 4491 03:15:36,040 --> 03:15:37,680 SO YOU CAN ALSO LIKE WITH 4492 03:15:37,680 --> 03:15:39,800 MEDIATION CAN STUDY A WHOLE 4493 03:15:39,800 --> 03:15:41,960 VARIETY OF VARIABLES AND IT'S 4494 03:15:41,960 --> 03:15:45,120 BEST TO STUDY WHEN THEY'RE 4495 03:15:45,120 --> 03:15:45,720 THEORETICALLY RELATED AND WE 4496 03:15:45,720 --> 03:15:47,600 HAVE A THEORY TO EXPLAIN AND 4497 03:15:47,600 --> 03:15:52,480 TEST ABOUT WHY THEY MIGHT BE 4498 03:15:52,480 --> 03:15:52,960 MODERATORS. 4499 03:15:52,960 --> 03:15:55,560 AND AGAIN TO UNDERSTAND FOR WHOM 4500 03:15:55,560 --> 03:15:56,600 TREATMENT WORKS AND AGAIN THE 4501 03:15:56,600 --> 03:15:59,600 FOCUS IS ON THE PERSON AND HOW 4502 03:15:59,600 --> 03:16:03,800 THAT PERSON INTERACTS WITH 4503 03:16:03,800 --> 03:16:04,240 TREATMENT. 4504 03:16:04,240 --> 03:16:08,320 AND THEN I WANT TO TALK ABOUT 4505 03:16:08,320 --> 03:16:15,280 MODERATED MEDIATION AND IN THIS 4506 03:16:15,280 --> 03:16:25,800 CASE, THEY HAVE SIMILAR WAYS OF 4507 03:16:28,360 --> 03:16:30,400 A VARIETY OF MEDIATORS. 4508 03:16:30,400 --> 03:16:32,400 BUT THEN LOOK AT WHAT IT IS 4509 03:16:32,400 --> 03:16:35,000 ABOUT THE PERSON THAT MIGHT 4510 03:16:35,000 --> 03:16:37,000 EXPLAIN HOW THESE DIFFERENT 4511 03:16:37,000 --> 03:16:38,200 TREATMENTS WORK. 4512 03:16:38,200 --> 03:16:47,080 SO AN POXEL OF A EXAMPLE OF EES 4513 03:16:47,080 --> 03:16:51,120 WHO MIGHT SPEND BEST TO WHAT 4514 03:16:51,120 --> 03:16:56,440 TREATMENT AND PREDICTS THE 4515 03:16:56,440 --> 03:17:01,760 PARTICULAR MEDIATORS AND IT'S A 4516 03:17:01,760 --> 03:17:03,160 HIP NOD I CAN TO PAIN OUTREACH 4517 03:17:03,160 --> 03:17:04,280 AND IT'S TO UNDERSTAND IN THIS 4518 03:17:04,280 --> 03:17:06,880 CASE THE PERSON FACTORS THAT 4519 03:17:06,880 --> 03:17:09,480 IMPACT THE EXPLANATORY 4520 03:17:09,480 --> 03:17:10,640 VARIABLES, DIFFERENT PEOPLE 4521 03:17:10,640 --> 03:17:11,720 MIGHT RESPOND TO DIFFERENT 4522 03:17:11,720 --> 03:17:12,440 TREATMENTS FOR DIFFERENT REASONS 4523 03:17:12,440 --> 03:17:17,480 AND THIS ANALYSIS ALLOWS FOR 4524 03:17:17,480 --> 03:17:17,920 THAT. 4525 03:17:17,920 --> 03:17:21,160 THE PRIMARY CONCERN RAISED BY 4526 03:17:21,160 --> 03:17:22,920 REVIEWERS OF GRANTS AND EDITORS 4527 03:17:22,920 --> 03:17:24,880 OF JOURNALS, IS THAT WHEN YOU 4528 03:17:24,880 --> 03:17:28,880 EXAMINE ALL OF THESE PERSON 4529 03:17:28,880 --> 03:17:31,400 VARIABLES, YOU ARE FINDING ONES 4530 03:17:31,400 --> 03:17:33,480 THAT ARE SIGNIFICANT BUT THAT 4531 03:17:33,480 --> 03:17:36,000 AREN'T IN FACT SIGNIFICANT IN 4532 03:17:36,000 --> 03:17:36,800 POPULATION. 4533 03:17:36,800 --> 03:17:38,840 SO, TO ADDRESS THIS FOUR 4534 03:17:38,840 --> 03:17:40,600 REVIEWERS AND EDITORS OF GRANTS 4535 03:17:40,600 --> 03:17:42,840 AND EDITORS OF ARTICLES, I 4536 03:17:42,840 --> 03:17:44,240 USUALLY SELECT JUST ONE OR A 4537 03:17:44,240 --> 03:17:46,440 SMALL SUBSET OF PRIMARY 4538 03:17:46,440 --> 03:17:48,240 VARIABLES TO LOOK AT AND MAKE 4539 03:17:48,240 --> 03:17:50,080 HYPOTHESIS ABOUT THAT AND MAKE 4540 03:17:50,080 --> 03:17:52,280 THE OTHERS EXPLANATORY SECONDARY 4541 03:17:52,280 --> 03:17:54,800 BUT MY VIEW IS THAT WE ARE TOO 4542 03:17:54,800 --> 03:17:57,520 DEPENDING ON THE P-VALUE THAT 4543 03:17:57,520 --> 03:17:58,960 IS, WE DON'T THINK WE SHOULD USE 4544 03:17:58,960 --> 03:18:01,520 ONE STUDY TO TEST ONE QUESTION 4545 03:18:01,520 --> 03:18:03,360 USING ALL THE POWER BUT RATHER 4546 03:18:03,360 --> 03:18:05,040 TO USE OUR RESEARCH TO 4547 03:18:05,040 --> 03:18:06,600 UNDERSTAND EFFECT SIZES AND LOOK 4548 03:18:06,600 --> 03:18:08,560 AT MULTIPLE STUDIES OVER TIME TO 4549 03:18:08,560 --> 03:18:10,320 SEE WHAT THE TRUE EFFECT SIZES 4550 03:18:10,320 --> 03:18:12,080 ARE ON AVERAGE SO, I'M HOPING 4551 03:18:12,080 --> 03:18:16,320 THAT AS A FIELD WE'LL MOVE FROM 4552 03:18:16,320 --> 03:18:18,200 GOALS OF EXAMINING THE 4553 03:18:18,200 --> 03:18:21,240 RELIABILITY OF THE SINGLE EFFECT 4554 03:18:21,240 --> 03:18:23,080 PROVIDING RELIABLE ESTIMATES OF 4555 03:18:23,080 --> 03:18:25,320 MANY EFFECTS, THE WHOLE PERSON. 4556 03:18:25,320 --> 03:18:31,960 NEXT SLIDE, PLEASE. 4557 03:18:31,960 --> 03:18:33,720 I THINK WE'VE BEEN USING 4558 03:18:33,720 --> 03:18:35,920 RIGOROUSLY DESIGNED EXPLANATORY 4559 03:18:35,920 --> 03:18:37,280 TRIALS FOR DECADES AND THEY'RE 4560 03:18:37,280 --> 03:18:39,080 VERY STRONG TO DEFINITIVELY 4561 03:18:39,080 --> 03:18:41,360 ANSWER ONE QUESTION -- DOES THE 4562 03:18:41,360 --> 03:18:44,160 TREATMENT WORK? 4563 03:18:44,160 --> 03:18:45,520 BUT, I HAVE A CONCERN THAT THE 4564 03:18:45,520 --> 03:18:50,840 FONDINGS MAY BE OF LIMITED 4565 03:18:50,840 --> 03:19:01,400 PRACTICAL USE BECAUSE I THINK WE 4566 03:19:16,760 --> 03:19:18,080 CAN CONSIDER PUTTING THE WHOLE 4567 03:19:18,080 --> 03:19:20,400 PERSON BACK INTO OUR CLINICAL 4568 03:19:20,400 --> 03:19:23,080 RESEARCH AND ALLOWING GREATER 4569 03:19:23,080 --> 03:19:24,560 VARIABILITY AND EMBRACE 4570 03:19:24,560 --> 03:19:25,880 VARIABILITY LIKE THERE IS IN THE 4571 03:19:25,880 --> 03:19:29,000 REAL WORLD AND RIGOROUSLY 4572 03:19:29,000 --> 03:19:31,600 MEASURE THAT VARIABILITY AND 4573 03:19:31,600 --> 03:19:33,760 ASSESS KEY BIOLOGICAL FACTORS 4574 03:19:33,760 --> 03:19:36,600 AND AT BASELINE TREATMENT OF 4575 03:19:36,600 --> 03:19:38,280 POST TREATMENT AND THEN CONDUCT 4576 03:19:38,280 --> 03:19:40,120 ANALYSIS TO UNDERSTAND THE 4577 03:19:40,120 --> 03:19:41,920 VARIABLE THAT'S EXPLAIN WHY 4578 03:19:41,920 --> 03:19:43,400 TREATMENTS WORK AND FOR WHOM 4579 03:19:43,400 --> 03:19:45,000 THEY WORK. 4580 03:19:45,000 --> 03:19:46,760 AND, CONSIDER MODERATED 4581 03:19:46,760 --> 03:19:48,440 MEDIATION TO UNDERSTAND FOR WHOM 4582 03:19:48,440 --> 03:19:52,840 DIFFERENT MEDIATORS PLAY A ROLE. 4583 03:19:52,840 --> 03:19:57,280 AND THAT IS IT. 4584 03:19:57,280 --> 03:19:57,800 THANK YOU VERY MUCH. 4585 03:19:57,800 --> 03:20:02,120 I'M LOOKING FORWARD TO HEARING 4586 03:20:02,120 --> 03:20:05,160 Dr. ATLAS' TALK ABOUT 4587 03:20:05,160 --> 03:20:06,520 VENTROMEDIAL PREFRONTAL CORTEX 4588 03:20:06,520 --> 03:20:09,000 BECAUSE WE ARE STUDYING INTERIOR 4589 03:20:09,000 --> 03:20:10,160 ACTIVITY IN THE LEFT ANTERIOR 4590 03:20:10,160 --> 03:20:11,800 BECAUSE WE'RE FINDING A LOT OF 4591 03:20:11,800 --> 03:20:13,160 ACTIVITY THERE IS GOOD IF YOU 4592 03:20:13,160 --> 03:20:17,360 WANT TO BE COGNITIVE THERAPY BUT 4593 03:20:17,360 --> 03:20:19,160 CAN GET IN THE WAY OF HYPNOSIS 4594 03:20:19,160 --> 03:20:20,520 SO WE'RE TRYING TO UNDERSTAND 4595 03:20:20,520 --> 03:20:21,920 THIS FOR PRECISION MEDICINE SO 4596 03:20:21,920 --> 03:20:23,360 I'M LOOKING FORWARD TO HEARING 4597 03:20:23,360 --> 03:20:24,400 Dr. ATLAS, THANK YOU, VERY 4598 03:20:24,400 --> 03:20:24,760 MUCH. 4599 03:20:24,760 --> 03:20:25,680 >> THANK YOU VERY MUCH. 4600 03:20:25,680 --> 03:20:27,560 THANK YOU FOR THAT SET UP WITH 4601 03:20:27,560 --> 03:20:29,040 MEDIATION ANALYSIS BECAUSE I 4602 03:20:29,040 --> 03:20:30,440 ACTUALLY HAVE MODERATED 4603 03:20:30,440 --> 03:20:35,080 MEDIATION IN THIS TALK. 4604 03:20:35,080 --> 03:20:38,280 SO, I AM A TEN YOUR TRACK 4605 03:20:38,280 --> 03:20:39,720 INVESTIGATORS WITH AFFECT OF 4606 03:20:39,720 --> 03:20:40,880 NEUROSCIENCE IN PAIN IN THE 4607 03:20:40,880 --> 03:20:45,400 NATIONAL CENTER FOR COMMENT TREE 4608 03:20:45,400 --> 03:20:47,600 ENTA GRAY TIVE HEALTH AND OUR 4609 03:20:47,600 --> 03:20:52,040 LAB IS INTERESTED IN MECHANISMS 4610 03:20:52,040 --> 03:20:56,600 OF HOW EXPECTATIONS SHAPE PAIN. 4611 03:20:56,600 --> 03:20:58,960 WE USED AS A GUIDED MODEL IN 4612 03:20:58,960 --> 03:21:01,000 ORDER TO UNDERSTAND HOW THE 4613 03:21:01,000 --> 03:21:02,640 PSYCHOSOCIAL CONTEXT SURROUNDING 4614 03:21:02,640 --> 03:21:04,280 TREATMENT INFLUENCES CLINICAL 4615 03:21:04,280 --> 03:21:05,880 OUTCOMES AND BECAUSE PLACEBO 4616 03:21:05,880 --> 03:21:07,240 EFFECTS ARE LARGEST IN PAIN AND 4617 03:21:07,240 --> 03:21:09,280 SA DETECTIVE OUTCOMES THIS IS A 4618 03:21:09,280 --> 03:21:12,080 REALLY MOTIVATING FACTOR FOR WHY 4619 03:21:12,080 --> 03:21:13,640 WE SHOULD STUDY PLACEBO TO 4620 03:21:13,640 --> 03:21:15,120 UNDERSTAND HOW PSYCHOLOGICAL 4621 03:21:15,120 --> 03:21:16,680 FACTORS CAN DIRECTLY AFFECT 4622 03:21:16,680 --> 03:21:19,840 PATIENT OUTCOMES. 4623 03:21:19,840 --> 03:21:21,600 SO, OUR APPROACH IS TO USE BASIC 4624 03:21:21,600 --> 03:21:24,920 SCIENCE TO ISOLATE COMPONENT 4625 03:21:24,920 --> 03:21:26,520 MECHANISMS AND DO CLINICAL 4626 03:21:26,520 --> 03:21:27,840 EXTENSIONS AND WE CAN TEST 4627 03:21:27,840 --> 03:21:29,200 WHETHER THEY'RE ALTERED IN 4628 03:21:29,200 --> 03:21:31,080 PATIENT POPULATION AND OUR GOAL 4629 03:21:31,080 --> 03:21:33,280 IS TO INTEGRATE THESE 4630 03:21:33,280 --> 03:21:35,560 PSYCHOLOGICAL FACTORS ALONGSIDE 4631 03:21:35,560 --> 03:21:37,240 TREATMENT TO MAXIMIZE PATIENT 4632 03:21:37,240 --> 03:21:37,640 OUTCOMES. 4633 03:21:37,640 --> 03:21:38,960 NEXT SLIDE. 4634 03:21:38,960 --> 03:21:40,480 SO OUR APPROACH YOU CAN CLICK 4635 03:21:40,480 --> 03:21:41,360 THROW TIMES. 4636 03:21:41,360 --> 03:21:44,920 IS BASICALLY TO MANIPULATE THE 4637 03:21:44,920 --> 03:21:45,720 STIMULUS INTENSITY, 4638 03:21:45,720 --> 03:21:46,920 PSYCHOLOGICAL FACTORS ASK 4639 03:21:46,920 --> 03:21:48,520 CONTEXT SURROUNDING TREATMENT TO 4640 03:21:48,520 --> 03:21:52,800 MEASURE A WHOLE HOST OF 4641 03:21:52,800 --> 03:21:53,640 DIFFERENT PARALLEL MEASURES 4642 03:21:53,640 --> 03:21:56,360 RELATED TO PAIN INCLUDING 4643 03:21:56,360 --> 03:21:58,720 REPORTS ON RESPONSES AND 4644 03:21:58,720 --> 03:22:00,600 MEDIATORS AND TO UNDERSTAND HOW 4645 03:22:00,600 --> 03:22:03,200 THESE RESPONSES ARE MODERATED BY 4646 03:22:03,200 --> 03:22:05,640 THINGS LIKE PATIENT DYING KNOW 4647 03:22:05,640 --> 03:22:16,800 PAY DIAGNOSIS, TODAYI'LL TALK AE 4648 03:22:16,800 --> 03:22:18,240 OF THIS WHOLE-PERSON HEALTH, 4649 03:22:18,240 --> 03:22:19,560 I'LL TALK ABOUT THE RELATIONSHIP 4650 03:22:19,560 --> 03:22:28,160 BETWEENDEDUCK TIVE PAIN HOW IT S 4651 03:22:28,160 --> 03:22:33,280 PAIN EXPECTANCY AND AROUSAL. 4652 03:22:33,280 --> 03:22:36,440 PAIN IS AN UNPLEASANT SENSORY 4653 03:22:36,440 --> 03:22:37,800 AND EMOTIONAL EXPERIENCE WITH 4654 03:22:37,800 --> 03:22:40,640 TISSUE DAMAGE AND IT IS DISTINCT 4655 03:22:40,640 --> 03:22:43,760 FROM THOSE THE NEURAL PROCESS OF 4656 03:22:43,760 --> 03:22:49,040 ENCODING STIMULI. 4657 03:22:49,040 --> 03:22:50,160 PAIN CAN GO FURTHER DIVIDED INTO 4658 03:22:50,160 --> 03:22:53,360 IT'S SENSORY OR DIS CRIMINAL NA 4659 03:22:53,360 --> 03:22:56,080 TIVE COMPONENT AND IT OF COURSE 4660 03:22:56,080 --> 03:23:01,680 TIVE IN MOTIVATIONAL, PAIN 4661 03:23:01,680 --> 03:23:02,160 UNPLEASANT. 4662 03:23:02,160 --> 03:23:04,360 SO, BASICALLY, WITH THIS 4663 03:23:04,360 --> 03:23:08,640 DISTINCTION, THE IDEA IS IF WE 4664 03:23:08,640 --> 03:23:11,400 CAN UNDERSTAND HOW PSYCHOLOGICAL 4665 03:23:11,400 --> 03:23:12,960 FACTORS WERE ALONG THIS PATHWAY 4666 03:23:12,960 --> 03:23:14,200 WITH NO SUSPENSION TO PAIN DO 4667 03:23:14,200 --> 03:23:16,600 THEY HAVE THEIR IMPACT. 4668 03:23:16,600 --> 03:23:19,360 AND WE'VE IDENTIFIED GRADIENTS 4669 03:23:19,360 --> 03:23:21,480 ALONG THE CINGULAR LET RELATED 4670 03:23:21,480 --> 03:23:23,280 TO NO SUN EXCEPTION TO PAIN OR 4671 03:23:23,280 --> 03:23:27,400 THAT FORMALLY MEDIATE THE LINK 4672 03:23:27,400 --> 03:23:28,960 BETWEEN PAIN. 4673 03:23:28,960 --> 03:23:34,520 SO, MY POSTDOC WAS INTERESTED IN 4674 03:23:34,520 --> 03:23:36,200 TESTING WHETHER AUTO NOM I CAN 4675 03:23:36,200 --> 03:23:40,920 ACTIVITY IS MORE RELATED TO NO 4676 03:23:40,920 --> 03:23:43,840 SUN ACCEPTION THAN PAIN AND HOW 4677 03:23:43,840 --> 03:23:51,840 PAIN SPEEXPERIENCE TO PAIN. 4678 03:23:51,840 --> 03:23:53,840 SO, DON DEVELOPED A TWO-STEP 4679 03:23:53,840 --> 03:23:55,880 PAIN ASSESSMENT TASK WHERE 4680 03:23:55,880 --> 03:23:57,520 INDIVIDUALS CAME INTO THE LAB 4681 03:23:57,520 --> 03:23:59,720 AND EXPERIENCED ACUTE PAIN WITH 4682 03:23:59,720 --> 03:24:01,920 A THERMO DEVICE ON THE LEFT 4683 03:24:01,920 --> 03:24:03,240 WHICH HEATS UP TO DIFFERENT 4684 03:24:03,240 --> 03:24:03,560 TEMPERATURES. 4685 03:24:03,560 --> 03:24:04,720 AND EVERYBODY RECEIVED A WHOLE 4686 03:24:04,720 --> 03:24:06,520 DIFFERENT RANGE OF TEMPERATURES 4687 03:24:06,520 --> 03:24:08,000 ON EACH TRIAL THEY WOULD TELL US 4688 03:24:08,000 --> 03:24:11,680 IF IT WAS PAINFUL OR NOT, CLICK. 4689 03:24:11,680 --> 03:24:14,240 AND THEN HOW PAINFUL IT WAS. 4690 03:24:14,240 --> 03:24:16,080 OR HOW INTENSE IT WAS IF IT 4691 03:24:16,080 --> 03:24:17,480 WASN'T PAINFUL. 4692 03:24:17,480 --> 03:24:20,120 IN IN ADDITION WE MEASURED 4693 03:24:20,120 --> 03:24:25,320 STAYING CONNECTED AS WELL AS 4694 03:24:25,320 --> 03:24:27,800 PUPIL DILATION. 4695 03:24:27,800 --> 03:24:32,160 WHAT WE FOUND IS THAT WHAT WE 4696 03:24:32,160 --> 03:24:38,120 SEE WHEN INDIVIDUALS AND ON THE 4697 03:24:38,120 --> 03:24:40,520 WHY EXAMINATION IS AND THE HEAT 4698 03:24:40,520 --> 03:24:44,360 AND IT COMES ON SLOWLY AND IT'S 4699 03:24:44,360 --> 03:24:47,960 AT MAXIMUM AND YOU CAN SEE 4700 03:24:47,960 --> 03:24:49,720 THERE'S AN EFFECT OF 4701 03:24:49,720 --> 03:24:51,160 TEMPERATURES ON A TRIAL WHICH 4702 03:24:51,160 --> 03:25:00,520 SUBJECTS CALLED IT NOT PAINFUL 4703 03:25:00,520 --> 03:25:02,080 WHEN PEOPLE CALL THOSE 4704 03:25:02,080 --> 03:25:05,480 TEMPERATURES PAINFUL. 4705 03:25:05,480 --> 03:25:08,720 AND WHAT WE FOUND IS EVIDENCE OF 4706 03:25:08,720 --> 03:25:09,920 MODERATED MEDIATION WHERE WHAT 4707 03:25:09,920 --> 03:25:12,720 WE CAN SEE IS ON THE TRIALS ONE 4708 03:25:12,720 --> 03:25:13,880 SUBJECT IS CALLED THE 4709 03:25:13,880 --> 03:25:18,120 TEMPERATURE NOT PAINFUL AND THEN 4710 03:25:18,120 --> 03:25:19,760 IT DROVE THE SKIN CONDITION AND 4711 03:25:19,760 --> 03:25:22,800 ON THE TRIALS WHEN INDIVIDUALS 4712 03:25:22,800 --> 03:25:26,680 CALLED IT PAINFUL, WE FOUND THAT 4713 03:25:26,680 --> 03:25:28,640 IT AFFECTS THE TEMPERATURE ON 4714 03:25:28,640 --> 03:25:31,320 SKIN WERE FULLY MEDIATED BY THE 4715 03:25:31,320 --> 03:25:32,560 SUBJECTIVE PAIN READING SO 4716 03:25:32,560 --> 03:25:34,440 REALLY WHEN IT'S PAINFUL, IT'S 4717 03:25:34,440 --> 03:25:35,680 HOW PAINFUL IT IS THAT IS 4718 03:25:35,680 --> 03:25:37,480 DRIVING YOUR BODY'S RESPONSE 4719 03:25:37,480 --> 03:25:39,120 WHEREAS IF YOU CHARACTER EYES IT 4720 03:25:39,120 --> 03:25:41,880 AS NOT PAINFUL IT'S JUST THE 4721 03:25:41,880 --> 03:25:45,720 INPUT THAT MATTERS. 4722 03:25:45,720 --> 03:25:47,720 YOU CAN CLICK THIS THREE TIMES. 4723 03:25:47,720 --> 03:25:50,160 WHAT WE FIND IS THAT THE NERVOUS 4724 03:25:50,160 --> 03:25:52,440 SYSTEM RESPONSES TO NOXIOUS 4725 03:25:52,440 --> 03:25:53,720 STIMULI ARE MEDIATED BY 4726 03:25:53,720 --> 03:25:54,920 EXPERIENCED PAIN AND I SWEAR 4727 03:25:54,920 --> 03:25:57,440 THAT Dr. JENSON AND I DID NOT 4728 03:25:57,440 --> 03:25:59,080 HAVE A SET UP YOU WOULD TEACH 4729 03:25:59,080 --> 03:26:00,520 YOU UP THE BACKGROUND ABOUT 4730 03:26:00,520 --> 03:26:01,000 THIS. 4731 03:26:01,000 --> 03:26:02,640 WE REPLICATED THIS IN A SEPARATE 4732 03:26:02,640 --> 03:26:05,520 PAIN ASSESSMENT TEST AS WELL AS 4733 03:26:05,520 --> 03:26:07,080 THE PUPIL DILATION AND IT SHOWS 4734 03:26:07,080 --> 03:26:09,360 LABELING THE STIMULUS AS 4735 03:26:09,360 --> 03:26:10,400 PAINFUL, SHAPES HOW YOUR BODY 4736 03:26:10,400 --> 03:26:11,680 RESPONDS TO IT. 4737 03:26:11,680 --> 03:26:13,280 AS A PSYCHOLOGIST, THIS IS 4738 03:26:13,280 --> 03:26:15,000 ACTUALLY NOT TOO SURPRISING. 4739 03:26:15,000 --> 03:26:17,120 THIS IS CONSISTENT WITH THE 4740 03:26:17,120 --> 03:26:18,200 APPRAISAL THEORY OF MOTION AND 4741 03:26:18,200 --> 03:26:20,480 THE IDEA HOW WE APPRAISE EVENTS 4742 03:26:20,480 --> 03:26:22,200 IN THE ENVIRONMENT CAN SHAPE HOW 4743 03:26:22,200 --> 03:26:24,000 OUR BODY RESPONDS TO THEM. 4744 03:26:24,000 --> 03:26:25,880 NOW AM I ALLOWED THIS MOVING 4745 03:26:25,880 --> 03:26:28,440 FORWARD TO LOOK AT THIS KIND OF 4746 03:26:28,440 --> 03:26:30,360 DECISION THAT IS MAKING PROCESS 4747 03:26:30,360 --> 03:26:31,920 SURROUNDING PAIN AND TO 4748 03:26:31,920 --> 03:26:34,840 UNDERSTAND HOW THIS CAN DRIVE 4749 03:26:34,840 --> 03:26:45,240 OUR BODY'S RESPONSES. 4750 03:26:58,000 --> 03:26:59,600 IT'S REALLY THE CORNER STONE OF 4751 03:26:59,600 --> 03:27:02,720 WHAT IS CALLED THIS MARKET AND 4752 03:27:02,720 --> 03:27:07,640 HYPOTHESIS THAT WAS INTRODUCED 4753 03:27:07,640 --> 03:27:10,640 IN 1994 AND IT'S THOUGHT THAT 4754 03:27:10,640 --> 03:27:17,360 THE VMPSC AND THE AND IN ORANGE 4755 03:27:17,360 --> 03:27:18,680 IS CRITICAL LINKING EMOTION 4756 03:27:18,680 --> 03:27:22,160 AROUND AROUSAL AND 4757 03:27:22,160 --> 03:27:24,600 DECISION-MAKING IT COMES FROM 4758 03:27:24,600 --> 03:27:27,560 BILATERAL LESIONS AND PREFRONTAL 4759 03:27:27,560 --> 03:27:30,720 CORTEX WHERE THEY FIND, YOU CAN 4760 03:27:30,720 --> 03:27:35,520 CLICK, THAT INDIVIDUALS WITH 4761 03:27:35,520 --> 03:27:38,880 LESIONS AND SHOW DEFICITS IN 4762 03:27:38,880 --> 03:27:40,120 DECISION-MAKING AND IN SHOW 4763 03:27:40,120 --> 03:27:44,240 BLUNTING THE SKIN CONDUCTANTS 4764 03:27:44,240 --> 03:27:45,960 WHERE THEY MAKE DIFFERENT 4765 03:27:45,960 --> 03:27:47,200 DECISIONS ABOUT TRYING TO FIGURE 4766 03:27:47,200 --> 03:27:50,480 OUT WHAT IS THE OPTIMAL DECK. 4767 03:27:50,480 --> 03:27:53,440 AND SO BASICALLY, THEY DON'T 4768 03:27:53,440 --> 03:27:57,120 SHOW SCR IN RESPONSE TO A 4769 03:27:57,120 --> 03:27:58,240 POTENTIALLY ADVANTAGEOUS DECK 4770 03:27:58,240 --> 03:28:01,720 AND IT'S THOUGHT THAT IN TURN 4771 03:28:01,720 --> 03:28:04,960 EXPLAINS WHY THEY SHOW LESS 4772 03:28:04,960 --> 03:28:06,960 OPTIMAL BEHAVIOR ON THIS TASK. 4773 03:28:06,960 --> 03:28:11,640 SO THE IDEA IS THAT THE VENTURE 4774 03:28:11,640 --> 03:28:15,640 PREFRONTAL CORTEX ACTS AS A 4775 03:28:15,640 --> 03:28:16,840 REPOSITORY BETWEEN REGULATORY 4776 03:28:16,840 --> 03:28:19,160 STATES SO ON THE LEFT, 4777 03:28:19,160 --> 03:28:22,840 BASICALLY, IS A LOOP WHERE THE 4778 03:28:22,840 --> 03:28:24,000 VMPFC GETS IMPACT THROUGH THE 4779 03:28:24,000 --> 03:28:25,960 BODY AS WE GO THROUGH EMOTIONAL 4780 03:28:25,960 --> 03:28:27,080 EXPERIENCE AND ON THE RIGHT IT'S 4781 03:28:27,080 --> 03:28:30,040 OVER TIME, THE VMPSD CAN USE 4782 03:28:30,040 --> 03:28:34,400 THAT LEARNING TO GUIDE FUTURE 4783 03:28:34,400 --> 03:28:34,720 DECISIONS. 4784 03:28:34,720 --> 03:28:37,240 SO OUR HYPOTHESIS, BEGIN THIS 4785 03:28:37,240 --> 03:28:39,000 LINK BETWEEN AUTO NOM I CAN 4786 03:28:39,000 --> 03:28:41,320 RESPONSES AND PAIN IS THAT 4787 03:28:41,320 --> 03:28:43,800 INDIVIDUALS WITH VMPS LESIONS 4788 03:28:43,800 --> 03:28:46,040 WILL SHOW ALTERED PAIN ACTIVITY 4789 03:28:46,040 --> 03:28:48,840 HOWEVER IT'S NOT THAT SIMPLE, 4790 03:28:48,840 --> 03:28:49,400 CLICK. 4791 03:28:49,400 --> 03:28:51,840 IT'S ALSO KNOWN TO BE A HUB FOR 4792 03:28:51,840 --> 03:28:53,960 EXPECTATIONS, VALUE AND 4793 03:28:53,960 --> 03:28:55,160 EFFECTIVE MEANING. 4794 03:28:55,160 --> 03:28:57,200 SO OVER THE PAST 25 YEARS OR SO 4795 03:28:57,200 --> 03:28:58,880 THERE'S BEEN SO MANY DIFFERENT 4796 03:28:58,880 --> 03:29:00,880 REVIEWS ON THE ROLE OF THE OSD 4797 03:29:00,880 --> 03:29:02,320 BUT THEY ALL CONVERGE ON THE 4798 03:29:02,320 --> 03:29:04,120 IDEA OF THIS REGISTER ON IS 4799 03:29:04,120 --> 03:29:06,520 CRITICAL FOR PREDICTION AND 4800 03:29:06,520 --> 03:29:08,320 GENERATING RULES FROM 4801 03:29:08,320 --> 03:29:08,680 EXPERIENCE. 4802 03:29:08,680 --> 03:29:10,240 AND AS I MENTIONED EARLIER AND 4803 03:29:10,240 --> 03:29:12,360 WE HEARD EARLIER TODAY, 4804 03:29:12,360 --> 03:29:13,880 EXPECTATIONS DIRECTLY AFFECT 4805 03:29:13,880 --> 03:29:15,920 PAIN IN THE FORM OF PLACEBO 4806 03:29:15,920 --> 03:29:16,360 EFFECTS. 4807 03:29:16,360 --> 03:29:19,400 SO THE IDEA IS, BY LEARNING FROM 4808 03:29:19,400 --> 03:29:21,280 INTERACTIONS OF PHYSICIAN, THE 4809 03:29:21,280 --> 03:29:23,640 CLINICAL CONTEXT, OUTCOMES, WE 4810 03:29:23,640 --> 03:29:25,240 DEVELOP EXPECTATIONS WHICH CAN 4811 03:29:25,240 --> 03:29:32,640 SHAPE OUR BODIES' RESPONSES AND 4812 03:29:32,640 --> 03:29:36,400 WE SHOWED THAT RESPONSES TO PAIN 4813 03:29:36,400 --> 03:29:38,560 PREDICTIVE ISSUES AND THE TRY 4814 03:29:38,560 --> 03:29:40,120 EIGHT UM PREDICTS RESPONSES IN 4815 03:29:40,120 --> 03:29:42,680 PAIN PROCESSING MEDIATORS THAT 4816 03:29:42,680 --> 03:29:47,920 IN TURN DRIVES SUBJECTIVE PAIN. 4817 03:29:47,920 --> 03:29:51,400 OUR SECOND HYPOTHESIS, THE 4818 03:29:51,400 --> 03:29:53,040 LESIONS WOULD REDUCE THE IMPACT 4819 03:29:53,040 --> 03:29:55,400 OF EXPECTATIONS ON PAIN. 4820 03:29:55,400 --> 03:29:58,040 AND FINALLY, MORE BROADLY, 4821 03:29:58,040 --> 03:29:59,640 THERE'S ALSO A POSSIBILITY THAT 4822 03:29:59,640 --> 03:30:03,440 THE MPSD MIGHT IMPACT PAIN ON 4823 03:30:03,440 --> 03:30:05,000 PLEASANTNESS IN GENERAL SO IT'S 4824 03:30:05,000 --> 03:30:07,480 BEEN KNOWN FOR A LONG TIME, IT 4825 03:30:07,480 --> 03:30:10,200 CAN ALTER PAIN ON PLEASANTNESS 4826 03:30:10,200 --> 03:30:12,080 IN TERMS OF PAIN EFFECT AND 4827 03:30:12,080 --> 03:30:13,840 STUDIES OF NEUROIMAGING SHOW 4828 03:30:13,840 --> 03:30:24,400 THAT PAIN RELIEF, WHICH IS -- WE 4829 03:30:45,320 --> 03:30:47,200 COLLABORATED TO MEASURE THE 4830 03:30:47,200 --> 03:30:52,240 EFFECTS OF VMPS LESIONS ON PAIN 4831 03:30:52,240 --> 03:30:52,560 MODULATION. 4832 03:30:52,560 --> 03:30:54,240 WE MEASURED RESPONSES IN FIVE 4833 03:30:54,240 --> 03:30:59,600 PATIENTS WITH BILATERAL NEWER 4834 03:30:59,600 --> 03:31:00,400 SURGICAL LESIONS AS A RESULT SO 4835 03:31:00,400 --> 03:31:02,240 THEY HAD TISSUE REMOVED SO WE 4836 03:31:02,240 --> 03:31:06,240 KNOW THAT IT'S BILATERAL AND CAN 4837 03:31:06,240 --> 03:31:07,680 FIND TWO PREFRONTAL CORTEX AND 4838 03:31:07,680 --> 03:31:09,280 NO OTHER REGIONS THAT ARE 4839 03:31:09,280 --> 03:31:11,560 EFFECTS THE PAIN. 4840 03:31:11,560 --> 03:31:14,280 AND WE COMPARED THEM TO 20 4841 03:31:14,280 --> 03:31:15,520 HEALTHY INDIVIDUALS AND 4842 03:31:15,520 --> 03:31:17,800 EVERYBODY WENT THROUGH THIS 4843 03:31:17,800 --> 03:31:18,720 ADAPTIVE STAIRCASE CALIBRATION 4844 03:31:18,720 --> 03:31:20,120 TASK THAT I WON'T DESCRIBE IN 4845 03:31:20,120 --> 03:31:22,840 DETAIL BUT BASICALLY THROUGH AN 4846 03:31:22,840 --> 03:31:24,680 ITERATIVE TASK SIMILAR TO 4847 03:31:24,680 --> 03:31:26,600 EARLIER, WE CAN FIND EACH 4848 03:31:26,600 --> 03:31:28,560 INDIVIDUAL'S PAIN SENSITIVITY 4849 03:31:28,560 --> 03:31:30,600 AND THE TEMPERATURES THAT HAVE 4850 03:31:30,600 --> 03:31:34,320 ASSOCIATED PAIN THRESHOLD AND 4851 03:31:34,320 --> 03:31:43,640 TOLERANCE. 4852 03:31:43,640 --> 03:31:45,520 AND WE HAD PEOPLE RATE PAIN 4853 03:31:45,520 --> 03:31:46,920 INTENSITY BUT ALSO 4854 03:31:46,920 --> 03:31:48,120 UNPLEASANTNESS BECAUSE OF THIS 4855 03:31:48,120 --> 03:31:50,680 HYPOTHESIS AND HERE IS AN 4856 03:31:50,680 --> 03:31:55,880 EXAMPLE INDIVIDUAL IN THE LESION 4857 03:31:55,880 --> 03:31:56,640 GROUP, CLICK. 4858 03:31:56,640 --> 03:31:58,840 WE FOUND THAT VMPS LEGION DID 4859 03:31:58,840 --> 03:32:01,960 NOT IMPACT PAIN SENSITIVITY OR 4860 03:32:01,960 --> 03:32:03,640 UNPLEASANTNESS SO YOU CAN SEE ON 4861 03:32:03,640 --> 03:32:06,320 THE Y AXIS IS INTENSITY OR PAIN 4862 03:32:06,320 --> 03:32:09,360 AND UNPLEASANTNESS AND ON THE X 4863 03:32:09,360 --> 03:32:11,880 AXIS IS TEMPERATURE AND THE 4864 03:32:11,880 --> 03:32:13,240 PATIENTS' IN BLUE SHOW VERY 4865 03:32:13,240 --> 03:32:18,280 SIMILAR RESPONSES TO THE HEALTHY 4866 03:32:18,280 --> 03:32:19,040 CONTROLS. 4867 03:32:19,040 --> 03:32:20,760 SO, YOU CAN SKIP THIS. 4868 03:32:20,760 --> 03:32:22,840 SO TO TEST OUR FIRST HYPOTHESIS 4869 03:32:22,840 --> 03:32:24,120 WE FOUND THAT IN FACT THERE WAS 4870 03:32:24,120 --> 03:32:26,720 NO IMPACT OF THE LESIONS ON OVER 4871 03:32:26,720 --> 03:32:28,680 ALL PAIN SENSITIVITY. 4872 03:32:28,680 --> 03:32:31,040 AND OUR NEXT TEST WAS WHETHER 4873 03:32:31,040 --> 03:32:38,360 THE VMPFC HAS EFFECTED ON PAIN. 4874 03:32:38,360 --> 03:32:42,240 AND BASICALLY WHAT WE DID IS WE 4875 03:32:42,240 --> 03:32:43,840 HAD INDIVIDUALS UNDERGO A A TASK 4876 03:32:43,840 --> 03:32:47,000 IN WHICH THEY WERE INSTRUCTED 4877 03:32:47,000 --> 03:32:49,480 THEY WOULD PREDICT LOWER HIGH P 4878 03:32:49,480 --> 03:32:50,560 AND THEY WENT THROUGH 4879 03:32:50,560 --> 03:32:51,880 CONDITIONING WHERE IT WAS 4880 03:32:51,880 --> 03:32:53,200 REINFORCED WITH A LOWER 4881 03:32:53,200 --> 03:32:54,080 TEMPERATURE AND HIGH TEMPERATURE 4882 03:32:54,080 --> 03:32:55,840 AND DURING A TEST PHASE, 4883 03:32:55,840 --> 03:32:57,960 INDIVIDUALS RECEIVED SIM YOU LIE 4884 03:32:57,960 --> 03:33:00,120 CALIBRATED TO MODERATE PAIN. 4885 03:33:00,120 --> 03:33:02,040 AND WHAT WE'VE SHOWN ACROSS MANY 4886 03:33:02,040 --> 03:33:04,560 DIFFERENT PAPERS IS THAT WHEN 4887 03:33:04,560 --> 03:33:06,760 THE SAME MEDIUM TEMPERATURES IS 4888 03:33:06,760 --> 03:33:07,960 PROCEEDED BY LOW PAIN CUES IN 4889 03:33:07,960 --> 03:33:09,880 YELLOW RELATIVE TO HIGH PAIN 4890 03:33:09,880 --> 03:33:12,000 CUES IN RED, INDIVIDUALS REPORT 4891 03:33:12,000 --> 03:33:14,560 LESS PAIN AND CLICK. 4892 03:33:14,560 --> 03:33:17,520 SO WE MEASURED BOTH PAIN RATINGS 4893 03:33:17,520 --> 03:33:20,840 AND AUTO NOM I CAN RESPONSES IN 4894 03:33:20,840 --> 03:33:21,320 RESPONSE TO NEED MEDIUM 4895 03:33:21,320 --> 03:33:23,680 TEMPERATURE STIMULI AND SO WE 4896 03:33:23,680 --> 03:33:33,920 CAN CLICK AGAIN. 4897 03:33:39,760 --> 03:33:41,040 AND THESE WERE SUSTAINED AND 4898 03:33:41,040 --> 03:33:43,800 GREW OVER TIME AND SO BASICALLY, 4899 03:33:43,800 --> 03:33:46,040 INDIVIDUALS WITH VMPS LESIONS 4900 03:33:46,040 --> 03:33:48,560 EXPECTED MORE PAIN WITH A PIE 4901 03:33:48,560 --> 03:33:50,880 PAIN CUE AND THEN INDIVIDUALS 4902 03:33:50,880 --> 03:33:53,720 WITHOUT LESIONS AND THAT WAS 4903 03:33:53,720 --> 03:33:55,480 BASICALLY DRIVEN BY LESS 4904 03:33:55,480 --> 03:33:56,760 UNLEARNING WHEN WE INTRODUCED 4905 03:33:56,760 --> 03:34:01,520 THE MEDIUM HEAT TRIALS. 4906 03:34:01,520 --> 03:34:02,960 SO, BASICALLY WHAT WE FIND IS 4907 03:34:02,960 --> 03:34:04,600 THAT THE GROUPS DID DIFFER IN 4908 03:34:04,600 --> 03:34:07,120 TERMS OF EXPECTANCY WHERE 4909 03:34:07,120 --> 03:34:08,720 PATIENTS EXPECTED LARGER 4910 03:34:08,720 --> 03:34:11,520 DIFFERENCES AS A FUNCTION. 4911 03:34:11,520 --> 03:34:14,720 WE TESTED HOW THIS MODULATED 4912 03:34:14,720 --> 03:34:15,520 MEDIUM HEAT PAIN. 4913 03:34:15,520 --> 03:34:17,360 AND FOCUSING SPECIFICALLY ON 4914 03:34:17,360 --> 03:34:19,560 PAIN AND UNPLEASANTNESS WE SEE 4915 03:34:19,560 --> 03:34:22,200 THAT RESPONSES TO LOW INTENSITY 4916 03:34:22,200 --> 03:34:24,280 STIMULI IN YELLOW AND HIGH 4917 03:34:24,280 --> 03:34:26,000 INTENSIVE STIMULI IN RED ARE THE 4918 03:34:26,000 --> 03:34:28,280 SAME BETWEEN THE GROUPS SHOWING 4919 03:34:28,280 --> 03:34:33,280 THAT PAIN SENSATION IS NOT 4920 03:34:33,280 --> 03:34:36,200 ALTERED, AND WHEN WE LOOK AT 4921 03:34:36,200 --> 03:34:38,160 RESPONSES TO THE CRITICAL MEDIUM 4922 03:34:38,160 --> 03:34:40,480 HEAT TRIALS, CLICK ONCE MORE, WE 4923 03:34:40,480 --> 03:34:42,520 FIND PATIENTS WITH LESIONS 4924 03:34:42,520 --> 03:34:44,600 REPORT LARGER DIFFERENCES AS A 4925 03:34:44,600 --> 03:34:46,960 FUNCTION OF CUE SO BASICALLY 4926 03:34:46,960 --> 03:34:57,440 THEY'RE REPORTING HIGHER HEAT. 4927 03:34:58,760 --> 03:35:01,360 SO, THIS SUGGESTS THAT THE 4928 03:35:01,360 --> 03:35:02,760 LESIONS ACTUALLY ENHANCE 4929 03:35:02,760 --> 03:35:09,480 EXPECTANCY EFFECTS ON PAIN. 4930 03:35:09,480 --> 03:35:14,160 WE TEST TESTED THIS MARKER. 4931 03:35:14,160 --> 03:35:18,280 WHAT WE FOUND IS THAT VMPFC 4932 03:35:18,280 --> 03:35:19,960 LESIONS DID HAVE OUGHT KNOT I 4933 03:35:19,960 --> 03:35:24,080 CAN RESPONSES BUT NOT THE PAIN 4934 03:35:24,080 --> 03:35:31,080 PREDICTIVE CUES. 4935 03:35:31,080 --> 03:35:33,440 WHEN WE NORMALIZE THAT AND 4936 03:35:33,440 --> 03:35:35,320 ACCOUNT FOR THE FACTS THAT 4937 03:35:35,320 --> 03:35:37,000 PATIENTS ARE DOWN OVER ALL THEY 4938 03:35:37,000 --> 03:35:38,880 SHOW HIGHER WHEN MEDIUM HEAT IS 4939 03:35:38,880 --> 03:35:40,800 PROCEEDED BY THE HIGH PAIN CUE 4940 03:35:40,800 --> 03:35:44,640 RELATIVE TO THE LOW PAIN CUE. 4941 03:35:44,640 --> 03:35:45,320 CLICK AGAIN. 4942 03:35:45,320 --> 03:35:46,720 WE CAN SEE THIS ALSO WHEN WE 4943 03:35:46,720 --> 03:35:48,560 LOOK AT THE RAW RESPONSES AND SO 4944 03:35:48,560 --> 03:35:51,160 YOU CAN SEE THIS IS MEDIUM HEAT 4945 03:35:51,160 --> 03:35:53,640 PROCEEDED BY THE HIGH IN ORANGE 4946 03:35:53,640 --> 03:35:54,960 AND THE LOW PAIN CUE IN GREN AND 4947 03:35:54,960 --> 03:35:56,440 YOU CAN SEE BOTH GROUPS ARE 4948 03:35:56,440 --> 03:35:58,680 SHOWING ELEVATED SKIN CON 4949 03:35:58,680 --> 03:36:04,080 ACCEPTANCE A PAIN PREDICTIVE CUE 4950 03:36:04,080 --> 03:36:08,480 AND THE CORRESPONDENCE BETWEEN 4951 03:36:08,480 --> 03:36:18,960 AROUSAL AND IT'S INTACT WITH 4952 03:36:33,040 --> 03:36:33,720 PATIENTS. 4953 03:36:33,720 --> 03:36:36,080 THAT THE LESIONS ENHANCE THE 4954 03:36:36,080 --> 03:36:37,720 EFFECTS ON PAIN AND DIFFERENCES 4955 03:36:37,720 --> 03:36:41,400 IN EXPECTATIONS ARE PRIOR TO 4956 03:36:41,400 --> 03:36:42,840 LEARNING BASED ON INSTRUCTION 4957 03:36:42,840 --> 03:36:44,640 AND WE SEE STRONGEST EFFECTS AND 4958 03:36:44,640 --> 03:36:46,080 PERCEIVED UNPLEASANTNESS AND 4959 03:36:46,080 --> 03:36:47,640 THERE'S NO DIFFERENCE IN THE 4960 03:36:47,640 --> 03:36:48,880 EFFECTS ON SKIN CONDUCT ANTS 4961 03:36:48,880 --> 03:36:52,280 WHICH IS CONSISTENT -- 4962 03:36:52,280 --> 03:36:54,520 INCONSISTENT WITH A MARKER 4963 03:36:54,520 --> 03:36:55,160 HYPOTHESIS. 4964 03:36:55,160 --> 03:36:56,560 AND SO OUR HYPOTHESIS GOING 4965 03:36:56,560 --> 03:36:57,920 FORWARD IS THAT THIS MIGHT MEAN 4966 03:36:57,920 --> 03:36:59,560 THAT THESE PATIENTS ARE RELYING 4967 03:36:59,560 --> 03:37:02,480 MORE ON THE INSTRUCTIONS ABOUT 4968 03:37:02,480 --> 03:37:04,280 UPCOMING PAIN AND LESSON THE 4969 03:37:04,280 --> 03:37:05,200 ACTUAL LEARNING. 4970 03:37:05,200 --> 03:37:07,240 AND WE KNOW FROM OUR OTHER WORK 4971 03:37:07,240 --> 03:37:11,000 THAT INSTRUCTIONS CAN LEAD TO 4972 03:37:11,000 --> 03:37:12,760 MODULATION THROUGH MECHANISMS 4973 03:37:12,760 --> 03:37:14,800 SUCH AS ENHANCING RESPONSES IN 4974 03:37:14,800 --> 03:37:17,240 THE PREFRONTAL CORTEX THAT MIGHT 4975 03:37:17,240 --> 03:37:20,360 BY PASS THE PREFRONTAL CORTEX TO 4976 03:37:20,360 --> 03:37:22,640 ENGAGE SUB CORTICAL CIRCUITS 4977 03:37:22,640 --> 03:37:28,800 THAT EFFECT AROUSAL. 4978 03:37:28,800 --> 03:37:31,280 OVER ALL, PAIN IS A 4979 03:37:31,280 --> 03:37:32,800 DECISION-MAKING PROCESS THAT IS 4980 03:37:32,800 --> 03:37:34,920 FACTORS AND MULTIPLE FACTORS 4981 03:37:34,920 --> 03:37:37,440 DRIVE ON RESPONSES TO NOXIOUS 4982 03:37:37,440 --> 03:37:38,760 STIMULI AND WE HAVE A BASIC 4983 03:37:38,760 --> 03:37:40,560 RESPONSE TO THE STIMULUS BUT 4984 03:37:40,560 --> 03:37:46,440 THAT CAN BE A LOT ALTERED BY CS 4985 03:37:46,440 --> 03:37:48,720 AND THE LESIONS ENHANCE 4986 03:37:48,720 --> 03:37:50,720 EXPECTANCY EFFECTS ON PAIN AND 4987 03:37:50,720 --> 03:37:54,480 AUTONOMIC RESPONSES TO CUES ARE 4988 03:37:54,480 --> 03:37:57,160 MEDIATED OUT OF THE VMPFC SO 4989 03:37:57,160 --> 03:38:00,600 WITH THAT I WANT TO ACKNOWLEDGE 4990 03:38:00,600 --> 03:38:05,120 MY COLLABORATORS AND MY FORMER 4991 03:38:05,120 --> 03:38:06,360 POSTDOC AND THANK YOU FOR IN 4992 03:38:06,360 --> 03:38:08,080 INVITING ME TO PARTICIPATE 4993 03:38:08,080 --> 03:38:08,320 TODAY. 4994 03:38:08,320 --> 03:38:10,800 THE NEXT SPEAKER IS DANIEL BAUER 4995 03:38:10,800 --> 03:38:12,960 WHO WILL BE TALKING ABOUT A 4996 03:38:12,960 --> 03:38:14,280 PERSON ORIENTED APPROACH TO 4997 03:38:14,280 --> 03:38:20,800 RESEARCH ON PAIN AND PAIN 4998 03:38:20,800 --> 03:38:21,080 MANAGEMENT. 4999 03:38:21,080 --> 03:38:22,240 >> THANK YOU SO MUCH. 5000 03:38:22,240 --> 03:38:25,320 I WANT TO SAY, I'M REALLY 5001 03:38:25,320 --> 03:38:26,280 PLEASED TO BE HERE AND I 5002 03:38:26,280 --> 03:38:27,640 APPRECIATE THE INVITATION TO 5003 03:38:27,640 --> 03:38:28,560 GIVE A TALK HERE. 5004 03:38:28,560 --> 03:38:30,640 I AM NOT A PAIN RESEARCHER 5005 03:38:30,640 --> 03:38:30,880 MYSELF. 5006 03:38:30,880 --> 03:38:34,920 I'M MORE OF A METHODOLOGIST 5007 03:38:34,920 --> 03:38:36,560 FOCUSED ON DEVELOPMENTAL 5008 03:38:36,560 --> 03:38:38,240 METHODOLOGY BUT I THINK THAT CAN 5009 03:38:38,240 --> 03:38:39,240 BE AN ADVANTAGE BECAUSE 5010 03:38:39,240 --> 03:38:40,840 SOMETIMES THE WAY RESEARCH MOVES 5011 03:38:40,840 --> 03:38:42,840 FORWARD IS BY DIFFERENT SUB 5012 03:38:42,840 --> 03:38:44,520 FIELDS INTERFACING WITH ONE 5013 03:38:44,520 --> 03:38:45,600 ANOTHER AND DRAWING IDEAS FROM 5014 03:38:45,600 --> 03:38:46,680 ONE ANOTHER SO I WILL INTRODUCE 5015 03:38:46,680 --> 03:38:51,280 YOU TO AN IDEA THAT IS QUITE 5016 03:38:51,280 --> 03:38:52,240 PREVALENT IN DEVELOPMENTAL 5017 03:38:52,240 --> 03:38:54,240 SCIENCE AND HAS POTENTIAL TO 5018 03:38:54,240 --> 03:38:56,360 OFFER A PERSON ORIENTED 5019 03:38:56,360 --> 03:38:57,480 VIEWPOINT TO RESEARCH ON PAIN 5020 03:38:57,480 --> 03:38:59,000 AND PAIN MANAGEMENT. 5021 03:38:59,000 --> 03:39:02,200 AND SO IN THAT WAY IT BUILDS ON 5022 03:39:02,200 --> 03:39:04,080 THE PREVIOUS PRESENTATIONS AND 5023 03:39:04,080 --> 03:39:07,880 PARTICULARLY THE ARGUMENT THAT 5024 03:39:07,880 --> 03:39:08,560 Dr. JENSEN MADE THAT WE NEED 5025 03:39:08,560 --> 03:39:10,160 TO FOCUS MORE ON THE PERSON. 5026 03:39:10,160 --> 03:39:12,600 THE PERSON AS A WHOLE AS OPPOSED 5027 03:39:12,600 --> 03:39:16,840 TO VARIABLES OR TREATMENTS AS 5028 03:39:16,840 --> 03:39:22,920 MECHANISMS IN PARTICULAR. 5029 03:39:22,920 --> 03:39:24,560 SO, I'M GOING TO BEGIN BY 5030 03:39:24,560 --> 03:39:26,040 TELLING WHAT YOU IS A PERSON 5031 03:39:26,040 --> 03:39:28,120 ORIENTED APPROACH. 5032 03:39:28,120 --> 03:39:29,080 AT LEAST AS DEFINED IN MY NECK 5033 03:39:29,080 --> 03:39:30,080 OF THE WOODS AND WE'LL TALK A 5034 03:39:30,080 --> 03:39:32,560 LITTLE BIT ABOUT SOME QUANTITIVE 5035 03:39:32,560 --> 03:39:34,200 METHODS CAN BE USED TO OBTAIN A 5036 03:39:34,200 --> 03:39:37,640 PERSON ORIENTED KIND OF RESEARCH 5037 03:39:37,640 --> 03:39:39,320 ORIENTATION AND LATE IN CLASS 5038 03:39:39,320 --> 03:39:41,160 AND PRO VILE ANALYSIS ARE WHO I 5039 03:39:41,160 --> 03:39:41,880 FOCUS ON. 5040 03:39:41,880 --> 03:39:43,200 I'LL GIVE YOU AN APPLICATION 5041 03:39:43,200 --> 03:39:45,040 FROM MY AREA, DEVELOPMENTAL 5042 03:39:45,040 --> 03:39:46,560 PSYCHOLOGY AND I'LL TALK ABOUT 5043 03:39:46,560 --> 03:39:49,400 POTENTIAL APPLICATIONS IN THE 5044 03:39:49,400 --> 03:39:50,600 WHOLE PERSON PAIN RESEARCH AND 5045 03:39:50,600 --> 03:39:52,680 CLOSE OUT WITH SOME PROS AND 5046 03:39:52,680 --> 03:39:56,280 CONS OF THIS APPROACH. 5047 03:39:56,280 --> 03:39:58,800 SO, THE PERSON ORIENTED APPROACH 5048 03:39:58,800 --> 03:40:02,800 COMES FROM DEVELOPMENTAL SYSTEMS 5049 03:40:02,800 --> 03:40:04,080 THEORY AND HERE A LITTLE QUOTE 5050 03:40:04,080 --> 03:40:05,440 ON THIS A DEVELOPMENTAL SYSTEM 5051 03:40:05,440 --> 03:40:09,080 IS COMPRISED OF MULTIPLE LEVELS, 5052 03:40:09,080 --> 03:40:10,040 BIOLOGICAL, PSYCHOLOGICAL, 5053 03:40:10,040 --> 03:40:12,280 SOCIOLOGICAL, CULTURAL THAT ARE 5054 03:40:12,280 --> 03:40:15,320 FUSED TO CREATE A FUNCTIONING 5055 03:40:15,320 --> 03:40:16,360 WHOLISM, THIS FUSE REFLECTS HIGH 5056 03:40:16,360 --> 03:40:18,680 LEVELS OF INTERACTION WITHIN AND 5057 03:40:18,680 --> 03:40:19,960 BETWEEN LEVELS OF THE SYSTEM AND 5058 03:40:19,960 --> 03:40:21,360 SO THERE ARE A COUPLE THINGS 5059 03:40:21,360 --> 03:40:23,240 HERE THAT I THINK ARE USEFUL TO 5060 03:40:23,240 --> 03:40:23,520 HIGHLIGHT. 5061 03:40:23,520 --> 03:40:27,280 THIS IDEA THAT THINGS ARE 5062 03:40:27,280 --> 03:40:29,320 INFUSED AND WE HAVE HIGH LEVELS 5063 03:40:29,320 --> 03:40:31,400 OF INTERACTIONS AND THAT WE'RE 5064 03:40:31,400 --> 03:40:34,480 TRYING TO CAPTURE A FUNCTIONING 5065 03:40:34,480 --> 03:40:34,720 WHOLISM. 5066 03:40:34,720 --> 03:40:38,640 THESE ARE THE CRITICAL IDEAS OF 5067 03:40:38,640 --> 03:40:46,240 THE PERSON O ORIENTED APPROACH. 5068 03:40:46,240 --> 03:40:51,600 IT'S THE THERAPY OF GILBERT. 5069 03:40:51,600 --> 03:40:54,160 HE WAS AN ANIMAL RESEARCHER AND 5070 03:40:54,160 --> 03:40:55,840 INTERESTED DOES DEVELOPMENT TAKE 5071 03:40:55,840 --> 03:40:56,160 PLACE. 5072 03:40:56,160 --> 03:40:57,400 WHAT ARE THE DIFFERENT FACTORS 5073 03:40:57,400 --> 03:41:00,200 THAT CONTRIBUTE TO INDIVIDUAL 5074 03:41:00,200 --> 03:41:02,000 DEVELOPMENT AND HE ARTICULATED 5075 03:41:02,000 --> 03:41:03,960 THE LEVELS OF THE SYSTEM THAT HE 5076 03:41:03,960 --> 03:41:05,320 WAS INTERESTED IN AND HE SAID 5077 03:41:05,320 --> 03:41:06,600 WELL OVER THE COURSE OF 5078 03:41:06,600 --> 03:41:08,160 DEVELOPMENT, THERE ARE THESE 5079 03:41:08,160 --> 03:41:10,000 INTERACTIONS AND CO ACTIONS THAT 5080 03:41:10,000 --> 03:41:11,920 OCCUR, THIS BY-DIRECTIONAL 5081 03:41:11,920 --> 03:41:14,080 EFFECTS OF THESE SYSTEMS 5082 03:41:14,080 --> 03:41:19,320 INTERACTING WITH ONE ANOTHER TO 5083 03:41:19,320 --> 03:41:21,120 PUSH IT FORWARD SO THERE'S A 5084 03:41:21,120 --> 03:41:26,240 MULTI LEVEL PERSPECTIVE AND IT'S 5085 03:41:26,240 --> 03:41:32,600 AIN'TER ACTIVE AND WHOA SAY CO 5086 03:41:32,600 --> 03:41:39,960 ACTIVE IT'S NIAAA NATURE AND AND 5087 03:41:39,960 --> 03:41:45,840 AND THAT WE FIRST KNOW AND 5088 03:41:45,840 --> 03:41:46,240 LEARN. 5089 03:41:46,240 --> 03:41:48,880 WE THINK ABOUT NOVA AND WHAT 5090 03:41:48,880 --> 03:41:50,840 WE'RE FOCUSED ON THERE IS 5091 03:41:50,840 --> 03:41:51,440 VARIABLES, RIGHT. 5092 03:41:51,440 --> 03:41:53,320 WHAT IS THE EFFECT OF A GIVEN 5093 03:41:53,320 --> 03:41:55,320 VARIABLE ON AN OUTCOME AND IN 5094 03:41:55,320 --> 03:41:59,120 THAT SENSE, IT'S RATHER WE'RE 5095 03:41:59,120 --> 03:42:01,160 NOT LOOKING AT THE PERSON AS A 5096 03:42:01,160 --> 03:42:02,920 WHOLE, WE'RE LOOKING AT A 5097 03:42:02,920 --> 03:42:03,720 PARTICULAR VARIABLE. 5098 03:42:03,720 --> 03:42:04,760 WHAT ARE THE INDIVIDUAL 5099 03:42:04,760 --> 03:42:06,560 DIFFERENCES ON THAT VARIABLE AND 5100 03:42:06,560 --> 03:42:07,760 WHERE DOES THIS PARTICULAR 5101 03:42:07,760 --> 03:42:09,400 PERSON RANK RELATIVE TO OTHER 5102 03:42:09,400 --> 03:42:11,800 PEOPLE ON THIS PARTICULAR 5103 03:42:11,800 --> 03:42:12,160 VARIABLE. 5104 03:42:12,160 --> 03:42:13,720 SO WHEN WE RUN SOMETHING LIKE A 5105 03:42:13,720 --> 03:42:19,560 REGREREGRESSION MODEL, HOW ARE E 5106 03:42:19,560 --> 03:42:20,960 CONTROLLING FOR ALL OTHERS, 5107 03:42:20,960 --> 03:42:22,440 HOLDING ALL ELSE CONSTANT AND 5108 03:42:22,440 --> 03:42:23,840 THAT'S A POWERFUL IDEA AND IT'S 5109 03:42:23,840 --> 03:42:25,560 THE IDEA OF STATISTICAL CONTROL. 5110 03:42:25,560 --> 03:42:27,840 I WANT TO KNOW WHAT IS THIS 5111 03:42:27,840 --> 03:42:29,720 VARIABLE I CAN CONTROL FOR ALL 5112 03:42:29,720 --> 03:42:31,960 OTHER VARIABLES AND HOLD THEM 5113 03:42:31,960 --> 03:42:33,520 CONSTANT AND LOOK AT ITS UNIQUE 5114 03:42:33,520 --> 03:42:33,960 EFFECT. 5115 03:42:33,960 --> 03:42:37,800 IT'S A COOL IDEA AND VERY 5116 03:42:37,800 --> 03:42:39,960 POWERFUL WE KNOW THINGS DON'T 5117 03:42:39,960 --> 03:42:47,640 STAY CONSTRUCTOR S TANT. 5118 03:42:47,640 --> 03:42:54,600 IT'S NOT THEIR VARIABLE SCORE ON 5119 03:42:54,600 --> 03:42:58,080 ONE BUT THEIR CONFIGURATION OF A 5120 03:42:58,080 --> 03:42:59,960 SET AND WHEN WE INCLUDE 5121 03:42:59,960 --> 03:43:01,840 INTERACTIONS IN OUR MODEL, WE 5122 03:43:01,840 --> 03:43:06,080 TALKED ABOUT HOW THESE SYSTEMS 5123 03:43:06,080 --> 03:43:10,600 ARE HIGHLY THEY ARE LOW ORDER SO 5124 03:43:10,600 --> 03:43:12,520 THE BUY LYNN Y'ALL ACTION AND 5125 03:43:12,520 --> 03:43:20,640 GIVE X1 AND X1 THERE ARE 5126 03:43:20,640 --> 03:43:22,240 TECHNIQUE THAT CAN RECOVER MORE 5127 03:43:22,240 --> 03:43:23,800 COMPLEX INTERACTIONS PATTERNS 5128 03:43:23,800 --> 03:43:29,280 BUT THE TECHNIQUES THAT WE GREW 5129 03:43:29,280 --> 03:43:36,200 UP WITH LOW ORDER INTERACTIONS 5130 03:43:36,200 --> 03:43:38,080 EFFECT. 5131 03:43:38,080 --> 03:43:39,400 THEY SAY I'M NOT INTERESTING IN 5132 03:43:39,400 --> 03:43:40,800 THIS VARIABLE CONTROL FOR ALL 5133 03:43:40,800 --> 03:43:42,080 OTHERS BUT I'M INTERESTED IN 5134 03:43:42,080 --> 03:43:46,000 PEOPLE AND PEOPLE ARE 5135 03:43:46,000 --> 03:43:48,240 CHARACTERIZED BY THEIR VALUABLE 5136 03:43:48,240 --> 03:43:49,400 OF SETS THAT ARE INTERESTED FOR 5137 03:43:49,400 --> 03:43:55,000 THE PROCESS THAT WE'RE STUDYING 5138 03:43:55,000 --> 03:44:03,480 SO WE LOOK AT CON FISSIONATION 5139 03:44:03,480 --> 03:44:12,960 AND ON THESE VARIABLES THAT 5140 03:44:12,960 --> 03:44:18,280 REFLECT PATTERNS OF FUNCTIONING 5141 03:44:18,280 --> 03:44:28,040 YOU LET'S SAY YOU HAVE WE ARE 5142 03:44:28,040 --> 03:44:32,080 LOOKING FOR THE SENSE AREAS AND 5143 03:44:32,080 --> 03:44:34,280 THE AWAY WANT TO IDENTIFY THOSE 5144 03:44:34,280 --> 03:44:36,200 LUMPS THAT REPRESENT PROTO TIP I 5145 03:44:36,200 --> 03:44:37,640 CANAL PATTERNS OF INDIVIDUAL 5146 03:44:37,640 --> 03:44:41,200 FUNCTIONING AND THE KINDS OF 5147 03:44:41,200 --> 03:44:42,920 TOOLS WE USE ARE THINGS LIKE K 5148 03:44:42,920 --> 03:44:47,080 MEANS CLUSTER ANALYSIS AND WHAT 5149 03:44:47,080 --> 03:44:49,320 I AM EMPHASIS MODELS AND THESE 5150 03:44:49,320 --> 03:44:51,400 FALL WITHIN THE REALM OF WHAT IS 5151 03:44:51,400 --> 03:44:53,280 NOW REFERRED TO WIDELY AS YOU 5152 03:44:53,280 --> 03:44:55,760 KNOW SUPERVISED PERSON AND THE 5153 03:44:55,760 --> 03:44:59,520 MACHINE LEARNING LITERATURE. 5154 03:44:59,520 --> 03:45:01,360 NEXT PLEASE. 5155 03:45:01,360 --> 03:45:03,680 AND PROFILE ANALYSIS IS THAT WE 5156 03:45:03,680 --> 03:45:05,840 HAVE K CLASSES OF INDIVIDUALS 5157 03:45:05,840 --> 03:45:09,080 MIXED TOGETHER AND THE 5158 03:45:09,080 --> 03:45:10,280 POPULATION AND WE DON'T KNOW WHO 5159 03:45:10,280 --> 03:45:20,720 IS A MEMBER WE SAY I IF WE 5160 03:45:51,240 --> 03:45:54,560 IDENTIFIED THESE PROFILES OF 5161 03:45:54,560 --> 03:45:55,880 DIFFERENT INDIVIDUALS CAN WE PRO 5162 03:45:55,880 --> 03:45:57,280 DICTIONARY WHO IS IN THAT CLASS 5163 03:45:57,280 --> 03:45:59,600 AND SO WE ADD OUR PREDICTORS TO 5164 03:45:59,600 --> 03:46:01,800 OUR MODEL AND WE SEE IF WE CAN 5165 03:46:01,800 --> 03:46:07,120 PRO DICTIONARPREDICTWHO IS A MES 5166 03:46:07,120 --> 03:46:09,000 AND WHAT ARE THE ASSOCIATED WITH 5167 03:46:09,000 --> 03:46:10,680 BEING IN A PARTICULAR CLASS AND 5168 03:46:10,680 --> 03:46:13,440 HOW DOES YOUR CLASS MEMBERSHIP 5169 03:46:13,440 --> 03:46:14,880 INFLUENCE YOUR ULTIMATE OUTCOME 5170 03:46:14,880 --> 03:46:18,520 ON SOME VARIABLE OF INTEREST. 5171 03:46:18,520 --> 03:46:20,040 AND THE OTHER THING WE CAN DO 5172 03:46:20,040 --> 03:46:22,080 WHICH IS REALLY COOL WE CAN SAY, 5173 03:46:22,080 --> 03:46:23,600 HEY, I'VE GOT THESE PREDICTORS 5174 03:46:23,600 --> 03:46:27,320 AND I KNOW RELATE TO MY OUTCOME 5175 03:46:27,320 --> 03:46:29,680 OF INTEREST BUT DOES IT RELATE 5176 03:46:29,680 --> 03:46:31,160 DIFFERENTLY FOR PEOPLE WHO SHOW 5177 03:46:31,160 --> 03:46:32,400 DIFFERENT CONFIGURATIONS ON 5178 03:46:32,400 --> 03:46:33,200 THESE INTEREST. 5179 03:46:33,200 --> 03:46:34,840 AND SO THAT IS THE THE THIRD 5180 03:46:34,840 --> 03:46:36,400 KIND OF RELATIONSHIP WE CAN LOOK 5181 03:46:36,400 --> 03:46:39,760 AT IS A LATENT CLASS MODERATION 5182 03:46:39,760 --> 03:46:41,560 MODEL. 5183 03:46:41,560 --> 03:46:42,120 NEXT, PLEASE. 5184 03:46:42,120 --> 03:46:44,800 SO JUST A VERY SIMPLE EXAMPLE 5185 03:46:44,800 --> 03:46:46,000 FROM AN EARLY PAPER USING A 5186 03:46:46,000 --> 03:46:49,320 PERSON ORIENTED APPROACH BY BOB 5187 03:46:49,320 --> 03:46:53,120 CARRENS IN 199 AS 1989 AND HOW Y 5188 03:46:53,120 --> 03:46:54,800 MIGHT RELATE TO HIGH SCHOOL DROP 5189 03:46:54,800 --> 03:46:55,120 OUT. 5190 03:46:55,120 --> 03:46:56,840 SO THE FEATURE OF INTEREST THAT 5191 03:46:56,840 --> 03:46:58,240 HE HAS THAT HE WANTS TO IDENTIFY 5192 03:46:58,240 --> 03:47:00,320 INDIVIDUALS ON, ARE AGGRESSION, 5193 03:47:00,320 --> 03:47:02,240 ACADEMIC PERFORMANCE, POPULARITY 5194 03:47:02,240 --> 03:47:04,600 IN THIS THING HE CALLED 5195 03:47:04,600 --> 03:47:09,000 ALL-AMERICAN REFERRED TO AS OLE 5196 03:47:09,000 --> 03:47:15,880 I AMANOLYMPIAN. 5197 03:47:15,880 --> 03:47:18,000 SO HE IDENTIFIED THESE DIFFERENT 5198 03:47:18,000 --> 03:47:18,920 PROFILES HERE AND I'M NOT GOING 5199 03:47:18,920 --> 03:47:21,040 TO SPEND A LOT OF TIME ON THIS 5200 03:47:21,040 --> 03:47:22,800 PLOT BUT IT'S SHOWING HOW THE 5201 03:47:22,800 --> 03:47:24,920 LEVEL OF EACH OF THESE SOCIAL 5202 03:47:24,920 --> 03:47:34,360 COMMENT TECOMPETENCY ANDTHE DIFD 5203 03:47:34,360 --> 03:47:35,960 THE VARIABLE ORIENTED APPROACH 5204 03:47:35,960 --> 03:47:38,160 IS WE SEE THERE ARE THREE LATENT 5205 03:47:38,160 --> 03:47:39,760 CLASSES HERE THAT ARE SIMILAR IN 5206 03:47:39,760 --> 03:47:42,360 THEIR ACADEMIC PERFORMANCE AND 5207 03:47:42,360 --> 03:47:43,640 NOTICE THAT THEY ARE QUITE 5208 03:47:43,640 --> 03:47:45,440 DIFFERENT IN THEIR PROBABILITY 5209 03:47:45,440 --> 03:47:47,240 OF HIGH SCHOOL DROP OUT. 5210 03:47:47,240 --> 03:47:47,920 WHY? 5211 03:47:47,920 --> 03:47:49,640 IT'S THE OTHER VARIABLES. 5212 03:47:49,640 --> 03:47:51,160 IT'S THE WHOLE PERSON THAT 5213 03:47:51,160 --> 03:47:52,880 MATTERS NOT THE SCORE JUST ON 5214 03:47:52,880 --> 03:47:54,560 THIS ACADEMIC VARIABLE. 5215 03:47:54,560 --> 03:47:56,800 AND THEY'RE VERY SIMILAR AND 5216 03:47:56,800 --> 03:47:59,440 SOME RESPECT ON AGGRESSION AND 5217 03:47:59,440 --> 03:48:01,560 THEY ARE VERY SIMILAR ON 5218 03:48:01,560 --> 03:48:02,160 ACADEMIC BUT THEY'RE DIFFERENT 5219 03:48:02,160 --> 03:48:06,760 IN OTHER WAYS AND THIS IS VERY 5220 03:48:06,760 --> 03:48:11,520 LOW IN POPULARITY AND ALL 5221 03:48:11,520 --> 03:48:15,480 AMERICAN AND THEY'RE TRYING TO 5222 03:48:15,480 --> 03:48:17,480 CHARACTERIZE AND THESE THREE 5223 03:48:17,480 --> 03:48:18,800 CONFIGURATIONS AND RELATE TO THE 5224 03:48:18,800 --> 03:48:24,040 ULTIMATE LIKELIHOOD OF DROP OUT. 5225 03:48:24,040 --> 03:48:25,920 SO NOW HOW CAN THIS BE USED IN 5226 03:48:25,920 --> 03:48:26,640 PAIN RESEARCH. 5227 03:48:26,640 --> 03:48:28,800 WELL I DID A LITTLE BIT OF 5228 03:48:28,800 --> 03:48:30,200 RESEARCH AND I WAS HELPED BY 5229 03:48:30,200 --> 03:48:31,680 Dr. JENSEN SENDING A FEW OF 5230 03:48:31,680 --> 03:48:32,920 HIS ARTICLES SO I APPRECIATE 5231 03:48:32,920 --> 03:48:35,120 THAT AND I CAME ACROSS A FEW 5232 03:48:35,120 --> 03:48:36,680 QUOTES THAT I THOUGHT REALLY 5233 03:48:36,680 --> 03:48:38,560 HIGHLIGHT THE NEED FOR A PERSON 5234 03:48:38,560 --> 03:48:45,400 ORIENTED APPROACH IN THIS AREA 5235 03:48:45,400 --> 03:48:47,160 SO EACH PAIN PROBLEM IS UNIQUE 5236 03:48:47,160 --> 03:48:57,680 AND NOT ALL PATIENTS WILL AND 5237 03:49:18,800 --> 03:49:22,480 EVALUATE TREATMENT EFFECTIVENESS 5238 03:49:22,480 --> 03:49:25,600 AND SO WE COULD IDENTIFY LATENT 5239 03:49:25,600 --> 03:49:27,840 PROFILES THAT REPRESENT 5240 03:49:27,840 --> 03:49:29,360 INDIVIDUALS AND WE CAN IDENTIFY 5241 03:49:29,360 --> 03:49:32,000 FOR ANY GIVEN PATIENT WHICH 5242 03:49:32,000 --> 03:49:33,480 PROFILE DO THEY BELONG TO EX 5243 03:49:33,480 --> 03:49:37,520 WHAT MIGHT BE THE MOST 5244 03:49:37,520 --> 03:49:41,320 APPROPRIATE TREATMENT. 5245 03:49:41,320 --> 03:49:41,920 SO JENSEN CONSIDERED SOCIAL 5246 03:49:41,920 --> 03:49:44,120 FACTORS AS POTENTIALLY IMPORTANT 5247 03:49:44,120 --> 03:49:46,280 HERE SO BRAIN STATE, COGNITIVE 5248 03:49:46,280 --> 03:49:49,920 CONTENT, COGNITIVE COPING, 5249 03:49:49,920 --> 03:49:51,200 BEHAVIORS LIKE GUARDING, REST, 5250 03:49:51,200 --> 03:49:52,360 SOCIAL SUPPORT AND OTHER 5251 03:49:52,360 --> 03:49:53,760 ENVIRONMENTAL FACTORS AND THE 5252 03:49:53,760 --> 03:49:56,880 FIRST STEP IN ANY KIND OF 5253 03:49:56,880 --> 03:49:57,920 CONFIGURATIONAL PERSON ORIENTED 5254 03:49:57,920 --> 03:49:59,640 APPROACH IS TO IDENTIFY WHAT ARE 5255 03:49:59,640 --> 03:50:02,760 THE KEY FACTORS THAT 5256 03:50:02,760 --> 03:50:03,640 CHARACTERIZE INDIVIDUALS THAT 5257 03:50:03,640 --> 03:50:05,000 ARE RELEVANT FOR WHAT I'M TRYING 5258 03:50:05,000 --> 03:50:15,160 TO STUDY. 5259 03:50:33,960 --> 03:50:36,360 AND IN ANOTHER PAPER IN 2015, 5260 03:50:36,360 --> 03:50:37,240 THIS IS SUPPOSED TO BE PERHAPS 5261 03:50:37,240 --> 03:50:39,680 YOU WOULD SEE FOUR PATIENT 5262 03:50:39,680 --> 03:50:41,760 PROFILES, A LIMIT PROFILE WITH 5263 03:50:41,760 --> 03:50:43,880 AN EXCESS OF MALE ADAPTIVE 5264 03:50:43,880 --> 03:50:44,920 COPING AND ACTIVATE PROFILE WITH 5265 03:50:44,920 --> 03:50:46,840 A DEFICIT OF HELPFUL COPING AND 5266 03:50:46,840 --> 03:50:48,480 ENHANCE PROFILE WITH STRONG 5267 03:50:48,480 --> 03:50:50,240 BASELINE COPING WITH NEED OF 5268 03:50:50,240 --> 03:50:51,400 ENHANCEMENT AND A COMBINATION 5269 03:50:51,400 --> 03:50:54,240 PROFILE WITH BOTH AN EXCESS OF 5270 03:50:54,240 --> 03:50:55,800 MALL ADAPTIVE COPING AND A LACK 5271 03:50:55,800 --> 03:50:58,320 OF HELPFUL COPING SO WE CAN SEE 5272 03:50:58,320 --> 03:50:59,720 DO THOSE SORTS OF PROFILES 5273 03:50:59,720 --> 03:51:01,360 EMERGE FROM THE EMPIRICAL 5274 03:51:01,360 --> 03:51:03,400 ANALYSIS AND IF THEY DO DOES THE 5275 03:51:03,400 --> 03:51:05,520 TREATMENT VARY IN ITS 5276 03:51:05,520 --> 03:51:06,760 EFFECTIVENESS ACROSS THE CLASSES 5277 03:51:06,760 --> 03:51:08,480 AND DO WE CHOSE DIFFERENT 5278 03:51:08,480 --> 03:51:12,320 TREATMENTS FOR DIFFERENT GROUPS? 5279 03:51:12,320 --> 03:51:13,480 NEXT, PLEASE. 5280 03:51:13,480 --> 03:51:16,960 SO WE CAN IMAGINE FOR SINCE AND 5281 03:51:16,960 --> 03:51:18,720 THESE PATIENTS PROFILES IN ANY 5282 03:51:18,720 --> 03:51:21,320 GIVEN SAMPLE THAT WE MIGHT HAVE 5283 03:51:21,320 --> 03:51:24,960 OF A HETEROGENEOUS SET OF 5284 03:51:24,960 --> 03:51:26,280 PATIENTS AND WE HAVE A TREATMENT 5285 03:51:26,280 --> 03:51:28,960 STUDY FOCUSES ON HYPNOSIS FOR 5286 03:51:28,960 --> 03:51:39,440 INSTANCE AND WE CAN SEE IT'S 5287 03:51:48,200 --> 03:51:50,640 COGNITIVE THERAPY AND OR SOME 5288 03:51:50,640 --> 03:51:51,600 COMBINATION OF TREATMENTS BUT 5289 03:51:51,600 --> 03:51:53,520 THE IDEA SO TO KIND OF MOVE 5290 03:51:53,520 --> 03:51:55,720 TOWARDS THIS IDEA OF A UNIQUE 5291 03:51:55,720 --> 03:51:57,840 INDIVIDUAL AND TRYING TO TARGET 5292 03:51:57,840 --> 03:51:58,960 TREATMENTS TOWARDS UNIQUE 5293 03:51:58,960 --> 03:52:00,360 INDIVIDUALS AND WHILE WE CAN'T 5294 03:52:00,360 --> 03:52:02,720 BUILD STATISTICAL MODELS 5295 03:52:02,720 --> 03:52:04,200 NECESSARILY FOR A SINGLE PERSON, 5296 03:52:04,200 --> 03:52:07,040 WE CAN MOVE TOWARDS THAT MORE 5297 03:52:07,040 --> 03:52:09,280 I'D YO GRAPHIC APPROACH BY 5298 03:52:09,280 --> 03:52:12,680 IDENTIFYING PROFILES AND 5299 03:52:12,680 --> 03:52:14,040 SUBSETTING AND IDENTIFYING 5300 03:52:14,040 --> 03:52:15,640 MEANINGFUL SUBGROUPS IN OUR 5301 03:52:15,640 --> 03:52:17,680 POPULATION FOR WHOM WE MIGHT SEE 5302 03:52:17,680 --> 03:52:22,480 DIFFERENTIAL EFFECTS. 5303 03:52:22,480 --> 03:52:25,880 NEXT, PLEASE. 5304 03:52:25,880 --> 03:52:28,200 THIS CLASS MODEL COULD BE USED 5305 03:52:28,200 --> 03:52:30,760 AND FOR THE LIKELY OUTCOMES OF A 5306 03:52:30,760 --> 03:52:31,640 GIVEN TREATMENT. 5307 03:52:31,640 --> 03:52:32,960 BASED ON THESE KINDS OF 5308 03:52:32,960 --> 03:52:39,960 FINDINGS, AND BASED ON A PATIENT 5309 03:52:39,960 --> 03:52:44,120 AND IT BELONG TO ANY LATENT 5310 03:52:44,120 --> 03:52:49,000 CLASS AND THEN WE CAN SAY OK, 5311 03:52:49,000 --> 03:52:50,960 WELL, GIVEN TO THE PROBABILITY 5312 03:52:50,960 --> 03:52:52,880 THEY CAN BELONG TO OTHERS AND IT 5313 03:52:52,880 --> 03:52:55,360 IS A .8 OF ONE CLASS AND OF 5314 03:52:55,360 --> 03:52:57,520 ANOTHER AND .1 PROBABILITY OF A 5315 03:52:57,520 --> 03:52:58,880 THIRD AND A ZERO PROPER ABILITY 5316 03:52:58,880 --> 03:53:00,520 OF A FOURTH, GIVEN THAT, WE 5317 03:53:00,520 --> 03:53:02,720 MIGHT SAY MOST LIKELY THEY'RE IN 5318 03:53:02,720 --> 03:53:04,880 THIS GROUP AND WE CAN TAKE THAT 5319 03:53:04,880 --> 03:53:06,760 PROBABILITY AS WELL AS OUR 5320 03:53:06,760 --> 03:53:08,200 DEMONSTRATED EFFECTIVENESS OF 5321 03:53:08,200 --> 03:53:09,760 THE TREATMENT FOR INDIVIDUALS IN 5322 03:53:09,760 --> 03:53:12,120 THAT CLASS, TO GENERATE AN 5323 03:53:12,120 --> 03:53:12,640 INDIVIDUAL PRO DICTION OF 5324 03:53:12,640 --> 03:53:15,960 TREATMENT EFFECTIVENESS FOR THAT 5325 03:53:15,960 --> 03:53:16,680 PATIENTS. 5326 03:53:16,680 --> 03:53:18,080 FOR THIS PATIENT IT WILL BE 5327 03:53:18,080 --> 03:53:18,880 DIFFERENT WITH THAT CLASS BUT 5328 03:53:18,880 --> 03:53:29,400 FOR A PATIENT WHO MIGHT HAVE A 5329 03:53:35,840 --> 03:53:36,760 NEXT PLEASE. 5330 03:53:36,760 --> 03:53:38,840 >> SO I THINK THAT IS A PRETTY 5331 03:53:38,840 --> 03:53:39,480 COOL IDEA. 5332 03:53:39,480 --> 03:53:47,800 IT GETS US CLOSER TO INDIVIDUALE 5333 03:53:47,800 --> 03:53:48,800 INDIVIDUALIZE PERSONS AND HOW WE 5334 03:53:48,800 --> 03:53:50,760 MIGHT HAVE TREATMENT BY 5335 03:53:50,760 --> 03:53:52,560 VARIABLES AND NOW WE CAN LOOK AT 5336 03:53:52,560 --> 03:54:03,080 TREATMENT BY PERSONS AND SO WE 5337 03:54:06,680 --> 03:54:08,120 CAN INCLUDE VIS LOGICAL 5338 03:54:08,120 --> 03:54:10,160 INDICATORS AND ASPECTS OF THE 5339 03:54:10,160 --> 03:54:14,960 SOCIAL ENVIRONMENT AND SO FOURTH 5340 03:54:14,960 --> 03:54:16,760 AND PROFILES FOR OUTCOMES RATHER 5341 03:54:16,760 --> 03:54:21,520 THAN JUST LOOK AT ONE OUTCOME AT 5342 03:54:21,520 --> 03:54:24,240 A TIME SO WE CAN HAVE PREDICTORS 5343 03:54:24,240 --> 03:54:24,840 OF OUTCOMES. 5344 03:54:24,840 --> 03:54:34,560 >> TWO MINUTE WARNING. 5345 03:54:34,560 --> 03:54:35,880 WHETHER THEY'RE EFFECTIVE 5346 03:54:35,880 --> 03:54:46,360 BETWEEN LATENT CLASSES AND SO WE 5347 03:54:46,360 --> 03:54:48,680 CAN LOOK AT OVER TIME RESPONSES 5348 03:54:48,680 --> 03:54:51,160 TO TREATMENT AND DO WE SEE 5349 03:54:51,160 --> 03:54:52,400 DIFFERENT SUBSETS OF INDIVIDUALS 5350 03:54:52,400 --> 03:54:53,840 RESPOND NORTH DIFFERENT WAYS TO 5351 03:54:53,840 --> 03:54:56,000 TREATMENT AND SO DO YOU SEE AN 5352 03:54:56,000 --> 03:55:02,800 EARLY IMPROVEMENT GROUP SO THERE 5353 03:55:02,800 --> 03:55:05,160 ARE RELATED KINDS OF MODEL 5354 03:55:05,160 --> 03:55:06,800 THAT'S LOOK AT THESE PATTERNS OF 5355 03:55:06,800 --> 03:55:10,440 CHANGE AS WELL. 5356 03:55:10,440 --> 03:55:14,240 NEXT, PLEASE. 5357 03:55:14,240 --> 03:55:15,920 THIS IS OBVIOUSLY A LITTLE BIT 5358 03:55:15,920 --> 03:55:17,280 OF SELF CITATION IN HERE WHICH 5359 03:55:17,280 --> 03:55:22,200 IS ALWAYS FUN AND AND TO LOOK AT 5360 03:55:22,200 --> 03:55:24,720 IF YOU ARE INTERESTED IN THIS 5361 03:55:24,720 --> 03:55:30,400 APPROACH TO RESEARCH. 5362 03:55:30,400 --> 03:55:32,640 AND THAT IT S IT FOR ME NEXT UP 5363 03:55:32,640 --> 03:55:43,200 IS DAVID WILLIAMS AND THANK YOU 5364 03:55:45,960 --> 03:55:46,320 VERY MUCH. 5365 03:55:46,320 --> 03:55:46,960 >> GOOD AFTERNOON. 5366 03:55:46,960 --> 03:55:48,680 I ENJOYED YOUR TALK. 5367 03:55:48,680 --> 03:55:50,240 I'M GOING TO TALK ABOUT 5368 03:55:50,240 --> 03:55:52,320 ASSESSING CHRONIC OVERLAPPING 5369 03:55:52,320 --> 03:55:55,320 PAIN CONDITIONS WITHIN THE 5370 03:55:55,320 --> 03:55:58,840 INDIVIDUALS AND NEXT SLIDE. 5371 03:55:58,840 --> 03:56:02,280 JUST A COUPLE DISCLOSURES, I DO 5372 03:56:02,280 --> 03:56:04,400 CONSULTING WITH COMMUNITY HEALTH 5373 03:56:04,400 --> 03:56:10,880 FOCUS AND FUNDING FOR NIH. 5374 03:56:10,880 --> 03:56:12,280 SO, WE'VE HEARD A LITTLE BIT 5375 03:56:12,280 --> 03:56:14,560 TODAY ABOUT CHRONIC OVERLAPPING 5376 03:56:14,560 --> 03:56:15,800 PAIN CONDITIONS AND JUST TO 5377 03:56:15,800 --> 03:56:17,600 REMIND YOU, THE CONDITIONS THAT 5378 03:56:17,600 --> 03:56:20,560 KIND OF FALL INTO THIS 5379 03:56:20,560 --> 03:56:22,680 CLASSIFICATION WOULD BE THESE 10 5380 03:56:22,680 --> 03:56:26,400 CONDITIONS AND IRRITABLE BOWEL 5381 03:56:26,400 --> 03:56:31,440 SYNDROME, CHRONIC LOW BACK PAIN, 5382 03:56:31,440 --> 03:56:35,400 CHRONIC PROSTATITIS ALSO KNOWN 5383 03:56:35,400 --> 03:56:40,000 AS UBPS AND HEADACHES AND 5384 03:56:40,000 --> 03:56:42,240 PAINFULLEN ENDOMETRIOSIS AND 5385 03:56:42,240 --> 03:56:46,520 FIBER MYALGIA AND MYALGIA OR 5386 03:56:46,520 --> 03:56:48,160 CHRONIC FATIGUE SYNDROME SO 5387 03:56:48,160 --> 03:56:50,280 THESE ARE THE 10 CONDITIONS THAT 5388 03:56:50,280 --> 03:56:56,320 TEND TO FOLLOW INTO THIS 5389 03:56:56,320 --> 03:56:56,920 CLASSIFICATION. 5390 03:56:56,920 --> 03:57:04,160 SO THE QUESTIONS THAT ARE RAISED 5391 03:57:04,160 --> 03:57:14,640 AND HOW THEY CAN BE LINKED AND 5392 03:57:16,680 --> 03:57:18,400 WE SHOULD BE TREATING SEPARATELY 5393 03:57:18,400 --> 03:57:20,680 OR SHOULD WE BE ADDRESSING SOME 5394 03:57:20,680 --> 03:57:24,800 COMMON UNDERLYING CAUSE OF THE 5395 03:57:24,800 --> 03:57:27,800 OVERLAP. 5396 03:57:27,800 --> 03:57:31,160 NEXT SLIDE. 5397 03:57:31,160 --> 03:57:33,760 WE RUN INTO A BARRIER AND THE 5398 03:57:33,760 --> 03:57:36,160 BARRIER THAT WE RUN INTO IS THAT 5399 03:57:36,160 --> 03:57:39,440 WE DON'T REALLY HAVE A RELIABLE 5400 03:57:39,440 --> 03:57:42,120 AND VALID WAY OF ASSESSING AWFUL 5401 03:57:42,120 --> 03:57:46,480 THESE CONDITIONS IN THE SAME 5402 03:57:46,480 --> 03:57:50,280 INDIVIDUAL AND THE UNTHINKABLE 5403 03:57:50,280 --> 03:57:54,680 WAY WOULD BE TO HAVE A COLLISION 5404 03:57:54,680 --> 03:57:57,280 DELIVER ALL 10 CRITERIA TO THE 5405 03:57:57,280 --> 03:57:58,840 SAME CRITERIA AND IT WON'T 5406 03:57:58,840 --> 03:58:02,160 HAPPEN IN THE REAL WORLD. 5407 03:58:02,160 --> 03:58:03,720 AND MORE COMMONLY WHAT HAPPENS 5408 03:58:03,720 --> 03:58:06,600 IN CLINICAL PRACTICE IS IF YOU 5409 03:58:06,600 --> 03:58:07,760 HAVE JAW PAIN YOU GO TO YOUR 5410 03:58:07,760 --> 03:58:10,120 DENTIST AND THE DENTIST ASKS YOU 5411 03:58:10,120 --> 03:58:13,760 ABOUT YOUR JOB JAW PAIN AND 5412 03:58:13,760 --> 03:58:15,800 ABOUT OFFERS TREATMENTS FOR JAW 5413 03:58:15,800 --> 03:58:17,640 PAIN AND IT'S PROBABLY UNLIKELY 5414 03:58:17,640 --> 03:58:21,240 TO ASK ABOUT PELVIC PAIN. 5415 03:58:21,240 --> 03:58:22,080 AT THE SAME TIME, WITH THE 5416 03:58:22,080 --> 03:58:24,240 PERSON GOES OVER TO THEIR G.I. 5417 03:58:24,240 --> 03:58:26,480 DOCTOR AND G.I. DOCTOR WILL ASK 5418 03:58:26,480 --> 03:58:27,680 ABOUT THEIR GUT AND OFFERS 5419 03:58:27,680 --> 03:58:30,840 TREATMENTS FOR IBS AND GUT 5420 03:58:30,840 --> 03:58:32,120 DISTRESS AND AGAIN IS PROBABLY 5421 03:58:32,120 --> 03:58:34,520 NOT GOING TO BE ASKING ABOUT 5422 03:58:34,520 --> 03:58:37,720 OTHER AREAS OUTSIDE OF THEIR 5423 03:58:37,720 --> 03:58:38,120 SPECIALIZATION. 5424 03:58:38,120 --> 03:58:40,800 SO SIMILARLY IF THE PERSON GOES 5425 03:58:40,800 --> 03:58:42,600 TO NEUROLOGIST WITH HEADACHES, 5426 03:58:42,600 --> 03:58:44,360 THEY'RE LIKELY TO ASK ABOUT 5427 03:58:44,360 --> 03:58:47,600 HEADACHES THEY WON'T ASK ABOUT 5428 03:58:47,600 --> 03:58:50,000 OTHER CONDITIONS THAT THE PERSON 5429 03:58:50,000 --> 03:58:50,400 MAY HAVE. 5430 03:58:50,400 --> 03:58:52,640 SO, AS A CONSEQUENCE WE TEND TO 5431 03:58:52,640 --> 03:58:54,440 HAVE A LOT OF INDEX CONDITIONS 5432 03:58:54,440 --> 03:58:56,360 AND THIS IS THE CONDITION THAT 5433 03:58:56,360 --> 03:58:58,200 THE PERSON GETS DYING KNOWED 5434 03:58:58,200 --> 03:59:00,880 WITH AND AT LEAST INITIALLY AND 5435 03:59:00,880 --> 03:59:02,480 MANY TIMES IF YOU LOOK AT 5436 03:59:02,480 --> 03:59:03,400 SOMEONE'S CLINICAL RECORDS, YOU 5437 03:59:03,400 --> 03:59:05,080 WILL SEE THAT THEY'VE BEEN TO 5438 03:59:05,080 --> 03:59:07,080 MANY DIFFERENT DOCTORS, EACH 5439 03:59:07,080 --> 03:59:08,600 GETTING INDIVIDUAL DIAGNOSIS BUT 5440 03:59:08,600 --> 03:59:12,120 NOT NECESSARILY SEEING ANY 5441 03:59:12,120 --> 03:59:13,880 LINKAGE BETWEEN THESE AND THERE 5442 03:59:13,880 --> 03:59:24,360 HAVE BEEN A COUPLE OF LARGE 5443 03:59:28,600 --> 03:59:30,240 WHERE THEY WERE ADULT AND WE GOT 5444 03:59:30,240 --> 03:59:32,840 A HANDLE ON SOME OF OVERLAP AND 5445 03:59:32,840 --> 03:59:38,240 EVEN THOSE VERY LARGE NETWORKS 5446 03:59:38,240 --> 03:59:42,320 IN STUDIES DID NOT A SASS ALL 5447 03:59:42,320 --> 03:59:44,240 THREE WITH THE SAME INDIVIDUAL 5448 03:59:44,240 --> 03:59:46,520 AND NEXT LIED, PLEASE. 5449 03:59:46,520 --> 03:59:52,360 AND JUST TO GIVE AN EXAMPLE OF 5450 03:59:52,360 --> 03:59:55,320 HOW IMPORTANT IT CAN BE THEY 5451 03:59:55,320 --> 03:59:58,480 LOOKED AT 424 PATIENTS WITH 5452 03:59:58,480 --> 04:00:02,760 PELVIC PAIN AND WE'RE DYING 5453 04:00:02,760 --> 04:00:06,080 KNOWS WITH CHRONIC PROSTATE US 5454 04:00:06,080 --> 04:00:08,160 AND EVEN THOUGH THEY CAME IN, 5455 04:00:08,160 --> 04:00:11,320 WITH THIS AS THEIR INDEX 5456 04:00:11,320 --> 04:00:14,280 CONDITION, ONLY 25% ONLY HAD 5457 04:00:14,280 --> 04:00:24,800 PAIN IN THE PELVIC REGION THEY 5458 04:00:25,720 --> 04:00:27,880 EXTENDED BEYOND JUST THE BELL 5459 04:00:27,880 --> 04:00:31,240 VICTIM REGION WITH THIS 5460 04:00:31,240 --> 04:00:35,400 DIAGNOSIS. 5461 04:00:35,400 --> 04:00:37,880 IT'S ONE TO TWO TO THREE TO 5462 04:00:37,880 --> 04:00:39,800 SOUTHERN REGIONS AND DESCRIBING 5463 04:00:39,800 --> 04:00:44,040 MORE WIDESPREAD PAIN AND 38% 5464 04:00:44,040 --> 04:00:45,480 QUALIFIED FOR WIDESPREAD PAIN 5465 04:00:45,480 --> 04:00:47,920 EVEN THOUGH THEY CAME IN ONLY 5466 04:00:47,920 --> 04:00:51,760 EXPECTING TO HAVE ONE CONDITION 5467 04:00:51,760 --> 04:00:59,720 WHICH WOULD BE PELVIC PAIN AND 5468 04:00:59,720 --> 04:01:02,600 OTHER TYPES OF PROBLEMS AND CORE 5469 04:01:02,600 --> 04:01:07,240 QUALITY OF LIFE AND NEXT SLIDE, 5470 04:01:07,240 --> 04:01:07,520 PLEASE. 5471 04:01:07,520 --> 04:01:11,240 WHAT I'M GOING TO DO BRIEFLY 5472 04:01:11,240 --> 04:01:13,200 TODAY IS DESCRIBE TWO METHODS 5473 04:01:13,200 --> 04:01:16,080 AND PAIN CONDITIONS AND FOR 5474 04:01:16,080 --> 04:01:19,680 CLINICAL RESEARCH AND THE FIRST 5475 04:01:19,680 --> 04:01:21,840 USE NOT THE COMPUTE ABLE 5476 04:01:21,840 --> 04:01:22,760 PHENOTYPE APPROACH AND THIS IS 5477 04:01:22,760 --> 04:01:25,480 FOR USE IN ADMINISTRATIVE 5478 04:01:25,480 --> 04:01:26,760 DATABASES AND THEN THE SECOND IS 5479 04:01:26,760 --> 04:01:29,560 THE CHRONIC OVERLAPPING PAIN 5480 04:01:29,560 --> 04:01:32,680 CONDITIONS. 5481 04:01:32,680 --> 04:01:36,360 NEXT SLIDE. 5482 04:01:36,360 --> 04:01:37,960 IF YOU HAVE AN ADMINISTRATIVE 5483 04:01:37,960 --> 04:01:42,240 DATABASE AND YOU WANT TO TAKE A 5484 04:01:42,240 --> 04:01:52,800 LOOK AT AND THIS IS A STUDY THAT 5485 04:02:01,480 --> 04:02:03,480 WAS LED BY ANDREW FROM THE 5486 04:02:03,480 --> 04:02:05,680 UNIVERSITY OF MICHIGAN AND BY VI 5487 04:02:05,680 --> 04:02:07,400 FAWN WHO WAS AN UNDERGRADUATE 5488 04:02:07,400 --> 04:02:11,920 AND IS NOW IN MEDICAL SCHOOL AT 5489 04:02:11,920 --> 04:02:12,840 GEORGETOWN. 5490 04:02:12,840 --> 04:02:14,760 THIS STUDY HAD SEVERAL PARTS TO 5491 04:02:14,760 --> 04:02:17,360 IT AND WE DID ASSEMBLE AN EXPERT 5492 04:02:17,360 --> 04:02:21,200 PANEL AND WE HAD THREE EXPERTS 5493 04:02:21,200 --> 04:02:24,440 SO 30 EXPERTS AND THESE WERE 5494 04:02:24,440 --> 04:02:26,720 INDIVIDUALS WHO FOCUSED ON THE 5495 04:02:26,720 --> 04:02:28,560 SPECIFIC CHRONIC OVERLAPPING 5496 04:02:28,560 --> 04:02:30,520 PAIN CONDITIONS AND MANY TIMES 5497 04:02:30,520 --> 04:02:31,280 WHERE PEOPLE WHO ARE INVOLVED IN 5498 04:02:31,280 --> 04:02:33,080 THE DEVELOPMENT OF THE 5499 04:02:33,080 --> 04:02:36,360 DIAGNOSTIC CRITERIA AND WE HAD 5500 04:02:36,360 --> 04:02:38,320 THEM RECOMMEND ICD CODES THAT 5501 04:02:38,320 --> 04:02:41,320 WOULD MAP ONTO THE VARIOUS 5502 04:02:41,320 --> 04:02:44,240 CONDITIONS OF INTEREST AND WE 5503 04:02:44,240 --> 04:02:46,840 THEN ALSO DID A NATURAL LANGUAGE 5504 04:02:46,840 --> 04:02:49,680 PROCESSING APPROACH WHERE WE 5505 04:02:49,680 --> 04:02:54,080 LOOKED FOR THE MEDICAL RECORDS 5506 04:02:54,080 --> 04:02:55,520 FOR DESCRIPTIVE TERMS FOR THE 5507 04:02:55,520 --> 04:02:58,160 OVERLAPPING PAIN CONDITIONS AND 5508 04:02:58,160 --> 04:02:59,920 THEN WENT IT MAKE SURE WE CAN 5509 04:02:59,920 --> 04:03:02,320 MAP THOSE DESCRIPTIVE TERMS WITH 5510 04:03:02,320 --> 04:03:13,280 THE CODES ACODES FORT INDIVIDUA. 5511 04:03:13,280 --> 04:03:14,920 WE RETAINED THAT CODE WHEN WE 5512 04:03:14,920 --> 04:03:16,520 FOUND THE CODE LINING UP WITH 5513 04:03:16,520 --> 04:03:18,640 THE DESCRIPTION IN THE CHARTS. 5514 04:03:18,640 --> 04:03:21,600 AND THEN FINALLY WE IN ONE 5515 04:03:21,600 --> 04:03:24,240 MEDICAL SYSTEM WE DID A 5516 04:03:24,240 --> 04:03:27,280 DEMONSTRATION PROJECT WITH 5517 04:03:27,280 --> 04:03:28,680 12,000 INDIVIDUALS AND USING THE 5518 04:03:28,680 --> 04:03:30,320 RETAIN CODES TO TAKE A LOOK AT 5519 04:03:30,320 --> 04:03:33,320 THE DEGREE OF OVERLAP THAT WAS 5520 04:03:33,320 --> 04:03:41,680 GOING TO BE PRESENT AND IN THESE 5521 04:03:41,680 --> 04:03:47,480 CONDITIONS. 5522 04:03:47,480 --> 04:03:49,440 THIS WAS LITTLE CONTROVERSY AND 5523 04:03:49,440 --> 04:03:51,640 ONLY ONE CODE AND THE AGREEMENT 5524 04:03:51,640 --> 04:03:55,040 THERE WAS GREAT AND IN OTHER 5525 04:03:55,040 --> 04:03:58,840 CONDITIONS, WHERE THERE WAS LESS 5526 04:03:58,840 --> 04:04:00,280 AGREEMENT ON THE DIAGNOSTIC 5527 04:04:00,280 --> 04:04:07,080 CRITERIA AS WELL AS THE CODES, 5528 04:04:07,080 --> 04:04:09,280 THAT WAS GREATER RELIANCE MAKING 5529 04:04:09,280 --> 04:04:10,400 SURE WE HAD ALIGNMENT BETWEEN 5530 04:04:10,400 --> 04:04:12,640 THE ICD CODES AND THE 5531 04:04:12,640 --> 04:04:18,200 DESCRIPTIVE TEXT AND THE CHARTS. 5532 04:04:18,200 --> 04:04:20,880 NEXT SLIDE. 5533 04:04:20,880 --> 04:04:21,480 THIS IS A CHART. 5534 04:04:21,480 --> 04:04:24,800 WE SAW A SIMILAR ONE IN Dr. 5535 04:04:24,800 --> 04:04:25,640 SAWSAN AS-SANIE TALK EARLIER 5536 04:04:25,640 --> 04:04:27,240 FROM THE SAME ARTICLE. 5537 04:04:27,240 --> 04:04:28,840 SHE WAS SHOWING ODDS AND RATIO 5538 04:04:28,840 --> 04:04:29,840 AND THIS LOOKED AT THE 5539 04:04:29,840 --> 04:04:32,160 PERCENTAGE OF OVERLAP IN THE 5540 04:04:32,160 --> 04:04:34,280 VARIOUS CONDITIONS WHERE THE 5541 04:04:34,280 --> 04:04:36,200 INDEX CONDITIONS AND AGAIN, WHAT 5542 04:04:36,200 --> 04:04:38,720 WE'VE NOTICED FROM THIS IS THAT 5543 04:04:38,720 --> 04:04:40,400 WHILE THESE CONDITIONS DO ALL 5544 04:04:40,400 --> 04:04:42,520 TEND TO OVERLAP WITH EACH OTHER 5545 04:04:42,520 --> 04:04:44,080 MORE THAN THE CONTROL 5546 04:04:44,080 --> 04:04:45,120 CONDITIONS, THE LAST THREE ON 5547 04:04:45,120 --> 04:04:49,880 THE BOTTOM, COPD, AND 5548 04:04:49,880 --> 04:04:53,320 CARDIOVASCULAR DISEASE, DIABETIC 5549 04:04:53,320 --> 04:04:55,960 MEASURE ON AGENT' WE SEE THERE'S 5550 04:04:55,960 --> 04:04:57,120 LITTLE OVERLAP WITH THE CONTROL 5551 04:04:57,120 --> 04:04:59,840 CONDITIONS BUT THERE'S A LOT OF 5552 04:04:59,840 --> 04:05:02,240 OVERLAP AMONG THESE 10 5553 04:05:02,240 --> 04:05:02,520 CONDITIONS. 5554 04:05:02,520 --> 04:05:04,400 AND SOME TEND TO OVERLAP MORE 5555 04:05:04,400 --> 04:05:07,880 THAN OTHERS, FIBER MYALGIA AND 5556 04:05:07,880 --> 04:05:10,480 IRRITABLE BOWEL OR FIBER MYALGIA 5557 04:05:10,480 --> 04:05:14,000 LOW BACK PAIN WITH HEADACHE AND 5558 04:05:14,000 --> 04:05:17,920 IBS AND UCPCS WITH HEADACHE FOR 5559 04:05:17,920 --> 04:05:20,480 EXAMPLE ANDEN DOUGH WITH 5560 04:05:20,480 --> 04:05:21,800 MIGRAINE HEADACHE. 5561 04:05:21,800 --> 04:05:23,560 SO WITH DO SEE SOME CONDITIONS 5562 04:05:23,560 --> 04:05:25,320 HAVE A HIGH DEGREE OF OVERLAP 5563 04:05:25,320 --> 04:05:27,400 AND OTHERS LESS SO AND SOME HAVE 5564 04:05:27,400 --> 04:05:28,720 A SPECIFIC OVERLAP AND SOME 5565 04:05:28,720 --> 04:05:29,800 CONDITIONS AND ABOUT WHAT IS 5566 04:05:29,800 --> 04:05:31,120 INTERESTING THOUGH, IS THAT WHEN 5567 04:05:31,120 --> 04:05:34,880 THE OVERLAP DOES OCCUR, IT'S 5568 04:05:34,880 --> 04:05:39,680 USUALLY SOME OTHER REGION OF THE 5569 04:05:39,680 --> 04:05:44,040 BODY, FOR EXAMPLE, HAVING PELVIC 5570 04:05:44,040 --> 04:05:46,520 PAIN AND HEADACHES AS WELL. 5571 04:05:46,520 --> 04:05:50,000 NEXT SLIDE, PLEASE. 5572 04:05:50,000 --> 04:05:51,480 SO, THESE SECOND APPROACH I 5573 04:05:51,480 --> 04:05:55,200 WANTED TO TALK ABOUT IS THE 5574 04:05:55,200 --> 04:05:55,760 CHRONIC OVERLAPPING PAIN 5575 04:05:55,760 --> 04:05:57,480 CONDITIONS AND THIS IS A 5576 04:05:57,480 --> 04:05:58,840 SCREENER THAT WE HAD BEGIN USED 5577 04:05:58,840 --> 04:06:01,600 THAT SAME PANELIST 30 EXPERTS TO 5578 04:06:01,600 --> 04:06:05,640 GIVE US ADVISE ON THE DIAGNOSTIC 5579 04:06:05,640 --> 04:06:07,560 CRITERIA AND WE WANTED TO MAKE 5580 04:06:07,560 --> 04:06:11,640 SURE THAT WE COULD, VERY 5581 04:06:11,640 --> 04:06:12,280 EFFICIENT LIKE ADMINISTERED THE 5582 04:06:12,280 --> 04:06:15,280 10 DIAGNOSTIC CRITERIA TO ANY 5583 04:06:15,280 --> 04:06:17,080 GIVEN INDIVIDUALS AND TO HELP US 5584 04:06:17,080 --> 04:06:20,040 TRIAGE THAT WE USE A BODY MAP 5585 04:06:20,040 --> 04:06:23,640 AND SHOWN ON THE SLIDE AND SO WE 5586 04:06:23,640 --> 04:06:25,640 HAVE PEOPLE COMPLETE THE BODY 5587 04:06:25,640 --> 04:06:26,160 MAP. 5588 04:06:26,160 --> 04:06:28,560 IF THEY DON'T INDICATE HEADACHE 5589 04:06:28,560 --> 04:06:31,600 FOR EXAMPLE, THEN WE WILL NOT 5590 04:06:31,600 --> 04:06:33,400 ADMINISTERED THE HEADACHE 5591 04:06:33,400 --> 04:06:34,480 CRITERIA TO THAT INDIVIDUAL WHO 5592 04:06:34,480 --> 04:06:36,240 IS NOT SOME PLACE THEY'RE 5593 04:06:36,240 --> 04:06:37,960 EXPERIENCING PAIN BUT ANY REGION 5594 04:06:37,960 --> 04:06:40,920 WHERE THEY DO INDICATE PAIN AND 5595 04:06:40,920 --> 04:06:43,120 IT'S A RELEVANCE TO THE 5596 04:06:43,120 --> 04:06:47,480 DIAGNOSTIC CRITERIA THEN WE WILL 5597 04:06:47,480 --> 04:06:49,240 ADMINISTERED THE PUBLISH 5598 04:06:49,240 --> 04:06:51,120 DIAGNOSE TICK CRITERIA OR THE 5599 04:06:51,120 --> 04:06:54,000 MODIFIED CRITERIA TO THEM. 5600 04:06:54,000 --> 04:06:56,080 WE HAVE WORKED TO MAKE SURE THAT 5601 04:06:56,080 --> 04:06:59,480 THIS IS A LOGIC-DRIVEN APPROACH 5602 04:06:59,480 --> 04:07:00,720 AND SO AS SOON AS SOMEONE IS NOT 5603 04:07:00,720 --> 04:07:02,920 GOING TO QUALIFY FOR THE 5604 04:07:02,920 --> 04:07:04,360 DIAGNOSTIC CRITERIA, THEY CAN 5605 04:07:04,360 --> 04:07:05,960 BAIL OUT OF THAT AND THEY MOVE 5606 04:07:05,960 --> 04:07:08,600 ONTO THE NEXT CRITERIA. 5607 04:07:08,600 --> 04:07:10,600 WHAT WE FIND IS THAT FOLKS ARE 5608 04:07:10,600 --> 04:07:12,120 ABLE TO USUALLY GET THROUGH THIS 5609 04:07:12,120 --> 04:07:13,520 IN ABOUT 10 MINUTES SO IT 5610 04:07:13,520 --> 04:07:15,600 DOESN'T TAKE A GREAT DEAL OF 5611 04:07:15,600 --> 04:07:17,120 TIME SO IT'S A LOT MORE 5612 04:07:17,120 --> 04:07:18,480 EFFICIENT THAN ADMINISTERED ALL 5613 04:07:18,480 --> 04:07:23,000 THE CRITERIA TO ANY GIVEN 5614 04:07:23,000 --> 04:07:25,400 INDIVIDUAL AND AT THE END, WE'RE 5615 04:07:25,400 --> 04:07:28,040 ABLE TO GET A REPORT THAT COMES 5616 04:07:28,040 --> 04:07:29,720 OUT AND THAT BASICALLY TELLS YOU 5617 04:07:29,720 --> 04:07:32,560 WHETHER YOU QUALIFY OR NOT FOR 5618 04:07:32,560 --> 04:07:33,680 EACH OF THE CONDITIONS AND THEN 5619 04:07:33,680 --> 04:07:37,640 IT TELLS YOU HOW MANY OF THE 5620 04:07:37,640 --> 04:07:39,600 CONDITIONS YOU QUALIFY FOR BASED 5621 04:07:39,600 --> 04:07:40,880 ON THIS SCREENER. 5622 04:07:40,880 --> 04:07:44,600 NEXT SLIDE, PLEASE. 5623 04:07:44,600 --> 04:07:48,440 AND THE SCREENER IS NOW IN 5624 04:07:48,440 --> 04:07:49,440 VERSION 11. 5625 04:07:49,440 --> 04:07:50,640 VERSION 11 IS A VERSION THAT'S 5626 04:07:50,640 --> 04:07:54,120 ABLE TO RUN ON RED CAP. 5627 04:07:54,120 --> 04:07:56,000 THIS WAS A REQUEST THAT WOULD BE 5628 04:07:56,000 --> 04:07:58,520 PUT INTO RED CAPS OF MORE 5629 04:07:58,520 --> 04:08:00,120 UNIVERSITIES AND MORE 5630 04:08:00,120 --> 04:08:01,520 INSTITUTIONS WOULD BE ABLE TO 5631 04:08:01,520 --> 04:08:03,040 TAKE ADVANTAGE OF THIS SCREENER 5632 04:08:03,040 --> 04:08:04,360 AND SO THIS COMPANY IS YOUR 5633 04:08:04,360 --> 04:08:05,360 GUIDE THAT TALKS ABOUT THE 5634 04:08:05,360 --> 04:08:09,760 DEVELOPMENT OF THE COPC SCREENER 5635 04:08:09,760 --> 04:08:11,200 AND LISTS OF ITEMS AND SCORING 5636 04:08:11,200 --> 04:08:13,320 AND THE OUTPUT AS WELL AS THE 5637 04:08:13,320 --> 04:08:14,600 VALIDATION PROPERTIES AND THIS 5638 04:08:14,600 --> 04:08:17,040 LATEST VERSION HAS GONE THROUGH 5639 04:08:17,040 --> 04:08:19,040 ADDITIONAL VALIDATION AND WE'VE 5640 04:08:19,040 --> 04:08:20,400 WORKED WITH A LOT OF PATIENT 5641 04:08:20,400 --> 04:08:22,040 GROUPS AND WE HAVE A LOT OF 5642 04:08:22,040 --> 04:08:24,400 PATIENT INPUT AND FOR EXAMPLE ON 5643 04:08:24,400 --> 04:08:26,160 THE BODY MAP, YOU PROBABLY 5644 04:08:26,160 --> 04:08:31,080 NOTICED THE COLORING OF THE BODY 5645 04:08:31,080 --> 04:08:32,160 MAP AND THIS WAS THE 5646 04:08:32,160 --> 04:08:33,240 RECOMMENDATION OF OUR PATIENT 5647 04:08:33,240 --> 04:08:34,800 GROUPS SO PEOPLE WHO MIGHT BE 5648 04:08:34,800 --> 04:08:37,840 COLOR BLIND WOULD BE ABLE TO USE 5649 04:08:37,840 --> 04:08:40,080 IT AND WE ACTUALLY DID THE 5650 04:08:40,080 --> 04:08:41,320 UNTHINKABLE IN THE VALIDATION 5651 04:08:41,320 --> 04:08:44,200 WHERE WE ACTUALLY HAD CLINICIANS 5652 04:08:44,200 --> 04:08:48,280 DELIVER ALL 1 10 DIAGNOSTIC 5653 04:08:48,280 --> 04:08:50,240 CRITERIA TO THE SAME INDIVIDUAL 5654 04:08:50,240 --> 04:09:00,760 AND WE HAD FOLKS IN EACH WHAT 5655 04:09:19,760 --> 04:09:21,320 THE CLINICIANS WERE GETTING AND 5656 04:09:21,320 --> 04:09:27,360 WHAT WE GOT WITH OUR A GROVATED 5657 04:09:27,360 --> 04:09:28,040 STRAINER. 5658 04:09:28,040 --> 04:09:30,480 IF YOU ARE INTERESTED IN 5659 04:09:30,480 --> 04:09:32,480 ACCESSING THE SCREENER, THERE'S 5660 04:09:32,480 --> 04:09:35,960 A WEBSITE AND WE HAVE SEVERAL 5661 04:09:35,960 --> 04:09:36,200 THINGS. 5662 04:09:36,200 --> 04:09:37,960 WE HAVE A DEMONSTRATION OF 5663 04:09:37,960 --> 04:09:38,800 SOMEONE USING THE SCREENERS SO 5664 04:09:38,800 --> 04:09:41,320 IF YOU WANT TO SEE HOW THAT'S 5665 04:09:41,320 --> 04:09:43,160 DONE, THE USER GUIDE WHICH I 5666 04:09:43,160 --> 04:09:44,760 JUST REFERRED TO IS AVAILABLE 5667 04:09:44,760 --> 04:09:46,600 FOR DOWNLOAD AND THERE'S AN 5668 04:09:46,600 --> 04:09:57,080 ON-LINE DEMONSTRATION -- TO 5669 04:10:16,120 --> 04:10:17,960 FOLKS WHO WANT TO USE IT AND THE 5670 04:10:17,960 --> 04:10:19,280 REQUIREMENT IS YOU HAVE TO HAVE 5671 04:10:19,280 --> 04:10:21,440 RED CAP IN ORDER TO USE IT. 5672 04:10:21,440 --> 04:10:24,560 NEXT SLIDE, PLEASE. 5673 04:10:24,560 --> 04:10:33,280 AND AGAIN HERE IS THE URL. 5674 04:10:33,280 --> 04:10:43,760 IF YOU DO YOU CAN ACCESS THIS 5675 04:10:43,760 --> 04:10:46,560 FOR FREE IF YOU ARE AN ACADEMIC 5676 04:10:46,560 --> 04:10:46,920 USER. 5677 04:10:46,920 --> 04:10:50,280 I'LL STOP THERE. 5678 04:10:50,280 --> 04:10:53,680 THANK YOU. 5679 04:10:53,680 --> 04:10:57,760 >> THANK YOU ALL FOR MY PANEL 5680 04:10:57,760 --> 04:10:58,000 MEMBERS. 5681 04:10:58,000 --> 04:11:02,760 WE HAVE VERY INTERESTING FOUR 5682 04:11:02,760 --> 04:11:04,600 PRESENTATIONS. 5683 04:11:04,600 --> 04:11:05,840 IT'S VERY DIFFERENT FROM OUR 5684 04:11:05,840 --> 04:11:06,920 FIRST PANEL DISCUSSION THIS 5685 04:11:06,920 --> 04:11:07,600 MORNING. 5686 04:11:07,600 --> 04:11:11,480 NOW THE FIRST PANEL DEFINITELY 5687 04:11:11,480 --> 04:11:13,760 INDICATED THE NEED TO GO ABOVE 5688 04:11:13,760 --> 04:11:15,480 AND BEYOND WHAT THE MAINSTREAM 5689 04:11:15,480 --> 04:11:19,120 SO WHAT CURRENTLY IS A WAY OF 5690 04:11:19,120 --> 04:11:21,720 LOOKING TO THE PAIN AND 5691 04:11:21,720 --> 04:11:24,560 EMPHASIZE THE NEED TO HAVE A 5692 04:11:24,560 --> 04:11:26,120 WHOLE-PERSON APPROACH. 5693 04:11:26,120 --> 04:11:31,200 NOW, FOR THIS PANEL, WE STARTED 5694 04:11:31,200 --> 04:11:33,720 WITH JENSEN'S OVERVIEW 5695 04:11:33,720 --> 04:11:37,120 INDICATING ABOUT THE APPROACHES, 5696 04:11:37,120 --> 04:11:39,120 ABOUT THE TOOLS AND ALL THE THE 5697 04:11:39,120 --> 04:11:40,720 DIRECTIONS, WHAT WE CAN DO TO 5698 04:11:40,720 --> 04:11:44,040 ADDRESS THE ISSUE RAISING THE 5699 04:11:44,040 --> 04:11:46,960 FIRST PANEL. 5700 04:11:46,960 --> 04:11:49,240 Dr. ATLAS PROVIDE HER RESEARCH 5701 04:11:49,240 --> 04:11:52,080 DATA USING BRAIN IMAGING THAT 5702 04:11:52,080 --> 04:11:53,600 CAN SERVE AT LEAST TWO THE WAY I 5703 04:11:53,600 --> 04:11:54,920 SEE IT. 5704 04:11:54,920 --> 04:11:59,840 ONE TO IDENTIFY THE BRAIN 5705 04:11:59,840 --> 04:12:03,240 SUBSTRATES, YOU KNOW, BRAIN 5706 04:12:03,240 --> 04:12:07,240 CIRCUITRIES THAT MAY PLAY 5707 04:12:07,240 --> 04:12:08,480 IMPORTANT ROLES IN PAIN 5708 04:12:08,480 --> 04:12:09,600 MANAGEMENT THAT BEYOND TO THE 5709 04:12:09,600 --> 04:12:12,440 PAIN SENSORY AND TO EVOLVE 5710 04:12:12,440 --> 04:12:15,200 EFFECTIVE PART OF THE PAIN AND 5711 04:12:15,200 --> 04:12:19,000 ALSO THEY HAVE POTENTIAL WERE 5712 04:12:19,000 --> 04:12:21,360 INFORMED THE HOW WE CAN PREDICT 5713 04:12:21,360 --> 04:12:22,880 PAIN USING DIFFERENT APPROACHES 5714 04:12:22,880 --> 04:12:24,800 AND IT'S NOT NECESSARY TO SAY 5715 04:12:24,800 --> 04:12:27,000 THAT WE HAVE TO USE BRAIN 5716 04:12:27,000 --> 04:12:30,040 IMAGING AS A PREDICT OR BUT THEN 5717 04:12:30,040 --> 04:12:32,800 THESE INFORM THE DIRECTIONS. 5718 04:12:32,800 --> 04:12:37,840 AND OF COURSE, WE HAVE Dr. 5719 04:12:37,840 --> 04:12:42,440 BAUER GIVE US A VERY INTERESTING 5720 04:12:42,440 --> 04:12:43,040 IDEA. 5721 04:12:43,040 --> 04:12:44,960 THIS IS HER EXPERTISE AND WHAT 5722 04:12:44,960 --> 04:12:48,120 WE CAN USE IN TERMS OF 5723 04:12:48,120 --> 04:12:50,400 METHODOLOGY WIDE TO LOOK INTO 5724 04:12:50,400 --> 04:12:52,960 SOME DIFFERENT ANGLES INTO THE 5725 04:12:52,960 --> 04:12:54,680 QUESTIONS THAT WE ARE ASKING 5726 04:12:54,680 --> 04:13:00,680 ABOUT THE DAY AND FINALLY, IN A 5727 04:13:00,680 --> 04:13:02,800 THE IDEAS STARTING FROM THE 5728 04:13:02,800 --> 04:13:05,760 CHRONIC OVERLAPPING PAIN 5729 04:13:05,760 --> 04:13:08,360 COMMISSIONERS AND USE THIS AS 5730 04:13:08,360 --> 04:13:14,640 EXAMPLES AND INTRODUCE US ABOUT 5731 04:13:14,640 --> 04:13:15,800 SCREENERS WITH THIS LET'S COME 5732 04:13:15,800 --> 04:13:19,560 TO THE DISCUSSIONS AND WE HAVE A 5733 04:13:19,560 --> 04:13:20,840 FEW EXTRA MINUTES BEYOND WHAT 5734 04:13:20,840 --> 04:13:31,160 WE'RE ASSIGNED FOR. 5735 04:13:31,520 --> 04:13:32,720 BECAUSE A FEW QUESTIONS ARE 5736 04:13:32,720 --> 04:13:35,520 SIMILAR APPROACHES AND FOR 5737 04:13:35,520 --> 04:13:37,400 EXAMPLE, EMPHASIZING SO WE START 5738 04:13:37,400 --> 04:13:41,600 FROM THIS QUESTION AND IT'S FOR 5739 04:13:41,600 --> 04:13:46,680 Dr. JENSON, SAYS IT'S UNLEARN 5740 04:13:46,680 --> 04:13:48,400 HOW YOU CAN DETERMINE BETWEEN 5741 04:13:48,400 --> 04:13:53,560 THE MECHANISMS IN THE MEDIATION 5742 04:13:53,560 --> 04:13:55,440 AND ANALYSIS WHERE THERE'S NOT 5743 04:13:55,440 --> 04:13:59,280 ENOUGH POWER FOR THOSE 5744 04:13:59,280 --> 04:14:03,520 MECHANISTIC OUTCOMES OR IT COMES 5745 04:14:03,520 --> 04:14:07,680 FROM THE SECONDARY OUTCOMES 5746 04:14:07,680 --> 04:14:10,840 BECAUSE THE TRIALS ARE POWERED 5747 04:14:10,840 --> 04:14:12,440 FROM THE PRIMARY CLINICAL 5748 04:14:12,440 --> 04:14:12,800 OUTCOME. 5749 04:14:12,800 --> 04:14:14,960 CAN YOU EXPLAIN THE POWER ISSUES 5750 04:14:14,960 --> 04:14:17,960 HERE? 5751 04:14:17,960 --> 04:14:19,960 I NEED TO REPEAT? 5752 04:14:19,960 --> 04:14:21,600 >> I THINK WE'RE GOOD. 5753 04:14:21,600 --> 04:14:26,240 THAT'S A FANTASTIC QUESTION AND 5754 04:14:26,240 --> 04:14:31,280 GETS AT THE CRUX OF THE ISSUE OF 5755 04:14:31,280 --> 04:14:32,960 DOES THIS ONE STUDY, CAN WE USE 5756 04:14:32,960 --> 04:14:35,280 THIS ONE STUDY TO ANSWER A 5757 04:14:35,280 --> 04:14:36,440 SERIES OF QUESTIONS AND THE 5758 04:14:36,440 --> 04:14:40,240 ANSWER TO THAT I THINK IS NO AND 5759 04:14:40,240 --> 04:14:44,520 MY VIEW IS THAT A SINGLE STUDY 5760 04:14:44,520 --> 04:14:46,800 IS USUALLY DESIGNED TO ANSWER 5761 04:14:46,800 --> 04:14:48,480 ONE QUESTION, IT'S USUALLY 5762 04:14:48,480 --> 04:14:50,200 POWERED FOR THAT. 5763 04:14:50,200 --> 04:14:54,160 WE CAN SHIFT OUR VIEW FROM 5764 04:14:54,160 --> 04:14:55,680 THINKING OF HAVING, SPENDING ALL 5765 04:14:55,680 --> 04:14:57,080 THIS MONEY AND ALL THIS 5766 04:14:57,080 --> 04:14:59,720 RESOURCES TO ANSWER ONE QUESTION 5767 04:14:59,720 --> 04:15:01,520 AND TO ASKING OURSELVES TO 5768 04:15:01,520 --> 04:15:05,480 DESIGN STUDIES THAT CAN CREATE 5769 04:15:05,480 --> 04:15:08,280 ANSWERS TO MULTIPLE QUESTIONS 5770 04:15:08,280 --> 04:15:10,480 AND SO NOT GET A DEFINITIVE 5771 04:15:10,480 --> 04:15:11,800 ANSWERS BUT EFFECT SIZE SO, YOU 5772 04:15:11,800 --> 04:15:15,000 KNOW, THE ROLE OF SELF-EFFICACY 5773 04:15:15,000 --> 04:15:17,120 AS TO EXPLAIN THE BIO FEED BACKS 5774 04:15:17,120 --> 04:15:20,360 IMPACT ON HEADACHE IN THIS STUDY 5775 04:15:20,360 --> 04:15:23,560 THAT IS .38 AND IF WE INCLUDE 5776 04:15:23,560 --> 04:15:25,920 THESE ANALYSIS ACROSS MULTIPLE 5777 04:15:25,920 --> 04:15:27,960 STUDIES, WE'LL SEE MULTIPLE 5778 04:15:27,960 --> 04:15:32,560 EFFECT SIZES .1, .38, .45, .12, 5779 04:15:32,560 --> 04:15:35,400 ET CETERA, AND WE'LL OVER TIME, 5780 04:15:35,400 --> 04:15:36,720 UNDERSTAND WHAT IS THE EFFECT, 5781 04:15:36,720 --> 04:15:39,080 WHAT IS THE ROLE OF THIS AS A 5782 04:15:39,080 --> 04:15:40,800 MECHANISM WHEN YOU EXAMINE A 5783 04:15:40,800 --> 04:15:44,520 CROSS MULTIPLE STUDIES, SO, 5784 04:15:44,520 --> 04:15:46,600 POWER, HE WANT TO POWER STUDIES 5785 04:15:46,600 --> 04:15:49,200 TO BE ABLE TO CREATE RELIABLE 5786 04:15:49,200 --> 04:15:51,080 EFFECT SIZES. 5787 04:15:51,080 --> 04:15:55,960 NOT TO ANSWER A DEFINITIVE 5788 04:15:55,960 --> 04:15:56,600 QUESTION. 5789 04:15:56,600 --> 04:15:59,200 THE POWER QUESTION GETS TURNED 5790 04:15:59,200 --> 04:16:09,520 ON ITS HEAD HERE. 5791 04:16:13,600 --> 04:16:15,680 I'M ADVOCATING FOR A SHIFT HOW 5792 04:16:15,680 --> 04:16:18,560 WE 5793 04:16:18,560 --> 04:16:20,120 I THINK WE SHOULD GET RID OF THE 5794 04:16:20,120 --> 04:16:21,560 P VALUE AND THINK ABOUT IT 5795 04:16:21,560 --> 04:16:22,120 DIFFERENTLY. 5796 04:16:22,120 --> 04:16:24,440 I WOULD LOVE TO HEAR DR. BAUER'S 5797 04:16:24,440 --> 04:16:25,880 RESPONSE ON IT, BECAUSE I THINK 5798 04:16:25,880 --> 04:16:28,360 WE MAY BE CONSTRAINED BY WHAT 5799 04:16:28,360 --> 04:16:30,560 I'M CALLING IN MY VIEW THE 5800 04:16:30,560 --> 04:16:31,800 TYRANNY OF THE P VALUE. 5801 04:16:31,800 --> 04:16:32,960 PRACTICALLY, WE NEED TO GET OUR 5802 04:16:32,960 --> 04:16:36,000 RESEARCH FUNDED SO I WILL OFTEN 5803 04:16:36,000 --> 04:16:37,200 IN MIGRANTS SAY WE'RE GOING TO 5804 04:16:37,200 --> 04:16:39,840 TEST THIS ONE QUESTION AND WE'RE 5805 04:16:39,840 --> 04:16:41,360 POWERED FOR T BUT BY THE WAY, 5806 04:16:41,360 --> 04:16:42,920 WE'RE GOING TO DO SECONDARY 5807 04:16:42,920 --> 04:16:44,080 ANALYSES TO GET THESE ESTIMATES 5808 04:16:44,080 --> 04:16:45,440 THAT FUTURE RESEARCHERS AND 5809 04:16:45,440 --> 04:16:46,080 SCIENTISTS CAN USE. 5810 04:16:46,080 --> 04:16:47,640 SO THAT'S MY THINKING. 5811 04:16:47,640 --> 04:16:53,200 BUT IT'S A LONG CONVERSATION. 5812 04:16:53,200 --> 04:16:55,360 >> ANY COMMENT, DR. BAUER? 5813 04:16:55,360 --> 04:16:56,720 >> SURE. 5814 04:16:56,720 --> 04:16:59,960 I MEAN, THERE HAVE BEEN A FEW 5815 04:16:59,960 --> 04:17:01,760 MOVEMENTS AFOOT IN SCIENCE, 5816 04:17:01,760 --> 04:17:03,680 PARTICULARLY IN PSYCHOLOGY, TO 5817 04:17:03,680 --> 04:17:07,000 TRY TO BAN P VALUES, AND THE 5818 04:17:07,000 --> 04:17:10,600 PROBLEM SEEMS TO BE FINDING, YOU 5819 04:17:10,600 --> 04:17:12,600 KNOW, ENOUGH PEOPLE TO BUY IN TO 5820 04:17:12,600 --> 04:17:15,880 THAT MOVEMENT AND THEN FINDING 5821 04:17:15,880 --> 04:17:16,840 GOOD ALTERNATIVES. 5822 04:17:16,840 --> 04:17:18,640 FOR A WHILE, PEOPLE SAID, OH, WE 5823 04:17:18,640 --> 04:17:22,320 COULD DO CONFIDENCE INTERVALS. 5824 04:17:22,320 --> 04:17:24,360 CONFIDENCE INTERVALS ARE BETTER. 5825 04:17:24,360 --> 04:17:25,760 SURE, BUT TO GET YOUR TEST 5826 04:17:25,760 --> 04:17:27,120 STATISTIC FOR THE P VALUE, 5827 04:17:27,120 --> 04:17:28,960 YOU'RE JUST TAKING AN ESTIMATE 5828 04:17:28,960 --> 04:17:33,360 AND DIVIDING BY THE STANDARD 5829 04:17:33,360 --> 04:17:35,280 ERROR, IT'S REALLY NOT 5830 04:17:35,280 --> 04:17:36,200 TREMENDOUSLY DIFFERENT IN TERMS 5831 04:17:36,200 --> 04:17:37,320 OF THE KIND OF INFORMATION 5832 04:17:37,320 --> 04:17:40,720 THAT'S BEING GIVEN THERE, BUT I 5833 04:17:40,720 --> 04:17:42,960 DO, YOU KNOW, CERTAINLY AGREE 5834 04:17:42,960 --> 04:17:46,480 THAT A GREATER FOCUS ON EFFECT 5835 04:17:46,480 --> 04:17:48,840 SIZES IS IN ORDER, AND 5836 04:17:48,840 --> 04:17:50,280 OFTENTIMES IN ALL HYPOTHESES, WE 5837 04:17:50,280 --> 04:17:53,040 TEST WITH P VALUES, CAN BE A BIT 5838 04:17:53,040 --> 04:17:54,600 SILLY AND NOT THAT INFORMATIVE, 5839 04:17:54,600 --> 04:17:56,760 AND SO I THINK IT'S ALL TO THE 5840 04:17:56,760 --> 04:17:58,920 BETTER TO FOCUS ON THOSE EFFECT 5841 04:17:58,920 --> 04:18:01,200 SIZES AND TO TRY TO AGGREGATE 5842 04:18:01,200 --> 04:18:02,920 INFORMATION ACROSS STUDIES BY 5843 04:18:02,920 --> 04:18:04,520 HAVING KIND OF STANDARDIZED 5844 04:18:04,520 --> 04:18:05,840 EFFECT SIZES THAT WE CAN LOOK 5845 04:18:05,840 --> 04:18:06,360 AT. 5846 04:18:06,360 --> 04:18:08,400 SO I DEFINITELY LIKE THOSE 5847 04:18:08,400 --> 04:18:08,720 IDEAS. 5848 04:18:08,720 --> 04:18:11,160 I DON'T KNOW IF THE P VALUE WILL 5849 04:18:11,160 --> 04:18:15,200 EVER BE BANNED, BUT WE CAN 5850 04:18:15,200 --> 04:18:16,000 CERTAINLY COMPLIMENT IT WITH 5851 04:18:16,000 --> 04:18:18,320 MORE FOCUS ON EFFECT SIZES. 5852 04:18:18,320 --> 04:18:21,040 >> THANK YOU, DR. BAUER. 5853 04:18:21,040 --> 04:18:26,280 NOW, THIS AGAIN IS ANOTHER 5854 04:18:26,280 --> 04:18:28,880 QUESTION RELATED TO -- DIRECT TO 5855 04:18:28,880 --> 04:18:29,320 DR. JENSEN. 5856 04:18:29,320 --> 04:18:31,840 YOU MAY HAVE ALREADY ANSWERED IN 5857 04:18:31,840 --> 04:18:33,080 PART, AT LEAST PARTIALLY THE 5858 04:18:33,080 --> 04:18:35,320 QUESTION BUT LET ME THROW IT OUT 5859 04:18:35,320 --> 04:18:39,960 ANYWAY JUST IN CASE YOU HAVE A 5860 04:18:39,960 --> 04:18:41,320 DIFFERENT -- THE QUESTION IS, 5861 04:18:41,320 --> 04:18:45,880 WITH THE ABILITY TO EXAMINE 5862 04:18:45,880 --> 04:18:48,800 MANY -- FACTORS IN -- ANALYSIS, 5863 04:18:48,800 --> 04:18:52,400 HOW DOES ONE ASSURE SUFFICIENT 5864 04:18:52,400 --> 04:18:56,120 POWER TO EXAMINE ALL FOUR OF 5865 04:18:56,120 --> 04:18:56,560 THOSE INDIVIDUAL 5866 04:18:56,560 --> 04:18:58,360 CHARACTERISTICS? 5867 04:18:58,360 --> 04:19:03,680 >> SO YOU'RE ABSOLUTELY RIGHT, 5868 04:19:03,680 --> 04:19:05,960 THAT THAT, IN MY VIEW, IS A 5869 04:19:05,960 --> 04:19:06,720 DIFFERENT WAY OF LOOKING AT THE 5870 04:19:06,720 --> 04:19:11,320 SAME QUESTION, THAT I DON'T 5871 04:19:11,320 --> 04:19:12,560 THINK WE DO HAVE THE POWER, IF 5872 04:19:12,560 --> 04:19:14,120 WE'RE THINKING IN TERMS OF P 5873 04:19:14,120 --> 04:19:16,280 VALUES, TO EXAMINE 30 5874 04:19:16,280 --> 04:19:16,720 RELATIONSHIPS. 5875 04:19:16,720 --> 04:19:21,080 WHAT WE DO IS, IF A STUDY IS 5876 04:19:21,080 --> 04:19:22,960 DESIGNED WELL, ARE RELIABLE 5877 04:19:22,960 --> 04:19:24,040 MEASURES, ADEQUATE SAMPLE SIZE 5878 04:19:24,040 --> 04:19:27,320 TO BE ABLE TO CREATE RELIABLE 5879 04:19:27,320 --> 04:19:31,880 EFFECT SIZES THAT THEN CAN BE 5880 04:19:31,880 --> 04:19:33,120 EVALUATED -- REPLICATED IN OTHER 5881 04:19:33,120 --> 04:19:33,440 STUDIES. 5882 04:19:33,440 --> 04:19:36,280 SO IF A CERTAIN MECHANISM 5883 04:19:36,280 --> 04:19:38,600 EMERGES AS HAVING A POWERFUL 5884 04:19:38,600 --> 04:19:40,080 EFFECT ACROSS STUDIES REGARDLESS 5885 04:19:40,080 --> 04:19:41,520 OF THE POWER IN EACH OF THOSE 5886 04:19:41,520 --> 04:19:43,360 INDIVIDUAL STUDIES, WE CAN 5887 04:19:43,360 --> 04:19:44,840 PROBABLY TRUST, YOU KNOW, THAT'S 5888 04:19:44,840 --> 04:19:47,520 A PRETTY IMPORTANT VARIABLE. 5889 04:19:47,520 --> 04:19:51,320 SO I DON'T THINK WE SHOULD -- IN 5890 04:19:51,320 --> 04:19:53,320 MY VIEW, AGAIN, IT'S GOOD TO 5891 04:19:53,320 --> 04:19:55,880 HAVE A SINGLE PRIMARY ANALYSIS, 5892 04:19:55,880 --> 04:19:58,480 A SINGLE PRIMARY OUTCOME, WE CAN 5893 04:19:58,480 --> 04:19:59,480 TEST THAT DEFINITIVELY, ANSWER 5894 04:19:59,480 --> 04:20:01,240 THE QUESTION YES OR NO, BUT MY 5895 04:20:01,240 --> 04:20:02,560 PERSONAL INTEREST IS ALWAYS IN 5896 04:20:02,560 --> 04:20:03,760 THE SECONDARY ANALYSES, TO SEE 5897 04:20:03,760 --> 04:20:07,680 WHAT I CALL DISCOVERY ANALYSES. 5898 04:20:07,680 --> 04:20:09,280 WHICH THEN CAN LEAD TO INFORMED 5899 04:20:09,280 --> 04:20:10,120 FUTURE RESEARCH. 5900 04:20:10,120 --> 04:20:11,120 SO MY ANSWER TO THE QUESTION, 5901 04:20:11,120 --> 04:20:13,040 HOW DO YOU HAVE ADEQUATE POWER? 5902 04:20:13,040 --> 04:20:13,480 YOU CAN'T. 5903 04:20:13,480 --> 04:20:14,600 BUT I DON'T THINK THAT'S THE 5904 04:20:14,600 --> 04:20:17,160 IMPORTANT QUESTION HERE. 5905 04:20:17,160 --> 04:20:18,520 THE IMPORTANT QUESTION IS, 5906 04:20:18,520 --> 04:20:19,800 WHAT'S HAPPENING HERE, AND 5907 04:20:19,800 --> 04:20:22,960 WHAT'S HAPPENING WITH THESE 5908 04:20:22,960 --> 04:20:25,320 PEOPLE, AND IN OUR ONE STUDY WE 5909 04:20:25,320 --> 04:20:27,680 SAY THIS IS WHAT LOOKS LIKE IS 5910 04:20:27,680 --> 04:20:29,240 LAPPING AND THEN WE DO ANOTHER 5911 04:20:29,240 --> 04:20:33,320 STUDY TO SEE, HEY, OF THOSE 10 5912 04:20:33,320 --> 04:20:35,640 THINGS, SEVEN SEEM TO BE 5913 04:20:35,640 --> 04:20:38,440 HAPPENING ACROSS TWO -- AND 5914 04:20:38,440 --> 04:20:39,840 THOSE THINGS REPLICATE. 5915 04:20:39,840 --> 04:20:42,040 THAT'S THE STUDY OF SCIENCE OVER 5916 04:20:42,040 --> 04:20:42,800 TIME, I THINK. 5917 04:20:42,800 --> 04:20:43,600 >> THAT'S INTERESTING. 5918 04:20:43,600 --> 04:20:46,320 IF WE HAVE TIME, WE'LL BRING 5919 04:20:46,320 --> 04:20:47,200 BACK THIS QUESTION AGAIN BECAUSE 5920 04:20:47,200 --> 04:20:49,280 I HAVE SOME RELATED QUESTIONS, 5921 04:20:49,280 --> 04:20:51,080 AND SOME THOUGHTS. 5922 04:20:51,080 --> 04:20:56,200 BUT FOR NOW, LET'S MOVE TO A 5923 04:20:56,200 --> 04:21:00,600 QUESTION, HOW DO WE MEASURE 5924 04:21:00,600 --> 04:21:02,200 TREATMENT EXPECTANCY IN CLINICAL 5925 04:21:02,200 --> 04:21:07,480 SETTINGS? 5926 04:21:07,480 --> 04:21:08,560 CAN YOU SHARE YOUR COMMENTS? 5927 04:21:08,560 --> 04:21:10,760 >> THERE ARE A NUMBER OF 5928 04:21:10,760 --> 04:21:11,800 QUESTIONNAIRES THAT EXIST TO BE 5929 04:21:11,800 --> 04:21:16,240 ABLE TO ASK QUESTIONS ABOUT 5930 04:21:16,240 --> 04:21:17,640 THE -- THEY'VE HAD IN ADVANCE OF 5931 04:21:17,640 --> 04:21:18,640 A PROCEDURE. 5932 04:21:18,640 --> 04:21:20,440 BUT ONE OF THE APPROACHES THAT I 5933 04:21:20,440 --> 04:21:22,640 THINK IS MOST EXCITING THAT HAS 5934 04:21:22,640 --> 04:21:24,320 EXISTED FOR A LONG TIME BUT 5935 04:21:24,320 --> 04:21:25,800 BECAUSE IT REQUIRES DECEPTION IS 5936 04:21:25,800 --> 04:21:27,840 A LITTLE BIT TOUGH TO USE, IS 5937 04:21:27,840 --> 04:21:30,360 WHAT'S CALLED THE BALANCED 5938 04:21:30,360 --> 04:21:31,720 PLACEBO DESIGN IN THE CONTEXT OF 5939 04:21:31,720 --> 04:21:32,080 CLINICAL TRIALS. 5940 04:21:32,080 --> 04:21:33,600 AND THERE, WHAT YOU CAN DO IS, 5941 04:21:33,600 --> 04:21:34,960 RATHER THAN JUST HAVING A 5942 04:21:34,960 --> 04:21:38,000 TREATMENT AND A PLACEBO ARM, YOU 5943 04:21:38,000 --> 04:21:40,440 CAN CROSS THE ADMINISTRATION OF 5944 04:21:40,440 --> 04:21:42,960 THE TREATMENT WITH KNOWLEDGE 5945 04:21:42,960 --> 04:21:43,720 ABOUT THE TREATMENT. 5946 04:21:43,720 --> 04:21:45,080 SO BASICALLY PEOPLE CAN RECEIVE 5947 04:21:45,080 --> 04:21:46,080 A TREATMENT WHEN THEY KNOW 5948 04:21:46,080 --> 04:21:47,960 THEY'RE GETTING IT, OR WHEN THEY 5949 04:21:47,960 --> 04:21:49,800 BELIEVE THEY'RE NOT RECEIVING A 5950 04:21:49,800 --> 04:21:51,600 TREATMENT, AND LIKEWISE, WE CAN 5951 04:21:51,600 --> 04:21:52,840 RECEIVE PLACEBO WHEN YOU BELIEVE 5952 04:21:52,840 --> 04:21:54,320 YOU'RE RECEIVING A TREATMENT OR 5953 04:21:54,320 --> 04:21:55,760 BELIEVE YOU'RE NOT RECEIVING A 5954 04:21:55,760 --> 04:21:56,520 TREATMENT. 5955 04:21:56,520 --> 04:21:58,480 AND THIS ALLOWS YOU TO SEPARATE 5956 04:21:58,480 --> 04:22:00,440 OUT THE EFFECTS OF THE TREATMENT 5957 04:22:00,440 --> 04:22:01,560 ITSELF FROM BELIEF IN THE 5958 04:22:01,560 --> 04:22:03,960 TREATMENT. 5959 04:22:03,960 --> 04:22:07,600 AND SO I'M -- I THINK IT USES -- 5960 04:22:07,600 --> 04:22:09,320 IT LEVERAGES CAUSAL 5961 04:22:09,320 --> 04:22:10,600 MANIPULATIONS TO ACTUALLY 5962 04:22:10,600 --> 04:22:12,480 UNDERSTAND HOW EXPECTATIONS 5963 04:22:12,480 --> 04:22:14,120 COMBINE WITH DIFFERENT TYPES OF 5964 04:22:14,120 --> 04:22:14,560 TREATMENTS. 5965 04:22:14,560 --> 04:22:17,600 AND WE'VE SHOWN THAT 5966 04:22:17,600 --> 04:22:18,480 EXPECTATIONS OR KNOWLEDGE ABOUT 5967 04:22:18,480 --> 04:22:20,240 DRUG DELIVERY HAVE ADDITIVE 5968 04:22:20,240 --> 04:22:23,440 EFFECTS WITH THE NEW OPIOID 5969 04:22:23,440 --> 04:22:24,680 AGONIST BUT DIFFERENT TYPES OF 5970 04:22:24,680 --> 04:22:26,880 TREATMENTS SEEM TO HAVE 5971 04:22:26,880 --> 04:22:30,240 DIFFERENT TYPES OF COMBINATIONS 5972 04:22:30,240 --> 04:22:31,320 WITH EXPECTANCY. 5973 04:22:31,320 --> 04:22:32,560 SO BASICALLY I WOULD OFFER THAT 5974 04:22:32,560 --> 04:22:33,520 AS SOMETHING THAT I WOULD HOPE 5975 04:22:33,520 --> 04:22:35,160 MORE AND MORE RESEARCHERS 5976 04:22:35,160 --> 04:22:36,760 THINKING ABOUT DIFFERENT 5977 04:22:36,760 --> 04:22:37,840 INTERVENTIONS CAN THINK ABOUT 5978 04:22:37,840 --> 04:22:40,440 CAN YOU ALSO ISOLATE 5979 04:22:40,440 --> 04:22:41,800 MECHANISTICALLY THE CONTRIBUTION 5980 04:22:41,800 --> 04:22:44,120 OF EXPECTANCY, AND THEN, OF 5981 04:22:44,120 --> 04:22:48,320 COURSE, YOU CAN ADD THOSE 5982 04:22:48,320 --> 04:22:49,360 INDIVIDUAL DIFFERENCE -- 5983 04:22:49,360 --> 04:22:50,240 QUESTIONNAIRES AND THINGS LIKE 5984 04:22:50,240 --> 04:22:54,360 THAT ON TOP AS PERSON LEVEL 5985 04:22:54,360 --> 04:22:54,680 MODERATORS. 5986 04:22:54,680 --> 04:23:01,120 >> THIS IS A QUESTION, VERY 5987 04:23:01,120 --> 04:23:02,520 SHORT, HOPEFULLY IT WILL BE AN 5988 04:23:02,520 --> 04:23:02,920 EASY ANSWER. 5989 04:23:02,920 --> 04:23:11,680 IT SAYS, HAS THE COPCs, THE 5990 04:23:11,680 --> 04:23:16,400 CHRONIC -- SCREENER, SORRY, COPC 5991 04:23:16,400 --> 04:23:18,000 SCREENER BEING TRANSLATED? 5992 04:23:18,000 --> 04:23:20,520 I'M NOT SURE TRANSLATED HERE 5993 04:23:20,520 --> 04:23:22,080 MEANS FROM RESEARCH TO CLINIC OR 5994 04:23:22,080 --> 04:23:24,760 SOME OTHER TRANSLATIONS. 5995 04:23:24,760 --> 04:23:26,280 BUT LET ME THROW IT OUT. 5996 04:23:26,280 --> 04:23:30,800 >> I ASSUME IT -- HAS IT BEEN 5997 04:23:30,800 --> 04:23:32,200 TRANSLATED INTO OTHER LANGUAGES. 5998 04:23:32,200 --> 04:23:33,640 CURRENTLY, NO, RIGHT NOW IT'S 5999 04:23:33,640 --> 04:23:36,760 ONLY IN ENGLISH, BUT I ASSUME 6000 04:23:36,760 --> 04:23:37,960 THE TRANSLATION INTO OTHER 6001 04:23:37,960 --> 04:23:39,000 LANGUAGES IS SOMETHING THAT 6002 04:23:39,000 --> 04:23:40,800 PEOPLE WILL BE INTERESTED IN 6003 04:23:40,800 --> 04:23:42,040 DOING. 6004 04:23:42,040 --> 04:23:45,160 WE'RE OPEN TO THOSE 6005 04:23:45,160 --> 04:23:45,520 COLLABORATIONS. 6006 04:23:45,520 --> 04:23:48,040 >> THERE IS ANOTHER SHORT ONE 6007 04:23:48,040 --> 04:23:49,480 DIRECT TO YOU. 6008 04:23:49,480 --> 04:23:56,800 WILL THE COPCs WORK IN ONCO? 6009 04:23:56,800 --> 04:23:58,440 >> RIGHT, THAT'S PROBABLY -- 6010 04:23:58,440 --> 04:24:03,440 THAT'S ANOTHER PLATFORM. 6011 04:24:03,440 --> 04:24:04,600 CURRENTLY, THE VERSION 11, WHICH 6012 04:24:04,600 --> 04:24:06,120 IS THE MOST RECENT VERSION THAT 6013 04:24:06,120 --> 04:24:07,960 HAS BEEN VALIDATED, IS ONLY 6014 04:24:07,960 --> 04:24:10,520 AVAILABLE IN REDCAP. 6015 04:24:10,520 --> 04:24:13,680 WE DO HAVE PLANS TO MAKE A 6016 04:24:13,680 --> 04:24:14,960 QUALTRICS VERSION AND PROBABLY 6017 04:24:14,960 --> 04:24:19,720 ANOTHER VERSION IN OTHER 6018 04:24:19,720 --> 04:24:20,840 PLATFORMS, BUT RIGHT NOW IT'S 6019 04:24:20,840 --> 04:24:23,320 ONLY AVAILABLE IN REDCAP. 6020 04:24:23,320 --> 04:24:25,640 >> ALL RIGHT, THANK YOU. 6021 04:24:25,640 --> 04:24:27,840 THIS IS -- NEXT QUESTION 6022 04:24:27,840 --> 04:24:29,840 PROBABLY CAN BE DIRECT TO ANY 6023 04:24:29,840 --> 04:24:31,760 ONE OF MY PANEL MEMBERS. 6024 04:24:31,760 --> 04:24:34,520 IT SAYS, THANK YOU ALL FOR YOUR 6025 04:24:34,520 --> 04:24:37,720 WONDERFUL TALKS IN ADDITION 6026 04:24:37,720 --> 04:24:41,760 TO -- WHAT ARE SOME OTHER STUDY 6027 04:24:41,760 --> 04:24:43,240 DESIGN AND METHODOLOGICAL 6028 04:24:43,240 --> 04:24:46,440 CONSIDERATION FOR STUDIES IN 6029 04:24:46,440 --> 04:24:50,200 WHICH AN INVESTIGATOR MIGHT WANT 6030 04:24:50,200 --> 04:24:56,760 TO USE -- AND THE LATENT CLASS 6031 04:24:56,760 --> 04:24:59,360 AND PROFILE ANALYSIS? 6032 04:24:59,360 --> 04:25:04,160 ANYONE LIKE TO TAKE A LEAD? 6033 04:25:04,160 --> 04:25:06,200 >> I'LL JUMP IN JUST BECAUSE I 6034 04:25:06,200 --> 04:25:07,160 HAD SOME THOUGHTS. 6035 04:25:07,160 --> 04:25:11,320 ONE IS, I'M SORRY THE QUESTION 6036 04:25:11,320 --> 04:25:12,400 WAS ASKED LIKE THAT BECAUSE I 6037 04:25:12,400 --> 04:25:14,760 THINK IN MY VIEW, THE FIRST 6038 04:25:14,760 --> 04:25:16,200 THREE ISSUES ARE SAMPLE SIZE, 6039 04:25:16,200 --> 04:25:17,200 SAMPLE SIZE AND SAMPLE SIZE. 6040 04:25:17,200 --> 04:25:20,640 SO THAT'S JUST CRITICAL. 6041 04:25:20,640 --> 04:25:22,520 AND THEN, YOU KNOW, HOW MUCH OF 6042 04:25:22,520 --> 04:25:25,200 A SAMPLE SIZE, I DEFER TO MY 6043 04:25:25,200 --> 04:25:27,800 STATISTICIAN EXPERTS, BUT THE 6044 04:25:27,800 --> 04:25:30,240 ANSWER I OFTEN GET IS, MORE. 6045 04:25:30,240 --> 04:25:33,920 BUT THE SECOND ISSUE IS THAT I 6046 04:25:33,920 --> 04:25:36,760 WOULD -- THE SELECTION OF THE 6047 04:25:36,760 --> 04:25:38,360 MEASURES BE THEORY-DRIVEN. 6048 04:25:38,360 --> 04:25:42,240 BY THAT, I MEAN SO MANY OF PRIOR 6049 04:25:42,240 --> 04:25:46,880 MODERATION ANALYSES EXAMINE THE 6050 04:25:46,880 --> 04:25:47,800 MODERATORS OF CONVENIENCE, THE 6051 04:25:47,800 --> 04:25:49,600 ONES YOU HAPPEN TO HAVE 6052 04:25:49,600 --> 04:25:50,240 ASSESSED. 6053 04:25:50,240 --> 04:25:52,120 DEMOGRAPHIC VARIABLES, MAYBE 6054 04:25:52,120 --> 04:25:53,960 OUTCOME VARIABLES AT BASELINE, 6055 04:25:53,960 --> 04:25:55,920 BUT WHEN YOU DO IT THAT WAY, THE 6056 04:25:55,920 --> 04:25:58,640 CHANCES OF FINDING SOMETHING 6057 04:25:58,640 --> 04:25:59,800 THAT'S OF IMPORTANCE ARE 6058 04:25:59,800 --> 04:26:02,400 LIMITED, AND PROBABLY NOT 6059 04:26:02,400 --> 04:26:04,800 REPLICABLE. 6060 04:26:04,800 --> 04:26:06,000 SO THE IMPORTANT ISSUE IS TO 6061 04:26:06,000 --> 04:26:10,240 THINK AHEAD OF TIME BASED ON OUR 6062 04:26:10,240 --> 04:26:11,440 THEORIES AND BASED ON OUR 6063 04:26:11,440 --> 04:26:12,120 CLINICAL EXPERIENCE EVEN, WHAT 6064 04:26:12,120 --> 04:26:13,880 ARE THE MODERATORS AND 6065 04:26:13,880 --> 04:26:14,400 MEDIATORS? 6066 04:26:14,400 --> 04:26:15,840 WHY DO WE THINK THIS WORKS? 6067 04:26:15,840 --> 04:26:17,280 AND THEN FOR WHOM DO WE THINK 6068 04:26:17,280 --> 04:26:19,880 THIS WORKS, AND WRITE THOSE 6069 04:26:19,880 --> 04:26:21,520 DOWN, AND THEN FIND THE BEST, 6070 04:26:21,520 --> 04:26:26,280 MOST RELIABLE MEASURES OF THOSE 6071 04:26:26,280 --> 04:26:26,560 THINGS. 6072 04:26:26,560 --> 04:26:27,800 PERSONALLY, I OFTEN MAKE THAT 6073 04:26:27,800 --> 04:26:31,040 LIST AND THEN I ASK MYSELF, HOW 6074 04:26:31,040 --> 04:26:31,960 MIGHT IT WORK? 6075 04:26:31,960 --> 04:26:33,600 SO THEN I HAVE KIND OF 6076 04:26:33,600 --> 04:26:35,200 EXPLORATORY ONES. 6077 04:26:35,200 --> 04:26:35,840 DISCOVERY ONES. 6078 04:26:35,840 --> 04:26:39,040 AND SO WE MIGHT ADD SOME MEASURE 6079 04:26:39,040 --> 04:26:41,040 TO THOSE JUST TO SEE TO START TO 6080 04:26:41,040 --> 04:26:42,240 BUILD THE EMPIRICAL BASE. 6081 04:26:42,240 --> 04:26:43,920 SO THE FOUR ISSUES: SAMPLE 6082 04:26:43,920 --> 04:26:45,840 SIZE, SAMPLE SIZE, SAMPLE SIZE, 6083 04:26:45,840 --> 04:26:49,080 AND THEORY. 6084 04:26:49,080 --> 04:26:51,160 >> SAMPLE SIZE, SAMPLE SIZE, 6085 04:26:51,160 --> 04:26:52,440 SAMPLE SIZE, AND THEORY. 6086 04:26:52,440 --> 04:26:53,520 GREAT. 6087 04:26:53,520 --> 04:26:57,720 >> IF I COULD -- IS IT OKAY IF I 6088 04:26:57,720 --> 04:27:01,600 ADD TO THAT, DR. LIN? 6089 04:27:01,600 --> 04:27:02,560 >> PLEASE GO AHEAD. 6090 04:27:02,560 --> 04:27:05,600 >> I WAS GOING TO ECHO 6091 04:27:05,600 --> 04:27:06,360 DR. JENSEN'S COMMENT ABOUT FIND 6092 04:27:06,360 --> 04:27:07,920 THE MOST RELIABLE MEASURES 6093 04:27:07,920 --> 04:27:08,800 POSSIBLE FOR THE THINGS YOU'RE 6094 04:27:08,800 --> 04:27:09,400 INTERESTED IN. 6095 04:27:09,400 --> 04:27:12,640 I THINK SOMETIMES WHEN WE ARE 6096 04:27:12,640 --> 04:27:14,160 FIRST EXPOSED TO POWER ANALYSIS 6097 04:27:14,160 --> 04:27:16,080 AND THINK ABOUT POWER, WE THINK, 6098 04:27:16,080 --> 04:27:17,640 OH, POWER IS A FUNCTION OF 6099 04:27:17,640 --> 04:27:21,480 EFFECT SIZE AND POWER IS A 6100 04:27:21,480 --> 04:27:23,960 FUNCTION OF SAMPLE SIZE. 6101 04:27:23,960 --> 04:27:25,800 IT'S INCLUDED IN RELIABILITY 6102 04:27:25,800 --> 04:27:26,840 BECAUSE IF YOU HAVE A POOR 6103 04:27:26,840 --> 04:27:28,320 MEASURE THAT HAS A LOT OF NOISE 6104 04:27:28,320 --> 04:27:29,720 IN T THAT'S VARIABILITY YOU'LL 6105 04:27:29,720 --> 04:27:30,960 NEVER PREDICT SO YOUR EFFECT 6106 04:27:30,960 --> 04:27:32,440 SIZE GOES DOWN SIMPLY DUE TO 6107 04:27:32,440 --> 04:27:33,320 POOR MEASUREMENT. 6108 04:27:33,320 --> 04:27:35,480 AND SO IF UZ ARE LIMITED IN THE 6109 04:27:35,480 --> 04:27:38,120 SAMPLE SIZE THAT YOU CAN GET, 6110 04:27:38,120 --> 04:27:39,400 INVEST YOUR TIME IN IDENTIFYING 6111 04:27:39,400 --> 04:27:43,640 AND DEVELOPING HIGHLY RELIABLE 6112 04:27:43,640 --> 04:27:44,200 MEASURES. 6113 04:27:44,200 --> 04:27:45,400 ANOTHER THING THAT CAN HELP YOU, 6114 04:27:45,400 --> 04:27:46,640 AGAIN, IF YOU'RE WORKING WITH 6115 04:27:46,640 --> 04:27:48,640 LIMITED SAMPLE SIZE IS REPEATED 6116 04:27:48,640 --> 04:27:48,880 MEASURES. 6117 04:27:48,880 --> 04:27:50,200 SO IF YOU'RE DOING SOME KIND OF 6118 04:27:50,200 --> 04:27:52,080 A TREATMENT STUDY, IF YOU CAN 6119 04:27:52,080 --> 04:27:53,640 GET MULTIPLE PRE-TESTS AND 6120 04:27:53,640 --> 04:27:57,400 MULTIPLE POST-TESTS AND LOOK 6121 04:27:57,400 --> 04:28:03,240 TETRAJEK TRI SOMEONE K 6122 04:28:03,240 --> 04:28:04,880 TRAJECTORY, YOU CAN GAIN A LOT 6123 04:28:04,880 --> 04:28:06,960 OF POWER SIMPLY BY HAVING THOSE 6124 04:28:06,960 --> 04:28:07,640 REPEATED MEASURES. 6125 04:28:07,640 --> 04:28:10,040 SO SAMPLE SIZE, SAMPLE SIZE, 6126 04:28:10,040 --> 04:28:11,800 SAMPLE SIZE, SAMPLE SIZE PLUS 6127 04:28:11,800 --> 04:28:15,320 WILL ADD REPEATED LIABILITY AND 6128 04:28:15,320 --> 04:28:16,600 MEASURES ON TOP OF THOSE. 6129 04:28:16,600 --> 04:28:18,200 >> THIS IS ALL ABOUT SAMPLE 6130 04:28:18,200 --> 04:28:19,840 SIZE, RIGHT? 6131 04:28:19,840 --> 04:28:23,040 NEXT QUESTION IS DIRECT TO 6132 04:28:23,040 --> 04:28:23,440 LAUREN. 6133 04:28:23,440 --> 04:28:24,840 IT'S VERY INTERESTING DATA, 6134 04:28:24,840 --> 04:28:25,200 LAUREN. 6135 04:28:25,200 --> 04:28:28,080 DID YOU ASSESS PAIN 6136 04:28:28,080 --> 04:28:31,560 COMORBIDITIES IN THE PATIENTS 6137 04:28:31,560 --> 04:28:34,560 AND THEIR SPECIFIC DISEASE AND 6138 04:28:34,560 --> 04:28:36,280 HEALTH CONTROLS THAT YOU HAD 6139 04:28:36,280 --> 04:28:40,360 ENROLLED IN YOUR STUDIES, SINCE 6140 04:28:40,360 --> 04:28:43,760 COPCs COULD INFLUENCE THE 6141 04:28:43,760 --> 04:28:44,160 RESULTS? 6142 04:28:44,160 --> 04:28:50,760 NOW THE DISEASE SPECIFIED HERE 6143 04:28:50,760 --> 04:28:54,120 IS ME NIN -- 6144 04:28:54,120 --> 04:28:56,200 >> THIS WAS ACTUALLY A BRAIN 6145 04:28:56,200 --> 04:28:58,120 LESION STUDY SO WE COMPARED 6146 04:28:58,120 --> 04:28:59,840 PATIENTS WITH LESIONS TO 6147 04:28:59,840 --> 04:29:00,920 CONTROLS AS WELL AS SAMPLE OF 6148 04:29:00,920 --> 04:29:02,680 PATIENTS WITH LESIONS IN OTHER 6149 04:29:02,680 --> 04:29:04,080 BRAIN AREAS, AND THERE WERE NO 6150 04:29:04,080 --> 04:29:05,360 DIFFERENCES IN ANY PAIN MEASURES 6151 04:29:05,360 --> 04:29:07,320 OR ANY PSYCHOLOGICAL INDICES. 6152 04:29:07,320 --> 04:29:09,120 SO REALLY, THE DIFFERENCES WE 6153 04:29:09,120 --> 04:29:10,200 SAW WERE SPECIFIC TO THIS 6154 04:29:10,200 --> 04:29:13,400 LEARNING COMPONENT. 6155 04:29:13,400 --> 04:29:14,760 AND TO OUR SURPRISE, THERE WERE 6156 04:29:14,760 --> 04:29:16,120 NO DIFFERENCES IN GENERAL 6157 04:29:16,120 --> 04:29:17,120 CHRONIC PAIN QUESTIONNAIRES OR 6158 04:29:17,120 --> 04:29:18,920 ANY KIND OF MEDICAL OR 6159 04:29:18,920 --> 04:29:24,680 PSYCHOLOGICAL FACTORS. 6160 04:29:24,680 --> 04:29:26,240 SO IT WAS QUITE SURPRISING TO US 6161 04:29:26,240 --> 04:29:28,480 BUT I THINK VERY CONSISTENT WITH 6162 04:29:28,480 --> 04:29:31,680 CURRENT VIEWS ON THE ROLE OF -- 6163 04:29:31,680 --> 04:29:32,560 PREFRONTAL CORTEX. 6164 04:29:32,560 --> 04:29:33,480 >> THANK YOU VERY MUCH. 6165 04:29:33,480 --> 04:29:35,240 NEXT QUESTION IS DIRECT TO 6166 04:29:35,240 --> 04:29:39,080 DR. BAUER. 6167 04:29:39,080 --> 04:29:42,120 VERY INFORMATIVE TALK. 6168 04:29:42,120 --> 04:29:44,200 LATENT CLASS ANALYSIS AND A 6169 04:29:44,200 --> 04:29:46,600 SIMILAR APPROACH ARE BASED ON 6170 04:29:46,600 --> 04:29:47,160 PROBABILITY. 6171 04:29:47,160 --> 04:29:49,320 IN RESEARCH AND CLINICAL 6172 04:29:49,320 --> 04:29:51,960 PRACTICE, WHAT DO WE DO WITH 6173 04:29:51,960 --> 04:29:57,360 PEOPLE WHO DON'T FIT PERFECTLY 6174 04:29:57,360 --> 04:29:58,960 WITH ONE GROUP? 6175 04:29:58,960 --> 04:30:03,040 IN OTHER WORDS, NOT TYPICAL? 6176 04:30:03,040 --> 04:30:06,080 >> YEAH, THAT'S A GREAT 6177 04:30:06,080 --> 04:30:07,440 QUESTION. 6178 04:30:07,440 --> 04:30:09,040 ONE OF THE REASONS WHY I LIKE 6179 04:30:09,040 --> 04:30:12,760 LATENT PROFILE AND LATENT CLASS 6180 04:30:12,760 --> 04:30:14,920 ANALYSIS IS IT CREATES A FUZZY 6181 04:30:14,920 --> 04:30:16,600 CLUSTERING, SO IT'S NOT FORCING 6182 04:30:16,600 --> 04:30:18,920 A PARTITION ON YOUR SAMPLE, IT'S 6183 04:30:18,920 --> 04:30:20,040 SAYING, WELL, THIS PERSON HAS 6184 04:30:20,040 --> 04:30:24,800 90% CLANS OF BEING IN S 6185 04:30:24,800 --> 04:30:26,240 CLASS AND THIS PERSON HAS 60% 6186 04:30:26,240 --> 04:30:27,120 CHANCE OF BEING IN THIS CLASS. 6187 04:30:27,120 --> 04:30:29,400 IF YOU HAVE INDIVIDUALS THAT 6188 04:30:29,400 --> 04:30:30,920 DON'T CLASSIFY VERY NEATLY, THEY 6189 04:30:30,920 --> 04:30:32,000 MIGHT HAVE KIND OF A SPLIT. 6190 04:30:32,000 --> 04:30:33,040 YOU MIGHT NOT BE SURE. 6191 04:30:33,040 --> 04:30:34,400 THEY MIGHT BE OVER HERE, BUT 6192 04:30:34,400 --> 04:30:38,320 THEY ALSO MIGHT BE OVER THERE. 6193 04:30:38,320 --> 04:30:40,240 WE CAN CALCULATE ESSENTIALLY 6194 04:30:40,240 --> 04:30:42,960 WEIGHTED ESTIMATES OF WHAT 6195 04:30:42,960 --> 04:30:45,920 SOMETHING LIKE TREATMENT MIGHT 6196 04:30:45,920 --> 04:30:48,200 LOOK LIKE FOR THAT PERSON GIVEN 6197 04:30:48,200 --> 04:30:50,040 THEY'RE 60% LIKELY TO BE IN THIS 6198 04:30:50,040 --> 04:30:51,800 CLASS AND 40% LIKELY TO BE IN 6199 04:30:51,800 --> 04:30:52,240 THAT ONE. 6200 04:30:52,240 --> 04:30:53,640 SO IT'S CERTAINLY POSSIBLE TO 6201 04:30:53,640 --> 04:30:55,360 HAVE PEOPLE WHO KIND OF LIE IN 6202 04:30:55,360 --> 04:30:56,520 BETWEEN, AND THE WAY I LIKE TO 6203 04:30:56,520 --> 04:30:58,880 THINK ABOUT IT IS THE PROFILES, 6204 04:30:58,880 --> 04:31:01,680 THEY'RE SORT OF LIKE LANDMARKS 6205 04:31:01,680 --> 04:31:03,200 IN THIS COMPLEX MULTIDIMENSIONAL 6206 04:31:03,200 --> 04:31:05,160 SPACE OF ALL THESE VARIABLES, 6207 04:31:05,160 --> 04:31:05,600 RIGHT? 6208 04:31:05,600 --> 04:31:07,880 WE CAN'T THINK IN 10 CONTINUOUS 6209 04:31:07,880 --> 04:31:09,640 DIMENSIONS AT ONCE, BUT WE CAN 6210 04:31:09,640 --> 04:31:12,760 IDENTIFY PROFILES WITHIN THAT 10 6211 04:31:12,760 --> 04:31:14,320 DIMENSIONAL SPACE AND SAY OH, 6212 04:31:14,320 --> 04:31:15,680 THIS PERSON KIND OF LOOKS LIKE 6213 04:31:15,680 --> 04:31:16,960 THAT, OR THIS PERSON MIGHT BE IN 6214 04:31:16,960 --> 04:31:18,520 BETWEEN THESE TWO PROFILES BUT 6215 04:31:18,520 --> 04:31:20,480 LOOKS DIFFERENT THAN THOSE OTHER 6216 04:31:20,480 --> 04:31:20,680 THREE. 6217 04:31:20,680 --> 04:31:22,200 AND SO IN THAT SENSE, I THINK 6218 04:31:22,200 --> 04:31:23,960 IT'S OKAY TO HAVE SOME PEOPLE 6219 04:31:23,960 --> 04:31:26,200 WHO DON'T FALL NEATLY INTO ONE 6220 04:31:26,200 --> 04:31:27,920 CATEGORY VERSUS ANOTHER. 6221 04:31:27,920 --> 04:31:29,720 THERE ARE SOME MORE COMPLEX 6222 04:31:29,720 --> 04:31:32,560 APPROACHES THAT KIND OF ALLOW 6223 04:31:32,560 --> 04:31:34,320 FOR UNCLASSIFIABLE INDIVIDUALS, 6224 04:31:34,320 --> 04:31:36,000 SO YOU KIND OF HAVE LIKE A CLASS 6225 04:31:36,000 --> 04:31:37,640 THAT'S JUST ALMOST LIKE NOISE, 6226 04:31:37,640 --> 04:31:39,240 IT'S LIKE THE PEOPLE WHO DON'T 6227 04:31:39,240 --> 04:31:42,240 FIT, AND THEN THE OTHER CLASSES 6228 04:31:42,240 --> 04:31:43,760 CAPTURE THE DENSE REGIONS WHERE 6229 04:31:43,760 --> 04:31:46,280 YOU DO SEE PEOPLE KIND OF 6230 04:31:46,280 --> 04:31:47,480 CLUSTERING IN THEIR 6231 04:31:47,480 --> 04:31:49,800 CONFIGURATIONS. 6232 04:31:49,800 --> 04:31:51,200 >> THANK YOU, THANK YOU. 6233 04:31:51,200 --> 04:31:55,920 AND NEXT QUESTION IS DIRECT TO 6234 04:31:55,920 --> 04:31:57,960 DR. JENSEN. 6235 04:31:57,960 --> 04:31:59,520 THE QUESTION ACTUALLY FOLLOWS 6236 04:31:59,520 --> 04:32:03,120 WITH CLARIFICATION THAT IT'S NOT 6237 04:32:03,120 --> 04:32:10,000 RELATED TO COMMENTS ON NOT USING 6238 04:32:10,000 --> 04:32:11,800 P VALUE, SO THEN WE COME TO THE 6239 04:32:11,800 --> 04:32:12,960 QUESTION ITSELF. 6240 04:32:12,960 --> 04:32:14,280 DR. JENSEN, WOULD YOU ADVOCATE 6241 04:32:14,280 --> 04:32:18,360 FOR INSTEAD OF PHASING 6242 04:32:18,360 --> 04:32:23,240 IESKTTIVENESS 6243 04:32:23,240 --> 04:32:25,920 EFFECTIVENESS ON PATIENTS 6244 04:32:25,920 --> 04:32:26,760 EXPECTATIONS WHAT PAIN IS 6245 04:32:26,760 --> 04:32:27,680 MEANINGFUL TO THE PATIENTS? 6246 04:32:27,680 --> 04:32:30,000 IF SO, CAN YOU COMMENT ON HOW 6247 04:32:30,000 --> 04:32:33,720 YOU WOULD CONSIDER THIS IN THE 6248 04:32:33,720 --> 04:32:36,160 CONTEXT OF VARIABLE INDIVIDUAL 6249 04:32:36,160 --> 04:32:38,720 PATIENTS' EXPECTATIONS? 6250 04:32:38,720 --> 04:32:41,000 SHOULD WE BE MEASURING 6251 04:32:41,000 --> 04:32:43,400 EXPECTATIONS MORE CONSISTENTLY 6252 04:32:43,400 --> 04:32:45,960 AND USING THAT TO GUIDE OUR 6253 04:32:45,960 --> 04:32:46,440 TREATMENT? 6254 04:32:46,440 --> 04:32:49,800 SO ESSENTIALLY RELATED TO PAIN 6255 04:32:49,800 --> 04:32:54,040 AND EXPECTATION. 6256 04:32:54,040 --> 04:32:57,160 >> SO WE DO MEASURE OUTCOME 6257 04:32:57,160 --> 04:32:58,200 EXPECTANCIES IN EVERY ONE OF OUR 6258 04:32:58,200 --> 04:32:58,600 CLINICAL TRIALS. 6259 04:32:58,600 --> 04:33:01,320 I THINK IT'S IMPORTANT TO 6260 04:33:01,320 --> 04:33:02,280 MEASURE, AND I THINK IT'S 6261 04:33:02,280 --> 04:33:03,520 IMPORTANT TO EVALUATE WHAT IS 6262 04:33:03,520 --> 04:33:06,600 THE ROLE OF EXPECTANCIES IN THIS 6263 04:33:06,600 --> 04:33:07,680 PARTICULAR TREATMENT VERSUS 6264 04:33:07,680 --> 04:33:08,880 OTHER TREATMENTS, BECAUSE THEY 6265 04:33:08,880 --> 04:33:11,120 DO VARY FROM TREATMENT TO 6266 04:33:11,120 --> 04:33:11,520 TREATMENT. 6267 04:33:11,520 --> 04:33:12,640 SOME TREATMENTS ARE MORE 6268 04:33:12,640 --> 04:33:16,760 RESPONSIVE TO ECT PECK EXPN 6269 04:33:16,760 --> 04:33:17,000 OTHERS. 6270 04:33:17,000 --> 04:33:18,480 SO I DO THINK IT'S IMPORTANT TO 6271 04:33:18,480 --> 04:33:20,240 ASSESS IT IN EVERY TRIAL, 6272 04:33:20,240 --> 04:33:21,960 EXAMINE THAT, AGAIN, OFTEN IN 6273 04:33:21,960 --> 04:33:27,200 SECONDARY ANALYSES. 6274 04:33:27,200 --> 04:33:29,160 I WASN'T -- IF I UNDERSTOOD THE 6275 04:33:29,160 --> 04:33:30,960 FIRST PART OF THE QUESTION 6276 04:33:30,960 --> 04:33:35,000 CORRECTLY ABOUT LOOKING AT 6277 04:33:35,000 --> 04:33:35,960 MEANINGFUL CHANGE IN PAIN, IN 6278 04:33:35,960 --> 04:33:40,640 OUR STUDIES, WE OFTEN MEASURE 6279 04:33:40,640 --> 04:33:42,800 NOT JUST IS THERE A 6280 04:33:42,800 --> 04:33:43,360 STATISTICALLY SIGNIFICANT 6281 04:33:43,360 --> 04:33:43,880 DIFFERENCE BETWEEN THE 6282 04:33:43,880 --> 04:33:45,280 CONDITIONS, WHICH IS OFTEN OUR 6283 04:33:45,280 --> 04:33:46,480 PRIMARY ANALYSIS, BUT AGAIN, 6284 04:33:46,480 --> 04:33:50,800 ANOTHER SECONDARY ANALYSIS IS A 6285 04:33:50,800 --> 04:33:51,240 RESPONDER ANALYSIS. 6286 04:33:51,240 --> 04:33:52,680 HOW MANY PEOPLE IN EACH GROUP 6287 04:33:52,680 --> 04:33:54,160 OBTAINED A MEANINGFUL CHANGE IN 6288 04:33:54,160 --> 04:33:54,920 PAIN. 6289 04:33:54,920 --> 04:33:57,760 AND THE STANDARD IN THE FIELD IS 6290 04:33:57,760 --> 04:34:00,040 USUALLY ABOUT TWO POINTS ON A 6291 04:34:00,040 --> 04:34:01,600 ZERO TO 10 SCALE FOR SOMEBODY TO 6292 04:34:01,600 --> 04:34:04,880 REPORT THAT MUCH CHANGE, PEOPLE 6293 04:34:04,880 --> 04:34:06,240 ON AVERAGE SAY THAT WAS 6294 04:34:06,240 --> 04:34:07,600 MEANINGFUL TO ME. 6295 04:34:07,600 --> 04:34:09,000 IT WASN'T AN ELIMINATION, IT 6296 04:34:09,000 --> 04:34:10,760 WASN'T A COMPLETE REDUCTION, BUT 6297 04:34:10,760 --> 04:34:11,520 MEANINGFUL. 6298 04:34:11,520 --> 04:34:13,160 LESS THAN 2 OUT OF 10, PEOPLE 6299 04:34:13,160 --> 04:34:15,440 CAN NOTICE, BUT THEY SAY OFTEN 6300 04:34:15,440 --> 04:34:17,000 IT WASN'T THAT MEANINGFUL. 6301 04:34:17,000 --> 04:34:21,320 SO I THINK IT'S VERY USEFUL TO 6302 04:34:21,320 --> 04:34:23,200 INCLUDE RESPONDER ANALYSES IN 6303 04:34:23,200 --> 04:34:25,600 YOUR ANALYSES AND THEN LOOK AT 6304 04:34:25,600 --> 04:34:26,720 PREDICTS WHO RESPONDS TO THIS 6305 04:34:26,720 --> 04:34:28,120 TREATMENT, WHO IS A RESPONDER 6306 04:34:28,120 --> 04:34:32,040 VERSUS A NON-RESPONDER. 6307 04:34:32,040 --> 04:34:36,680 AGAIN, THESE ARE SECOND DI SECOY 6308 04:34:36,680 --> 04:34:38,040 ANALYSES, OF WHICH THERE ARE 6309 04:34:38,040 --> 04:34:39,360 TENS AND MAYBE EVEN A HUNDRED 6310 04:34:39,360 --> 04:34:41,160 WHEN THEY'RE REPORTED, SO IT'S 6311 04:34:41,160 --> 04:34:42,600 IMPORTANT TO SAY, TO MAKE IT 6312 04:34:42,600 --> 04:34:44,400 CLEAR, THESE ARE SECONDARY 6313 04:34:44,400 --> 04:34:45,240 EXPLORATORY ANALYSES THAT THEN 6314 04:34:45,240 --> 04:34:46,560 NEED TO BE REPLICATED. 6315 04:34:46,560 --> 04:34:48,960 BUT GET THEM IN THE FIELD, I 6316 04:34:48,960 --> 04:34:50,520 WOULD SAY SUBMIT THOSE TO THE 6317 04:34:50,520 --> 04:34:50,880 JOURNAL OF PAIN. 6318 04:34:50,880 --> 04:34:52,480 THANK YOU FOR THE CITATIONS FOR 6319 04:34:52,480 --> 04:34:56,280 THOSE OF YOU SPEAKERS WHO 6320 04:34:56,280 --> 04:34:57,400 REPORTED YOUR RESULTS FROM THE 6321 04:34:57,400 --> 04:34:59,560 JOURNAL PAIN, BUT I'M LEAVING AS 6322 04:34:59,560 --> 04:35:01,560 EDITOR THIS MONTH SO I WON'T BE 6323 04:35:01,560 --> 04:35:02,960 NECESSARILY ADVOCATING STRONGLY 6324 04:35:02,960 --> 04:35:03,840 FOR THE JOURNAL PAIN OTHER THAN 6325 04:35:03,840 --> 04:35:05,440 IT'S A GREAT JOURNAL. 6326 04:35:05,440 --> 04:35:07,520 BUT ANYWAY, AS AN EDITOR, I LOVE 6327 04:35:07,520 --> 04:35:09,440 TO SEE SECONDARY ANALYSES ABOUT 6328 04:35:09,440 --> 04:35:12,920 THESE CRITICAL ISSUES. 6329 04:35:12,920 --> 04:35:16,880 >> WONDERFUL, WONDERFUL. 6330 04:35:16,880 --> 04:35:19,680 NOW, THE CORE QUESTION FOR THIS 6331 04:35:19,680 --> 04:35:23,880 PANEL REALLY IS ABOUT THE TWO 6332 04:35:23,880 --> 04:35:24,960 WORLDS AND APPROACHES THAT CAN 6333 04:35:24,960 --> 04:35:30,800 BE USED TO ADDRESS THE BIG 6334 04:35:30,800 --> 04:35:32,480 QUESTION THAT RAISED IN THIS 6335 04:35:32,480 --> 04:35:38,720 YEAR'S SYMPOSIUM, THAT IS, WHOLE 6336 04:35:38,720 --> 04:35:39,800 BODY, WHOLE PERSON APPROACH. 6337 04:35:39,800 --> 04:35:41,160 NOW WE DEFINITELY TALK A LOT 6338 04:35:41,160 --> 04:35:44,840 ABOUT DIFFERENT APPROACHES, 6339 04:35:44,840 --> 04:35:46,000 DIFFERENT TOOLS, AND THERE'S 6340 04:35:46,000 --> 04:35:47,280 EVEN MORE, WE DO NOT HAVE ENOUGH 6341 04:35:47,280 --> 04:35:52,720 TIME TO COVER, AND ALSO THE 6342 04:35:52,720 --> 04:35:55,720 DIRECTIONS PRESENT IN YOUR 6343 04:35:55,720 --> 04:35:57,400 OVERVIEW -- NOW ONE OF THE 6344 04:35:57,400 --> 04:36:00,680 THINGS THAT YOU ALSO MENTIONED 6345 04:36:00,680 --> 04:36:04,360 THIS PROBLEMATIC APPROACH, THAT 6346 04:36:04,360 --> 04:36:06,160 IN FACT WE TALK VERY LITTLE -- I 6347 04:36:06,160 --> 04:36:09,560 MEAN, THE QUESTION RAISED VERY 6348 04:36:09,560 --> 04:36:10,440 LITTLE ADDRESS TO THAT. 6349 04:36:10,440 --> 04:36:12,200 MOST QUESTIONS STILL ADDRESS TO 6350 04:36:12,200 --> 04:36:17,040 HOW TO DESIGN THE STUDY. 6351 04:36:17,040 --> 04:36:18,400 HOWEVER, THE PRAGMATIC APPROACH 6352 04:36:18,400 --> 04:36:21,920 REALLY IS TALKING ABOUT WHAT 6353 04:36:21,920 --> 04:36:22,760 HAPPENED REAL WORLD FOR THE 6354 04:36:22,760 --> 04:36:25,440 PURPOSE OF TREATMENT. 6355 04:36:25,440 --> 04:36:29,680 SO I JUST WONDER, ANOTHER 6356 04:36:29,680 --> 04:36:32,760 APPROACH WE NEVER MENTIONED HERE 6357 04:36:32,760 --> 04:36:37,120 COULD BE USEFUL, I INVITE 6358 04:36:37,120 --> 04:36:40,120 COMMENTS FROM MY PANEL MEMBERS, 6359 04:36:40,120 --> 04:36:41,720 THAT IS DATA SCIENCE. 6360 04:36:41,720 --> 04:36:45,000 IF WE COMBINE THE PRAGMATIC 6361 04:36:45,000 --> 04:36:48,720 APPROACH, NOT NECESSARILY 6362 04:36:48,720 --> 04:36:50,400 PRAGMATIC TRIAL BECAUSE THIS MAY 6363 04:36:50,400 --> 04:36:52,880 HAVE DIFFERENT DEFINITIONS IN 6364 04:36:52,880 --> 04:36:54,920 DIFFERENT PEOPLE'S MIND, BUT I'M 6365 04:36:54,920 --> 04:36:56,800 TALKING ABOUT THE REAL WORLD 6366 04:36:56,800 --> 04:37:01,960 APPROACH, COMBINED WITH BIG DATA 6367 04:37:01,960 --> 04:37:05,800 SCIENCE, COMPUTATIONAL SCIENCE 6368 04:37:05,800 --> 04:37:08,280 AND COMBINE THOSE DIFFERENT 6369 04:37:08,280 --> 04:37:10,240 APPROACHES TO ADDRESS REAL WORLD 6370 04:37:10,240 --> 04:37:11,480 QUESTIONS. 6371 04:37:11,480 --> 04:37:13,120 MIGHT THAT BE A WAY TO RESOLVE 6372 04:37:13,120 --> 04:37:17,520 SOME ISSUES LIKE POWER ANALYSIS? 6373 04:37:17,520 --> 04:37:20,080 WE MENTIONED WE TALK A LOT, 6374 04:37:20,080 --> 04:37:21,240 THERE'S OTHER QUESTIONS RELATED 6375 04:37:21,240 --> 04:37:23,800 TO THAT, SO I WILL STOP HERE AND 6376 04:37:23,800 --> 04:37:25,880 JUST INVITE YOUR COMMENTS, MY 6377 04:37:25,880 --> 04:37:35,120 PANEL MEMBERS. 6378 04:37:35,120 --> 04:37:37,200 >> SO THE QUESTION IS, 6379 04:37:37,200 --> 04:37:39,200 BASICALLY, IF WE MOVE TOWARD BIG 6380 04:37:39,200 --> 04:37:40,720 DATA AND NATURALISTIC DATA, WILL 6381 04:37:40,720 --> 04:37:42,240 IT HELP ADDRESS SOME OF THESE 6382 04:37:42,240 --> 04:37:43,800 QUESTIONS? 6383 04:37:43,800 --> 04:37:46,600 >> LET ME ELABORATE FROM A 6384 04:37:46,600 --> 04:37:50,720 DIFFERENT APPROACH. 6385 04:37:50,720 --> 04:37:54,800 NOW, GOOGLE. 6386 04:37:54,800 --> 04:37:56,960 GOOGLE MAKES A BIG SPLASH A FEW 6387 04:37:56,960 --> 04:37:58,480 YEARS AGO ANNOUNCING THAT THEY 6388 04:37:58,480 --> 04:38:02,720 ARE ABLE TO PREDICT THE 6389 04:38:02,720 --> 04:38:04,920 INFLUENZA, THE FLU SEASON. 6390 04:38:04,920 --> 04:38:08,040 WITHOUT ANY BIOLOGICAL DATA. 6391 04:38:08,040 --> 04:38:11,760 WHAT THEY ARE BASED ON IS HOW 6392 04:38:11,760 --> 04:38:13,400 MUCH THE FACE MASK HAVE BEEN 6393 04:38:13,400 --> 04:38:15,200 SOLD IN ONE AREA. 6394 04:38:15,200 --> 04:38:19,080 IN COMPARISON TO OTHER. 6395 04:38:19,080 --> 04:38:20,840 AND THAT GIVES THEM A HINT. 6396 04:38:20,840 --> 04:38:24,200 AND THAT'S BASED UPON SALES AND 6397 04:38:24,200 --> 04:38:26,040 THERE'S BIG DATA COLLECT ALL 6398 04:38:26,040 --> 04:38:27,920 TOGETHER, GIVE THEM THE POWER TO 6399 04:38:27,920 --> 04:38:28,800 PREDICT THAT. 6400 04:38:28,800 --> 04:38:31,000 AND THAT TURNED OUT TO BE VERY 6401 04:38:31,000 --> 04:38:33,400 ACCURATE. 6402 04:38:33,400 --> 04:38:37,000 SO I'M THINKING IN THE CLINICAL 6403 04:38:37,000 --> 04:38:39,640 PRACTICE THAT EVERY -- IF WE 6404 04:38:39,640 --> 04:38:40,760 HAVE THE SYSTEM. 6405 04:38:40,760 --> 04:38:45,560 I'M ASKING THIS WITHOUT THINKING 6406 04:38:45,560 --> 04:38:47,160 HOW MUCH COST THERE WOULD BE AND 6407 04:38:47,160 --> 04:38:50,600 IT MIGHT NOT BE -- IT MIGHT BE A 6408 04:38:50,600 --> 04:38:54,400 LOT, JUST TALKING ABOUT APPROACH 6409 04:38:54,400 --> 04:38:57,440 SAYING ALL CLINICS, WE COLLECT 6410 04:38:57,440 --> 04:39:00,080 SYMPTOMS, AND WE -- SYMPTOMS 6411 04:39:00,080 --> 04:39:02,400 RELATED TO PAIN WITH DIFFERENT 6412 04:39:02,400 --> 04:39:05,000 TREATMENTS, AND ACCUMULATE ALL 6413 04:39:05,000 --> 04:39:09,600 THE PIECES OF INFORMATIONS AND 6414 04:39:09,600 --> 04:39:10,480 OF COURSE GRADUALLY AFTER A 6415 04:39:10,480 --> 04:39:14,400 WHILE, WE CAN IDENTIFY WHAT ARE 6416 04:39:14,400 --> 04:39:15,440 MEANINGFUL DATA ELEMENTS THAT 6417 04:39:15,440 --> 04:39:19,600 CAN BE USED FOR BIG DATA 6418 04:39:19,600 --> 04:39:21,800 APPROACHES THAT MAY GIVE US A 6419 04:39:21,800 --> 04:39:24,120 DIFFERENT ANGLE TO ADDRESS THE 6420 04:39:24,120 --> 04:39:26,960 ISSUES OF THEIR WHOLE PERSON OR 6421 04:39:26,960 --> 04:39:28,320 WHOLE BODY APPROACH. 6422 04:39:28,320 --> 04:39:28,720 YES. 6423 04:39:28,720 --> 04:39:30,000 >> 2-MINUTE WARNING. 6424 04:39:30,000 --> 04:39:31,680 >> I'LL MAKE A QUICK COMMENT. 6425 04:39:31,680 --> 04:39:33,520 I THINK IT DEPENDS ON HOW GOOD 6426 04:39:33,520 --> 04:39:33,960 OUR DATA ARE. 6427 04:39:33,960 --> 04:39:37,440 IF ALL OF OUR DATA ARE MEASURED 6428 04:39:37,440 --> 04:39:38,880 ON WHITE MALES, THEN I THINK 6429 04:39:38,880 --> 04:39:40,520 THAT THE MACHINE LEARNING 6430 04:39:40,520 --> 04:39:41,440 APPROACHES AND ALL THAT ARE 6431 04:39:41,440 --> 04:39:44,120 GOING TO BE BIASED JUST LIKE OUR 6432 04:39:44,120 --> 04:39:45,400 TREATMENTS CURRENTLY ARE, SO WE 6433 04:39:45,400 --> 04:39:47,760 KNOW THAT WOMEN AND NON-WHITE 6434 04:39:47,760 --> 04:39:48,600 INDIVIDUALS ARE LESS LIKELY TO 6435 04:39:48,600 --> 04:39:50,680 BE TREATED FOR PAIN, AND THE 6436 04:39:50,680 --> 04:39:52,720 STIMULUS SETS THAT WE HAVE OF 6437 04:39:52,720 --> 04:39:54,240 PATIENTS AND PAIN THAT ARE USED 6438 04:39:54,240 --> 04:39:56,720 FOR TREATMENT ARE GENERALLY ALL 6439 04:39:56,720 --> 04:39:57,280 WHITE INDIVIDUALS. 6440 04:39:57,280 --> 04:39:59,840 SO I THINK THAT ANY OF THESE 6441 04:39:59,840 --> 04:40:01,920 KINDS OF BIG DATA APPROACHES ARE 6442 04:40:01,920 --> 04:40:03,200 SENSITIVE TO WHAT DATA ARE PUT 6443 04:40:03,200 --> 04:40:05,520 INTO THE MODELS, AND SO I THINK 6444 04:40:05,520 --> 04:40:07,160 WE AS RESEARCHERS AND CLINICIANS 6445 04:40:07,160 --> 04:40:09,320 HAVE A RESPONSIBILITY TO MAKE 6446 04:40:09,320 --> 04:40:11,080 SURE THAT THE DATA THAT ARE USED 6447 04:40:11,080 --> 04:40:13,960 FOR THESE KINDS OF APPROACHES 6448 04:40:13,960 --> 04:40:14,920 ARE REPRESENTATIVE OF THE 6449 04:40:14,920 --> 04:40:17,520 POPULATION THAT WE KNOW THE 6450 04:40:17,520 --> 04:40:18,520 LIMITATIONS IN THESE APPROACHES. 6451 04:40:18,520 --> 04:40:21,000 SO I THINK LIKE A.I. IS GREAT, 6452 04:40:21,000 --> 04:40:22,320 BUT IT DEPENDS ON HOW GOOD THE 6453 04:40:22,320 --> 04:40:22,840 DATA ARE. 6454 04:40:22,840 --> 04:40:24,280 WE KNOW THERE'S A LOT OF BIASES 6455 04:40:24,280 --> 04:40:24,600 THERE. 6456 04:40:24,600 --> 04:40:27,240 SO THAT'S MY 2 CENTS. 6457 04:40:27,240 --> 04:40:29,280 >> WE HAVE ABOUT 30 SECONDS. 6458 04:40:29,280 --> 04:40:35,480 ANY LAST COMMENTS? 6459 04:40:35,480 --> 04:40:37,560 IF NOT, I WOULD LIKE TO TAKE 6460 04:40:37,560 --> 04:40:39,960 THIS OPPORTUNITY TO THANK YOU 6461 04:40:39,960 --> 04:40:43,560 VERY MUCH, ALL OF MY SPEAKERS, 6462 04:40:43,560 --> 04:40:47,520 AND VERY ENJOYABLE TO WORK 6463 04:40:47,520 --> 04:40:48,320 TOGETHER ON THIS PANEL. 6464 04:40:48,320 --> 04:40:49,600 THANK YOU VERY MUCH. 6465 04:40:49,600 --> 04:40:59,840 >> THANK YOU. 6466 04:41:02,280 --> 04:41:04,040 >> THANK YOU, EVERYONE, FOR THAT 6467 04:41:04,040 --> 04:41:05,840 WONDERFUL TALK. 6468 04:41:05,840 --> 04:41:07,520 I'M MO NOW GOING TO INTRODUCE MY 6469 04:41:07,520 --> 04:41:08,920 COLLEAGUE, DR. SARAH WOLLER. 6470 04:41:08,920 --> 04:41:13,680 SHE IS THE SCIENTIFIC PROJECT 6471 04:41:13,680 --> 04:41:15,320 MANAGER WITHIN THE NATIONAL 6472 04:41:15,320 --> 04:41:17,240 INSTITUTE OF NEUROLOGICAL 6473 04:41:17,240 --> 04:41:19,680 DISORDER AND STROKE DIVISION AND 6474 04:41:19,680 --> 04:41:23,320 SHE'S GOING TO TAKE US THROUGH 6475 04:41:23,320 --> 04:41:24,360 OUR SECOND JUNIOR POSTER 6476 04:41:24,360 --> 04:41:25,120 SESSION. 6477 04:41:25,120 --> 04:41:25,680 THANKS. 6478 04:41:25,680 --> 04:41:28,920 >> THANKS FOR THAT INTRODUCTION. 6479 04:41:28,920 --> 04:41:31,000 SO AS THE FIRST SESSION, WE'LL 6480 04:41:31,000 --> 04:41:34,240 HAVE FIVE PRERECORDED TALKS AND 6481 04:41:34,240 --> 04:41:35,600 WE WILL HAVE TIME FOR QUESTIONS 6482 04:41:35,600 --> 04:41:37,480 FOLLOWING THE TALK VIDEOS. 6483 04:41:37,480 --> 04:41:40,160 SO IF YOU HAVE QUESTIONS, PLEASE 6484 04:41:40,160 --> 04:41:41,440 PUT THEM IN THE Q & A BOX. 6485 04:41:41,440 --> 04:41:44,600 TODAY OUR SPEAKERS INCLUDE MOLLY 6486 04:41:44,600 --> 04:41:45,760 JARMAN, ASSISTANT PROFESSOR OF 6487 04:41:45,760 --> 04:41:48,120 SURGERY AT BRIGHAM AND WOMEN'S 6488 04:41:48,120 --> 04:41:49,680 HOSPITAL IN HARVARD MEDICAL 6489 04:41:49,680 --> 04:41:51,360 SCHOOL, AND SHE'LL BE PRESENTING 6490 04:41:51,360 --> 04:41:54,120 A PRE-HOSPITAL OPIOIDS AND SHORT 6491 04:41:54,120 --> 04:41:55,360 TERM OUTCOMES FOR OLDER ADULTS 6492 04:41:55,360 --> 04:41:56,760 WITH FALL-RELATED INJURY. 6493 04:41:56,760 --> 04:42:00,160 NEXT WILL BE MAICHOU LOR, 6494 04:42:00,160 --> 04:42:01,640 ASSISTANT PROFESSOR AT THE 6495 04:42:01,640 --> 04:42:02,280 UNIVERSITY OF WISCONSIN-MADISON 6496 04:42:02,280 --> 04:42:04,040 SCHOOL OF NURSING PRESENTING 6497 04:42:04,040 --> 04:42:05,840 "ENGAGING A LIMITED ENGLISH 6498 04:42:05,840 --> 04:42:07,240 PROFICIENT POPULATION IN 6499 04:42:07,240 --> 04:42:09,000 DESIGNING AND EVALUATING A PAIN 6500 04:42:09,000 --> 04:42:11,160 QUALITY ASSESSMENT INFORMATION 6501 04:42:11,160 --> 04:42:14,760 VISUALIZATION TOOL TO IMPROVE 6502 04:42:14,760 --> 04:42:16,760 PATIENT-INTERPRETER-PROVIDER 6503 04:42:16,760 --> 04:42:17,120 COMMUNICATION." 6504 04:42:17,120 --> 04:42:20,480 NEXT WILL BE LIZ LOSIN, 6505 04:42:20,480 --> 04:42:21,080 ASSISTANT PROFESSOR IN THE 6506 04:42:21,080 --> 04:42:23,120 DEPARTMENT OF PSYCHOLOGY AT 6507 04:42:23,120 --> 04:42:24,280 UNIVERSITY OF MIAMI, AND SHE'LL 6508 04:42:24,280 --> 04:42:28,280 BE PRESENTING "SOCIOCULTURAL 6509 04:42:28,280 --> 04:42:29,880 MECHANISMS UNDERLYING 6510 04:42:29,880 --> 04:42:31,280 DISPARITIES PAIN ASSESSMENT AND 6511 04:42:31,280 --> 04:42:32,880 TREATMENT DURING TELEMEDICINE." 6512 04:42:32,880 --> 04:42:34,880 NEXT WILL BE SARAH NELSON, 6513 04:42:34,880 --> 04:42:35,960 ASSISTANT PROFESSOR IN THE 6514 04:42:35,960 --> 04:42:40,280 DEPARTMENT OF PSYCHIATRY AT 6515 04:42:40,280 --> 04:42:42,240 HARVARD MEDICAL SCHOOL AND 6516 04:42:42,240 --> 04:42:44,440 DEPARTMENT OF ANESTHESIOLOGY 6517 04:42:44,440 --> 04:42:46,240 CRITICAL CARE AND PAIN MEDICINE 6518 04:42:46,240 --> 04:42:47,480 AT BOSTON CHILDREN'S HOSPITAL, 6519 04:42:47,480 --> 04:42:49,360 AND SHE'LL BE PRESENTING THE 6520 04:42:49,360 --> 04:42:51,840 ROLE OF NEUROBIOLOGICAL 6521 04:42:51,840 --> 04:42:53,520 MECHANISMS OF STRESS IN PAIN 6522 04:42:53,520 --> 04:42:55,680 MAINTENANCE AND MIND-BODY 6523 04:42:55,680 --> 04:42:56,760 INTERVENTION RESPONSE IN YOUTH 6524 04:42:56,760 --> 04:42:58,720 WITH CHRONIC PAIN. 6525 04:42:58,720 --> 04:43:03,120 AND FINALLY, ELLEN STAEDTLER, 6526 04:43:03,120 --> 04:43:04,760 VISITING FELLOW IN THE 6527 04:43:04,760 --> 04:43:06,160 DEPARTMENT OF PERIOPERATIVE 6528 04:43:06,160 --> 04:43:08,480 MEDICINE AT THE NIH CLINICAL 6529 04:43:08,480 --> 04:43:09,800 CENTER WILL BE PRESENTING "STEP 6530 04:43:09,800 --> 04:43:11,960 BY STEP TOWARDS IMPROVED HEALTH 6531 04:43:11,960 --> 04:43:14,240 SENSORY PHENOTYPING OF FEET 6532 04:43:14,240 --> 04:43:16,040 AFFECTED BY MORTON'S NEUROMA AND 6533 04:43:16,040 --> 04:43:18,360 REDUCING REFRACTORY PAIN WITH AN 6534 04:43:18,360 --> 04:43:21,920 INJECTION OF RESINIFERATOXIN." 6535 04:43:21,920 --> 04:43:23,240 SO AT THIS TIME WE'LL PLAY THE 6536 04:43:23,240 --> 04:43:29,880 VIDEOS. 6537 04:43:29,880 --> 04:43:31,400 >> HELLO. 6538 04:43:31,400 --> 04:43:36,640 I'M MOLLY JARMON. 6539 04:43:36,640 --> 04:43:37,840 THE WORK I'M PRESENTING TODAY 6540 04:43:37,840 --> 04:43:40,960 WAS SUPPORTED BY A K01 AWARD 6541 04:43:40,960 --> 04:43:42,440 FROM THE NATIONAL INSTITUTE ON 6542 04:43:42,440 --> 04:43:43,240 AGING. 6543 04:43:43,240 --> 04:43:44,240 3 MILLION OLDER ADULTS 6544 04:43:44,240 --> 04:43:45,720 EXPERIENCE A FALL-RELATED INJURY 6545 04:43:45,720 --> 04:43:47,960 EACH YEAR IN THE UNITED STATES. 6546 04:43:47,960 --> 04:43:51,120 ACCOUNTING FOR 17% OF ALL 6547 04:43:51,120 --> 04:43:54,240 911 CALLS FOR EMERGENCY MEDICAL 6548 04:43:54,240 --> 04:43:54,600 ASSISTANCE. 6549 04:43:54,600 --> 04:43:56,440 NATIONAL GUIDELINES FOR EMS CARE 6550 04:43:56,440 --> 04:43:58,040 RECOMMEND OPIOID ANALGESIA FOR 6551 04:43:58,040 --> 04:44:01,920 THE TREAT M OF TREATMENT E 6552 04:44:01,920 --> 04:44:02,680 INJURED PATIENTS REACH THE 6553 04:44:02,680 --> 04:44:03,480 HOSPITAL. 6554 04:44:03,480 --> 04:44:05,160 PAIN MANAGEMENT IN OLDER ADULTS 6555 04:44:05,160 --> 04:44:05,880 REQUIRE SPECIAL CONSIDERATION 6556 04:44:05,880 --> 04:44:07,240 DUE TO THE RISK OF DELIRIUM, 6557 04:44:07,240 --> 04:44:09,360 WHICH IS INCREASED BOTH BY 6558 04:44:09,360 --> 04:44:11,440 PSYCHOACTIVE MEDICATIONS LIKE 6559 04:44:11,440 --> 04:44:13,280 OPIOIDS AND BY SEVERE ACUTE 6560 04:44:13,280 --> 04:44:13,840 PAIN. 6561 04:44:13,840 --> 04:44:15,520 CURRENTLY, THERE ARE NO SPECIFIC 6562 04:44:15,520 --> 04:44:17,200 GUIDELINES FOR PRE-HOSPITAL PAIN 6563 04:44:17,200 --> 04:44:18,160 MANAGEMENT IN OLDER ADULTS. 6564 04:44:18,160 --> 04:44:20,000 OUR EARLY WORK IN THIS DOMAIN 6565 04:44:20,000 --> 04:44:22,120 SHOWS THAT 7% OF INJURED OLDER 6566 04:44:22,120 --> 04:44:24,240 ADULTS RECEIVE OPIOIDS IN THE 6567 04:44:24,240 --> 04:44:25,160 PRE-HOSPITAL SETTING. 6568 04:44:25,160 --> 04:44:26,560 AND TREATMENT OF PAIN WAS 6569 04:44:26,560 --> 04:44:28,040 CORRELATED WITH HIGHER PAIN 6570 04:44:28,040 --> 04:44:31,920 SCORES AND MORE SEVERE INJURIES. 6571 04:44:31,920 --> 04:44:33,800 AND WAS NOT ASSOCIATED WITH 6572 04:44:33,800 --> 04:44:34,720 INCREASED RISK OF COMPLICATIONS 6573 04:44:34,720 --> 04:44:37,280 SUCH AS ALTERED MENTAL STATUS OR 6574 04:44:37,280 --> 04:44:38,360 RESPIRATORY DISTRESS REPORTED BY 6575 04:44:38,360 --> 04:44:41,520 EMS. 6576 04:44:41,520 --> 04:44:43,320 TO DETERMINE IF PRE-HOSPITAL 6577 04:44:43,320 --> 04:44:44,240 OPIOID PAIN MANAGEMENT WAS 6578 04:44:44,240 --> 04:44:45,520 ASSOCIATED WITH SHORT TERM 6579 04:44:45,520 --> 04:44:47,240 CLINICAL OUTCOMES FOLLOWING 6580 04:44:47,240 --> 04:44:48,840 FALL-RELATED INJURY, WE LINKED 6581 04:44:48,840 --> 04:44:51,600 EMS PATIENT CARE REPORTS FROM 6582 04:44:51,600 --> 04:44:52,600 THE ILLINOIS DEPARTMENT OF 6583 04:44:52,600 --> 04:44:53,240 PUBLIC HEALTH WITH MEDICARE 6584 04:44:53,240 --> 04:44:55,000 CLAIMS DATA FOR OLDER ADULTS 6585 04:44:55,000 --> 04:44:59,120 DIAGNOSED WITH A FALL IN 2014 6586 04:44:59,120 --> 04:44:59,480 AND 2015. 6587 04:44:59,480 --> 04:45:01,240 WE USED INVERSE PROBABILITY OF 6588 04:45:01,240 --> 04:45:02,440 TREATMENT WAITING TO ADJUST FOR 6589 04:45:02,440 --> 04:45:05,880 COMPOUNDING BY AGE, SEX, RACE, 6590 04:45:05,880 --> 04:45:07,560 FRAILTY, COMORBIDITIES, INJURY 6591 04:45:07,560 --> 04:45:08,880 SEVERITY, PRESENCE OF A 6592 04:45:08,880 --> 04:45:11,480 TRAUMATIC BRAIN INJURY, TOTAL 6593 04:45:11,480 --> 04:45:12,920 PRE-HOSPITAL TIME, PRE-HOSPITAL 6594 04:45:12,920 --> 04:45:16,640 VITAL SIGNS AND TRAUMA CENTER 6595 04:45:16,640 --> 04:45:17,120 DESIGNATION. 6596 04:45:17,120 --> 04:45:18,960 WE USED REGRESSION TO COMPARE 6597 04:45:18,960 --> 04:45:23,960 TOTAL PATIENT DAYS AND INTENSIVE 6598 04:45:23,960 --> 04:45:26,080 CARE DAYS -- FOR PATIENTS WITH 6599 04:45:26,080 --> 04:45:28,000 AND WITHOUT PRE-HOSPITAL OPIOID 6600 04:45:28,000 --> 04:45:30,080 PAIN MANAGEMENT. 6601 04:45:30,080 --> 04:45:33,760 IN OUR SAMPLE OF 28,000 OLDER 6602 04:45:33,760 --> 04:45:37,080 ADULTS, 70% WERE FEMALE, 94% 6603 04:45:37,080 --> 04:45:38,760 WERE WHITE AND THE MEAN AGE WAS 6604 04:45:38,760 --> 04:45:39,280 82. 6605 04:45:39,280 --> 04:45:43,920 3% RECEIVED A A PRE-HOSPITAL 6606 04:45:43,920 --> 04:45:46,040 OPIOID PAIN MANAGEMENT, THE MEAN 6607 04:45:46,040 --> 04:45:48,720 LENGTH OF STAY WAS 4 DAYS, 2% 6608 04:45:48,720 --> 04:45:50,560 WERE DIAGNOSED WITH DELIRIUM 6609 04:45:50,560 --> 04:45:52,760 DURING THEIR HOSPITAL STAY. 6610 04:45:52,760 --> 04:45:54,040 PRE-HOSPITAL OPIOID PAIN 6611 04:45:54,040 --> 04:45:55,920 MANAGEMENT WAS ASSOCIATED WITH A 6612 04:45:55,920 --> 04:45:58,160 9% DECREASE IN TOTAL LENGTH OF 6613 04:45:58,160 --> 04:46:00,760 STAY AND A 20% DECREASE IN ICU 6614 04:46:00,760 --> 04:46:02,440 LENGTH OF STAY, WHILE ODDS OF 6615 04:46:02,440 --> 04:46:04,120 DELIRIUM DIAGNOSIS WERE NOT 6616 04:46:04,120 --> 04:46:05,320 SIGNIFICANTLY DIFFERENT FOR 6617 04:46:05,320 --> 04:46:06,880 PATIENTS WITH AND WITHOUT 6618 04:46:06,880 --> 04:46:10,440 PRE-HOSPITAL OPIOID PAIN 6619 04:46:10,440 --> 04:46:12,880 MANAGEMENT. 6620 04:46:12,880 --> 04:46:15,480 OUR FINDINGS SHOW PRE-HOSPITAL 6621 04:46:15,480 --> 04:46:18,360 OPIOID MANAGEMENT DOES NOT 6622 04:46:18,360 --> 04:46:20,120 DECREASE FOR ADULTS WITH A FALL 6623 04:46:20,120 --> 04:46:21,720 RELATED INJURY AND MAY REDUCE 6624 04:46:21,720 --> 04:46:23,520 TIME SPENT IN THE HOSPITAL. 6625 04:46:23,520 --> 04:46:25,960 OUR NEXT STEPS INCLUDE 6626 04:46:25,960 --> 04:46:28,600 ASSESSMENT OF LONG TERM OUTCOMES 6627 04:46:28,600 --> 04:46:35,000 INCLUDING DEMENTIA AND CHRONIC 6628 04:46:35,000 --> 04:46:36,160 PAIN -- 6629 04:46:36,160 --> 04:46:37,400 >> HI, I'M AN ASSISTANT 6630 04:46:37,400 --> 04:46:39,720 PROFESSOR FROM THE UNIVERSITY OF 6631 04:46:39,720 --> 04:46:40,600 WISCONSIN-MADISON. 6632 04:46:40,600 --> 04:46:42,080 CURRENTLY THERE ARE NO 6633 04:46:42,080 --> 04:46:42,760 CULTURALLY APPROPRIATE 6634 04:46:42,760 --> 04:46:45,920 INFORMATION VISUALIZATION INFO 6635 04:46:45,920 --> 04:46:50,040 VIZ TOOLS FOR LEP PATIENTS AND 6636 04:46:50,040 --> 04:46:51,240 INTERPRETERS TO COMMUNICATE WITH 6637 04:46:51,240 --> 04:46:53,120 HEALTHCARE PROVIDERS DURING PAIN 6638 04:46:53,120 --> 04:46:54,320 ASSESSMENT AND MANAGEMENT. 6639 04:46:54,320 --> 04:46:55,880 THE PURPOSE OF THIS STUDY WAS TO 6640 04:46:55,880 --> 04:46:58,680 DEVELOP A CULTURALLY APPROPRIATE 6641 04:46:58,680 --> 04:47:01,560 INFO VIZ PAIN QUALITY ASSESSMENT 6642 04:47:01,560 --> 04:47:03,280 TOOL USING A MULTISTEP USER 6643 04:47:03,280 --> 04:47:04,240 CENTERED APPROACH. 6644 04:47:04,240 --> 04:47:06,400 WE CONDUCTED THIS STUDY IN THREE 6645 04:47:06,400 --> 04:47:10,040 PHASES ADDRESSING THREE AIMS. 6646 04:47:10,040 --> 04:47:13,360 PHASE ONE ADDRESSES A1 WHERE LEP 6647 04:47:13,360 --> 04:47:16,680 AND BILINGUAL HMONG PARTICIPANTS 6648 04:47:16,680 --> 04:47:18,760 AND INTERPRETERS EVALUATED AND 6649 04:47:18,760 --> 04:47:20,800 PROVIDED SUGGESTIONS DOCTOR FOR 6650 04:47:20,800 --> 04:47:23,000 INITIAL SET OF PAIN QUALITY 6651 04:47:23,000 --> 04:47:23,680 INFOGRAPHICS CREATED IN A 6652 04:47:23,680 --> 04:47:25,120 PREVIOUS STUDY. 6653 04:47:25,120 --> 04:47:27,040 PHASE TWO ADDRESSES WHERE WE 6654 04:47:27,040 --> 04:47:28,920 NARROW THE NUMBER OF PAIN INFO 6655 04:47:28,920 --> 04:47:30,120 GRAPHICS TO 15 AND CONDUCTED 6656 04:47:30,120 --> 04:47:31,840 CARD SORTING SESSIONS TO GATHER 6657 04:47:31,840 --> 04:47:34,240 DATA ON ORGANIZING THE 15 PAIN 6658 04:47:34,240 --> 04:47:37,080 QUALITY INFOGRAPHICS ON INVO VIZ 6659 04:47:37,080 --> 04:47:40,520 TOOL ACCORDING TO THE MENTAL 6660 04:47:40,520 --> 04:47:43,400 MODELS OF THE YOUNG ADULTS. 6661 04:47:43,400 --> 04:47:44,480 PHASE 3 ADDRESSES AIM 3 WHICH IS 6662 04:47:44,480 --> 04:47:46,640 TO IDENTIFY A TOOL THAT 6663 04:47:46,640 --> 04:47:47,600 ACCURATELY REPRESENT MENTAL 6664 04:47:47,600 --> 04:47:49,000 MODEL AND IS PREFERRED TO BE 6665 04:47:49,000 --> 04:47:50,680 USED IN THE CLINICAL SETTING. 6666 04:47:50,680 --> 04:47:52,280 OVERALL, THE MAJORITY OF 6667 04:47:52,280 --> 04:47:53,320 PARTICIPANTS WERE FEMALE WITH 6668 04:47:53,320 --> 04:47:56,480 THE MEAN AGE OF 62 FOR LEP 6669 04:47:56,480 --> 04:47:58,840 HMONG, 39.5 FOR BILINGUAL HMONG, 6670 04:47:58,840 --> 04:48:00,320 AND 39 FOR HMONG INTERPRETERS. 6671 04:48:00,320 --> 04:48:02,120 FOR AIM ONE, THERE WERE THREE 6672 04:48:02,120 --> 04:48:05,320 COMMON THEMES THAT AROSE FROM 6673 04:48:05,320 --> 04:48:06,560 PARTICIPANTS' SUGGESTIONS DURING 6674 04:48:06,560 --> 04:48:07,640 THE PARTICIPATORY DESIGN 6675 04:48:07,640 --> 04:48:08,160 SESSIONS. 6676 04:48:08,160 --> 04:48:09,480 THE FIRST WAS THE USE OF 6677 04:48:09,480 --> 04:48:11,760 CULTURALLY RELEVANT COLORS. 6678 04:48:11,760 --> 04:48:13,000 PARTICIPANTS CONSISTENTLY 6679 04:48:13,000 --> 04:48:14,600 EMPHASIZED TWO COLORS THAT HAVE 6680 04:48:14,600 --> 04:48:17,440 CULTURE MEANINGS AS VISUAL 6681 04:48:17,440 --> 04:48:19,000 SYMBOLS, RED AND WHITE. 6682 04:48:19,000 --> 04:48:20,080 RED CULTURALLY INDICATE PAIN OR 6683 04:48:20,080 --> 04:48:21,640 HURTING AND DIFFERENT SHADES OF 6684 04:48:21,640 --> 04:48:22,720 RED INDICATE PAIN SEVERITY. 6685 04:48:22,720 --> 04:48:26,080 FOR EXAMPLE, LIGHT RED IS LESS 6686 04:48:26,080 --> 04:48:27,840 INTENSE PAIN WHILE DARK RED IS 6687 04:48:27,840 --> 04:48:29,240 MORE OR SEVERE PAIN. 6688 04:48:29,240 --> 04:48:31,640 HENCE PARTICIPANTS ADJUSTED 6689 04:48:31,640 --> 04:48:32,840 ADDING RED TO PAIN QUALITY THAT 6690 04:48:32,840 --> 04:48:35,240 THEY PERCEIVE AS PAINFUL, AND 6691 04:48:35,240 --> 04:48:36,920 THIS IS ALSO ILLUSTRATED IN THE 6692 04:48:36,920 --> 04:48:37,840 SAMPLE QUOTE HERE. 6693 04:48:37,840 --> 04:48:39,160 SEVERAL PARTICIPANTS SUGGESTED 6694 04:48:39,160 --> 04:48:40,320 THAT CREAMY WHITE SHOULD 6695 04:48:40,320 --> 04:48:41,160 REPRESENT NUMBNESS TO 6696 04:48:41,160 --> 04:48:43,320 DISTINGUISH IT FROM PAIN SINCE 6697 04:48:43,320 --> 04:48:44,560 IT DID NOT ASSOCIATE NUMBERS 6698 04:48:44,560 --> 04:48:46,160 WITH PAIN. 6699 04:48:46,160 --> 04:48:47,200 THE SECOND THING WAS USE OF INFO 6700 04:48:47,200 --> 04:48:49,640 GRAPHICS TO RESEMBLE HUMAN 6701 04:48:49,640 --> 04:48:49,960 ANATOMY. 6702 04:48:49,960 --> 04:48:51,760 MANY EXPRESS THAT WITHOUT HUMAN 6703 04:48:51,760 --> 04:48:52,600 FIGURE IT WAS UNCLEAR WHETHER 6704 04:48:52,600 --> 04:48:54,360 THE PAIN WAS REAL AND THEY COULD 6705 04:48:54,360 --> 04:48:57,040 NOT UNDERSTAND WHAT THE PAIN 6706 04:48:57,040 --> 04:48:57,520 WAS. 6707 04:48:57,520 --> 04:48:59,880 THE THIRD THING WAS THE USE OF 6708 04:48:59,880 --> 04:49:03,680 ACTION-SPECIFIC QUIGLEY LINES. 6709 04:49:03,680 --> 04:49:05,320 PARTICIPANTS CONSISTENTLY 6710 04:49:05,320 --> 04:49:07,680 REQUESTED SQUIGGLY BEING BE 6711 04:49:07,680 --> 04:49:10,040 ADDED FOR CRAMPS, NUMBNESS, 6712 04:49:10,040 --> 04:49:11,880 SORENESS, PRESSURE AND ACHINESS 6713 04:49:11,880 --> 04:49:12,800 AS ILLUSTRATED IN THIS QUOTE. 6714 04:49:12,800 --> 04:49:14,760 FOR AIM TWO, WE IDENTIFIED THREE 6715 04:49:14,760 --> 04:49:15,840 MAIN THEMES FROM THE CODE 6716 04:49:15,840 --> 04:49:16,960 SORTING SESSION AMONG 6717 04:49:16,960 --> 04:49:18,040 PARTICIPANT CREATED CATEGORIES. 6718 04:49:18,040 --> 04:49:22,120 THESE INCLUDED SENSATION, 6719 04:49:22,120 --> 04:49:22,840 LOCALIZATION, AND SEVERITY. 6720 04:49:22,840 --> 04:49:24,920 FOR AIM THREE, 13 OF THE 6721 04:49:24,920 --> 04:49:26,320 21 PARTICIPANTS SELECTED THE 6722 04:49:26,320 --> 04:49:27,840 LOCALIZATION OF PAIN QUALITY AS 6723 04:49:27,840 --> 04:49:29,640 THE MOST APPROPRIATE TOOL 6724 04:49:29,640 --> 04:49:31,200 REPRESENTING THEIR MENTAL MODEL 6725 04:49:31,200 --> 04:49:32,520 AS PREFER TO USE IT IN THE 6726 04:49:32,520 --> 04:49:36,480 CLINICAL SETTINGS. 6727 04:49:36,480 --> 04:49:38,200 IN CONCLUSION, WE USE A 6728 04:49:38,200 --> 04:49:41,440 MULTISTEP USER CENTERED APPROACH 6729 04:49:41,440 --> 04:49:43,120 TO -- ASSESSMENT TOOL FOR 6730 04:49:43,120 --> 04:49:44,920 QUALITY OF PAIN IN LEP HMONG 6731 04:49:44,920 --> 04:49:45,840 PATIENTS. 6732 04:49:45,840 --> 04:49:47,040 WE ARE CURRENTLY TESTING THIS 6733 04:49:47,040 --> 04:49:48,160 TOOL IN THE PRIMARY CARE SETTING 6734 04:49:48,160 --> 04:49:50,160 AND HOPE THAT IT WILL INCREASE 6735 04:49:50,160 --> 04:49:51,560 THE CHANCES OF SUCCESSFUL 6736 04:49:51,560 --> 04:49:51,960 IMPLEMENTATION. 6737 04:49:51,960 --> 04:49:54,000 THANK YOU. 6738 04:49:54,000 --> 04:49:55,000 >> HI. 6739 04:49:55,000 --> 04:49:57,760 I'M DR. ELIZABETH LOSIN, 6740 04:49:57,760 --> 04:49:58,400 CURRENTLY ASSISTANT PROFESSOR IN 6741 04:49:58,400 --> 04:49:59,760 THE DEPARTMENT OF PSYCHOLOGY AT 6742 04:49:59,760 --> 04:50:01,040 THE UNIVERSITY OF MIAMI. 6743 04:50:01,040 --> 04:50:03,080 IN MARCH 2023, I'LL BE STARTING 6744 04:50:03,080 --> 04:50:05,520 A POSITION AS THE BENNETT PIERCE 6745 04:50:05,520 --> 04:50:07,920 ASSOCIATE PROFESSOR OF CARING 6746 04:50:07,920 --> 04:50:09,360 AND COMPASSION IN ADULTHOOD IN 6747 04:50:09,360 --> 04:50:11,400 THE DEPARTMENT OF BIOBEHAVIORAL 6748 04:50:11,400 --> 04:50:12,600 HEALTH AT PENN STATE UNIVERSITY. 6749 04:50:12,600 --> 04:50:14,800 TODAY I'M GOING TO BE PRESENTING 6750 04:50:14,800 --> 04:50:16,520 PRELIMINARY RESULTS FROM A STUDY 6751 04:50:16,520 --> 04:50:18,480 ON SOCIOCULTURAL MECHANISMS 6752 04:50:18,480 --> 04:50:19,520 UNDERLYING DISPARITIES IN PAIN 6753 04:50:19,520 --> 04:50:21,280 ASSESSMENT AND TREATMENT DURING 6754 04:50:21,280 --> 04:50:21,720 TELEMEDICINE. 6755 04:50:21,720 --> 04:50:23,880 SUPPORTED BY MY K01 AWART FROM 6756 04:50:23,880 --> 04:50:27,840 THE NATIONAL INSTITUTE ON DRUG 6757 04:50:27,840 --> 04:50:28,560 ABUSE. 6758 04:50:28,560 --> 04:50:29,560 OUR MAIN RESEARCH QUESTION WAS 6759 04:50:29,560 --> 04:50:31,560 HOW DO CLINICIANS CONTRIBUTE TO 6760 04:50:31,560 --> 04:50:32,840 PAIN TREATMENT DISPARITIES, 6761 04:50:32,840 --> 04:50:34,640 NAMELY, WOMEN AND MINORITIZED 6762 04:50:34,640 --> 04:50:37,280 INDIVIDUALS TEND TO BE 6763 04:50:37,280 --> 04:50:38,440 PRESCRIBED LESS PAIN 6764 04:50:38,440 --> 04:50:39,720 TERRITORIMENT THAN IS CLINICALLY 6765 04:50:39,720 --> 04:50:41,160 INDICATED LEADING TO POOR PAIN 6766 04:50:41,160 --> 04:50:42,280 MANAGEMENT IN THESE GROUPS, 6767 04:50:42,280 --> 04:50:44,000 WHILE MEN AND NON-HISPANIC WHITE 6768 04:50:44,000 --> 04:50:45,480 INDIVIDUALS ARE OFTEN PRESCRIBED 6769 04:50:45,480 --> 04:50:48,640 MORE PAIN TREATMENT THAN IS 6770 04:50:48,640 --> 04:50:49,120 CLINICALLY INDICATED 6771 04:50:49,120 --> 04:50:50,720 CONTRIBUTING TO THE OPIOID 6772 04:50:50,720 --> 04:50:51,000 EPIDEMIC. 6773 04:50:51,000 --> 04:50:52,440 WE HAD MEDICAL STUDENTS AND 6774 04:50:52,440 --> 04:50:53,800 RESIDENTS PLAY THE ROLE OF 6775 04:50:53,800 --> 04:50:55,400 CLINICIANS IN SIX TELEMEDICINE 6776 04:50:55,400 --> 04:50:58,280 APPOINTMENTS EACH. 6777 04:50:58,280 --> 04:50:59,560 PATIENTS WERE TRAINED COMMUNITY 6778 04:50:59,560 --> 04:51:02,680 MEMBERS WITH FICTITIOUS SHOULDER 6779 04:51:02,680 --> 04:51:04,160 INJURIES, ALL MET CLINICAL 6780 04:51:04,160 --> 04:51:06,000 CRITERIA FOR THE USE OF OPIOID 6781 04:51:06,000 --> 04:51:06,760 ANALGESICS. 6782 04:51:06,760 --> 04:51:07,720 EACH CLINICIAN WOULD TAKE A 6783 04:51:07,720 --> 04:51:10,840 MEDICAL HISTORY, PERFORM THE 6784 04:51:10,840 --> 04:51:12,000 MAYO CLINIC REMOTE 6785 04:51:12,000 --> 04:51:12,880 MUSCULOSKELETAL SHOULDER EXAM. 6786 04:51:12,880 --> 04:51:14,080 YOU CAN SEE A SCREEN SHOT HERE. 6787 04:51:14,080 --> 04:51:16,360 THEY'RE NOT JUST DOING A DAB. 6788 04:51:16,360 --> 04:51:18,360 AND FINALLY, THE CLINICIAN WOULD 6789 04:51:18,360 --> 04:51:21,200 MAKE AN ASSESSMENT OF THE 6790 04:51:21,200 --> 04:51:22,080 PATIENT'S PAIN AND 6791 04:51:22,080 --> 04:51:23,280 PHARMACOLOGICAL AND 6792 04:51:23,280 --> 04:51:25,480 NON-PHARMACOLOGICAL TREATMENT 6793 04:51:25,480 --> 04:51:26,280 DECISIONS. 6794 04:51:26,280 --> 04:51:28,000 MY GRADUATE STUDENT AND I USED 6795 04:51:28,000 --> 04:51:29,840 STRUCTURAL EQUATION MODELING TO 6796 04:51:29,840 --> 04:51:31,720 TEST WHETHER PATIENT 6797 04:51:31,720 --> 04:51:32,560 DEMOGRAPHICS INFLUENCE PAIN 6798 04:51:32,560 --> 04:51:35,440 ASSESSMENT AND TREATMENT 6799 04:51:35,440 --> 04:51:37,160 DECISIONS, AND IF SO, WHETHER 6800 04:51:37,160 --> 04:51:38,920 DEMOGRAPHIC STEREOTYPES AND 6801 04:51:38,920 --> 04:51:40,160 OPIOID ABUSE STEREOTYPES 6802 04:51:40,160 --> 04:51:41,240 MEDIATED THIS RELATIONSHIP. 6803 04:51:41,240 --> 04:51:42,640 WE ALSO CONTROLLED FOR SEVERAL 6804 04:51:42,640 --> 04:51:44,520 VARIABLES INCLUDING THE 6805 04:51:44,520 --> 04:51:47,320 CLINICIAN'S MEDICAL EXPERIENCE. 6806 04:51:47,320 --> 04:51:48,760 INTERESTINGLY, IN THE 119 6807 04:51:48,760 --> 04:51:49,960 INTERACTIONS ANALYZED HERE, 6808 04:51:49,960 --> 04:51:54,440 ABOUT 30% OF OUR FINAL SAMPLE, 6809 04:51:54,440 --> 04:51:56,000 PATIENT RACE AND ETHNICITY DID 6810 04:51:56,000 --> 04:51:57,160 NOT INFLUENCE PAIN ASSESSMENT 6811 04:51:57,160 --> 04:51:58,080 AND TREATMENT HOWEVER, IN THE 6812 04:51:58,080 --> 04:51:59,360 RED PACK, YOU CAN SEE THAT THE 6813 04:51:59,360 --> 04:52:00,560 MORE SENSITIVE THE CLINICIAN 6814 04:52:00,560 --> 04:52:02,560 PERCEIVED THE TYPICAL PERSON 6815 04:52:02,560 --> 04:52:03,840 FROM THAT PERSON'S RACIAL GROUP, 6816 04:52:03,840 --> 04:52:05,800 THE MORE INTENSE THEY PERCEIVED 6817 04:52:05,800 --> 04:52:07,800 THAT PATIENT'S PAIN. 6818 04:52:07,800 --> 04:52:08,880 AND THE MORE LIKELY THEY 6819 04:52:08,880 --> 04:52:10,200 REPORTED THEY WOULD BE TO 6820 04:52:10,200 --> 04:52:12,680 PRESCRIBE THEM OPIOIDS. 6821 04:52:12,680 --> 04:52:13,640 STRIKINGLY, THE RATINGS THE 6822 04:52:13,640 --> 04:52:14,880 PATIENTS PROVIDED OF THEIR OWN 6823 04:52:14,880 --> 04:52:18,040 PAIN IN BLUE DURING THE CLINICAL 6824 04:52:18,040 --> 04:52:20,120 EXAM DID NOT INFLUENCE THE 6825 04:52:20,120 --> 04:52:21,880 CLINICIAN'S PERCEPTIONS OF THEIR 6826 04:52:21,880 --> 04:52:24,080 PAIN INTENSITY OR LIKELIHOOD OF 6827 04:52:24,080 --> 04:52:25,080 PRESCRIBING ANALGESICS. 6828 04:52:25,080 --> 04:52:25,960 TOGETHER THESE PRELIMINARY DATA 6829 04:52:25,960 --> 04:52:27,360 SUGGEST THAT UNDER SOME 6830 04:52:27,360 --> 04:52:28,400 CIRCUMSTANCES, CLINICIANS MAY 6831 04:52:28,400 --> 04:52:30,000 RELY MORE HEAVILY ON THEIR 6832 04:52:30,000 --> 04:52:31,320 STEREOTYPES ABOUT THE TYPICAL 6833 04:52:31,320 --> 04:52:33,080 PAIN SENSITIVITY OF PEOPLE FROM 6834 04:52:33,080 --> 04:52:34,840 A PATIENT'S ETHNIC OR RACIAL 6835 04:52:34,840 --> 04:52:36,000 GROUP THAN THE PATIENT'S OWN 6836 04:52:36,000 --> 04:52:37,920 PAIN REPORT. 6837 04:52:37,920 --> 04:52:40,000 PROVIDING A POTENTIAL TARGET FOR 6838 04:52:40,000 --> 04:52:42,640 INTERVENTION. 6839 04:52:42,640 --> 04:52:42,920 THANKS. 6840 04:52:42,920 --> 04:52:45,520 >> HELLO, DR. SARAH NELSON, 6841 04:52:45,520 --> 04:52:47,080 PRESENTING ON MY RESEARCH 6842 04:52:47,080 --> 04:52:50,360 LOOKING AT THE NEUROBIOLOGICAL 6843 04:52:50,360 --> 04:52:51,440 MECHANISMS OF STRESS IN 6844 04:52:51,440 --> 04:52:53,880 PEDIATRIC CHRONIC PAIN. 6845 04:52:53,880 --> 04:52:55,400 WE KNOW PEDIATRIC CHRONIC PAIN 6846 04:52:55,400 --> 04:52:57,320 IS A SERIOUS PUBLIC HEALTH ISSUE 6847 04:52:57,320 --> 04:52:58,840 AND IS OFTEN ASSOCIATED WITH 6848 04:52:58,840 --> 04:53:00,080 HIGH LEVELS OF PSYCHOLOGICAL 6849 04:53:00,080 --> 04:53:02,360 STRESS AND EXPOSURE TO ADVERSE 6850 04:53:02,360 --> 04:53:03,560 CHILD HOOD EXPERIENCES. 6851 04:53:03,560 --> 04:53:05,200 PRELIMINARY MECHANISTIC WORK HAS 6852 04:53:05,200 --> 04:53:06,840 ALSO IDENTIFIED ALLOSTATIC LOAD 6853 04:53:06,840 --> 04:53:08,640 AND BRAIN DEVELOPMENT INCLUDING 6854 04:53:08,640 --> 04:53:10,480 THE HIPPOCAMPUS AS POTENTIALLY 6855 04:53:10,480 --> 04:53:12,000 IMPLICATED IN PARALLELS BETWEEN 6856 04:53:12,000 --> 04:53:15,040 STRESS AND PAIN PERCEPTION AND 6857 04:53:15,040 --> 04:53:16,920 PAIN RESPONSE, HOWEVER, THESE 6858 04:53:16,920 --> 04:53:17,920 REMAIN POORLY UNDERSTOOD. 6859 04:53:17,920 --> 04:53:19,360 IN ADDITION TO THIS, 6860 04:53:19,360 --> 04:53:21,720 INTERVENTIONS THAT ADDRESS THE 6861 04:53:21,720 --> 04:53:23,240 MALADAPTIVE STRESS RESPONSE LIKE 6862 04:53:23,240 --> 04:53:24,840 MINDFULNESS BASED THERON HAVE 6863 04:53:24,840 --> 04:53:25,880 BEEN PROPOSED TO BE PARTICULARLY 6864 04:53:25,880 --> 04:53:28,200 RELEVANT TO PEDIATRIC CHRONIC 6865 04:53:28,200 --> 04:53:29,920 PAIN DUE TO THEIR PREVIOUS 6866 04:53:29,920 --> 04:53:31,440 EVIDENCE IN MODULATING STRESS 6867 04:53:31,440 --> 04:53:33,480 AND ALTERATIONS IN THESE AREAS 6868 04:53:33,480 --> 04:53:34,960 HOWEVER THESE INTERVENTIONS IN 6869 04:53:34,960 --> 04:53:36,160 PEDIATRIC CHRONIC PAIN 6870 04:53:36,160 --> 04:53:37,920 POPULATIONS PARTICULARLY FROM A 6871 04:53:37,920 --> 04:53:39,480 MECHANISTIC STANDPOINT HAVEN'T 6872 04:53:39,480 --> 04:53:42,160 BEEN SIGNIFICANTLY STUDIED. 6873 04:53:42,160 --> 04:53:43,560 THEREFORE, OBJECTIVES OF MY 6874 04:53:43,560 --> 04:53:46,640 CURRENT INVESTIGATION INCLUDE 6875 04:53:46,640 --> 04:53:47,880 SUMMARIZING MY RESEARCH TO DATE 6876 04:53:47,880 --> 04:53:49,720 AND NUMBER TWO, HIGHLIGHTING AN 6877 04:53:49,720 --> 04:53:51,400 ONGOING RESEARCH FUNDED BY NCCIH 6878 04:53:51,400 --> 04:53:53,840 THAT LOOKS AT THESE MECHANISMS 6879 04:53:53,840 --> 04:53:55,760 IN RELATION TO MIND-BODY 6880 04:53:55,760 --> 04:53:56,880 INTERVENTION RESPONSE IN 6881 04:53:56,880 --> 04:54:01,800 PEDIATRIC CHRONIC PAIN. 6882 04:54:01,800 --> 04:54:03,160 PRIMARY RESULTS OF MY STUDIES 6883 04:54:03,160 --> 04:54:04,880 LOOK AT ALLOSTATIC LOAD AND HAVE 6884 04:54:04,880 --> 04:54:06,240 FOUND THAT OVER 50% OF YOUTH 6885 04:54:06,240 --> 04:54:07,920 WITH CHRONIC PAIN ARE AT HIGH 6886 04:54:07,920 --> 04:54:10,080 RISK FOR ALLOSTATIC LOAD MEANING 6887 04:54:10,080 --> 04:54:11,600 GREATER THAN TWO RISK FACTORS. 6888 04:54:11,600 --> 04:54:15,360 WE'VE ALSO FOUND ALLOSTATIC LOAD 6889 04:54:15,360 --> 04:54:18,080 MODERATE THE -- WHICH HIGHLIGHT 6890 04:54:18,080 --> 04:54:20,120 THE POTENTIAL ROLE OF STRESS, 6891 04:54:20,120 --> 04:54:22,080 WEAR AND TEAR AND MODULATED PAIN 6892 04:54:22,080 --> 04:54:22,760 RELATED FUNCTIONING. 6893 04:54:22,760 --> 04:54:25,600 IN THE CONTEXT OF MY K23, THE 6894 04:54:25,600 --> 04:54:26,960 AIMS ARE TO FURTHER ELUCIDATE 6895 04:54:26,960 --> 04:54:29,080 THE ROLE OF ALLOSTATIC LOAD AND 6896 04:54:29,080 --> 04:54:30,640 BRAIN BASED MALL ADAPTATION TO 6897 04:54:30,640 --> 04:54:34,040 STRESS IN MIND-BODY INTERVENTION 6898 04:54:34,040 --> 04:54:35,240 RESPONSE TO GET A BETTER 6899 04:54:35,240 --> 04:54:36,080 UNDERSTANDING OF THE MECHANISMS 6900 04:54:36,080 --> 04:54:37,720 OF THESE INTERACTIONS AND 6901 04:54:37,720 --> 04:54:38,840 INTERVENTIONS, I'M RECRUITING 6902 04:54:38,840 --> 04:54:40,200 YOUTH WITH CHRONIC WIDESPREAD 6903 04:54:40,200 --> 04:54:42,400 PAIN, A BASELINE VISIT INVOLVES 6904 04:54:42,400 --> 04:54:44,960 AN FMRI AND QUANTITATIVE SENSORY 6905 04:54:44,960 --> 04:54:48,520 TESTING IN ADDITION TO A 6906 04:54:48,520 --> 04:54:49,520 MULTIFACTORIAL ALLOSTATIC LOAD 6907 04:54:49,520 --> 04:54:52,280 COMPOSITE INCLUDING 6908 04:54:52,280 --> 04:54:53,600 GLUCOCORTICOIDS, WAIST-HIP RATIO 6909 04:54:53,600 --> 04:54:55,360 AND BMI AND THEN WE'RE GOING TO 6910 04:54:55,360 --> 04:54:57,000 BRING THEM BACK FOR FOLLOW-UP 6911 04:54:57,000 --> 04:54:58,320 FOR REPEAT COLLECTION OF 6912 04:54:58,320 --> 04:55:00,640 ALLOSTATIC LOAD. 6913 04:55:00,640 --> 04:55:01,680 PRELIMINARY RESULTS IN MY 6914 04:55:01,680 --> 04:55:02,880 RECRUITED PATIENTS TO DATE FOR 6915 04:55:02,880 --> 04:55:05,880 PAIN AND FOR HEALTHY CONTROLS 6916 04:55:05,880 --> 04:55:06,600 OBVIOUSLY INTERPRETED WITH 6917 04:55:06,600 --> 04:55:08,680 CAUTION BUT SHOW THAT YOUTH WITH 6918 04:55:08,680 --> 04:55:11,960 CHRONIC PAIN ON AVERAGE ENDORSE 6919 04:55:11,960 --> 04:55:13,200 OVERWHELMINGLY MUCH HIGHER RATE 6920 04:55:13,200 --> 04:55:17,440 OF TRAUMATIC EVENT EXPOSURE THAN 6921 04:55:17,440 --> 04:55:18,520 HEALTHY CONTROLS. 6922 04:55:18,520 --> 04:55:20,120 PRELIMINARY IMAGING ANALYSES IN 6923 04:55:20,120 --> 04:55:21,400 RESTING STATE ALSO FOUND 6924 04:55:21,400 --> 04:55:25,160 SIGNIFICANT DIFFERENCES IN THE 6925 04:55:25,160 --> 04:55:27,920 PERIHIPPOCAMPAL GYRATION AND 6926 04:55:27,920 --> 04:55:29,360 LEFT HIPPOCAMPUS, SO INTERESTING 6927 04:55:29,360 --> 04:55:29,840 PRELIMINARY RESULTS. 6928 04:55:29,840 --> 04:55:31,200 SIGNIFICANCE OF THESE FINDINGS 6929 04:55:31,200 --> 04:55:33,520 SHOW THAT EVIDENCE OF ALLOSTATIC 6930 04:55:33,520 --> 04:55:36,120 LOAD RISK FACTORS AND FUNCTIONAL 6931 04:55:36,120 --> 04:55:37,200 CONNECTIVITY MAY BE IMPORTANT TO 6932 04:55:37,200 --> 04:55:39,000 LOOK AT AND WOULD OFFER STRONG 6933 04:55:39,000 --> 04:55:41,440 SUPPORT FOR TARGETING THE 6934 04:55:41,440 --> 04:55:42,320 PHYSIOLOGICAL RESPONSE FOR USING 6935 04:55:42,320 --> 04:55:43,440 A MIND-BODY APPROACH. 6936 04:55:43,440 --> 04:55:47,680 THANK YOU. 6937 04:55:47,680 --> 04:55:52,240 >> MY A VISITING FELLOW IN THE 6938 04:55:52,240 --> 04:55:53,040 DEPARTMENT OF PERIOPERATIVE 6939 04:55:53,040 --> 04:55:53,560 MEDICINE. 6940 04:55:53,560 --> 04:55:55,360 ON THE BASIC SIDE OUR LAB IS 6941 04:55:55,360 --> 04:55:57,040 INTERESTED IN THE MOLECULAR 6942 04:55:57,040 --> 04:55:59,160 MECHANISMS UNDERLYING ACUTE AND 6943 04:55:59,160 --> 04:55:59,880 CHRONIC PAIN. 6944 04:55:59,880 --> 04:56:02,480 ON THE CLINICAL SIDE, WE FOCUS 6945 04:56:02,480 --> 04:56:04,600 ON OTHER TREATMENTS FOR RELIEF 6946 04:56:04,600 --> 04:56:07,000 OF REFRACTORY PAIN. 6947 04:56:07,000 --> 04:56:12,560 INJURY INDUCED NEUROPA TICK NEWN 6948 04:56:12,560 --> 04:56:20,280 PROBLEMS FALL INTO THIS CLASS. 6949 04:56:20,280 --> 04:56:23,040 MORTON'S NEUROMA IS A HIGHLY 6950 04:56:23,040 --> 04:56:24,680 LOCALIZED LESION IN THE BOTTOM 6951 04:56:24,680 --> 04:56:26,440 OF THE FOOTWEAR THE NERVE IS 6952 04:56:26,440 --> 04:56:27,640 NATURALLY EXPOSED TO REPEATED 6953 04:56:27,640 --> 04:56:29,320 MECHANICAL STRESS. 6954 04:56:29,320 --> 04:56:31,920 WHICH CAN BE AGGRAVATED BY 6955 04:56:31,920 --> 04:56:35,080 ENGAGING HIGH IMPACT SPORTS, 6956 04:56:35,080 --> 04:56:36,720 POOR FOOTWEAR CHOICES. 6957 04:56:36,720 --> 04:56:38,200 IN SOME INDIVIDUALS, THIS LEADS 6958 04:56:38,200 --> 04:56:42,840 TO AXONAL DAMAGE, ENLARGEMENT TO 6959 04:56:42,840 --> 04:56:44,240 FORM A NEUROMA. 6960 04:56:44,240 --> 04:56:46,600 WE DESIGNED A CLINICAL TRIAL TO 6961 04:56:46,600 --> 04:56:48,280 TREAT MORTON'S NEUROMA PATIENTS 6962 04:56:48,280 --> 04:56:50,240 WITH REFRACTORY PAIN AFTER 6963 04:56:50,240 --> 04:56:52,760 NON-SURGICAL PROCEDURES. 6964 04:56:52,760 --> 04:56:58,800 THE POTENTIAL KEY SET OF 6965 04:56:58,800 --> 04:56:59,480 NOCICEPTIVE -- TRIP V1. 6966 04:56:59,480 --> 04:57:02,160 WE KNOW FROM ANIMAL STUDIES AND 6967 04:57:02,160 --> 04:57:05,280 OTHER CLINICAL TRIALS THAT A 6968 04:57:05,280 --> 04:57:06,680 ONE-TIME INJECTION OF RTX LEADS 6969 04:57:06,680 --> 04:57:09,160 TO A LONG LASTING PAIN 6970 04:57:09,160 --> 04:57:10,160 REDUCTION. 6971 04:57:10,160 --> 04:57:13,080 RTX IS A VERY OLD REMEDY DIRECT 6972 04:57:13,080 --> 04:57:19,920 FROM THE PLANT -- RTX EXPOSURE 6973 04:57:19,920 --> 04:57:22,880 LEADS TO OVERFLOW INTO FIBERS 6974 04:57:22,880 --> 04:57:25,040 AND CONDUCTION BLOCK THAT LASTS 6975 04:57:25,040 --> 04:57:27,400 AT LEAST SEVERAL MONTHS. 6976 04:57:27,400 --> 04:57:29,640 THIS IS SELECTIVE AND DOES NOT 6977 04:57:29,640 --> 04:57:31,520 AFFECT MECHANICAL SENSATIONS OR 6978 04:57:31,520 --> 04:57:33,720 MOTOR FUNCTION. 6979 04:57:33,720 --> 04:57:37,080 WE ALSO AIM TO UNDERSTAND THE 6980 04:57:37,080 --> 04:57:39,040 UNDERLYING PATHOPHYSIOLOGY TO 6981 04:57:39,040 --> 04:57:40,040 ESTABLISH COLLABORATION WITH 6982 04:57:40,040 --> 04:57:41,560 LOCAL PODIATRISTS THAT PROVIDE 6983 04:57:41,560 --> 04:57:43,560 US WITH SURGICAL SPECIMENS OF 6984 04:57:43,560 --> 04:57:46,680 THE NEUROMA. 6985 04:57:46,680 --> 04:57:49,240 THIS ALLOWS US TO STUDY IN 6986 04:57:49,240 --> 04:57:51,040 COMPARISON TO HEALTHY NERVE 6987 04:57:51,040 --> 04:57:53,360 FIBERS AND POTENTIALLY IDENTIFY 6988 04:57:53,360 --> 04:57:54,400 ADDITIONAL PHARMACOLOGICAL 6989 04:57:54,400 --> 04:57:57,280 TARGETS FOR PAIN TREATMENT. 6990 04:57:57,280 --> 04:57:58,480 IN COLLABORATION WITH THE PAIN 6991 04:57:58,480 --> 04:57:59,880 RESEARCH CENTER, WE CHARACTERIZE 6992 04:57:59,880 --> 04:58:01,960 THE SENSORY PROFILES OF PATIENTS 6993 04:58:01,960 --> 04:58:03,720 WITH MORTON'S NEUROMA BY 6994 04:58:03,720 --> 04:58:05,320 APPLYING A COMPREHENSIVE SET OF 6995 04:58:05,320 --> 04:58:07,160 MECHANICAL AND THERMAL 6996 04:58:07,160 --> 04:58:07,720 SOMATOSENSORY TESTS. 6997 04:58:07,720 --> 04:58:10,040 THESE TESTS WILL NOT ONLY REVEAL 6998 04:58:10,040 --> 04:58:11,560 HOW PATIENTS WITH MORTON'S 6999 04:58:11,560 --> 04:58:13,800 NEUROMA PERCEIVE DIFFERENT 7000 04:58:13,800 --> 04:58:15,520 SENSORY STIMULI BUT ALSO PROVIDE 7001 04:58:15,520 --> 04:58:17,360 SAFETY AND EFFICACY OUT COME 7002 04:58:17,360 --> 04:58:18,760 MEASURES OF CLINICAL TRIAL. 7003 04:58:18,760 --> 04:58:19,760 WE THINK THAT THE KNOWLEDGE WE 7004 04:58:19,760 --> 04:58:27,160 GATHER FROM THIS PROJECT WILL BE 7005 04:58:27,160 --> 04:58:28,040 APPLICABLE -- POTENTIALLY 7006 04:58:28,040 --> 04:58:28,840 RELIEVE THESE PATIENTS' PAIN. 7007 04:58:28,840 --> 04:58:32,320 THANK YOU. 7008 04:58:32,320 --> 04:58:33,520 THANKS TO ALL THE PEOPLE 7009 04:58:33,520 --> 04:58:39,240 INVOLVED IN THIS PROJECT. 7010 04:58:39,240 --> 04:58:40,280 >> ALL RIGHT, THANK YOU, 7011 04:58:40,280 --> 04:58:41,160 EVERYONE, FOR THOSE 7012 04:58:41,160 --> 04:58:41,520 PRESENTATIONS. 7013 04:58:41,520 --> 04:58:44,000 IF YOU WOULD ALL TURN ON YOUR 7014 04:58:44,000 --> 04:58:48,640 CAMERAS NOW, WE CAN GO TO A FEW 7015 04:58:48,640 --> 04:58:50,680 QUESTIONS. 7016 04:58:50,680 --> 04:58:58,840 THE FIRST QUESTION I HAVE IS FOR 7017 04:58:58,840 --> 04:59:01,080 DR. JAR MAN, ONLY ASSOCIATED 7018 04:59:01,080 --> 04:59:03,440 WITH OPIOIDS OR WITH OTHER 7019 04:59:03,440 --> 04:59:04,480 ANALGESICS POTENTIALLY HAVE A 7020 04:59:04,480 --> 04:59:07,280 SIMILAR EFFECT? 7021 04:59:07,280 --> 04:59:08,880 >> SO I WOULD SAY THE SHORT 7022 04:59:08,880 --> 04:59:13,680 ANSWER IS WE DON'T KNOW. 7023 04:59:13,680 --> 04:59:15,080 LIKELY WE WOULD SEE A SIMILAR 7024 04:59:15,080 --> 04:59:18,560 BENEFICIAL EFFECT, THE BENEFIT 7025 04:59:18,560 --> 04:59:21,400 IS FROM MANAGING THE PAIN. 7026 04:59:21,400 --> 04:59:22,880 CURRENTLY THERE ARE NO 7027 04:59:22,880 --> 04:59:24,160 ALTERNATIVES AVAILABLE FOR 7028 04:59:24,160 --> 04:59:25,800 MANAGEMENT OF THAT TYPE OF 7029 04:59:25,800 --> 04:59:28,480 SEVERE ACUTE PAIN FROM SOMETHING 7030 04:59:28,480 --> 04:59:32,440 LIKE A HIP FRACTURE: THE 7031 04:59:32,440 --> 04:59:34,320 OPTIONS ARE IBUPROFEN AND 7032 04:59:34,320 --> 04:59:36,960 USUALLY FENTANYL. 7033 04:59:36,960 --> 04:59:37,440 >> GREAT. 7034 04:59:37,440 --> 04:59:38,520 THANK YOU. 7035 04:59:38,520 --> 04:59:40,120 IN A FOLLOW-UP QUESTION, THE 7036 04:59:40,120 --> 04:59:42,520 MAJORITY OF THE PEOPLE IN YOUR 7037 04:59:42,520 --> 04:59:44,000 STUDY WERE WHITE FEMALES. 7038 04:59:44,000 --> 04:59:45,920 CAN YOU COMMENT ABOUT WHETHER 7039 04:59:45,920 --> 04:59:47,360 YOU EXPECT YOUR RESULTS TO 7040 04:59:47,360 --> 04:59:51,760 GENERALIZE TO OTHER POPULATIONS? 7041 04:59:51,760 --> 04:59:54,680 >> SO THE POPULATION, IT IS 7042 04:59:54,680 --> 04:59:56,000 PRIMARILY WHITE FEMALES, IS 7043 04:59:56,000 --> 04:59:56,920 ACTUALLY FAIRLY REPRESENTATIVE 7044 04:59:56,920 --> 04:59:58,600 OF THE POPULATION EXPERIENCING 7045 04:59:58,600 --> 05:00:03,880 THESE INJURIES AT THAT AGE 7046 05:00:03,880 --> 05:00:04,200 RANGE. 7047 05:00:04,200 --> 05:00:05,560 I DON'T HAVE ANY REASON TO 7048 05:00:05,560 --> 05:00:08,000 BELIEVE THE EFFECTS WOULD BE 7049 05:00:08,000 --> 05:00:08,280 DIFFERENT. 7050 05:00:08,280 --> 05:00:09,360 THE ONLY MECHANISMS I CAN REALLY 7051 05:00:09,360 --> 05:00:12,720 THINK OF WOULD BE VARIATION IN 7052 05:00:12,720 --> 05:00:14,800 KIND OF PROFILE OF 7053 05:00:14,800 --> 05:00:15,440 COMORBIDITIES. 7054 05:00:15,440 --> 05:00:16,480 ONE IN PARTICULAR BEING PEOPLE 7055 05:00:16,480 --> 05:00:19,280 WHO MIGHT BE IN THE EARLY STAGES 7056 05:00:19,280 --> 05:00:28,600 OF COGNITIVE DECLINE AND 7057 05:00:28,600 --> 05:00:30,360 EXPOSURE MIGHT -- DEMENTIA. 7058 05:00:30,360 --> 05:00:31,840 AT THE SAME TIME EXPOSURE TO 7059 05:00:31,840 --> 05:00:34,840 PAIN MAY ALSO PRECIPITATE THEIR 7060 05:00:34,840 --> 05:00:36,440 DEMENTIA, SO IT WOULD BE GREAT 7061 05:00:36,440 --> 05:00:40,000 TO HAVE ACCESS TO DATA WITH A 7062 05:00:40,000 --> 05:00:41,640 RICHER DEMOGRAPHIC PROFILE. 7063 05:00:41,640 --> 05:00:42,480 >> GREAT, THANK YOU. 7064 05:00:42,480 --> 05:00:46,640 AND THANK YOU FOR YOUR 7065 05:00:46,640 --> 05:00:47,280 PRESENTATION. 7066 05:00:47,280 --> 05:00:53,160 THE NEXT QUESTION WE HAVE IS FOR 7067 05:00:53,160 --> 05:00:53,360 DR. LOR. 7068 05:00:53,360 --> 05:00:54,600 THERE WAS A COMMENT, THE INFO 7069 05:00:54,600 --> 05:00:55,240 GRAPHICS ARE GREAT. 7070 05:00:55,240 --> 05:00:56,760 AND WHEN LANGUAGE IS LESS OF A 7071 05:00:56,760 --> 05:00:58,280 BARRIER, ARE THERE 7072 05:00:58,280 --> 05:00:59,800 RECOMMENDATIONS FOR IMPROVING 7073 05:00:59,800 --> 05:01:01,920 VERBAL REPORT TOOLS, ESPECIALLY 7074 05:01:01,920 --> 05:01:05,120 IN CASES WHEN A VISUAL DOESN'T 7075 05:01:05,120 --> 05:01:05,360 SUFFICE? 7076 05:01:05,360 --> 05:01:08,480 >> THAT'S A REALLY AWESOME 7077 05:01:08,480 --> 05:01:10,080 QUESTION THAT I THINK I DON'T 7078 05:01:10,080 --> 05:01:12,040 HAVE THE ANSWER TO, BUT I CAN 7079 05:01:12,040 --> 05:01:15,960 KIND OF DRAW ON MY CURRENT 7080 05:01:15,960 --> 05:01:17,280 KNOWLEDGE JUST LOOKING AT THE 7081 05:01:17,280 --> 05:01:18,040 LITERATURE. 7082 05:01:18,040 --> 05:01:22,520 I THINK IN TERMS OF TOOLS IN 7083 05:01:22,520 --> 05:01:23,720 GENERAL FOR PAIN ASSESSMENT, 7084 05:01:23,720 --> 05:01:26,680 THERE'S BEEN A LOT OF WORK DONE 7085 05:01:26,680 --> 05:01:28,720 WITH PAIN SEVERITY TOOLS, SO 7086 05:01:28,720 --> 05:01:32,600 YOU'LL GET THE SMILEY FACES, 7087 05:01:32,600 --> 05:01:34,280 REVISED FACE THAT COULD BE USED 7088 05:01:34,280 --> 05:01:36,040 FOR PAIN INTENSITY, BUT I THINK 7089 05:01:36,040 --> 05:01:40,320 ONE OF MY RECOMMENDATIONS FOR 7090 05:01:40,320 --> 05:01:41,720 IMPROVING VERBAL REPORT TOOL IS 7091 05:01:41,720 --> 05:01:42,760 TO DO MORE RESEARCH, BECAUSE THE 7092 05:01:42,760 --> 05:01:44,440 EXISTING RESEARCH HAVE ALWAYS 7093 05:01:44,440 --> 05:01:46,600 BEEN JUST TRANSLATING INTO 7094 05:01:46,600 --> 05:01:52,520 ANOTHER LANGUAGE AND THEN AROUND 7095 05:01:52,520 --> 05:01:53,520 TESTING IT WITH THE POPULATION 7096 05:01:53,520 --> 05:01:55,680 BUT NOT REALLY GROUNDED FROM THE 7097 05:01:55,680 --> 05:01:56,480 PATIENT'S PERSPECTIVE UP. 7098 05:01:56,480 --> 05:01:59,080 SO I THINK THERE NEEDS TO BE 7099 05:01:59,080 --> 05:02:02,160 SOME MORE RESEARCH DONE TO MAKE 7100 05:02:02,160 --> 05:02:04,520 SURE THAT PAIN INFORMATION ARE 7101 05:02:04,520 --> 05:02:06,480 COLLECTED ACCURATELY, 7102 05:02:06,480 --> 05:02:07,240 PARTICULARLY FOR VERBAL. 7103 05:02:07,240 --> 05:02:10,600 I THINK ONE OF THE 7104 05:02:10,600 --> 05:02:12,560 RECOMMENDATIONS DRAWING FROM 7105 05:02:12,560 --> 05:02:15,240 SOME OF THE HEALTH LITERACY -- 7106 05:02:15,240 --> 05:02:19,280 IS TO USELESS USE LESS JARGN 7107 05:02:19,280 --> 05:02:21,360 YOU'RE TRYING TO ASSESS PAIN AND 7108 05:02:21,360 --> 05:02:22,520 GET THE INFORMATION FROM 7109 05:02:22,520 --> 05:02:23,560 PATIENTS, AS WELL AS VISUAL, 7110 05:02:23,560 --> 05:02:24,560 BECAUSE I KNOW THAT WORKS VERY 7111 05:02:24,560 --> 05:02:28,040 WELL, BUT OF COURSE YOU'RE 7112 05:02:28,040 --> 05:02:28,920 COMMENTING ABOUT WHEN VISUAL 7113 05:02:28,920 --> 05:02:29,520 DOESN'T WORK. 7114 05:02:29,520 --> 05:02:32,960 SO I RO RECOMMEND WOULD E 7115 05:02:32,960 --> 05:02:35,040 PROVIDERS REALLY TRY NOT TO USE 7116 05:02:35,040 --> 05:02:37,560 JARGON AND PROVIDE EXAMPLES TO 7117 05:02:37,560 --> 05:02:39,440 TALK WITH PATIENTS IN EXCESSIVE 7118 05:02:39,440 --> 05:02:39,880 PAIN. 7119 05:02:39,880 --> 05:02:43,040 I HOPE THAT ANSWERS YOUR 7120 05:02:43,040 --> 05:02:46,000 QUESTION. 7121 05:02:46,000 --> 05:02:52,040 >> HOW CAN YOUR VISH VAITION YON 7122 05:02:52,040 --> 05:02:54,920 TOOL BE WIDELY IMPLEMENTED 7123 05:02:54,920 --> 05:02:57,480 ACROSS SITES AND DOES IT REQUIRE 7124 05:02:57,480 --> 05:02:57,720 TRAINING? 7125 05:02:57,720 --> 05:02:58,680 >> YES, THAT'S A GREAT QUESTION 7126 05:02:58,680 --> 05:02:59,800 AS WELL. 7127 05:02:59,800 --> 05:03:01,280 WHAT WE HAVE -- ONE UNIQUE THING 7128 05:03:01,280 --> 05:03:07,360 ABOUT THIS TOOL THAT WE REALLY 7129 05:03:07,360 --> 05:03:09,240 TRIED TO DO IS CREATE A 7130 05:03:09,240 --> 05:03:16,280 METHODOLOGY THAT WE CAN 7131 05:03:16,280 --> 05:03:17,400 POTENTIALLY REPEAT TO CREATE THE 7132 05:03:17,400 --> 05:03:18,560 VISUALS THAT WOULD WORK FOR 7133 05:03:18,560 --> 05:03:18,760 THEM. 7134 05:03:18,760 --> 05:03:20,840 WE HAVE ALSO INVOLVED PROVIDERS 7135 05:03:20,840 --> 05:03:23,720 IN THE PROCESS WHICH I DIDN'T 7136 05:03:23,720 --> 05:03:27,760 REPORT ON BUT TO GIVE US 7137 05:03:27,760 --> 05:03:29,080 FEEDBACK ON WHAT ARE THE MOST 7138 05:03:29,080 --> 05:03:30,480 IMPORTANT PAIN QUALITIES THAT 7139 05:03:30,480 --> 05:03:31,920 THEY PRIORITIZE IN ASSESSING 7140 05:03:31,920 --> 05:03:32,240 PAIN. 7141 05:03:32,240 --> 05:03:39,120 SO WE DID INCLUDE THEM. 7142 05:03:39,120 --> 05:03:43,360 >> ANOTHER QUESTION, DR. LOR, 7143 05:03:43,360 --> 05:03:49,640 YOUR -- ON A -- WHAT THOUGHTS DO 7144 05:03:49,640 --> 05:03:53,680 YOU HAVE ABOUT SYSTEMATICALLY -- 7145 05:03:53,680 --> 05:03:54,800 AWARENESS AND PAIN IN DIFFERENT 7146 05:03:54,800 --> 05:03:59,040 CULTURES AND DO YOU PLAN TO 7147 05:03:59,040 --> 05:04:00,240 PROMOTE OR -- THESE TOOLS SO 7148 05:04:00,240 --> 05:04:01,520 THEY CAN BE USED THROUGHOUT THE 7149 05:04:01,520 --> 05:04:03,120 U.S. IN HOSPITALS AND CLINICS? 7150 05:04:03,120 --> 05:04:04,280 >> YEAH, DEFINITELY. 7151 05:04:04,280 --> 05:04:06,720 THAT'S A REALLY GOOD QUESTION. 7152 05:04:06,720 --> 05:04:07,840 AS YOU'VE MENTIONED, YOU KNOW, 7153 05:04:07,840 --> 05:04:10,400 PAIN IS EXPRESSED DIFFERENTLY 7154 05:04:10,400 --> 05:04:11,560 ACROSS CULTURE, AND I'M 7155 05:04:11,560 --> 05:04:13,600 CURRENTLY DOING A SYSTEMATIC 7156 05:04:13,600 --> 05:04:16,080 REVIEW NOW TO LOOK AT HOW PAIN 7157 05:04:16,080 --> 05:04:17,880 IS BEING EXPRESSED, SPECIFICALLY 7158 05:04:17,880 --> 05:04:20,280 FOR POPULATION WITH LIMITED AGE 7159 05:04:20,280 --> 05:04:22,000 PROFICIENCY BECAUSE I FEEL THAT 7160 05:04:22,000 --> 05:04:23,120 THEY HAVE BEEN LEFT OUT OF THE 7161 05:04:23,120 --> 05:04:25,080 PAIN CONVERSATION. 7162 05:04:25,080 --> 05:04:26,600 SO FAR THERE'S NOT A LOT OF 7163 05:04:26,600 --> 05:04:28,200 RESEARCH DONE IN THAT AND NOT A 7164 05:04:28,200 --> 05:04:30,240 LOT OF TOOLS THAT HAVE BEEN 7165 05:04:30,240 --> 05:04:37,720 CO-CREATED WITH THE POPULATION. 7166 05:04:37,720 --> 05:04:39,440 I'M REALLY HOPING THE WORK WE'VE 7167 05:04:39,440 --> 05:04:41,400 STARTED FOR THIS K CAN BE A ROAD 7168 05:04:41,400 --> 05:04:43,040 MAP TO REALLY EXPAND TO OTHER 7169 05:04:43,040 --> 05:04:46,120 POPULATIONS AND TO MAKE IT MORE 7170 05:04:46,120 --> 05:04:47,480 ACCESSIBLE TO DIFFERENT PATIENT 7171 05:04:47,480 --> 05:04:50,760 POPULATION AND CLINICIANS TO 7172 05:04:50,760 --> 05:04:54,720 USE. 7173 05:04:54,720 --> 05:04:55,960 WE'RE PILOT TESTING IT RIGHT NOW 7174 05:04:55,960 --> 05:04:57,920 SO I CAN'T GIVE YOU WHAT THE 7175 05:04:57,920 --> 05:04:58,880 EFFECTIVENESS IS BUT I'M HOPING 7176 05:04:58,880 --> 05:05:00,520 THAT WILL BE THE ULTIMATE GOAL 7177 05:05:00,520 --> 05:05:01,640 IN THE NEXT FIVE YEARS TO 7178 05:05:01,640 --> 05:05:02,440 IMPLEMENT IT AND TO MAKE SURE WE 7179 05:05:02,440 --> 05:05:05,520 CAN EXPAND TO OTHER POPULATIONS. 7180 05:05:05,520 --> 05:05:06,960 >> THANK YOU SO MUCH, AND AGAIN, 7181 05:05:06,960 --> 05:05:09,280 THANK YOU FOR YOUR PRESENTATION. 7182 05:05:09,280 --> 05:05:12,960 I HAVE A QUESTION HERE FOR 7183 05:05:12,960 --> 05:05:13,360 DR. LOSIN. 7184 05:05:13,360 --> 05:05:14,960 AT THE END OF YOUR TALK, YOU 7185 05:05:14,960 --> 05:05:16,920 MENTIONED A TARGET FOR 7186 05:05:16,920 --> 05:05:17,240 INTERVENTION. 7187 05:05:17,240 --> 05:05:20,600 CAN YOU EXPAND ON THAT? 7188 05:05:20,600 --> 05:05:24,520 >> YEAH, SO THE IDEA WOULD BE 7189 05:05:24,520 --> 05:05:25,960 IF -- YOU KNOW, THESE 7190 05:05:25,960 --> 05:05:28,280 PRELIMINARY DATA SUGGEST THAT AT 7191 05:05:28,280 --> 05:05:29,560 LEAST SOMETIMES CLINICIANS MAY 7192 05:05:29,560 --> 05:05:34,080 BE RELYING MORE ON THEIR STEREO 7193 05:05:34,080 --> 05:05:36,040 TIME TYPES ABOUT A PATIENT'S 7194 05:05:36,040 --> 05:05:37,400 DEMOGRAPHICS, THE TYPICAL PERSON 7195 05:05:37,400 --> 05:05:38,840 FROM THAT PATIENT'S DEMOGRAPHIC 7196 05:05:38,840 --> 05:05:40,120 GROUP, VERSUS THE INFORMATION 7197 05:05:40,120 --> 05:05:41,680 THE PATIENT IS PROVIDING ABOUT 7198 05:05:41,680 --> 05:05:46,280 THEIR OWN PAIN. 7199 05:05:46,280 --> 05:05:47,840 SO WE ARE ULTIMATELY HOPING TO 7200 05:05:47,840 --> 05:05:48,880 INFORM AND INTERVENTION AND 7201 05:05:48,880 --> 05:05:50,120 ACTUALLY TEST IT BASED ON THESE 7202 05:05:50,120 --> 05:05:50,480 DATA. 7203 05:05:50,480 --> 05:05:54,680 BUT THE IDEA WOULD BE SOMETHING 7204 05:05:54,680 --> 05:05:56,360 THAT HELPS CLINICIANS TO SHIFT 7205 05:05:56,360 --> 05:05:57,280 THEIR FOCUS TO THE INFORMATION 7206 05:05:57,280 --> 05:05:59,120 THAT THE PATIENTS ARE PROVIDING 7207 05:05:59,120 --> 05:06:00,840 THEM TO VALUE THAT MORE OR 7208 05:06:00,840 --> 05:06:05,880 WEIGHT IT MORE HEAVILY IN THEIR 7209 05:06:05,880 --> 05:06:08,440 PAIN ASSESSMENT AND TREATMENT 7210 05:06:08,440 --> 05:06:09,040 DECISION-MAKING PROCESS. 7211 05:06:09,040 --> 05:06:11,960 SO WHAT IS, WE HAVEN'T GOTTEN 7212 05:06:11,960 --> 05:06:12,240 THERE YET. 7213 05:06:12,240 --> 05:06:12,680 >> GREAT. 7214 05:06:12,680 --> 05:06:15,360 THANK YOU. 7215 05:06:15,360 --> 05:06:17,000 THE NEXT QUESTION IS FOR 7216 05:06:17,000 --> 05:06:18,520 DR. NELSON AND THE QUESTION IS, 7217 05:06:18,520 --> 05:06:21,520 DOES THE MIND-BODY APPROACH 7218 05:06:21,520 --> 05:06:24,600 DEPEND ON THE AGE OF THE 7219 05:06:24,600 --> 05:06:34,760 PATIENT? 7220 05:06:39,120 --> 05:06:40,000 YOU'RE MUTED. 7221 05:06:40,000 --> 05:06:40,600 >> SORRY ABOUT THAT. 7222 05:06:40,600 --> 05:06:42,880 CAN YOU REPEAT THAT? 7223 05:06:42,880 --> 05:06:44,840 >> THE QUESTION WAS, DOES THE 7224 05:06:44,840 --> 05:06:46,080 MIND-BODY APPROACH DEPEND ON THE 7225 05:06:46,080 --> 05:06:48,000 AGE OF THE PATIENT? 7226 05:06:48,000 --> 05:06:49,680 SO I THINK ESPECIALLY IN A 7227 05:06:49,680 --> 05:06:52,400 PEDIATRIC POPULATION, THERE'S 7228 05:06:52,400 --> 05:06:53,520 JUST A BROAD RANGE IN THE 7229 05:06:53,520 --> 05:06:57,680 OVERALL DEVELOPMENT TO THE STAGE 7230 05:06:57,680 --> 05:06:59,400 OF THE PATIENT AND DOES THE 7231 05:06:59,400 --> 05:07:00,240 APPROACH YOU TAKE DEPEND ON THE 7232 05:07:00,240 --> 05:07:06,560 AGE? 7233 05:07:06,560 --> 05:07:07,880 >> ABSOLUTELY. 7234 05:07:07,880 --> 05:07:10,000 I MEAN, AS A PSYCHOLOGIST, WE 7235 05:07:10,000 --> 05:07:11,960 DEFINITELY WANT TO CATER THE 7236 05:07:11,960 --> 05:07:13,160 MIND-BODY APPROACH TO THE 7237 05:07:13,160 --> 05:07:14,240 DEVELOPMENTAL LEVEL OF THE 7238 05:07:14,240 --> 05:07:17,120 PATIENT, BUT A LOT OF THESE MORE 7239 05:07:17,120 --> 05:07:18,680 BURGEONING MIND-BODY 7240 05:07:18,680 --> 05:07:19,880 INTERVENTIONS LIKE MINDFULNESS 7241 05:07:19,880 --> 05:07:21,080 BASED STRESS REDUCTION ACT, 7242 05:07:21,080 --> 05:07:22,600 THINGS LIKE THAT, CAN BE CATERED 7243 05:07:22,600 --> 05:07:25,280 TO ANY NUMBER OF DEMOGRAPHICS, 7244 05:07:25,280 --> 05:07:26,960 ANY NUMBER OF AGE RANGES 7245 05:07:26,960 --> 05:07:27,920 DEPENDING ON THE PRESENTING 7246 05:07:27,920 --> 05:07:30,480 PROBLEM. 7247 05:07:30,480 --> 05:07:32,120 >> AND THERE'S A FOLLOW-UP 7248 05:07:32,120 --> 05:07:32,920 QUESTION THAT SAYS YOU TALKED 7249 05:07:32,920 --> 05:07:34,640 ABOUT DIFFERENT MEASURES OF 7250 05:07:34,640 --> 05:07:35,200 ALLOSTATIC LOADS. 7251 05:07:35,200 --> 05:07:36,560 WHAT ARE THE PROS AND CONS FOR 7252 05:07:36,560 --> 05:07:38,800 THOSE MEASURES, AND WHAT ARE THE 7253 05:07:38,800 --> 05:07:40,200 CONSIDERATIONS FOR TIMING THESE 7254 05:07:40,200 --> 05:07:50,440 MEASUREMENTS? 7255 05:07:56,960 --> 05:07:59,520 >> I THINK ALLOSTATIC LOAD IS A 7256 05:07:59,520 --> 05:08:01,000 STILL AN UP AND COMING MEASURE. 7257 05:08:01,000 --> 05:08:03,040 THINK THE BASELINE IS YOU NEED 7258 05:08:03,040 --> 05:08:06,560 TO HAVE A MULTIFACTORIAL -- 7259 05:08:06,560 --> 05:08:08,000 LOOKING AT DIFFERENT TYPES OF 7260 05:08:08,000 --> 05:08:10,160 PHYSIOLOGICAL FUNCTIONING TO 7261 05:08:10,160 --> 05:08:12,240 KIND OF ACCUMULATE THAT RISK FOR 7262 05:08:12,240 --> 05:08:12,760 ALLOSTATIC LOAD. 7263 05:08:12,760 --> 05:08:16,800 THE PROS AND CONS ARE JUST 7264 05:08:16,800 --> 05:08:18,720 LACKING AT DIFFERENT KINDS OF 7265 05:08:18,720 --> 05:08:19,600 DEMOGRAPHICS, RISK 7266 05:08:19,600 --> 05:08:20,640 STRATIFICATIONS, THERE'S BEEN 7267 05:08:20,640 --> 05:08:24,840 SOME GOOD STUDIES COMING OUT 7268 05:08:24,840 --> 05:08:26,440 LOOKING AT PEOPLE IN DIFFERENT 7269 05:08:26,440 --> 05:08:27,640 NEIGHBORHOODS, DIFFERENT 7270 05:08:27,640 --> 05:08:28,080 SOCIOECONOMIC STATUS. 7271 05:08:28,080 --> 05:08:29,880 I THINK THERE'S A LOT OF 7272 05:08:29,880 --> 05:08:30,840 CONFOUNDING FACTORS THAT COULD 7273 05:08:30,840 --> 05:08:33,040 BE TAKEN INTO ACCOUNT THERE, BUT 7274 05:08:33,040 --> 05:08:34,720 WE'RE REALLY EXCITED ABOUT WHERE 7275 05:08:34,720 --> 05:08:36,120 THE FIELD IS GOING AND LOOKING 7276 05:08:36,120 --> 05:08:44,000 AT THIS IN THE CONTEXT OF PAIN. 7277 05:08:44,000 --> 05:08:44,720 >> GREAT, THANK YOU. 7278 05:08:44,720 --> 05:08:49,480 WE HAVE A QUESTION FOR 7279 05:08:49,480 --> 05:08:49,960 DR. STAEDTLER. 7280 05:08:49,960 --> 05:08:51,920 FIRST IS WHAT ARE THE SIDE 7281 05:08:51,920 --> 05:08:53,120 EFFECTS AND HOW LONG AFTER 7282 05:08:53,120 --> 05:08:54,280 INJECTION BEFORE YOU CAN WALK? 7283 05:08:54,280 --> 05:08:56,040 AND ALSO ARE MANY PEOPLE 7284 05:08:56,040 --> 05:08:56,680 ALLERGIC? 7285 05:08:56,680 --> 05:08:59,440 >> SO I'LL START WITH THE LAST 7286 05:08:59,440 --> 05:09:00,040 QUESTION. 7287 05:09:00,040 --> 05:09:01,600 NO, NOT MANY PEOPLE ARE ALLERGIC 7288 05:09:01,600 --> 05:09:04,960 TO RTX, IT'S A CAP SIGH SIN 7289 05:09:04,960 --> 05:09:05,960 ANALOG THAT HAS BEEN USED IN 7290 05:09:05,960 --> 05:09:08,280 MANY DOZENS OF PEOPLE WITH 7291 05:09:08,280 --> 05:09:10,960 DIFFERENT ROUTES OF 7292 05:09:10,960 --> 05:09:12,840 ADMINISTRATION, INTRATHECALLY OR 7293 05:09:12,840 --> 05:09:14,720 INJECTIONS EPIDURALLY, AND THERE 7294 05:09:14,720 --> 05:09:17,760 HAS NEVER BEEN A REPORT OF AN 7295 05:09:17,760 --> 05:09:19,760 ANAPHYLACTIC OR ALLERGIC 7296 05:09:19,760 --> 05:09:21,160 REACTION, SO IN THEORY THAT'S 7297 05:09:21,160 --> 05:09:22,160 POSSIBLE BUT HAS NOT BEEN 7298 05:09:22,160 --> 05:09:23,120 OBSERVED SO FAR, SO IT DOESN'T 7299 05:09:23,120 --> 05:09:27,840 SEEM TO BE A STRONG ALLERGEN PER 7300 05:09:27,840 --> 05:09:28,120 SE. 7301 05:09:28,120 --> 05:09:33,640 THE SECOND ONE, THE SIDE EFFECT 7302 05:09:33,640 --> 05:09:36,120 IS IT ACTIVATES NOCICEPTIVE 7303 05:09:36,120 --> 05:09:37,280 FIBERS, HEAT AND PAIN 7304 05:09:37,280 --> 05:09:38,400 TRANSMITTING FIBERS, SO WHEN YOU 7305 05:09:38,400 --> 05:09:39,680 INJECT IT OR YOU EXPOSE YOURSELF 7306 05:09:39,680 --> 05:09:42,160 TO IT, YOU HAVE BURNING PAIN, 7307 05:09:42,160 --> 05:09:45,560 BURNING PAIN SENSATION, WHICH 7308 05:09:45,560 --> 05:09:49,680 CAN BE REDUCED BY INJENGTING A 7309 05:09:49,680 --> 05:09:51,280 LOCAL ANESTHETIC FIRST SO YOU 7310 05:09:51,280 --> 05:09:53,440 HAVE NO PAIN CONDUCTION, IT'S 7311 05:09:53,440 --> 05:09:56,760 BLOCKED, THEN YOU INJECT THE RTX 7312 05:09:56,760 --> 05:09:58,320 AND IN IDEAL CASE, YOU COULD 7313 05:09:58,320 --> 05:10:00,840 HAVE PANT ANYMORE. 7314 05:10:00,840 --> 05:10:01,200 PAIN ANYMORE. 7315 05:10:01,200 --> 05:10:02,400 THAT'S WHAT REAR PLANNING TO DO 7316 05:10:02,400 --> 05:10:04,240 AND ARE CONFIDENT IT CAN WORK. 7317 05:10:04,240 --> 05:10:05,560 IT ONLY AFFECTS A CERTAIN 7318 05:10:05,560 --> 05:10:07,960 SUBPOPULATION OF FIBERS, SO IT 7319 05:10:07,960 --> 05:10:11,720 DOESN'T AFFECT MOTOR FIBERS, SO 7320 05:10:11,720 --> 05:10:13,640 USUALLY RTX ITSELF DOES NOT 7321 05:10:13,640 --> 05:10:15,800 PREVENT WALKING ABILITY, SO THAT 7322 05:10:15,800 --> 05:10:16,920 IS TOTALLY PRESERVED. 7323 05:10:16,920 --> 05:10:18,320 THE LOCAL ANESTHETIC THAT YOU 7324 05:10:18,320 --> 05:10:21,200 WILL INJECT MIGHT LEAD TO A 7325 05:10:21,200 --> 05:10:27,200 LITTLE BIT OF MAYBE -- BUT 7326 05:10:27,200 --> 05:10:28,520 HONESTLY MOTOR FIBERS FOREFOOT 7327 05:10:28,520 --> 05:10:30,600 MUSCLES IN THAT STAGE WHERE THE 7328 05:10:30,600 --> 05:10:31,800 NEUROMA SITS HAVE ALREADY LEFT 7329 05:10:31,800 --> 05:10:37,160 THE NERVE, SO THERE SHOULD BE NO 7330 05:10:37,160 --> 05:10:39,280 MOTOR -- REDUCTION MOTOR 7331 05:10:39,280 --> 05:10:40,840 FUNCTION AT ALL, NOT EVEN FOR 7332 05:10:40,840 --> 05:10:42,520 THE TOES. 7333 05:10:42,520 --> 05:10:44,280 BUT THE RTX PER SE DOES NOT 7334 05:10:44,280 --> 05:10:45,280 AFFECT MOTOR FUNCTION. 7335 05:10:45,280 --> 05:10:46,800 THAT WOULD BE ONLY A SIDE EFFECT 7336 05:10:46,800 --> 05:10:48,960 OF LOCAL ANESTHETIC, IT WOULD BE 7337 05:10:48,960 --> 05:10:51,360 VERY SHORT LASTING. 7338 05:10:51,360 --> 05:10:52,920 ANOTHER EFFECT THAT IS KNOWN 7339 05:10:52,920 --> 05:10:56,960 THAT IT ALSO REDUCES THE 7340 05:10:56,960 --> 05:10:59,360 SENSITIVITY TO NOXIOUS HEAT, SO 7341 05:10:59,360 --> 05:11:02,240 THIS IS A SMALL AREA THAT WILL 7342 05:11:02,240 --> 05:11:06,840 BE NUMB FOR HEAT SENSITIVITY IF 7343 05:11:06,840 --> 05:11:08,560 THE FOREFOOT BUT IF YOU HAVE 7344 05:11:08,560 --> 05:11:09,280 INTRATHECAL APPLICATION, YOU 7345 05:11:09,280 --> 05:11:12,880 HAVE TO WARN PATIENTS THAT THERY 7346 05:11:12,880 --> 05:11:14,040 MIGHT NOT FEEL WHEN THEY STEP 7347 05:11:14,040 --> 05:11:16,280 INTO A HOT BATH, FOR EXAMPLE. 7348 05:11:16,280 --> 05:11:17,760 THAT'S IMPORTANT TO EDUCATE THEM 7349 05:11:17,760 --> 05:11:20,320 ABOUT THIS. 7350 05:11:20,320 --> 05:11:24,000 >> GREAT, THANK YOU. 7351 05:11:24,000 --> 05:11:25,880 HOW IS THE DOSE OF RTX 7352 05:11:25,880 --> 05:11:26,800 DETERMINED THAT YOU'RE USING FOR 7353 05:11:26,800 --> 05:11:27,320 THE STUDY? 7354 05:11:27,320 --> 05:11:29,800 >> HOW IT'S DETERMINED? 7355 05:11:29,800 --> 05:11:35,000 IT WAS INFERRED FROM CLINICAL 7356 05:11:35,000 --> 05:11:38,240 TRIALS, STUDIES WHERE WE USED, 7357 05:11:38,240 --> 05:11:40,120 MY COLLEAGUES USED INJECTION IN 7358 05:11:40,120 --> 05:11:43,200 A NERVE IN THE RAT'S LEG, AND 7359 05:11:43,200 --> 05:11:47,400 THEN LOOK FOR EFFECTS ON 7360 05:11:47,400 --> 05:11:51,720 INFLAMMATION, PAIN, AND SO WE 7361 05:11:51,720 --> 05:11:53,800 USED THE DOSE THAT WAS EFFECTIVE 7362 05:11:53,800 --> 05:11:54,640 IN PRE-CLINICAL TRIALS AS A 7363 05:11:54,640 --> 05:11:56,600 STARTING DOSE AND THEN HAVE LIKE 7364 05:11:56,600 --> 05:11:57,800 FOUR STEPS THAT THEY WILL 7365 05:11:57,800 --> 05:12:01,760 INCREASE THE DOSES. 7366 05:12:01,760 --> 05:12:03,920 IT'S USED IMMENSELY LOW 7367 05:12:03,920 --> 05:12:06,120 CONCENTRATION SO WE START AT 7368 05:12:06,120 --> 05:12:08,200 SOMETHING LIKE 250 NANOGRAMS. 7369 05:12:08,200 --> 05:12:10,040 IT'S A REALLY LOW DOSE THAT'S 7370 05:12:10,040 --> 05:12:12,360 EFFECTIVE. 7371 05:12:12,360 --> 05:12:15,520 AND IF WE ARE POSITIVE THIS WILL 7372 05:12:15,520 --> 05:12:17,040 HAVE AN ANALGESIC EFFECT AND 7373 05:12:17,040 --> 05:12:18,360 WE'RE FAR AWAY FROM ANY DOSE 7374 05:12:18,360 --> 05:12:19,880 THAT WOULD VERY LIKELY HAVE SOME 7375 05:12:19,880 --> 05:12:23,000 SIDE EFFECTS ACTUALLY. 7376 05:12:23,000 --> 05:12:23,840 >> THANK YOU SO MUCH. 7377 05:12:23,840 --> 05:12:30,720 WE HAVE ANOTHER QUESTION FOR DR. 7378 05:12:30,720 --> 05:12:33,080 THE COMMENT SAYS IT'S VERY 7379 05:12:33,080 --> 05:12:34,160 INTERESTING THE ENDORSEMENT OF 7380 05:12:34,160 --> 05:12:36,280 STEREOTYPE BUT NOT TARGET 7381 05:12:36,280 --> 05:12:38,560 DEMOGRAPHICS PREDICTED PERCEIVED 7382 05:12:38,560 --> 05:12:40,160 PAIN INTENSITY THAT THESE 7383 05:12:40,160 --> 05:12:42,480 STEREOTYPES APPLY TO ALL 7384 05:12:42,480 --> 05:12:43,240 CATEGORY, FOR EXAMPLE, FOR WHITE 7385 05:12:43,240 --> 05:12:44,160 PATIENTS IN CONSIDERATION OF 7386 05:12:44,160 --> 05:12:45,840 RACE, OR WERE THEY DRIVEN BY 7387 05:12:45,840 --> 05:12:47,240 STEREOTYPES FOR CERTAIN TARGET 7388 05:12:47,240 --> 05:12:48,800 DEMOGRAPHICS? 7389 05:12:48,800 --> 05:12:50,400 >> THANKS FOR THAT QUESTION. 7390 05:12:50,400 --> 05:12:52,480 SO THE WAY WE HAVE RUN THE SEM 7391 05:12:52,480 --> 05:12:55,840 MODELS SO FAR, IT'S JUST 7392 05:12:55,840 --> 05:12:58,480 PLUGGING IN THAT PARTICIPANT'S 7393 05:12:58,480 --> 05:13:01,640 RATING OF STEREOTYPICAL PAIN 7394 05:13:01,640 --> 05:13:03,480 SENSITIVITY FOR EACH ETHNIC AND 7395 05:13:03,480 --> 05:13:05,520 RACIAL GROUP, AND THEN THAT'S 7396 05:13:05,520 --> 05:13:08,400 PUT IN THE MODEL FOR EVERY 7397 05:13:08,400 --> 05:13:10,520 PATIENT FROM THAT ETHNIC OR 7398 05:13:10,520 --> 05:13:11,280 RACIAL GROUP. 7399 05:13:11,280 --> 05:13:13,360 SO I CAN'T -- WITH THE WAY WE'VE 7400 05:13:13,360 --> 05:13:14,960 DONE THE ANALYSIS SO FAR, I 7401 05:13:14,960 --> 05:13:19,760 CAN'T SAY WHETHER STEREOTYPES 7402 05:13:19,760 --> 05:13:20,920 ABOUT ONE SPECIFIC GROUP ARE 7403 05:13:20,920 --> 05:13:21,840 DRIVING THAT RESULT MORE THAN 7404 05:13:21,840 --> 05:13:24,040 OTHERS, BUT THAT IS DEFINITELY 7405 05:13:24,040 --> 05:13:25,720 THE PLAN FOR THE NEXT STEPS IN 7406 05:13:25,720 --> 05:13:28,680 THE ANALYSIS, BECAUSE CLEARLY 7407 05:13:28,680 --> 05:13:31,680 THAT WELL MAY BE THE CASE. 7408 05:13:31,680 --> 05:13:33,160 SO I DON'T KNOW YET, BUT WE'RE 7409 05:13:33,160 --> 05:13:36,080 GETTING THERE. 7410 05:13:36,080 --> 05:13:38,120 >> THANK YOU. 7411 05:13:38,120 --> 05:13:39,040 AND AS A BROADER QUESTION FOR 7412 05:13:39,040 --> 05:13:40,840 ALL OF THE PANELISTS, THAT IS, 7413 05:13:40,840 --> 05:13:43,640 CAN YOU COMPARE AN 7414 05:13:43,640 --> 05:13:45,160 INTERVENTIONAL TREATMENT LIKE 7415 05:13:45,160 --> 05:13:48,760 WHAT DR. STAEDTLER WAS PROPOSING 7416 05:13:48,760 --> 05:13:49,760 COMPARED TO THE OTHER TYPES OF 7417 05:13:49,760 --> 05:13:52,840 TREATMENTS THAT WERE DISCUSSED 7418 05:13:52,840 --> 05:14:02,640 ON PAIN? 7419 05:14:02,640 --> 05:14:04,200 >> I MEAN, I CAN ADD SOMETHING. 7420 05:14:04,200 --> 05:14:06,120 I THINK AS A PAIN PSYCHOLOGIST, 7421 05:14:06,120 --> 05:14:07,480 ONE OF THE BIG MESSAGES THAT WE 7422 05:14:07,480 --> 05:14:11,160 LIKE TO CONVEY IS THAT CHRONIC 7423 05:14:11,160 --> 05:14:12,360 PAIN ESPECIALLY IS A 7424 05:14:12,360 --> 05:14:15,080 MULTIPRONGED APPROACH, WHERE YOU 7425 05:14:15,080 --> 05:14:17,840 COME AT IT WITH A VARIETY OF 7426 05:14:17,840 --> 05:14:19,960 BOTH KIND OF MEDICAL AND 7427 05:14:19,960 --> 05:14:22,440 PHARMICOLOGICAL, PHYSICAL AND 7428 05:14:22,440 --> 05:14:24,040 MIND-BODY INTERVENTION, FIT TO 7429 05:14:24,040 --> 05:14:25,320 MEET THE NEEDS OF EACH 7430 05:14:25,320 --> 05:14:29,040 INDIVIDUAL PATIENT. 7431 05:14:29,040 --> 05:14:30,200 >> THANK YOU FOR THAT. 7432 05:14:30,200 --> 05:14:31,280 DOES ANYONE ELSE WANT TO 7433 05:14:31,280 --> 05:14:35,800 COMMENT? 7434 05:14:35,800 --> 05:14:38,320 >> I HOPE THAT WAS HELPFUL. 7435 05:14:38,320 --> 05:14:40,920 >> SO IN OUR CASE, WE'RE 7436 05:14:40,920 --> 05:14:41,920 STUDYING CLINICIANS AND THEIR 7437 05:14:41,920 --> 05:14:43,560 PAIN TREATMENT DECISIONS, SO 7438 05:14:43,560 --> 05:14:46,280 WHILE WE'RE NOT INTERVENING 7439 05:14:46,280 --> 05:14:49,560 DIRECTLY ON THE PATIENT'S PAIN, 7440 05:14:49,560 --> 05:14:52,600 I IMAGINE THAT TRAINING 7441 05:14:52,600 --> 05:14:53,400 CLINICIANS DIFFERENTLY TO 7442 05:14:53,400 --> 05:14:54,560 INCREASE THE EFFECTIVENESS OF 7443 05:14:54,560 --> 05:14:55,920 THEIR PAIN MANAGEMENT AND 7444 05:14:55,920 --> 05:14:58,320 DECREASE ANY BIASES THEY MAY 7445 05:14:58,320 --> 05:15:00,080 HAVE WILL OBVIOUSLY HAVE AN 7446 05:15:00,080 --> 05:15:02,400 EFFECT ON PATIENTS' PAIN AND 7447 05:15:02,400 --> 05:15:03,680 HOPEFULLY PARTICULARLY IN 7448 05:15:03,680 --> 05:15:05,680 ALLEVIATING PAIN OF GROUPS THAT 7449 05:15:05,680 --> 05:15:08,600 HAVE HISTORICALLY BEEN RECEIVING 7450 05:15:08,600 --> 05:15:17,640 LESS ADEQUATE TREATMENT. 7451 05:15:17,640 --> 05:15:19,320 >> I CAN SHARE OURS TOOL. 7452 05:15:19,320 --> 05:15:21,720 WITH OUR TOOL, THE GOAL IS TO 7453 05:15:21,720 --> 05:15:22,720 REALLY FACILITATE THAT 7454 05:15:22,720 --> 05:15:24,000 COMMUNICATION SO THAT PROVIDERS 7455 05:15:24,000 --> 05:15:25,080 DON'T NEED TO LEARN THE 7456 05:15:25,080 --> 05:15:26,680 PATIENT'S LANGUAGE OR MENTAL 7457 05:15:26,680 --> 05:15:28,840 MODEL OF HOW PAIN IS BEING 7458 05:15:28,840 --> 05:15:29,800 CONCEPTUALIZED, AND SO THE WAY 7459 05:15:29,800 --> 05:15:33,680 WE HAVE MAPPED OUR TOOL IS TO 7460 05:15:33,680 --> 05:15:35,920 HAVE THE PATIENT'S PAIN 7461 05:15:35,920 --> 05:15:39,000 DESCRIPTOR IN THEIR OWN LANGUAGE 7462 05:15:39,000 --> 05:15:43,400 THAT ARE METAPHORS OF HOW THEIR 7463 05:15:43,400 --> 05:15:44,560 PAIN IS BEING EXPRESSED. 7464 05:15:44,560 --> 05:15:46,440 THE ROLE OF THE INTERPRETER IS 7465 05:15:46,440 --> 05:15:49,640 REALLY TO HELP FACILITATE THAT, 7466 05:15:49,640 --> 05:15:52,280 NOT TO GIVE MORE WORK TO THE 7467 05:15:52,280 --> 05:15:53,320 INTERPRETER, WE'VE MAPPED OUT 7468 05:15:53,320 --> 05:15:56,400 THOSE METAPHORS TO WHAT 7469 05:15:56,400 --> 05:15:58,880 PROVIDERS WOULD EXPECT FOR PAIN 7470 05:15:58,880 --> 05:16:00,040 QUALITY OR PAIN SEVERITY AS 7471 05:16:00,040 --> 05:16:00,320 WELL. 7472 05:16:00,320 --> 05:16:02,200 I DIDN'T FOCUS ON PAIN SEVERITY 7473 05:16:02,200 --> 05:16:03,280 BUT THAT'S ALSO PART OF THE WORK 7474 05:16:03,280 --> 05:16:04,280 WE'RE WORKING ON AS WELL. 7475 05:16:04,280 --> 05:16:05,800 SO HOW THAT COMPARED TO USUAL 7476 05:16:05,800 --> 05:16:08,360 CARE, USUAL CARE, YOU KNOW, 7477 05:16:08,360 --> 05:16:09,880 PATIENTS ARE BEING ASKED HOW TO 7478 05:16:09,880 --> 05:16:14,360 DESCRIBE THEIR PAIN OR IF YOU'VE 7479 05:16:14,360 --> 05:16:15,640 NEVER HAD PAIN BEFORE, YOU MIGHT 7480 05:16:15,640 --> 05:16:16,440 EXPRESS IT DIFFERENTLY THAN WHAT 7481 05:16:16,440 --> 05:16:18,960 YOU WOULD EXPECT IN THE WESTERN 7482 05:16:18,960 --> 05:16:23,560 KIND OF CULTURE FROM PROVIDERS. 7483 05:16:23,560 --> 05:16:24,600 SO THAT'S KIND OF HOW WE'RE 7484 05:16:24,600 --> 05:16:26,160 TESTING IT, COMPARING IT WITH 7485 05:16:26,160 --> 05:16:29,400 USUAL CARE, JUST THE USUAL -- 7486 05:16:29,400 --> 05:16:31,400 COMPARE IT WITH WHAT PROVIDERS 7487 05:16:31,400 --> 05:16:32,760 WOULD ASK THE PATIENT, WHAT THAT 7488 05:16:32,760 --> 05:16:34,200 COMES OUT TO BE, AND COMPARE IT 7489 05:16:34,200 --> 05:16:37,080 WITH OUR TOOL, HAVING THIS 7490 05:16:37,080 --> 05:16:38,680 MAPPED OUT INFOGRAPHIC TOOL THAT 7491 05:16:38,680 --> 05:16:40,160 WOULD HELP FACILITATE THAT 7492 05:16:40,160 --> 05:16:41,000 COMMUNICATION BETWEEN PATIENTS, 7493 05:16:41,000 --> 05:16:42,640 PROVIDER AND THE INTERPRETER, 7494 05:16:42,640 --> 05:16:44,080 WHAT THAT WOULD LOOK LIKE FOR 7495 05:16:44,080 --> 05:16:45,400 PAIN ASSESSMENT AND TREATMENT AS 7496 05:16:45,400 --> 05:16:53,080 WELL. 7497 05:16:53,080 --> 05:16:54,920 >> THOSE ARE ALL REALLY 7498 05:16:54,920 --> 05:16:57,520 IMPORTANT POINTS AND IS THERE -- 7499 05:16:57,520 --> 05:16:58,640 DO ANY OF THE OTHER PANELISTS 7500 05:16:58,640 --> 05:17:05,760 HAVE ANYTHING TO ADD? 7501 05:17:05,760 --> 05:17:06,200 ALL RIGHT. 7502 05:17:06,200 --> 05:17:09,880 I THINK WE DON'T HAVE ANY MORE 7503 05:17:09,880 --> 05:17:12,080 QUESTIONS AT THIS TIME, SO I CAN 7504 05:17:12,080 --> 05:17:14,000 GIVE YOU ALL ONE MORE CHANCE IF 7505 05:17:14,000 --> 05:17:16,720 YOU HAVE ANYTHING ELSE TO ADD OR 7506 05:17:16,720 --> 05:17:20,200 ANYTHING ELSE YOU'D LIKE TO 7507 05:17:20,200 --> 05:17:20,520 MENTION. 7508 05:17:20,520 --> 05:17:22,840 IF NOT, I CAN TURN THIS BANK 7509 05:17:22,840 --> 05:17:29,560 OVER FOR THE WRAP-UP. 7510 05:17:29,560 --> 05:17:30,120 ALL RIGHT. 7511 05:17:30,120 --> 05:17:34,400 THANK YOU ALL. 7512 05:17:34,400 --> 05:17:44,720 INA, ARE YOU ON NOW? 7513 05:17:47,600 --> 05:17:55,760 INNA, ARE YOU ON NOW? 7514 05:17:55,760 --> 05:17:59,320 SORRY, LEAH, DO YOU OR ANY UNONE 7515 05:17:59,320 --> 05:18:00,800 ELSE HAVE THE -- DO YOU WANT TO 7516 05:18:00,800 --> 05:18:11,280 DO THE CLOSE OF THE SESSION? 7517 05:18:16,840 --> 05:18:19,120 >> SURE, I CAN GIVE CLOSING 7518 05:18:19,120 --> 05:18:20,400 REMARKS. 7519 05:18:20,400 --> 05:18:23,000 >> THANKS, MELISSA. 7520 05:18:23,000 --> 05:18:24,520 >> THEY MAY HAVE JUST STEPPED 7521 05:18:24,520 --> 05:18:30,280 AWAY. 7522 05:18:30,280 --> 05:18:32,560 I THANK ALL THE OTHER 7523 05:18:32,560 --> 05:18:37,320 ORGANIZERS, THE -- THE 7524 05:18:37,320 --> 05:18:39,280 MODERATORS, THE FACILITATORS, 7525 05:18:39,280 --> 05:18:45,240 EVERYONE HAS REALLY PUT IN -- 7526 05:18:45,240 --> 05:18:48,280 INTO THE CONTENT. 7527 05:18:48,280 --> 05:18:50,320 HELLO, INNA. 7528 05:18:50,320 --> 05:18:51,720 >> HELLO. 7529 05:18:51,720 --> 05:18:53,760 I WAS FROZEN. 7530 05:18:53,760 --> 05:18:59,280 BUT THANK YOU FOR STEPPING IN. 7531 05:18:59,280 --> 05:19:00,280 >> TAKE IT AWAY. 7532 05:19:00,280 --> 05:19:02,040 >> NO PROBLEM. 7533 05:19:02,040 --> 05:19:03,320 THANK ALL THE JUNIOR 7534 05:19:03,320 --> 05:19:04,520 INVESTIGATORS FOR THIS EXCELLENT 7535 05:19:04,520 --> 05:19:06,640 SESSION, AND FOR ALL THE DATA 7536 05:19:06,640 --> 05:19:07,600 THAT YOU WORKED ON. 7537 05:19:07,600 --> 05:19:08,760 THIS WAS REALLY GREAT. 7538 05:19:08,760 --> 05:19:12,160 FOR ALL THE QUESTIONS, THANK YOU 7539 05:19:12,160 --> 05:19:14,000 FOR THE -- TO OUR DEDICATED 7540 05:19:14,000 --> 05:19:18,640 AUDIENCE, AND I ALSO LIKE TO 7541 05:19:18,640 --> 05:19:20,160 THANK EVERYONE WATCHING THE 7542 05:19:20,160 --> 05:19:21,440 VIDEOCAST FOR JOINING TODAY, AND 7543 05:19:21,440 --> 05:19:25,200 REMIND YOU ALL THAT YOU PLEASE 7544 05:19:25,200 --> 05:19:27,440 SHOULD JOIN US AGAIN TOMORROW 7545 05:19:27,440 --> 05:19:30,760 FOR DAY TWO, BEGINNING AT 7546 05:19:30,760 --> 05:19:33,000 11:00 A.M. EASTERN TIME. 7547 05:19:33,000 --> 05:19:35,880 THE NIH VIDEOCAST. 7548 05:19:35,880 --> 05:19:38,000 AND PLEASE USE YOUR SAME LINK TO 7549 05:19:38,000 --> 05:19:40,160 LOG IN TOMORROW, AND WITH THIS, 7550 05:19:40,160 --> 05:19:41,600 HAVE A GREAT EVENING. 7551 05:19:41,600 --> 05:19:43,240 THANK YOU SO MUCH. 7552 05:19:43,240 --> 05:19:53,640 AND SEE YOU TOMORROW.