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I'M INNA BELFER AT THE NATIONAL 

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INSTITUTES OF HEALTH.

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ON BEHALF OF MY CO-CHAIR AND 

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COMMITTEE I WANT TO WELCOME YOU 

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00:00:21,240 --> 00:00:26,400
ALL TO DAY TWO OF THE SEVENTH 

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ANNUAL PAIN CONSORTIUM ENTITLED 

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PAIN MANAGEMENT THROUGH THE LENS

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OF HEALTH.

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AND NOW PLEASED TO INVITE 

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DR. LANGEVIN DIRECTOR FOR THE 

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CENTER FOR COMPLIMENTARY AND 

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INTEGRATIVE HEALTH TO BEGIN DAY 

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TWO WITH OPENING REMARKS.

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DR. LANGEVIN.

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>> THANK YOU VERY MUCH.

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IT IS REALLY MY PLEASURE TO OPEN

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THE SECOND DAY OF THIS ALREADY 

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FASCINATING SYMPOSSYMPOSIUM.

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THIS WORKSHOP IS VERY TIMELY AS 

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WE'RE BECOMING INCREASINGINGLY 

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AWARE OF THE ASPECTS OF PAIN AND

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PAIN MANAGEMENT.

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OVER THE PAST DECADES PAIN 

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RESEARCH AND PAIN CARE HAS 

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MOSTLY FOCUSSED ON PAIN AS A 

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SYMPTOM AND PAIN MANAGEMENT HAS 

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RESIDING WITHIN THE NERVOUS 

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SYSTEM.

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BECAUSE OF THIS, WE TEND TO 

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THINK OF PAIN MANAGEMENT AS 

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ANALGESIA.

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AS WE'VE BEEN LEARNING 

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THROUGHOUT THIS SYMPOSIUM, THE 

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REALITY IS MORE COMPLEX.

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I'M DELIGHTED THE WHOLE PERSON 

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HEALTH HAS BEEN CHOSEN AS A 

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THEME FOR OUR DISCUSSION AS IT'S

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OF GREAT INTEREST TO NCCIH AND 

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CENTRAL TO OUR NEW STRATEGIC 

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PLAN.

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NEXT SLIDE.

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AT NCCIH WE THINK OF WHOLE 

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PERSON HEALTH AS HAVING TWO 

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COMPONENTS.

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THE WHOLE PERSON COMPONENT WHICH

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EMPHASIZES THE CONNECTIONS 

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BETWEEN THE DIFFERENT 

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PHYSIOLOGICAL SYMPTOMS AS WELL 

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AS ACROSS THE BIOLOGICAL, 

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BEHAVIORAL AND SOCIAL AND 

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ENVIRONMENTAL DOMAIN.

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AND THEN THERE'S THE HEALTH 

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COMPONENT WHICH EMPHASIZES THAT 

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HEALTH IS ON WHAT WE CALL A 

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BI-DIRECTIONAL ACCESS BETWEEN 

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HEALTH AND DISEASE WITH 

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OPPORTUNITIES NOT ONLY TO 

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PREVENT DISEASE BUT ALSO TO 

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RESTORE HEALTH.

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SO UNDERSTANDING PAIN THROUGH 

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THE LENS OF WHOLE PERSON HEALTH 

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MEANS TWO THINGS.

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FIRST, IT MEANS LOOKING AT PAIN 

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AS A CONVERSATION BETWEEN A 

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NERVOUS SYSTEM AND THE REST OF 

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THE BODY INCLUDING MULTIPLE 

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ORGANS AND SYSTEMS AND SECOND IT

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MEANS TO THINK OF CLINICAL 

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APPROACH TO PAIN BEYOND SYMPTOM 

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MANAGEMENT AND ALSO INCLUDE 

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RESTORATION OF HEALTH AND 

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FUNCTION AND EVEN PREVENTING 

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PAIN FROM OCCURRING IN THE FIRST

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PLACE.

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WE HEARD YESTERDAY EXAMPLES OF 

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HOW PAIN INTERFERES WITH SLEEP, 

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FOR EXAMPLE, AND SUBSTANCE USE 

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DISORDERS AND HEARD GREAT 

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EXAMPLES ON CHRONIC OVERLAPPING 

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PAIN CONDITIONS SUCH AS PELVIC 

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PAIN AND IRRITABLE BOWEL 

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SYNDROME AND FIBROMYALGIA WHICH 

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INVOLVES MANY ORGANS AND PARTS 

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OF THE BODY.

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IT'S ALSO IMPORTANT TO THINK OF 

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00:03:32,560 --> 00:03:35,080
THE SYSTEMS THAT MAY NOT BE 

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OBVIOUSLY INVOLVED IN THE PAIN 

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SYMPTOMS THEMSELVES AND HOW THE 

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00:03:39,880 --> 00:03:40,560
SYSTEMS CAN NEVERTHELESS BE 

90
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IMPORTANT FOR ADDRESSING A 

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PATIENT'S PAIN FROM THE POINT OF

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VIEW OF THE WHOLE PERSON.

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FOR EXAMPLE, SOMEBODY WITH PAIN 

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00:03:48,200 --> 00:03:49,400
IN THEIR KNEE MAY BE UNDER 

95
00:03:49,400 --> 00:03:51,720
STRESS AT WORK AND HAVE 

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DIFFICULTY SLEEPING AND ALSO NOT

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00:03:53,920 --> 00:03:55,120
GETTING ENOUGH EXERCISE AND 

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00:03:55,120 --> 00:03:57,600
MAYBE HAS TROUBLE STICKING TO A 

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00:03:57,600 --> 00:03:59,040
HEALTHY DIET AND MAYBE GAINED 

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SOME WEIGHT AND ALL THESE 

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00:04:00,520 --> 00:04:04,400
FACTORS COULD BE CONTRIBUTING TO

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THE KNEE PAIN.

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00:04:08,680 --> 00:04:11,920
EVEN THOUGH SOME OF THE PAIN 

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MECHANISMS MAY NOT BE ALL PAIN 

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MECHANISMS PER SE, TREATING PAIN

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IN THE CONTEXT OF THE WHOLE 

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PERSON MEANS ADDRESSING THE 

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PROBLEMS AS WELL.

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AS DR. GODET POINTING OUT 

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YESTERDAY NUTRITIONAL AND 

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PSYCHOLOGICAL THERAPIES CAN HELP

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WITH PAIN AND I'M DELIGHTED TO 

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INTRODUCE TODAY'S KEY NOTE 

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SPEAKER WHO IS A LEADER IN PAIN 

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MANAGEMENT STRATEGIES THAT TRULY

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ADDRESS THE WHOLE PERSON.

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DR. WOLEVER IS A PROFESSOR OF 

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MEDICINE AND REHABILITATION AT 

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VANDERBILT MEDICAL CENTER AND A 

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CLINICAL PSYCHOLOGIST AND BOARD 

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CERTIFIED HEALTH AND WELLNESS 

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COACH AND HAS OVER 25 YEARS 

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EXPERIENCE TRAINING AND 

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MENTORING MEDICAL AND ALLIED 

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HEALTH PROFESSIONALS IN 

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EMOTIONAL HEALTH AND HEALTH 

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COACHING AND DESIGNING, 

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IMPLEMENTING AND EVALUATING 

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BEHAVIOR CHANGE PROGRAMS.

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HER RESEARCH HAS BEEN FUNDED BY 

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THE NATIONAL INSTITUTES OF 

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HEALTH INCLUDING NCCIH AND THE 

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OFFICE WOMEN'S HEALTH, NATIONAL 

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HEART LUNG AND BLOOD INSTITUTE, 

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NATIONAL INSTITUTES FOR DEAFNESS

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AND COMMUNICATION DISORDER AND 

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THE U.S. AIR FORCE CENTER FOR 

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MEDICARE AND MEDICAID SERVICES, 

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INDUSTRY AND PHILANTHROPY.

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PRIOR TO JOINING VANDERBILT SHE 

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WAS THE FOUNDING RESEARCH FOR 

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DUKE INTEGRATIVE MEDICINE AND 

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ASSOCIATE PROFESSOR AT DUKE.

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SHE EARNED A Ph.D. AT THE 

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00:06:06,440 --> 00:06:10,400
UNIVERSITY OF MIAMI, 

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POST-DOCTORAL FELLOWSHIP AT DUKE

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MEDICAL CENTER AND LOOKS AT 

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MINDFUL AND BEHAVIOR CHANGE AND 

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HER TALK IS ENTITLED THE VALUE 

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OF DECONTSTRUCTING EXPERIENCE TO

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DISCOVER THE WHOLE PERSON.

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THANK YOU SO MUCH FOR JOINING US

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00:06:31,840 --> 00:06:34,400
DR. WOLEVER.

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>> THANK YOU, I APPRECIATE
THE 

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INVITATION AND THAT OF THE 

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ENTIRE COMMITTEE FOR THIS 

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WONDERFUL PAIN CONSORTIUM.

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I'LL BE TALKING ABOUT THE VALUE 

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OF DECONTSTRUCTING EXPERIENCE AS

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A WAY TO REALLY ACCESS THE WHOLE

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PIRN -- PERSON.

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THESE ARE DISCLOSURES.

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SO MY OBJECTIVE IS THAT THROUGH 

164
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THIS TIME WE SPEND TOGETHER I 

165
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HOPE TO HELP YOU DEVELOP A 

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CONSENSUAL UNDERSTANDING OF 

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HUMAN EXPERIENCE PERHAPS FROM A 

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SLIGHTLY DIFFERENT LENS THAN YOU

169
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MAY BE USED TO.

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WE'LL TALK ABOUT HOW LEARNING 

171
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CREATES THE COMPLEXITY OF THE 

172
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WHOLE PERSON AND HOW 

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DECONTSTRUCTING EXPERIENCE 

174
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ACTUALLY ALLOWS ACCESS TO THE 

175
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SELF.

176
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I WILL SHARE SOME RECENT NEURAL 

177
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SCIENTIFIC MODELS IN SUPPORT OF 

178
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WHAT I'LL BE TALKING ABOUT AND 

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TRY TO SPRINKLE IN EXPERIENTIAL 

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INFORMATION.

181
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SO THANKS TO DR. LANGEVIN FOR 

182
00:07:56,840 --> 00:08:00,080
SHARING THE NCCIH'S PERSPECTIVE 

183
00:08:00,080 --> 00:08:01,560
ON WHOLE PERSON HELPS AND LOOKS 

184
00:08:01,560 --> 00:08:03,720
AT MOLECULES UP TO THE WHOLE 

185
00:08:03,720 --> 00:08:05,320
PERSON AND IN THESE MULTIPLE 

186
00:08:05,320 --> 00:08:07,000
DOMAIN THE PERSON AS AN 

187
00:08:07,000 --> 00:08:08,520
INDIVIDUAL WITH MULTIPLE DOMAINS

188
00:08:08,520 --> 00:08:10,080
AND ALSO IN CONTEXT WITH THEIR 

189
00:08:10,080 --> 00:08:12,600
LIVING SITUATION AND FAMILY AND 

190
00:08:12,600 --> 00:08:14,720
COMMUNITY AND THE POPULATION AT 

191
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LARGE.

192
00:08:18,120 --> 00:08:21,880
SO THIS IS THE MODEL WE USE AT 

193
00:08:21,880 --> 00:08:23,880
THE CENTER FOR INTEGRATIVE 

194
00:08:23,880 --> 00:08:25,320
MEDICINE AND HEALTH AT 

195
00:08:25,320 --> 00:08:25,640
VANDERBILT.

196
00:08:25,640 --> 00:08:30,000
THIS IS ANOTHER KIND OF WHEEL OF

197
00:08:30,000 --> 00:08:30,240
HEALTH.

198
00:08:30,240 --> 00:08:33,360
DR. GAUDETTE PRESENTED IT FROM 

199
00:08:33,360 --> 00:08:34,320
THE V.A. AND THE HEALTH 

200
00:08:34,320 --> 00:08:35,200
INSTITUTE.

201
00:08:35,200 --> 00:08:37,600
YOU'LL NOTICE AT THE CENTER IS 

202
00:08:37,600 --> 00:08:40,160
LIKE THE ONES YOU'VE SEEN, SELF.

203
00:08:40,160 --> 00:08:44,000
WHAT I WOULD CALL THE CORE SELF 

204
00:08:44,000 --> 00:08:46,840
OR THE TRUE SELF AND THE 

205
00:08:46,840 --> 00:08:48,080
BRIGHTLY COLORED AREAS ARE 

206
00:08:48,080 --> 00:08:48,920
VARIES DOMAINS IN AN 

207
00:08:48,920 --> 00:08:49,680
INDIVIDUAL'S LIFE.

208
00:08:49,680 --> 00:08:57,400
WITHIN EACH OF THESE DOMAINS ARE

209
00:08:57,400 --> 00:09:00,280
STRATEGIES TO OPTIMIZE HEALTH 

210
00:09:00,280 --> 00:09:05,480
AND WELL BEING AND PREVENT SOME 

211
00:09:05,480 --> 00:09:10,280
TYPE OF CHRONIC PAIN AND YOU MAY

212
00:09:10,280 --> 00:09:12,360
THINK OF THE PATIENT WHO COMES 

213
00:09:12,360 --> 00:09:14,800
TO YOU AS A CLINICIAN BECAUSE 

214
00:09:14,800 --> 00:09:16,200
THEY'RE EXHAUSTED.

215
00:09:16,200 --> 00:09:17,800
THEY'RE PAIN IS CONSISTENT OR 

216
00:09:17,800 --> 00:09:20,520
VERY FREQUENT AND START AT THE 

217
00:09:20,520 --> 00:09:26,160
TOP ORANGE THEY MAY NOT HAVE A 

218
00:09:26,160 --> 00:09:27,520
VERY ROUTINE DAILY SCHEDULE 

219
00:09:27,520 --> 00:09:30,560
BECAUSE THEIR PAIN IS TOO 

220
00:09:30,560 --> 00:09:31,480
UNPREDICTABLE.

221
00:09:31,480 --> 00:09:34,320
THEY MAY NOT BE MOVING A LOT.

222
00:09:34,320 --> 00:09:37,000
THE AREA OF MOVEMENT AND 

223
00:09:37,000 --> 00:09:38,720
EXERCISE AND PLAY MAY BE 

224
00:09:38,720 --> 00:09:39,680
UNDERMINED.

225
00:09:39,680 --> 00:09:45,040
THEY MAY BE OVER EATING OR UNDER

226
00:09:45,040 --> 00:09:47,240
EATING DEPENDING ON THE ACCESS 

227
00:09:47,240 --> 00:09:51,200
TO COMFORT FOODS AND ACCESS AND 

228
00:09:51,200 --> 00:09:52,400
AFFORDABILITY OF HEALTHFUL 

229
00:09:52,400 --> 00:09:52,760
FOODS.

230
00:09:52,760 --> 00:09:56,760
THEY'RE ENVIRONMENT MAY BE 

231
00:09:56,760 --> 00:09:58,200
CHAOTIC DOWN TO CHAOTIC BECAUSE 

232
00:09:58,200 --> 00:10:00,560
THEY DON'T HAVE THE ENERGY TO 

233
00:10:00,560 --> 00:10:03,240
TEND TO IT OR MAY BE MORE 

234
00:10:03,240 --> 00:10:05,960
CHAOTIC FOR THINKING OF PEOPLE 

235
00:10:05,960 --> 00:10:07,400
THAT ARE STREET DWELLERS.

236
00:10:07,400 --> 00:10:08,960
SLEEP MAY BE UNDERMINED BECAUSE 

237
00:10:08,960 --> 00:10:11,720
THE SLEEP DRIVE MAY BE UNDER 

238
00:10:11,720 --> 00:10:13,360
MINDED BECAUSE PERHAPS THEY'RE 

239
00:10:13,360 --> 00:10:14,360
RESTING FOR LONG PERIODS 

240
00:10:14,360 --> 00:10:17,600
THROUGHOUT THE DAY IN AN ATTEMPT

241
00:10:17,600 --> 00:10:20,360
TO ALLEVIATE PAIN AND OFTEN 

242
00:10:20,360 --> 00:10:23,000
THEY'VE WITHDRAWN FROM KEY 

243
00:10:23,000 --> 00:10:24,400
RELATIONSHIPS AND ACTIVITIES 

244
00:10:24,400 --> 00:10:26,280
THAT USED TO BE MEANINGFUL TO 

245
00:10:26,280 --> 00:10:27,520
THEM AGAIN BECAUSE IT'S SO HARD 

246
00:10:27,520 --> 00:10:29,920
TO PLAN WITH THE 

247
00:10:29,920 --> 00:10:34,120
UNPREDICTABILITY OF PAIN OR THEY

248
00:10:34,120 --> 00:10:40,080
MAY HAVE PATTERNS OF THOUGHT 

249
00:10:40,080 --> 00:10:46,360
LIKE RUMINATION OR 

250
00:10:46,360 --> 00:10:49,960
CATASTROPHIZING AND THE WAY THEY

251
00:10:49,960 --> 00:10:51,640
MAKE MEANING FROM THEIR 

252
00:10:51,640 --> 00:10:53,640
EXPERIENCE THAT DEFINES THEM 

253
00:10:53,640 --> 00:10:58,040
THAT MAY NOT HELP THEM OPTIMIZE 

254
00:10:58,040 --> 00:10:59,640
THEIR WELL BEING.

255
00:10:59,640 --> 00:11:01,880
THE SAME AREAS MAY BE AREAS IN 

256
00:11:01,880 --> 00:11:06,280
WHICH TO BEGIN TO EXPLORE WHERE 

257
00:11:06,280 --> 00:11:08,920
THEIR BEHAVIORS ARE MALADAPTIVE 

258
00:11:08,920 --> 00:11:11,280
AND WHERE THEY ARE ADAPTIVE.

259
00:11:11,280 --> 00:11:14,040
SO I THINK ABOUT THIS AND THE 

260
00:11:14,040 --> 00:11:15,360
PRESENT PLAY OF THE AREAS LIKE A

261
00:11:15,360 --> 00:11:18,960
MOBILE YOU HANG OVER A BABY'S 

262
00:11:18,960 --> 00:11:20,120
BED, YOU MOVE ONE LITTLE PIECE 

263
00:11:20,120 --> 00:11:22,400
OF THE MOBILE AND THE WHOLE 

264
00:11:22,400 --> 00:11:25,040
THING STARTS TO ADJUST.

265
00:11:25,040 --> 00:11:29,320
SO WHEN ASKING YOURSELF WHERE TO

266
00:11:29,320 --> 00:11:32,800
START WITH THE PERSON I THINK 

267
00:11:32,800 --> 00:11:33,840
IT'S USEFUL TO RECOGNIZE MANY 

268
00:11:33,840 --> 00:11:35,000
THINGS WILL PLAY OUT AND YOU 

269
00:11:35,000 --> 00:11:36,440
DON'T ALWAYS NEED TO START IN 

270
00:11:36,440 --> 00:11:37,240
THE SAME PLACE.

271
00:11:37,240 --> 00:11:38,640
WHAT MAKES MOST SENSE IN GENERAL

272
00:11:38,640 --> 00:11:41,640
IS TO START WHERE THE PATIENT 

273
00:11:41,640 --> 00:11:44,080
HAS THE MOST ENERGY TO FOCUS.

274
00:11:44,080 --> 00:11:48,360
WHERE THEY ALREADY HAVE SOME 

275
00:11:48,360 --> 00:11:51,880
INTRINSIC MOTIVATION TO MAKE 

276
00:11:51,880 --> 00:11:52,720
EFFORTS WHICH MIGHT IN THE 

277
00:11:52,720 --> 00:11:55,320
IMMEDIATE FUTURE MAY SEEM 

278
00:11:55,320 --> 00:11:57,080
CONTRAINDICATED BECAUSE THEY MAY

279
00:11:57,080 --> 00:11:57,680
ACTUALLY HURT.

280
00:11:57,680 --> 00:12:00,000
I ALSO WANT TO ACKNOWLEDGE THE 

281
00:12:00,000 --> 00:12:02,800
ROLE OF STRESS IN THIS BECAUSE 

282
00:12:02,800 --> 00:12:05,760
STRESS REALLY DEEPLY INGRAINS 

283
00:12:05,760 --> 00:12:08,480
OUR HABITUAL PATTERNS AND CAN 

284
00:12:08,480 --> 00:12:10,400
MAKE IT MORE DIFFICULT TO LEARN 

285
00:12:10,400 --> 00:12:14,600
NEW WAYS OF BEING.

286
00:12:14,600 --> 00:12:18,000
SO THERE'S A PARADOX HERE.

287
00:12:18,000 --> 00:12:19,560
THERE'S LOTS OF PARTS THAT NEED 

288
00:12:19,560 --> 00:12:22,400
TO BE PUT TOGETHER TO CONSIDER 

289
00:12:22,400 --> 00:12:24,080
THE WHOLE.

290
00:12:24,080 --> 00:12:27,000
AND SIMILARLY WE HAVE TO GO VERY

291
00:12:27,000 --> 00:12:29,000
DEEP AND GRANULAR IN INDIVIDUAL 

292
00:12:29,000 --> 00:12:30,320
PARTS TO UNDERSTAND THEM.

293
00:12:30,320 --> 00:12:34,360
SO I JUST WANT TO ACKNOWLEDGE 

294
00:12:34,360 --> 00:12:37,160
THE TENSION BETWEEN THOSE TWO 

295
00:12:37,160 --> 00:12:39,960
THINGS I'M GOING TO GO VERY 

296
00:12:39,960 --> 00:12:44,160
GRANULAR TO THEN TALK ABOUT HOW 

297
00:12:44,160 --> 00:12:46,120
DECONTSTRUCTING, UNDOING 

298
00:12:46,120 --> 00:12:46,960
PATTERNS OF EXPERIENCE CAN 

299
00:12:46,960 --> 00:12:48,080
ACTUALLY GIVE US MORE ACCESS TO 

300
00:12:48,080 --> 00:12:51,840
SELF.

301
00:12:51,840 --> 00:12:54,400
SO FOR THOSE THAT DON'T HAVE A 

302
00:12:54,400 --> 00:12:55,640
LOT OF DEEP SEA FISHING 

303
00:12:55,640 --> 00:12:56,560
EXPERIENCE, THIS IS SOMETHING 

304
00:12:56,560 --> 00:12:57,680
CALLED A BAIT BALL.

305
00:12:57,680 --> 00:12:58,560
YOU MAY OR MAY NOT BE FAMILIAR 

306
00:12:58,560 --> 00:13:00,920
WITH IT.

307
00:13:00,920 --> 00:13:03,720
IT IS A SURVIVAL STRATEGY FOR 

308
00:13:03,720 --> 00:13:05,000
SMALL FISH.

309
00:13:05,000 --> 00:13:08,880
SO WHAT HAPPENS IS FROM FAR AWAY

310
00:13:08,880 --> 00:13:10,360
THE SMALL FISH LOOK AS IF 

311
00:13:10,360 --> 00:13:13,200
THEY'RE A SINGLE ENTITY BUT IF 

312
00:13:13,200 --> 00:13:15,360
YOU ZOOM IN CLOSE, THERE ARE 

313
00:13:15,360 --> 00:13:17,200
HUNDREDS AND HUNDREDS OF FISH 

314
00:13:17,200 --> 00:13:20,040
ALL MOVING TOGETHER IN THE SAME 

315
00:13:20,040 --> 00:13:22,000
WAY TO TRY TO CREATE THIS IMAGE 

316
00:13:22,000 --> 00:13:26,000
THAT THEY'RE EXPECT BIGGER SO A 

317
00:13:26,000 --> 00:13:26,800
PREDATOR SHOULDN'T BOTHER.

318
00:13:26,800 --> 00:13:30,360
WELL, THIS IS A GREAT ANALOGY 

319
00:13:30,360 --> 00:13:33,440
FOR BEHAVIOR AND FOR PATTERNS 

320
00:13:33,440 --> 00:13:35,720
THAT INVOLVE BEHAVIOR AND 

321
00:13:35,720 --> 00:13:38,080
EMOTION THAT INVOLVE SENSATION 

322
00:13:38,080 --> 00:13:41,040
AND THAT OFTEN BECOME ENGRAINED 

323
00:13:41,040 --> 00:13:42,360
AND MOVE TO BE OUTSIDE OF OUR 

324
00:13:42,360 --> 00:13:52,560
AWARENESS.

325
00:13:53,680 --> 00:13:55,920
SO THESE PATTERNS OF BEHAVIOR 

326
00:13:55,920 --> 00:13:59,440
ARE OFTEN TRIGGERED BY AN 

327
00:13:59,440 --> 00:14:01,120
EXTERNAL QUEUE BUT WE ALL KNOW 

328
00:14:01,120 --> 00:14:03,680
THEY CAN BE TRIGGERED BY 

329
00:14:03,680 --> 00:14:04,800
INTERNAL QUEUES.

330
00:14:04,800 --> 00:14:06,640
OVER TIME WHEN WE'VE REPEATED 

331
00:14:06,640 --> 00:14:09,520
THE PATTERN SO FREQUENTLY WHAT 

332
00:14:09,520 --> 00:14:11,760
HAPPENS IS A PERCEPTION, A 

333
00:14:11,760 --> 00:14:13,960
SENSATION, A THOUGHT, AN 

334
00:14:13,960 --> 00:14:17,000
EMOTION, AN URGE TO ACT, ALL OF 

335
00:14:17,000 --> 00:14:18,680
THESE THINGS BECOME GLOMMED 

336
00:14:18,680 --> 00:14:20,240
TOGETHER LIKE THIS BIG BAIT BALL

337
00:14:20,240 --> 00:14:23,000
AND THEY'RE REINFORCED BY SOME 

338
00:14:23,000 --> 00:14:25,880
TYPE OF REWARD AND THROUGH 

339
00:14:25,880 --> 00:14:27,520
PRACTICE THEY MOVE AS I 

340
00:14:27,520 --> 00:14:30,800
MENTIONED OUTSIDE OF OUR 

341
00:14:30,800 --> 00:14:31,040
AWARENESS.

342
00:14:31,040 --> 00:14:34,080
SO RIGHT NOW, FOR EXAMPLE, YOU 

343
00:14:34,080 --> 00:14:36,200
KNOW HOW TO PARTICIPATE IN A 

344
00:14:36,200 --> 00:14:38,840
SYMPOSIUM SO YOU SIGNED UP, YOU 

345
00:14:38,840 --> 00:14:40,040
LOGGED IN AND HERE YOU ARE 

346
00:14:40,040 --> 00:14:43,320
PERHAPS YOU'RE LISTENING TO ME.

347
00:14:43,320 --> 00:14:45,520
HOPEFULLY YOU'RE LISTENING TO ME

348
00:14:45,520 --> 00:14:47,360
AND HOPEFULLY THERE'LL BE SOME 

349
00:14:47,360 --> 00:14:47,600
REWARD.

350
00:14:47,600 --> 00:14:50,360
YOU'LL EXPAND YOUR WAY OF 

351
00:14:50,360 --> 00:14:51,680
THINKING OR PERHAPS YOU'LL MEET 

352
00:14:51,680 --> 00:14:53,200
A COLLEAGUE THROUGH THE 

353
00:14:53,200 --> 00:14:54,400
SYMPOSIUM.

354
00:14:54,400 --> 00:14:56,000
HOPEFULLY THE SYMPOSIUM WILL 

355
00:14:56,000 --> 00:15:00,040
PROVIDE YOU YOUR BEHAVIOR AND 

356
00:15:00,040 --> 00:15:01,440
THE REWARD THAT WILL ENCOURAGE 

357
00:15:01,440 --> 00:15:03,760
TO YOU GO TO ANOTHER SYMPOSIUM.

358
00:15:03,760 --> 00:15:05,840
THE THING IS WHILE YOU'RE BEING 

359
00:15:05,840 --> 00:15:08,480
THE QUINTESSENTIAL ACADEMIC 

360
00:15:08,480 --> 00:15:10,880
SKILLED IN PARTICIPATING IN 

361
00:15:10,880 --> 00:15:13,560
SYMPOSIUM, THERE'S AN INCREDIBLE

362
00:15:13,560 --> 00:15:14,400
AMOUNT OF INFORMATION AVAILABLE 

363
00:15:14,400 --> 00:15:15,480
TO YOU RIGHT NOW SHOULD YOU 

364
00:15:15,480 --> 00:15:17,520
DECIDE TO ACCESS IT.

365
00:15:17,520 --> 00:15:19,920
SO FOR EXAMPLE, IF YOU WANTED 

366
00:15:19,920 --> 00:15:22,640
TO, YOU COULD FEEL DOWN INTO 

367
00:15:22,640 --> 00:15:23,120
YOUR TOES.

368
00:15:23,120 --> 00:15:24,320
CHANCE ARE YOU HAVEN'T BEEN 

369
00:15:24,320 --> 00:15:26,000
PAYING THAT MUCH ATTENTION TO 

370
00:15:26,000 --> 00:15:28,760
YOUR TOES RIGHT NOW BUT YOU 

371
00:15:28,760 --> 00:15:31,840
COULD ACCESS SENSATION IN YOUR 

372
00:15:31,840 --> 00:15:33,640
TOES RIGHT NOW.

373
00:15:33,640 --> 00:15:34,720
MAYBE YOU COULD EVEN FEEL EACH 

374
00:15:34,720 --> 00:15:45,040
ONE OF YOUR TOES.

375
00:15:45,400 --> 00:15:46,720
OR CONTINUE ON THE SOUND OF MY 

376
00:15:46,720 --> 00:15:49,320
VOICE OR EXPAND YOUR AWARENESS 

377
00:15:49,320 --> 00:15:50,880
TO DISCOVER AMBIENT SOUNDS 

378
00:15:50,880 --> 00:15:52,640
AROUND AND MAYBE YOU HEAR THE 

379
00:15:52,640 --> 00:15:57,560
AIR HANDLER OR COMPUTER OR PET 

380
00:15:57,560 --> 00:15:58,760
SNORING NEARBY.

381
00:15:58,760 --> 00:16:01,200
WHATEVER THOSE AMBIENT SOUNDS 

382
00:16:01,200 --> 00:16:02,120
MAY BE.

383
00:16:02,120 --> 00:16:02,760
THERE'S SENSORY INFORMATION 

384
00:16:02,760 --> 00:16:04,960
AVAILABLE TO YOU YOU MAY OR MAY 

385
00:16:04,960 --> 00:16:06,440
NOT HAVE BEEN ATTENDING TO 

386
00:16:06,440 --> 00:16:09,440
BEFORE I DIRECTED YOUR ATTENTION

387
00:16:09,440 --> 00:16:10,320
THAT WAY.

388
00:16:10,320 --> 00:16:13,480
THIS IS REALLY IMPORTANT BECAUSE

389
00:16:13,480 --> 00:16:16,640
IT GIVES YOU ACCESS TO OTHER 

390
00:16:16,640 --> 00:16:18,880
PIECES OF EXPERIENCE THAT YOU 

391
00:16:18,880 --> 00:16:27,360
CAN USE TO CRAFT A NEW PATTERN.

392
00:16:27,360 --> 00:16:30,400
LET'S TALK BRIEFLY ABOUT 

393
00:16:30,400 --> 00:16:31,360
PROCEDURAL LEARNING BECAUSE IT'S

394
00:16:31,360 --> 00:16:32,920
THE PROCESS WHERE WE DEVELOP 

395
00:16:32,920 --> 00:16:35,000
EITHER A SERIES OF MOTOR SKILLS 

396
00:16:35,000 --> 00:16:37,640
OR A SERIES OF PERCEPTUAL SKILLS

397
00:16:37,640 --> 00:16:42,640
THAT BECOME ENGRAINED IN THIS 

398
00:16:42,640 --> 00:16:45,480
QUEUE PATTERN REWARD PIECE.

399
00:16:45,480 --> 00:16:47,040
YOU MAY THINK OF TYING YOUR 

400
00:16:47,040 --> 00:16:47,280
SHOES.

401
00:16:47,280 --> 00:16:50,080
WHEN YOU FIRST LEARNED TO TIE 

402
00:16:50,080 --> 00:16:53,000
YOUR SHOES YOU HAD TO FOCUS 

403
00:16:53,000 --> 00:16:54,000
ABOUT HOLDING THE LOOP AND GOING

404
00:16:54,000 --> 00:16:55,680
AROUND THE LOOP WITH THE OTHER 

405
00:16:55,680 --> 00:16:56,120
LACE.

406
00:16:56,120 --> 00:16:59,960
BUT NOW PROBABLY TIE YOUR SHOES 

407
00:16:59,960 --> 00:17:01,440
WHILE YOU'RE TALKING TO 

408
00:17:01,440 --> 00:17:01,720
SOMEBODY.

409
00:17:01,720 --> 00:17:04,160
YOU CAN DO MULTIPLE THINGS.

410
00:17:04,160 --> 00:17:06,400
IT'S WONDERFUL FOR AN EFFICIENT 

411
00:17:06,400 --> 00:17:08,360
PROCESSING SYSTEM.

412
00:17:08,360 --> 00:17:09,040
THE PROBLEM BECOMES WHEN THAT 

413
00:17:09,040 --> 00:17:11,000
BECOMES AUTOMATIC IN A WAY 

414
00:17:11,000 --> 00:17:13,400
THAT'S ACTUALLY NOT SUPPORTING 

415
00:17:13,400 --> 00:17:14,440
OR OPTIMIZING YOUR HEALTH AND 

416
00:17:14,440 --> 00:17:22,400
WELL BEING.

417
00:17:22,400 --> 00:17:24,400
THE PROCEDURAL LEARNING THEN 

418
00:17:24,400 --> 00:17:26,520
BECOMES A JUST MOTOR EXPERIENCE 

419
00:17:26,520 --> 00:17:32,120
BUT IT BECOMES MORE COMPLICATED 

420
00:17:32,120 --> 00:17:36,720
BECAUSE OF ASSOCIATIONAL 

421
00:17:36,720 --> 00:17:41,000
LEARNING AND THERE'S PAVLOV'S 

422
00:17:41,000 --> 00:17:46,000
DOG AND WE LEARN TO ASSOCIATE 

423
00:17:46,000 --> 00:17:47,640
QUEUES WITH VISCERAL SOMATIC 

424
00:17:47,640 --> 00:17:48,440
SENSORY INFORMATION.

425
00:17:48,440 --> 00:17:53,000
WE CAN LEARN TO DO PHYSIOLOGICAL

426
00:17:53,000 --> 00:17:56,720
PROCESSES COMPLETELY OUTSIDE OF 

427
00:17:56,720 --> 00:17:58,360
AWARENESS BUT THAT ASSOCIATED 

428
00:17:58,360 --> 00:18:02,120
LEARNING STILL DRIVES THEM.

429
00:18:02,120 --> 00:18:04,120
ANOTHER IS OPERANT CONDITIONING 

430
00:18:04,120 --> 00:18:06,360
WHERE WE'RE MANIPULATING 

431
00:18:06,360 --> 00:18:11,040
BEHAVIOR BY USING REWARDS OR 

432
00:18:11,040 --> 00:18:13,600
PUNISHMENT AND THAT PROCESS IS 

433
00:18:13,600 --> 00:18:14,240
VERY POWERFUL.

434
00:18:14,240 --> 00:18:17,800
I'M SURE YOU ALL KNOW THAT FROM 

435
00:18:17,800 --> 00:18:20,080
THE WORLD WIDE EXPERIMENT IN 

436
00:18:20,080 --> 00:18:20,320
TEXTING.

437
00:18:20,320 --> 00:18:21,360
WE GET THAT DOPAMINE HIT AND 

438
00:18:21,360 --> 00:18:26,400
WHAT ARE WE DOING ALL THE TIME?

439
00:18:26,400 --> 00:18:30,880
WE'RE WATCHING OUR PHONES.

440
00:18:30,880 --> 00:18:34,600
SO THESE BEGIN TO PAIR WITH THE 

441
00:18:34,600 --> 00:18:35,680
INDIVIDUAL COMPONENTS OF 

442
00:18:35,680 --> 00:18:35,960
EXPERIENCE.

443
00:18:35,960 --> 00:18:38,360
IF YOU THINK OF IT AS A HABIT 

444
00:18:38,360 --> 00:18:40,280
LOOP YOU MAY HAVE BEEN IN TUNE 

445
00:18:40,280 --> 00:18:45,880
WITH THE SCIENCE I'M SHOWING 

446
00:18:45,880 --> 00:18:47,720
THAT QUEUE LEADS TO A SEQUENCE, 

447
00:18:47,720 --> 00:18:52,720
LEADS TO A REWARD AND THAT 

448
00:18:52,720 --> 00:18:56,200
REWARDS THE BEHAVIOR AND WE 

449
00:18:56,200 --> 00:18:57,320
DEVELOP THESE NEURAL CIRCUITS 

450
00:18:57,320 --> 00:19:03,040
AND THIS CAN BE FOR BEHAVIORS 

451
00:19:03,040 --> 00:19:05,120
BUT CAN ALSO BE FOR PERCEPTUAL 

452
00:19:05,120 --> 00:19:05,960
EXPERIENCES.

453
00:19:05,960 --> 00:19:08,120
IT CAN BE FOR EMOTIONAL 

454
00:19:08,120 --> 00:19:10,360
EXPERIENCES AND FOR HABITS OF 

455
00:19:10,360 --> 00:19:16,080
THOUGHT.

456
00:19:16,080 --> 00:19:20,120
I WANT TO TALK A LITTLE BIT 

457
00:19:20,120 --> 00:19:21,840
ABOUT HOW THIS HAPPENS WITH 

458
00:19:21,840 --> 00:19:22,400
PROCESSING.

459
00:19:22,400 --> 00:19:24,040
WE HAVE TWO PROCESSING SYSTEMS 

460
00:19:24,040 --> 00:19:25,040
AT LEAST.

461
00:19:25,040 --> 00:19:28,280
TWO THAT WE KNOW A LOT ABOUT.

462
00:19:28,280 --> 00:19:38,800
ONE IS THE BOTTOM-UP THROUGH 

463
00:19:40,960 --> 00:19:43,280
VISORO SENSORY CUES AND SOUND 

464
00:19:43,280 --> 00:19:44,640
AND SMELL AND MOVEMENT OF THE 

465
00:19:44,640 --> 00:19:45,520
BODY AND ALL THE INFORMATION 

466
00:19:45,520 --> 00:19:48,240
THAT COMES IN THE SENSES, RUNS 

467
00:19:48,240 --> 00:19:52,440
UP THE DORSAL HARNS THROUGH THE 

468
00:19:52,440 --> 00:19:56,440
SPINE AND THE SPINAL THALAMIC 

469
00:19:56,440 --> 00:20:02,400
TRACKS INTO THE PRIMARY CORTEX, 

470
00:20:02,400 --> 00:20:06,480
ASSOCIATIONAL CORTEX AND THERE'S

471
00:20:06,480 --> 00:20:11,920
NEURAL TRACKS THAT ASSOCIATE IT 

472
00:20:11,920 --> 00:20:15,640
WITH CUES OR AN EMOTIONAL 

473
00:20:15,640 --> 00:20:16,000
EXPERIENCE.

474
00:20:16,000 --> 00:20:17,720
WE TEND TO HAVE ASSOCIATIONAL 

475
00:20:17,720 --> 00:20:18,760
LEARNING HERE.

476
00:20:18,760 --> 00:20:25,400
SOME IS BOTTOM-UP AND SOME IS 

477
00:20:25,400 --> 00:20:25,640
TOP-DOWN.

478
00:20:25,640 --> 00:20:30,400
THE BOTTOM-UP IS THE PERCEPTUAL 

479
00:20:30,400 --> 00:20:31,200
SENSORY PROCESSING SYSTEM AND 

480
00:20:31,200 --> 00:20:41,560
THE TOP-DOWN SYSTEM AND IS 

481
00:20:41,560 --> 00:20:42,400
HIGHLY PREFERRED IN WESTERN 

482
00:20:42,400 --> 00:20:43,280
EDUCATION SO WE TEND TO FOCUS 

483
00:20:43,280 --> 00:20:47,360
MORE ON IT.

484
00:20:47,360 --> 00:20:49,480
IT'S THE WAY WE ORGANIZE 

485
00:20:49,480 --> 00:20:51,200
INFORMATION AND LABEL EXPERIENCE

486
00:20:51,200 --> 00:20:52,600
AND ACTUALLY CREATE MEANING OUT 

487
00:20:52,600 --> 00:20:53,120
OF WHATEVER IT IS WE'RE 

488
00:20:53,120 --> 00:20:58,320
EXPERIENCING.

489
00:20:58,320 --> 00:21:03,560
SO THESE SYSTEMS WORK TOGETHER 

490
00:21:03,560 --> 00:21:04,920
TO CREATE EXPERIENCES AND PAIN 

491
00:21:04,920 --> 00:21:08,280
AS WE KNOW IS AN EXPERIENCE 

492
00:21:08,280 --> 00:21:13,720
WHERE SENSORY INFORMATION FROM 

493
00:21:13,720 --> 00:21:21,120
THE BOUGTBOTTOM-UP SYSTEMS IS RD

494
00:21:21,120 --> 00:21:24,280
TO PHYSIOLOGIC AND BEHAVIORAL 

495
00:21:24,280 --> 00:21:25,280
RESPONSES TO THOSE.

496
00:21:25,280 --> 00:21:28,840
SO IT'S A PSYCHO PHYSIOLOGICAL 

497
00:21:28,840 --> 00:21:30,360
PHENOMENON WHICH IS A DEFINITION

498
00:21:30,360 --> 00:21:31,680
I VERY MUCH LIKE.

499
00:21:31,680 --> 00:21:35,000
IT IS TIME THEN FOR WHEN WE GET 

500
00:21:35,000 --> 00:21:37,040
INTO SYSTEMS LIKE THIS TO BACK 

501
00:21:37,040 --> 00:21:42,520
UP AND SEE IF WE CAN BEGIN TO 

502
00:21:42,520 --> 00:21:52,920
UNPACK THAT BAIT BALL.

503
00:21:54,360 --> 00:21:58,360
 THERE NEEDS TO BE SOMETHING TO 

504
00:21:58,360 --> 00:22:03,880
PAUSE BETWEEN THE QUEUE AND 

505
00:22:03,880 --> 00:22:09,600
SEQUENCE AND THAT PAUSE CAN BE 

506
00:22:09,600 --> 00:22:13,480
CREATED WITH COGNITIVE 

507
00:22:13,480 --> 00:22:15,120
BEHAVIORAL THERAPY AND SELF 

508
00:22:15,120 --> 00:22:18,400
MONITORING AND INQUIRY AND 

509
00:22:18,400 --> 00:22:20,680
CLINICAL HYPNOSIS AND 

510
00:22:20,680 --> 00:22:25,320
MINDFULNESS MEDITATION AND I'LL 

511
00:22:25,320 --> 00:22:27,720
USE MINDFULNESS AND MEDITATION 

512
00:22:27,720 --> 00:22:28,920
TO TALK ABOUT IT.

513
00:22:28,920 --> 00:22:37,080
I WANT TO BE CLEAR THERE MAY BE 

514
00:22:37,080 --> 00:22:43,800
A RELAXATION THERE'S A LOVELY 

515
00:22:43,800 --> 00:22:48,200
REACTION AND CAN HELP SOOTH THE 

516
00:22:48,200 --> 00:22:50,040
NERVOUS SYSTEM AND MAKE OUR 

517
00:22:50,040 --> 00:22:53,840
LEARNING STRATEGIES ACCESSIBLE 

518
00:22:53,840 --> 00:22:55,360
AND HELP US.

519
00:22:55,360 --> 00:22:57,480
RELAXATION IS FABULOUS BUT I'M 

520
00:22:57,480 --> 00:23:00,160
TALKING ABOUT USING MINDFULNESS 

521
00:23:00,160 --> 00:23:02,440
AS A WAY TO DISENTANGLE 

522
00:23:02,440 --> 00:23:03,440
EXPERIENCE AND SEE THE WHOLE 

523
00:23:03,440 --> 00:23:06,120
BAIT BALL AND ZOOM INTO THE 

524
00:23:06,120 --> 00:23:10,280
LITTLE TINY FISH OF EXPERIENCE.

525
00:23:10,280 --> 00:23:14,000
TO DO THIS FOR THE PURPOSE OF 

526
00:23:14,000 --> 00:23:15,680
ALLOWING PEOPLE TO REGULATE 

527
00:23:15,680 --> 00:23:18,000
THEIR HABITUAL REACTIONS AND 

528
00:23:18,000 --> 00:23:18,520
BEGIN TO REPATTERN THEIR 

529
00:23:18,520 --> 00:23:28,720
EXPERIENCE.

530
00:23:30,920 --> 00:23:32,920
MINDFULNESS IS THE AWARENESS OF 

531
00:23:32,920 --> 00:23:35,200
PAYING ATTENTION TO A PARTICULAR

532
00:23:35,200 --> 00:23:37,800
WAY AND PAYING ATTENTION WITH 

533
00:23:37,800 --> 00:23:38,880
INTENTION.

534
00:23:38,880 --> 00:23:41,040
IT'S IN THIS PARTICULAR MOMENT 

535
00:23:41,040 --> 00:23:42,360
AND WITHOUT JUDGMENT AND 

536
00:23:42,360 --> 00:23:44,160
JUDGMENT HERE IS NOT SO MUCH 

537
00:23:44,160 --> 00:23:47,400
ABOUT CRITICISM OR NOT BUT IT'S 

538
00:23:47,400 --> 00:23:48,640
ACTUALLY ABOUT WITHOUT 

539
00:23:48,640 --> 00:23:50,400
ELABORATION.

540
00:23:50,400 --> 00:23:52,960
SO IT'S BEGINNING TO LEARN 

541
00:23:52,960 --> 00:23:55,400
DIRECT SENSORY EXPERIENCE AND 

542
00:23:55,400 --> 00:23:58,080
HOW WE TAKE THAT SENSORY 

543
00:23:58,080 --> 00:24:00,680
EXPERIENCE AND THEN INTERPRET IT

544
00:24:00,680 --> 00:24:04,920
OR ELABORATE OUT IN TO BEGIN TO 

545
00:24:04,920 --> 00:24:05,920
CREATE OUR NARRATIVE.

546
00:24:05,920 --> 00:24:08,040
THAT'S OUR POINT OF INTERVENTION

547
00:24:08,040 --> 00:24:10,360
THAT BECOMES KEY IN CHRONIC 

548
00:24:10,360 --> 00:24:15,360
PAIN.

549
00:24:15,360 --> 00:24:20,600
IF WE GO BACK TO OUR WHEEL SELF 

550
00:24:20,600 --> 00:24:23,040
THE CORE SELF OR WHEEL OF SELF 

551
00:24:23,040 --> 00:24:26,400
IS SURROUNDED BY COMPASSIONATE 

552
00:24:26,400 --> 00:24:28,840
AWARENESS BEFORE GOING TO 

553
00:24:28,840 --> 00:24:32,880
DOMAINS THROUGH WHICH PEOPLE CAN

554
00:24:32,880 --> 00:24:34,040
OPTIMIZE THEIR HEALTH AND WELL 

555
00:24:34,040 --> 00:24:34,760
BEING AND MANAGE PAIN.

556
00:24:34,760 --> 00:24:36,480
I WANT TO BE CLEAR THIS IS NOT 

557
00:24:36,480 --> 00:24:40,440
JUST ANY AWARENESS BUT THIS IS 

558
00:24:40,440 --> 00:24:43,200
COMPASSIONATE AWARENESS AND 

559
00:24:43,200 --> 00:24:46,320
COMES WITH A KIND OF KINDNESS 

560
00:24:46,320 --> 00:24:47,760
AND CURIOSITY.

561
00:24:47,760 --> 00:24:49,280
REALLY IMPORTANT FOR LEARNING 

562
00:24:49,280 --> 00:24:50,560
THAT WE'RE WILLING TO TAKE RISKS

563
00:24:50,560 --> 00:24:54,800
AND TAKE ON NEW PATTERNS AND 

564
00:24:54,800 --> 00:24:55,800
DROP DEFENSES IN ORDER TO DO 

565
00:24:55,800 --> 00:25:00,280
THAT WE HAVE TO KNOW IT'S A SAFE

566
00:25:00,280 --> 00:25:03,680
PLACE TO DO IT.

567
00:25:03,680 --> 00:25:04,600
PEOPLE NEED TO LEARN 

568
00:25:04,600 --> 00:25:10,440
COMPASSIONATE APPROACHES TO 

569
00:25:10,440 --> 00:25:20,840
CHANGE THEIR PATTERNING.

570
00:25:24,760 --> 00:25:27,920
THIS IS A MODEL OF HOW 

571
00:25:27,920 --> 00:25:29,600
MINDFULNESS CAN HELP US UNPACK 

572
00:25:29,600 --> 00:25:29,920
EXPERIENCE.

573
00:25:29,920 --> 00:25:32,280
THE TOP LAYER IS THE CHATTERING 

574
00:25:32,280 --> 00:25:32,760
MIND.

575
00:25:32,760 --> 00:25:35,200
WHEN YOU FIRST BEGIN TO TRAIN IN

576
00:25:35,200 --> 00:25:36,640
SOME PROCESS OF TURNING INTO 

577
00:25:36,640 --> 00:25:38,320
YOU'RE INTERNAL EXPERIENCE YOU 

578
00:25:38,320 --> 00:25:40,080
BEGIN TO SEE WE HAVE A RUNNING 

579
00:25:40,080 --> 00:25:41,080
NARRATIVE ALL THE TIME.

580
00:25:41,080 --> 00:25:42,520
RIGHT NOW I'M FOCUSSED ON WHAT 

581
00:25:42,520 --> 00:25:47,080
I'M SAYING BUT I STILL HAVE THIS

582
00:25:47,080 --> 00:25:49,320
LIKE DON'T FORGET, RUTH, IN TWO 

583
00:25:49,320 --> 00:25:51,800
SLIDES I WANT TO SAY X AND I 

584
00:25:51,800 --> 00:25:53,040
WONDER IF THERE'S GOING TO BE 

585
00:25:53,040 --> 00:25:56,360
ENOUGH TIME TO DO AN 

586
00:25:56,360 --> 00:25:57,400
EXPERIENTIAL EXERCISE IN THE END

587
00:25:57,400 --> 00:25:59,720
AND I HAVE TO REMEMBER TO CALL 

588
00:25:59,720 --> 00:26:00,360
MY SISTER.

589
00:26:00,360 --> 00:26:08,640
I HAVE THIS NON SEBS GOING ON.

590
00:26:08,640 --> 00:26:10,360
AND WHEN YOU'RE PRACTICING 

591
00:26:10,360 --> 00:26:12,000
TRAINING IN MINDFULNESS AND 

592
00:26:12,000 --> 00:26:14,280
MEDITATION WHAT YOU'RE DOING IS 

593
00:26:14,280 --> 00:26:16,720
ALLOWING THE CHATTERING MIND TO 

594
00:26:16,720 --> 00:26:24,360
SETTLE SO YOU BEGIN TO SEE YOU 

595
00:26:24,360 --> 00:26:26,040
SEE THE SINGLE THOUGHT OR RISE 

596
00:26:26,040 --> 00:26:29,040
AND FALL OF AN EMOTION OR A 

597
00:26:29,040 --> 00:26:31,760
SPECIFIC SENSATION WHICH MAY BE 

598
00:26:31,760 --> 00:26:34,400
AND OFTEN IS TRANSIENT BUT NOT 

599
00:26:34,400 --> 00:26:39,360
ALWAYS.

600
00:26:39,360 --> 00:26:43,240
OR FEEL A BEHAVIORAL URGE LIKE 

601
00:26:43,240 --> 00:26:44,240
SWALLOW OR MOVE AND WHAT HAPPENS

602
00:26:44,240 --> 00:26:46,400
IF I DO OR DON'T.

603
00:26:46,400 --> 00:26:51,520
AS YOU BEGIN TO ACCESS THE MICRO

604
00:26:51,520 --> 00:26:53,080
EXPERIENCE YOU BEGIN TO SEE 

605
00:26:53,080 --> 00:26:54,440
THEIR TRANSIENT NATURE AND BEGIN

606
00:26:54,440 --> 00:26:56,320
TO HAVE MORE CHOICE IN WHICH 

607
00:26:56,320 --> 00:27:04,920
PARTS YOU WANT TO ATTEND TO.

608
00:27:04,920 --> 00:27:06,440
IF YOU ACCESS THOSE PIECES AND 

609
00:27:06,440 --> 00:27:11,640
ALLOW THEM TO SETTLE MORE YOU 

610
00:27:11,640 --> 00:27:13,440
OPEN TO A BROADER EXPERIENCE 

611
00:27:13,440 --> 00:27:15,440
WHICH IN THIS MODEL IS CALLED 

612
00:27:15,440 --> 00:27:16,760
WISE MIND.

613
00:27:16,760 --> 00:27:19,400
IN SOME WE CALL IT TRUE SELF OR 

614
00:27:19,400 --> 00:27:23,080
CORE SELF AND OTHER MODELS 

615
00:27:23,080 --> 00:27:30,440
SPIRITUAL AND PHILOSOPHICAL 

616
00:27:30,440 --> 00:27:40,840
MODELS HAVE COLLECTIVE 

617
00:27:41,360 --> 00:27:42,000
UNCONSC

618
00:27:42,000 --> 00:27:42,280
UNCONSCIOUS.

619
00:27:42,280 --> 00:27:42,880
BOTH ARE ACTIVE.

620
00:27:42,880 --> 00:27:46,400
HAVE YOU INFORMATION COMING UP 

621
00:27:46,400 --> 00:27:48,760
AND ASSOCIATIONS AND HAVE THE 

622
00:27:48,760 --> 00:27:50,400
DIRECT COGNITIVE CONTROL COMING 

623
00:27:50,400 --> 00:27:51,200
DOWN.

624
00:27:51,200 --> 00:27:53,920
AND ONE OF THE REASONS I LIKE 

625
00:27:53,920 --> 00:27:55,240
MINDFULNESS IS BECAUSE TRAINING 

626
00:27:55,240 --> 00:27:58,720
IN MINDFULNESS ACTUALLY GIVES US

627
00:27:58,720 --> 00:28:00,800
ACCESS TO BOTH OF THESE 

628
00:28:00,800 --> 00:28:02,360
PROCESSING SYSTEMS.

629
00:28:02,360 --> 00:28:06,400
WHAT WE KNOW IS THAT THE 

630
00:28:06,400 --> 00:28:08,840
INDIVIDUAL MECHANISMS THAT 

631
00:28:08,840 --> 00:28:10,080
APPEAR TO BE AT PLAY ARE 

632
00:28:10,080 --> 00:28:11,760
DEPENDENT ON A TON OF FACTORS.

633
00:28:11,760 --> 00:28:13,600
THEY'RE DEPENDENT ON THE 

634
00:28:13,600 --> 00:28:15,280
EXPERIENCE LEVEL OF THE 

635
00:28:15,280 --> 00:28:16,000
PRACTITIONER AND WHICH PRACTICE 

636
00:28:16,000 --> 00:28:18,280
THE PERSON'S ENGAGING IN, ON THE

637
00:28:18,280 --> 00:28:20,040
LENGTH OF THEIR TRAINING, 

638
00:28:20,040 --> 00:28:21,480
ETCETERA.

639
00:28:21,480 --> 00:28:24,160
FOR EXAMPLE, WE KNOW NOVICE 

640
00:28:24,160 --> 00:28:26,400
MEDITATORS DEMONSTRATE A SHIFT 

641
00:28:26,400 --> 00:28:30,400
IN THEIR ORIENTING FUNCTION 

642
00:28:30,400 --> 00:28:35,080
WITHIN WORKING MEMORY A 

643
00:28:35,080 --> 00:28:35,600
BOTTOM-UP FUNCTION.

644
00:28:35,600 --> 00:28:37,320
AND WE DON'T SEE THAT IN MORE 

645
00:28:37,320 --> 00:28:40,280
EXPERIENCED PRACTITIONERS.

646
00:28:40,280 --> 00:28:44,720
WE SEE IN EXPERIENCED 

647
00:28:44,720 --> 00:28:53,280
PRACTITIONERS ABILITY IN 

648
00:28:53,280 --> 00:28:56,640
TRAINING AND WE'RE BEGINNING TO 

649
00:28:56,640 --> 00:28:58,480
UNDERSTAND FROM BOTTOM-UP AS 

650
00:28:58,480 --> 00:28:59,640
WELL AS FROM TOP-DOWN HOW IT IS 

651
00:28:59,640 --> 00:29:02,400
PEOPLE ACCESS COMPONENTS OF 

652
00:29:02,400 --> 00:29:12,600
EXPERIENCE.

653
00:29:13,080 --> 00:29:17,720
ONE THAT IS GETTING MULTIPLE 

654
00:29:17,720 --> 00:29:20,720
INTERVENTIONS IS WHAT 

655
00:29:20,720 --> 00:29:21,520
MINDFULNESS BASED COGNITIVE 

656
00:29:21,520 --> 00:29:25,480
THERAPY CALLED DE CENTERING OR 

657
00:29:25,480 --> 00:29:29,800
ACT CALLED DIFFUSING OR 

658
00:29:29,800 --> 00:29:34,880
MINDFULNESS TAKES THE STANCE OF 

659
00:29:34,880 --> 00:29:39,200
THE CURIOUS OBSERVANCE WHO IS 

660
00:29:39,200 --> 00:29:40,320
WATCHING WITH EXPERIENCE IT'S 

661
00:29:40,320 --> 00:29:46,600
THE PROCESS OF STEPPING BACK AND

662
00:29:46,600 --> 00:29:49,040
DEVELOP METACOGNITIVE AWARENESS 

663
00:29:49,040 --> 00:29:50,760
WHERE YOU SEE HOW YOUR OWN MIND 

664
00:29:50,760 --> 00:29:50,960
WORKS.

665
00:29:50,960 --> 00:29:54,200
YOU BEGIN TO SEE HOW IT IS THAT 

666
00:29:54,200 --> 00:29:58,400
YOU CREATE THE EXPERIENCE YOU 

667
00:29:58,400 --> 00:30:01,640
CREATE FOR YOURSELF.

668
00:30:01,640 --> 00:30:06,480
WE KNOW DECENTERING APPEARS TO 

669
00:30:06,480 --> 00:30:08,680
BE CENTRAL IN THE NEUROCENTRIC 

670
00:30:08,680 --> 00:30:10,360
MODELS IN WORKING WIN CHRONIC 

671
00:30:10,360 --> 00:30:16,040
PAIN AND DEPRESSION AND ANXIETY.

672
00:30:16,040 --> 00:30:24,880
THIS IS THE WORK OF SEGAL AND 

673
00:30:24,880 --> 00:30:26,400
RELAPSE IN DEPRESSION IS 

674
00:30:26,400 --> 00:30:27,480
TRIGGERING TO THE NEGATIVE 

675
00:30:27,480 --> 00:30:29,040
THINKING PATTERNS THAT HAVE BEEN

676
00:30:29,040 --> 00:30:30,400
ASSOCIATED WITH THE INDUCEMENT 

677
00:30:30,400 --> 00:30:35,040
OF THE SAD MOOD.

678
00:30:35,040 --> 00:30:36,360
THEY COULD EXPERIMENTALLY INDUCE

679
00:30:36,360 --> 00:30:39,800
A SAD MOOD AND SEE THE THINKING 

680
00:30:39,800 --> 00:30:41,840
PATTERNS COME ONLINE.

681
00:30:41,840 --> 00:30:45,680
THEY FOUND WHEN PEOPLE PRACTICE 

682
00:30:45,680 --> 00:30:47,080
THE SELF-REGULATION SKILLS THAT 

683
00:30:47,080 --> 00:30:51,680
WERE TRAINED AT NBCT THERE WAS 

684
00:30:51,680 --> 00:30:53,920
NOT A DIRECT RELATIONSHIP TO THE

685
00:30:53,920 --> 00:30:55,560
DEGREE TO WHICH PEOPLE RELAPSED 

686
00:30:55,560 --> 00:31:02,400
BUT THERE WAS A MEDIATED 

687
00:31:02,400 --> 00:31:07,120
RELATIONSHIP IF THEY PRACTICED 

688
00:31:07,120 --> 00:31:08,600
LED TO THE AMOUNT OF LEARNING 

689
00:31:08,600 --> 00:31:10,800
THEY WERE DOING IN TERMS OF HOW 

690
00:31:10,800 --> 00:31:12,040
TO TAKE THAT OBSERVER STANCE.

691
00:31:12,040 --> 00:31:15,440
THAT IS WHAT ACTUALLY PREDICTED 

692
00:31:15,440 --> 00:31:21,840
THE RELAPSE OF DEPRESSION.

693
00:31:21,840 --> 00:31:26,240
ANOTHER MODEL IS THE WORK OF 

694
00:31:26,240 --> 00:31:28,760
ERIC GARLAND AND THE ATTENTIONAL

695
00:31:28,760 --> 00:31:34,400
CONTROL THE INHIBITORY CONTROL 

696
00:31:34,400 --> 00:31:35,920
AND METACOGNITION BASED ON WHERE

697
00:31:35,920 --> 00:31:37,600
YOU PUT YOUR ATTENTION AND THE 

698
00:31:37,600 --> 00:31:41,080
ABILITY TO STEP BACK AND WATCH, 

699
00:31:41,080 --> 00:31:46,400
THAT LEADS TO A SHIFT FROM 

700
00:31:46,400 --> 00:31:48,720
AFFECTIVE PROCESSING THAT IS 

701
00:31:48,720 --> 00:31:50,760
PREDOMINANT IN CHRONIC PAIN AND 

702
00:31:50,760 --> 00:31:53,680
ALSO IN THOSE PEOPLE THAT ARE 

703
00:31:53,680 --> 00:31:56,080
STRUGGLING WITH OPIOID USE AND 

704
00:31:56,080 --> 00:31:57,520
MOVING FROM THAT AFFECTIVE 

705
00:31:57,520 --> 00:31:59,640
PROCESSING, DECOUPLING IT, 

706
00:31:59,640 --> 00:32:01,480
SEPARATING IT FROM SENSORY 

707
00:32:01,480 --> 00:32:04,640
PROCESSING IS ONE OF THE MAIN 

708
00:32:04,640 --> 00:32:08,000
MECHANISMS THROUGH WHICH HIS 

709
00:32:08,000 --> 00:32:09,840
APPROACH THE MINDFULNESS 

710
00:32:09,840 --> 00:32:11,000
RECOVERY ENHANCEMENT PROGRAM 

711
00:32:11,000 --> 00:32:13,800
SEEMS TO WORK.

712
00:32:13,800 --> 00:32:17,000
THE PROCESS OF STEPPING BACK AND

713
00:32:17,000 --> 00:32:22,520
THEN WE SEE A SEPARATING OF THE 

714
00:32:22,520 --> 00:32:24,600
SENSORY PIECE AND THERE'S AN 

715
00:32:24,600 --> 00:32:25,760
AMPLIFICATION OF THE SENSORY 

716
00:32:25,760 --> 00:32:28,240
PIECE AND DISCONNECTED OR 

717
00:32:28,240 --> 00:32:30,160
DAMPENED IN TERMS OF ITS LINKING

718
00:32:30,160 --> 00:32:31,480
TO THE EMOTIONAL PIECE.

719
00:32:31,480 --> 00:32:34,840
THERE'S OTHER PIECES THAT HAVE 

720
00:32:34,840 --> 00:32:37,960
TO DO WITH SAVORING AND BUILDING

721
00:32:37,960 --> 00:32:39,600
UP THE EXPERIENCE OF PLEASURE 

722
00:32:39,600 --> 00:32:40,560
BUT WON'T GET INTO THAT FOR 

723
00:32:40,560 --> 00:32:45,120
RIGHT NOW.

724
00:32:45,120 --> 00:32:50,400
YOU MAY HAVE ALSO HEARD OF THE 

725
00:32:50,400 --> 00:32:53,440
WORK AND I DIDN'T HEAR LAURA'S 

726
00:32:53,440 --> 00:32:57,080
TALK YESTERDAY BUT MY GUESS IS 

727
00:32:57,080 --> 00:33:00,480
WHEN YOU LEARNED ABOUT THE 

728
00:33:00,480 --> 00:33:02,760
VENTRAL MEDIAL PREFRONTAL CORTEX

729
00:33:02,760 --> 00:33:06,920
MAYBE SOME OF THIS WAS MENTIONED

730
00:33:06,920 --> 00:33:09,040
BUT CHRONIC PAIN THROUGH THE 

731
00:33:09,040 --> 00:33:10,440
DISTRIBUTED NETWORKS ARE 

732
00:33:10,440 --> 00:33:15,920
DEACTIVATED THROUGH MINDFULNESS 

733
00:33:15,920 --> 00:33:25,880
TRAINING SUCH AS THE 

734
00:33:25,880 --> 00:33:28,640
VENTROMEDIAL PREFONT TAL CORTEX 

735
00:33:28,640 --> 00:33:30,080
AND MINDFULNESS IS HELPING 

736
00:33:30,080 --> 00:33:31,200
PEOPLE SEPARATE OUT COMPONENTS 

737
00:33:31,200 --> 00:33:33,960
OF EXPERIENCE AND SEPARATE OUT 

738
00:33:33,960 --> 00:33:35,920
THE DIRECT EXPERIENCE AND DATA, 

739
00:33:35,920 --> 00:33:41,840
IF YOU WILL, FROM THE PERSON'S 

740
00:33:41,840 --> 00:33:46,400
STORY OR SELF-REFERENTIAL 

741
00:33:46,400 --> 00:33:49,960
NARRATIVE OF THE STORY.

742
00:33:49,960 --> 00:33:52,000
THOSE ARE SOME NEURO SCIENTIFIC 

743
00:33:52,000 --> 00:33:54,240
METHODS OUT THERE AND A WANT TO 

744
00:33:54,240 --> 00:33:58,400
MENTION WHAT PATIENT HAVE TOLD 

745
00:33:58,400 --> 00:34:04,440
US.

746
00:34:04,440 --> 00:34:11,520
BE AND THIS IS PART OF A WEIGHT 

747
00:34:11,520 --> 00:34:13,080
LOSS CONSTRUCT AND HERE'S WHAT 

748
00:34:13,080 --> 00:34:14,960
PATIENTS TELL US AND THE GUIDING

749
00:34:14,960 --> 00:34:16,960
QUESTION IN THE QUALITATIVE 

750
00:34:16,960 --> 00:34:19,120
STUDY WAS WHAT WAS THE INTERNAL 

751
00:34:19,120 --> 00:34:21,000
EXPERIENCE OF MINDFULNESS 

752
00:34:21,000 --> 00:34:22,400
PARTICIPANTS TO CREATE CHANGES 

753
00:34:22,400 --> 00:34:26,120
IN BEHAVIOR.

754
00:34:26,120 --> 00:34:30,320
WHAT WE FOUND WAS THEY FOCUSSED 

755
00:34:30,320 --> 00:34:31,840
THEY REPORTED TO US THESE EXACT 

756
00:34:31,840 --> 00:34:33,400
SAME THING.

757
00:34:33,400 --> 00:34:38,400
THEY LEARNED TO ATTEND TO FOCUS 

758
00:34:38,400 --> 00:34:44,200
ON PARTICULAR CUES, SOCIAL CUES,

759
00:34:44,200 --> 00:34:49,160
CONTEXTUAL CUES AND LEARNED TO 

760
00:34:49,160 --> 00:34:54,400
FOCUS ON SENSATIONAL CUES 

761
00:34:54,400 --> 00:34:58,680
WITHOUT THE STORY OF THE 

762
00:34:58,680 --> 00:34:59,040
SENSATION.

763
00:34:59,040 --> 00:35:02,400
THE ACTUAL THINKING PROCESS AND 

764
00:35:02,400 --> 00:35:04,640
DECISION MAKING PROCESS THAT 

765
00:35:04,640 --> 00:35:07,240
THEY RECOGNIZED THROUGH THEIR 

766
00:35:07,240 --> 00:35:08,200
MINDFULNESS MEDITATION PRACTICE 

767
00:35:08,200 --> 00:35:12,440
HAS SEVERAL KEY THINGS.

768
00:35:12,440 --> 00:35:15,520
SO BEING ABLE TO TEASE A PART A 

769
00:35:15,520 --> 00:35:18,720
CUE, A SENSATION OR AN EMOTION 

770
00:35:18,720 --> 00:35:23,840
FROM A BEHAVIOR PATTERN WAS 

771
00:35:23,840 --> 00:35:25,760
IMPORTANT AND THAT PROCESS 

772
00:35:25,760 --> 00:35:28,080
ALLOWED THEM TO SEE OPTIONS THAT

773
00:35:28,080 --> 00:35:32,640
HAD BEEN THERE BUT THEY HADN'T 

774
00:35:32,640 --> 00:35:33,640
SEEN THEM.

775
00:35:33,640 --> 00:35:36,920
OR TO CREATE OPTIONS THAT WERE 

776
00:35:36,920 --> 00:35:38,240
ACTUALLY NOT THERE BEFORE AND 

777
00:35:38,240 --> 00:35:40,040
THEN THEY UTILIZED THOSE OPTIONS

778
00:35:40,040 --> 00:35:43,640
TO DO THINGS LIKE PLAN OR ENGAGE

779
00:35:43,640 --> 00:35:46,240
IN EXERCISE OR CREATE A MEAL 

780
00:35:46,240 --> 00:35:48,800
PLAN.

781
00:35:48,800 --> 00:35:51,160
THE INCREASING ABILITY TO 

782
00:35:51,160 --> 00:35:52,680
IDENTIFY WHAT THEIR CORE NEEDS 

783
00:35:52,680 --> 00:35:52,920
WERE.

784
00:35:52,920 --> 00:35:58,080
TO IDENTIFY AND ACT ON WHAT THEY

785
00:35:58,080 --> 00:36:01,360
MOST NEEDED AND TO ENGAGE THEIR 

786
00:36:01,360 --> 00:36:02,600
CONSCIOUSLY CHOSEN VALUES.

787
00:36:02,600 --> 00:36:04,400
THEY TALKED ABOUT A GROWING 

788
00:36:04,400 --> 00:36:05,040
AWARENESS OF THEIR ROLE IN 

789
00:36:05,040 --> 00:36:08,840
CREATING BEHAVIOR.

790
00:36:08,840 --> 00:36:10,240
THEIR OWN RESPONSIBILITY IN 

791
00:36:10,240 --> 00:36:12,680
THEIR KIND OF CONSTRUCTIVIST 

792
00:36:12,680 --> 00:36:13,080
EXPERIENCE.

793
00:36:13,080 --> 00:36:19,480
NOW, I WANT TO BE CLEAR THAT I'M

794
00:36:19,480 --> 00:36:23,720
NOT SUGGESTING THAT PEOPLE ARE 

795
00:36:23,720 --> 00:36:25,120
INTENTIONALLY CREATING DIFFICULT

796
00:36:25,120 --> 00:36:28,920
PATTERNS OF BEHAVIOR AND 

797
00:36:28,920 --> 00:36:30,560
UNCOMFORTABLE AND MISERABLE 

798
00:36:30,560 --> 00:36:30,920
EXPERIENCES.

799
00:36:30,920 --> 00:36:33,000
THIS HAPPENS OUTSIDE OF 

800
00:36:33,000 --> 00:36:34,240
AWARENESS.

801
00:36:34,240 --> 00:36:36,720
WHAT IS USEFUL AND IMPORTANT IN 

802
00:36:36,720 --> 00:36:38,240
UNDERSTANDING IN HOW TO ACCESS 

803
00:36:38,240 --> 00:36:40,840
THE WHOLE SELF BEFORE THE WHOLE 

804
00:36:40,840 --> 00:36:42,440
PATTERNS GET BUILT ON TO IT IS 

805
00:36:42,440 --> 00:36:45,440
BY TAKING A PART THOSE 

806
00:36:45,440 --> 00:36:48,200
EXPERIENCES AND SEEING WHERE 

807
00:36:48,200 --> 00:36:50,280
THEY'RE ACTUALLY IS CHOICE IN 

808
00:36:50,280 --> 00:36:52,080
THE BEHAVIOR.

809
00:36:52,080 --> 00:36:56,200
SO THANK YOU VERY MUCH FOR YOUR 

810
00:36:56,200 --> 00:36:56,560
TIME.

811
00:36:56,560 --> 00:36:58,240
I'M VERY READY TO HEAR YOUR 

812
00:36:58,240 --> 00:37:08,720
COMMENTS AND YOUR QUESTIONS.

813
00:37:14,040 --> 00:37:14,560
>> THANK YOU.

814
00:37:14,560 --> 00:37:15,600
WE HAVE MANY QUESTIONS AND WE'LL

815
00:37:15,600 --> 00:37:17,080
TAKE A FEW FROM THE AUDIENCE.

816
00:37:17,080 --> 00:37:22,640
WE'LL START WITH A QUESTION, CAN

817
00:37:22,640 --> 00:37:27,320
YOU GIVE AN EXAMPLE OF MUCH WHAT

818
00:37:27,320 --> 00:37:30,240
A RESEARCHER MAY SEE IN A 

819
00:37:30,240 --> 00:37:32,360
PATIENT WITH CHRONIC PAIN.

820
00:37:32,360 --> 00:37:33,640
>> THERE'S A LOT OF HABITS

821
00:37:33,640 --> 00:37:34,160
FORMED.

822
00:37:34,160 --> 00:37:36,880
THE TYPICAL ONES HAVE TO DO WITH

823
00:37:36,880 --> 00:37:38,560
DEVELOPING A CONDITION FEAR OF 

824
00:37:38,560 --> 00:37:40,920
MOVEMENT BECAUSE MOVEMENT 

825
00:37:40,920 --> 00:37:43,880
EXACERBATES THE PAIN AND IT 

826
00:37:43,880 --> 00:37:45,120
HURTS PEOPLE THEN LEARN TO BE 

827
00:37:45,120 --> 00:37:45,760
MORE STILL.

828
00:37:45,760 --> 00:37:47,320
IN THE MOMENT I MAY FEEL BETTER 

829
00:37:47,320 --> 00:37:50,760
BUT OVER TIME THE MUSCLES 

830
00:37:50,760 --> 00:38:01,320
TIGHTEN AND THE MEI -- MYOFACIA 

831
00:38:09,680 --> 00:38:15,320
GETS STUCK AND THERE'S LOTS OF 

832
00:38:15,320 --> 00:38:25,480
EXAMPL

833
00:38:26,480 --> 00:38:27,720
EXAMPLES.

834
00:38:27,720 --> 00:38:30,240
THERE'S EMOTIONAL AND THOUGHT 

835
00:38:30,240 --> 00:38:31,000
CONDITIONING.

836
00:38:31,000 --> 00:38:37,720
FEAR-BASED LACK OF MOVEMENT IS 

837
00:38:37,720 --> 00:38:39,960
ONE ANOTHER IS PEOPLE OVER DO OR

838
00:38:39,960 --> 00:38:41,200
UNDER DO.

839
00:38:41,200 --> 00:38:44,800
COMING OUT OF AN INTENTION FLARE

840
00:38:44,800 --> 00:38:45,720
THEY MAY HAVE A DAY WHERE THEY 

841
00:38:45,720 --> 00:38:48,720
FEEL GOOD AND DO AND DO AND OVER

842
00:38:48,720 --> 00:38:50,400
DO AND BACK IN BED THREE DAYS.

843
00:38:50,400 --> 00:38:51,600
THE CONDITIONS OF WHEN I'M 

844
00:38:51,600 --> 00:38:55,640
REALLY HURTING AND I CAN'T DO 

845
00:38:55,640 --> 00:38:57,440
ANYTHING, THE DRIVE TO GET LOTS 

846
00:38:57,440 --> 00:38:59,480
OF THINGS DONE RISES AND WHEN I 

847
00:38:59,480 --> 00:39:04,800
HAVE A BRIEF MOMENT OVER DOING 

848
00:39:04,800 --> 00:39:09,680
AND NEEDING TO FIGURE OUT A MORE

849
00:39:09,680 --> 00:39:11,200
APPROPRIATE PACING GIVEN THE 

850
00:39:11,200 --> 00:39:14,240
CONDITION OR EXPERIENCE I'M 

851
00:39:14,240 --> 00:39:21,160
HAVING IN A PARTICULAR MOMENT.

852
00:39:21,160 --> 00:39:24,960
>> HOW DO YOU HELP
PATIENTS 

853
00:39:24,960 --> 00:39:26,720
ENGAGE SO THEY DON'T FEEL OVER 

854
00:39:26,720 --> 00:39:29,440
WORKED AND DECLINE.

855
00:39:29,440 --> 00:39:30,320
>> GREAT QUESTION.

856
00:39:30,320 --> 00:39:33,080
SO ONE THING I WILL SAY ABOUT 

857
00:39:33,080 --> 00:39:35,200
MINDFULNESS IS YOU HAVE TO BE 

858
00:39:35,200 --> 00:39:38,120
REGULATED ENOUGH THAT YOU CAN 

859
00:39:38,120 --> 00:39:40,240
ACTUALLY SIT STILL OR DO SOME 

860
00:39:40,240 --> 00:39:44,000
KIND OF SOOTHING MINDFUL MOMENT.

861
00:39:44,000 --> 00:39:45,920
I WOULDN'T START WITH 

862
00:39:45,920 --> 00:39:49,200
MINDFULNESS RIGHT OFF THE BAT.

863
00:39:49,200 --> 00:39:52,880
I WOULD ASSESS THE DEGREE TO 

864
00:39:52,880 --> 00:39:54,120
WHICH A PERSON WAS OPEN TO 

865
00:39:54,120 --> 00:39:55,920
ACTUALLY LEARNING THAT.

866
00:39:55,920 --> 00:39:59,440
WHEN THE PAIN SIGNAL IS TOO LOUD

867
00:39:59,440 --> 00:40:03,440
OR THE PERSON YET DOESN'T HAVE 

868
00:40:03,440 --> 00:40:04,120
THE EDUCATION OR INFORMATION 

869
00:40:04,120 --> 00:40:05,760
ABOUT HOW THIS IS IMPORTANT, 

870
00:40:05,760 --> 00:40:10,680
IT'S USEFUL TO START BY DOING 

871
00:40:10,680 --> 00:40:11,040
SOME EDUCATION.

872
00:40:11,040 --> 00:40:12,320
ONE OF THE REASONS I LIKE THE 

873
00:40:12,320 --> 00:40:14,240
WHEEL IS YOU CAN START WHERE THE

874
00:40:14,240 --> 00:40:16,120
PERSON'S MOST INTERESTED.

875
00:40:16,120 --> 00:40:17,400
WHATEVER IT IS THEY'RE MOST 

876
00:40:17,400 --> 00:40:24,600
INTERESTED IN, YOU CAN INVITE 

877
00:40:24,600 --> 00:40:26,360
THEM TO START SELF-MONITOR.

878
00:40:26,360 --> 00:40:27,720
SAY THEY'RE INTERESTED IN 

879
00:40:27,720 --> 00:40:28,920
IMPROVING THEIR SLEEP.

880
00:40:28,920 --> 00:40:31,520
YOU CAN START TO HAVE THEM 

881
00:40:31,520 --> 00:40:37,200
SELF-MONITOR THE TIME THEY HAVE 

882
00:40:37,200 --> 00:40:38,400
IN BED AND RECOGNIZE THEIR OWN 

883
00:40:38,400 --> 00:40:39,600
PATTERNS OVER TIME.

884
00:40:39,600 --> 00:40:41,280
ONCE HAVE YOU A LITTLE 

885
00:40:41,280 --> 00:40:42,880
SELF-MONITORING GOING, YOU CAN 

886
00:40:42,880 --> 00:40:44,880
INVITE THEM TO TRY MINDFULNESS.

887
00:40:44,880 --> 00:40:47,760
WE HAVE A PROGRAM AT OUR CENTER 

888
00:40:47,760 --> 00:40:50,240
CALLED MINDFULNESS SKILLS WHICH 

889
00:40:50,240 --> 00:40:52,920
IS A GROUP-BASED PROGRAM WHERE 

890
00:40:52,920 --> 00:40:56,400
WE START TO HELP PEOPLE 

891
00:40:56,400 --> 00:40:58,920
RECOGNIZE, GROW THEIR AWARENESS 

892
00:40:58,920 --> 00:41:01,080
AND RECOGNIZE SOME OF THE LINKS.

893
00:41:01,080 --> 00:41:03,880
THAT KIND OF A PROGRAM CAN BE 

894
00:41:03,880 --> 00:41:04,120
HELPFUL.

895
00:41:04,120 --> 00:41:14,840
IT'S TRITRAIT TED AND BEGINNING 

896
00:41:19,920 --> 00:41:22,920
SMALL ASSOCIATION LEADING TIE 

897
00:41:22,920 --> 00:41:33,360
GREATER  -- TO A GREATER 

898
00:41:33,600 --> 00:41:34,680
WILLINGNESS.

899
00:41:34,680 --> 00:41:39,680
>> HAVE YOU FOUND WHAT IS 

900
00:41:39,680 --> 00:41:44,880
SUCCESSFUL IN COMPASSIONATE 

901
00:41:44,880 --> 00:41:46,240
AWARENESS.

902
00:41:46,240 --> 00:41:47,880
>> I LOVE INTERNAL FAMILY 

903
00:41:47,880 --> 00:41:48,520
SYMPTOMS WORK.

904
00:41:48,520 --> 00:41:49,840
I DIDN'T EVEN GET THAT IN HERE.

905
00:41:49,840 --> 00:41:51,760
FOR THOSE NOT AWARE, WE HAVE 

906
00:41:51,760 --> 00:41:56,040
PARTS OF OURSELVES AND WHAT YOU 

907
00:41:56,040 --> 00:42:00,040
DO IN INTERNAL FAMILY SYSTEMS.

908
00:42:00,040 --> 00:42:04,560
THEY'RE IN A HYPNOTIC DEEPLY 

909
00:42:04,560 --> 00:42:05,520
ABSORBED STATE WHERE YOU WORK ON

910
00:42:05,520 --> 00:42:07,520
PARTS OF SELF AND WORK ON THE 

911
00:42:07,520 --> 00:42:09,440
INFORMATION AND FUNCTION OF THAT

912
00:42:09,440 --> 00:42:15,200
PART AND IT'S VERY MUCH A 

913
00:42:15,200 --> 00:42:20,720
WELCOMING AND SO THERE'S IT'S 

914
00:42:20,720 --> 00:42:22,240
TAKING A PART OUR HISTORICAL 

915
00:42:22,240 --> 00:42:23,560
CRITICISM AND BEGINNING TO 

916
00:42:23,560 --> 00:42:26,080
UNDERSTAND AND APPRECIATE THE 

917
00:42:26,080 --> 00:42:26,720
ROLE IT'S PLAYING.

918
00:42:26,720 --> 00:42:31,720
I THINKIFS, INTERNAL FAMILY 

919
00:42:31,720 --> 00:42:32,280
SYSTEMS IS VERY MUCH IN THE 

920
00:42:32,280 --> 00:42:42,520
MODEL AS WELL.

921
00:42:45,600 --> 00:42:49,560
>> WHAT ROLE DO YOU SEE IN
THE 

922
00:42:49,560 --> 00:42:53,920
IMPLEMENTATION OF WHOLE HEALTH 

923
00:42:53,920 --> 00:42:54,160
STUDIES.

924
00:42:54,160 --> 00:42:55,600
>> I THINK THERE'S MANY 

925
00:42:55,600 --> 00:42:58,400
DIFFERENT POSSIBILITIES HERE.

926
00:42:58,400 --> 00:43:01,920
ONE IS TO BE ON ALERT, IF YOU 

927
00:43:01,920 --> 00:43:03,520
WILL, HOLDING THE SPACE FOR 

928
00:43:03,520 --> 00:43:05,760
PATIENTS SO THAT THEY CAN BEGIN 

929
00:43:05,760 --> 00:43:09,320
TO SHARE PIECES MUCH THEIR 

930
00:43:09,320 --> 00:43:09,760
ENVIRONMENT.

931
00:43:09,760 --> 00:43:10,840
EXCUSE ME, EXPERIENCE.

932
00:43:10,840 --> 00:43:12,440
ONE OF THE THING THE NURSES DO 

933
00:43:12,440 --> 00:43:15,600
REALLY WELL AND I'M TALKING 

934
00:43:15,600 --> 00:43:19,120
ABOUT RNs NOT TALKING ABOUT AN 

935
00:43:19,120 --> 00:43:21,760
NP BUT AN RN, THEY CREATE THE 

936
00:43:21,760 --> 00:43:24,320
ENVIRONMENT WHERE THE PATIENT 

937
00:43:24,320 --> 00:43:27,000
GETS THAT SENSE OF ACCEPTANCE 

938
00:43:27,000 --> 00:43:30,720
AND THAT YOU'RE OKAY AND WE 

939
00:43:30,720 --> 00:43:34,920
DON'T THINK YOU'RE MAKING THIS 

940
00:43:34,920 --> 00:43:35,320
UP.

941
00:43:35,320 --> 00:43:36,200
PEOPLE WITH CHRONIC PAIN 

942
00:43:36,200 --> 00:43:38,160
EXPERIENCE SO MUCH DISCOUNTING 

943
00:43:38,160 --> 00:43:48,600
AND NEGATIVE STIGMA AND 

944
00:43:52,920 --> 00:43:58,840
UNDERSTANDABLY PERCEIVED.

945
00:43:58,840 --> 00:44:01,840
AND CREATING A SPACE WHEREIN THE

946
00:44:01,840 --> 00:44:05,600
PATIENT IS STARTING TO SETTLE 

947
00:44:05,600 --> 00:44:08,200
AND THEY'RE HELPING SETTLE THE 

948
00:44:08,200 --> 00:44:08,960
PERSON'S NERVOUS SYSTEM FROM THE

949
00:44:08,960 --> 00:44:12,120
MOMENT THEY'RE WALKING DOWN THE 

950
00:44:12,120 --> 00:44:12,840
HALL BEFORE THEY GET SETTLED 

951
00:44:12,840 --> 00:44:19,560
INTO AN OFFICE.

952
00:44:19,560 --> 00:44:26,200
>> THERE'S A COUPLE
QUESTIONS 

953
00:44:26,200 --> 00:44:34,800
AND THEY SEEM TO WORK BETTER IN 

954
00:44:34,800 --> 00:44:37,160
PATIENTS WITH MILD OR MODERATE 

955
00:44:37,160 --> 00:44:38,160
PAIN.

956
00:44:38,160 --> 00:44:41,120
THE QUESTION IS WHAT ABOUT 

957
00:44:41,120 --> 00:44:43,520
PEOPLE SEVER CHRONIC PAIN, HOW 

958
00:44:43,520 --> 00:44:45,920
DO THEY HAVE THE PRESENTATION OF

959
00:44:45,920 --> 00:44:51,080
MIND TO HAVE MINDFULNESS IN SUCH

960
00:44:51,080 --> 00:44:51,720
PAIN?

961
00:44:51,720 --> 00:44:53,320
>> I WON'T SAY EVERYBODY
CAN.

962
00:44:53,320 --> 00:44:57,200
I DON'T THINK THAT IS THE CASE.

963
00:44:57,200 --> 00:45:01,960
AND WHILE I FIND MINDFULNESS 

964
00:45:01,960 --> 00:45:03,680
VERY POWERFUL IN TERMS OF MY OWN

965
00:45:03,680 --> 00:45:05,880
WORK AND WORK WITH PATIENTS.

966
00:45:05,880 --> 00:45:07,440
IT'S NOT FOR EVERYBODY.

967
00:45:07,440 --> 00:45:11,760
IF THE PAIN IS REALLY INTENSE, 

968
00:45:11,760 --> 00:45:13,320
CLINICAL HYPNOSIS, IN MY 

969
00:45:13,320 --> 00:45:16,840
EXPERIENCE, CAN HELP MORE 

970
00:45:16,840 --> 00:45:18,040
BECAUSE YOU'RN WORK A 

971
00:45:18,040 --> 00:45:21,360
DISSOCIATION STRATEGY AND YOU'RE

972
00:45:21,360 --> 00:45:24,960
WORKING ON ASSOCIATION STRATEGY 

973
00:45:24,960 --> 00:45:33,600
BUT ASSOCIATION TO OTHER THINGS.

974
00:45:33,600 --> 00:45:36,000
BUT YOU'RE TRYING TO CULTIVATE 

975
00:45:36,000 --> 00:45:37,680
WHAT PEOPLE CARE ABOUT AND MOVE 

976
00:45:37,680 --> 00:45:38,760
IT TO THE FOREGROUND AND PAIN TO

977
00:45:38,760 --> 00:45:43,880
THE BACKGROUND BUT FROM A BIGGER

978
00:45:43,880 --> 00:45:44,080
PICTURE.

979
00:45:44,080 --> 00:45:48,800
HAVE YOU THIS MUCH PRECIOUS 

980
00:45:48,800 --> 00:45:50,840
ENERGY A PERSON WITH CHRONIC 

981
00:45:50,840 --> 00:45:52,320
PAIN THIS MUCH PRECIOUS ENERGY, 

982
00:45:52,320 --> 00:45:55,600
WHAT DO YOU WANT TO DO WITH THAT

983
00:45:55,600 --> 00:45:56,960
AND BEGIN SOOTHING THE NERVOUS 

984
00:45:56,960 --> 00:45:58,560
SYSTEM IS REALLY IMPORTANT.

985
00:45:58,560 --> 00:46:04,720
CERTAINLY THERE'S A PLACE FOR 

986
00:46:04,720 --> 00:46:07,160
ANALGESIA.

987
00:46:07,160 --> 00:46:09,520
NO DOUBT ABOUT IT.

988
00:46:09,520 --> 00:46:16,720
FOR MIGRAINE IT'S MORE THE 

989
00:46:16,720 --> 00:46:17,920
HORMONES TO QUELL THE DEGREE BUT

990
00:46:17,920 --> 00:46:21,120
IT'S THE PATTERNS THAT 

991
00:46:21,120 --> 00:46:22,520
SIMULTANEOUSLY NEED TO BE WORKED

992
00:46:22,520 --> 00:46:22,840
ON.

993
00:46:22,840 --> 00:46:24,320
OF ALL THE BRIGHT COLORED AREAS 

994
00:46:24,320 --> 00:46:26,040
ON OUR WHEEL OF HEALTH TO 

995
00:46:26,040 --> 00:46:29,120
SUPPORT THE CREATION OF A 

996
00:46:29,120 --> 00:46:30,800
CONTEXT AND ENVIRONMENT WHERE 

997
00:46:30,800 --> 00:46:31,600
PEOPLE CAN THEN BUILD HEALTH AT 

998
00:46:31,600 --> 00:46:34,720
THE SAME TIME THEY'RE TRYING TO 

999
00:46:34,720 --> 00:46:38,040
LEARN TO MANAGE THIS INTENSE 

1000
00:46:38,040 --> 00:46:47,080
NOCICEPTIVE STIMULI.

1001
00:46:47,080 --> 00:46:49,680
>> AND ANOTHER QUESTION IS

1002
00:46:49,680 --> 00:46:51,720
PEDIATRIC VERSUS ADULT 

1003
00:46:51,720 --> 00:46:55,640
STRATEGIES ESPECIALLY WITH 

1004
00:46:55,640 --> 00:46:55,920
MINDFULNESS.

1005
00:46:55,920 --> 00:46:58,040
THE QUESTION IS HOW CON THE 

1006
00:46:58,040 --> 00:47:02,800
CONSTRUCT BE APPLIED IN THE 

1007
00:47:02,800 --> 00:47:04,520
PEDIATRIC CONTEXT OF THIS AND 

1008
00:47:04,520 --> 00:47:08,800
HOW DOES HUMAN DEVELOPMENT HELP 

1009
00:47:08,800 --> 00:47:14,040
THE APPROACH WITH CHILDREN AND 

1010
00:47:14,040 --> 00:47:18,840
YOUNG ADOLESCENTS.

1011
00:47:18,840 --> 00:47:22,720
AND A RELATED QUESTION, WHEN 

1012
00:47:22,720 --> 00:47:26,040
WILL MINDFULNESS TRAINING BE 

1013
00:47:26,040 --> 00:47:28,080
IMPLEMENTED IN ELEMENTARY SCHOOL

1014
00:47:28,080 --> 00:47:28,560
CURRICULUM.

1015
00:47:28,560 --> 00:47:30,480
>> WOW, I WISH I KNEW THAT
BUT I

1016
00:47:30,480 --> 00:47:30,760
DON'T.

1017
00:47:30,760 --> 00:47:33,040
IT IS IMPLEMENTED SOME PLACES 

1018
00:47:33,040 --> 00:47:34,040
EVEN IN ELEMENTARY SCHOOL 

1019
00:47:34,040 --> 00:47:44,200
TRAINING.

1020
00:47:47,840 --> 00:47:49,720
I DON'T WORK WITH CHILDREN 

1021
00:47:49,720 --> 00:47:51,520
OUTSIDE OF MY FAMILY AND FROM 

1022
00:47:51,520 --> 00:47:52,560
READING AND TALKING TO 

1023
00:47:52,560 --> 00:47:53,880
COLLEAGUES THAT DO WORK IN THIS 

1024
00:47:53,880 --> 00:47:56,520
AREA, THERE'S AN INNATE ABILITY 

1025
00:47:56,520 --> 00:48:00,600
THAT KIDS DO UNDERSTAND BUT IT 

1026
00:48:00,600 --> 00:48:05,720
HAS TO BE MORE FUN IN TERMS OF 

1027
00:48:05,720 --> 00:48:08,560
BEING ABLE TO TURN UP OR TURN 

1028
00:48:08,560 --> 00:48:10,680
DOWN ASPECTS OF THEIR SENSORY 

1029
00:48:10,680 --> 00:48:11,160
EXPERIENCE.

1030
00:48:11,160 --> 00:48:15,080
WORKING THROUGH BREATHING, FOR 

1031
00:48:15,080 --> 00:48:15,440
EXAMPLE.

1032
00:48:15,440 --> 00:48:17,160
THERE ARE ALSO SOME VERY 

1033
00:48:17,160 --> 00:48:19,760
SPECIFIC MINDFULNESS BASED 

1034
00:48:19,760 --> 00:48:23,640
PROGRAMS LIKE FOR ADOLESCENCE 

1035
00:48:23,640 --> 00:48:25,880
AND ONE DEVELOPED FOR 

1036
00:48:25,880 --> 00:48:27,040
COLLEGE-AGE STUDENTS UTILIZED 

1037
00:48:27,040 --> 00:48:32,960
SUCCESSFULLY IN ADOLESCENTS AS 

1038
00:48:32,960 --> 00:48:33,200
WELL.

1039
00:48:33,200 --> 00:48:35,560
I KNOW AND THERE'S DIFFERENT 

1040
00:48:35,560 --> 00:48:35,960
PRACTICES.

1041
00:48:35,960 --> 00:48:38,040
I CAN'T TELL YOU MORE SPECIFIC 

1042
00:48:38,040 --> 00:48:40,760
THAT.

1043
00:48:40,760 --> 00:48:42,480
YEAH, THAT'S ALL I GOT.

1044
00:48:42,480 --> 00:48:46,040
>> THIS IS INTERESTING AND

1045
00:48:46,040 --> 00:48:47,400
HOPEFULLY WE'LL HAVE SOME 

1046
00:48:47,400 --> 00:48:50,840
PEDIATRIC EXPERTS DURING THE 

1047
00:48:50,840 --> 00:48:52,200
NETWORKING SESSION LATER TODAY 

1048
00:48:52,200 --> 00:48:53,360
TO FURTHER DISCUSS THE TOPIC.

1049
00:48:53,360 --> 00:48:57,640
AS A LAST QUESTION BEFORE WE GO 

1050
00:48:57,640 --> 00:49:01,360
TO THE NEXT SESSION, IF 

1051
00:49:01,360 --> 00:49:06,520
CLINICIANS UNDERSTAND DE 

1052
00:49:06,520 --> 00:49:13,040
CONSTRUCTING AND CAN HELP PEOPLE

1053
00:49:13,040 --> 00:49:15,640
AND WHAT KIND OF TRAINING AND 

1054
00:49:15,640 --> 00:49:18,040
EDUCATION BE PROVIDED FOR 

1055
00:49:18,040 --> 00:49:18,600
THERAPY?

1056
00:49:18,600 --> 00:49:20,400
>> THAT'S A GREAT
QUESTION.

1057
00:49:20,400 --> 00:49:21,880
I HAVEN'T THOUGHT THAT THROUGH.

1058
00:49:21,880 --> 00:49:26,040
OFF THE TOP OF MY HEAD I WOULD 

1059
00:49:26,040 --> 00:49:28,240
SAY THAT THE CONTEXT IN THE 

1060
00:49:28,240 --> 00:49:30,840
TRAINING IS REALLY ABOUT CREATE 

1061
00:49:30,840 --> 00:49:33,320
SAFE CONTEXT WHERE YOU ASK 

1062
00:49:33,320 --> 00:49:36,440
PEOPLE THINGS AND LET THEM MAKE 

1063
00:49:36,440 --> 00:49:37,800
THEIR OWN -- COME TO THEIR OWN 

1064
00:49:37,800 --> 00:49:39,160
INSIGHT ABOUT IT.

1065
00:49:39,160 --> 00:49:40,960
FOR EXAMPLE, WHEN YOU HEAR A 

1066
00:49:40,960 --> 00:49:45,200
PATIENT'S AUTOMATED STORY, 

1067
00:49:45,200 --> 00:49:47,360
OFFERING COMPASSION AND SOME 

1068
00:49:47,360 --> 00:49:49,120
KIND OF QUESTION THAT WOULD 

1069
00:49:49,120 --> 00:49:51,720
INVITE GREATER AWARENESS TO THE 

1070
00:49:51,720 --> 00:50:01,200
WAY THEIR STORIES BECOME 

1071
00:50:01,200 --> 00:50:03,960
AUTOMOTIZED BECAUSE THE STORIES 

1072
00:50:03,960 --> 00:50:05,000
GET US STRUCK.

1073
00:50:05,000 --> 00:50:15,520
I'M BIG ON EXPERIENTIAL TRAINING

1074
00:50:17,920 --> 00:50:21,760
IS IMPORTANT AND WITH CHRONIC 

1075
00:50:21,760 --> 00:50:23,200
PAIN PATIENTS A LOT OF 

1076
00:50:23,200 --> 00:50:25,360
COMPASSION AND STRENGTHENING 

1077
00:50:25,360 --> 00:50:26,160
THOSE KINDS OF SKILLS BECOMES 

1078
00:50:26,160 --> 00:50:27,280
VERY IMPORTANT.

1079
00:50:27,280 --> 00:50:28,720
SORRY, I CAN'T BE MORE TANGIBLE 

1080
00:50:28,720 --> 00:50:30,760
FOR YOU.

1081
00:50:30,760 --> 00:50:35,640
>> THANK YOU.

1082
00:50:35,640 --> 00:50:41,480
THANK YOU SO MUCH.

1083
00:50:41,480 --> 00:50:47,000
THANK YOU SO MUCH FOR YOUR 

1084
00:50:47,000 --> 00:50:55,360
AROUND

1085
00:50:55,360 --> 00:50:55,680
AROUNDSES  -- AND 

1086
00:50:56,920 --> 00:50:59,560
I'D LIKE TO INVITE TO YOU COME 

1087
00:50:59,560 --> 00:51:01,760
TO THE NETWORKING SESSION.

1088
00:51:01,760 --> 00:51:02,520
AND NOW THE FLOOR IS LEFT TO 

1089
00:51:02,520 --> 00:51:07,440
LEAH.

1090
00:51:07,440 --> 00:51:10,720
>> THANK YOU, INNA AND 

1091
00:51:10,720 --> 00:51:13,640
DR. WOLEVER FOR THE FASCINATING 

1092
00:51:13,640 --> 00:51:15,480
TALK AND WONDERFUL CONVERSATION.

1093
00:51:15,480 --> 00:51:19,560
THE TOPIC IS SO IMPORTANT AND WE

1094
00:51:19,560 --> 00:51:21,800
HOPE EVERYONE CAN CONTINUE THE 

1095
00:51:21,800 --> 00:51:22,160
CONVERSATION.

1096
00:51:22,160 --> 00:51:25,360
NOW, IT'S MY PLEASURE TO 

1097
00:51:25,360 --> 00:51:29,520
INTRODUCE OUR NEXT SPEAKER, 

1098
00:51:29,520 --> 00:51:36,200
LIEUTENANT COLONEL CONNIE SNYDER

1099
00:51:36,200 --> 00:51:38,160
A RETIRED INTELLIGENCE OFFICER 

1100
00:51:38,160 --> 00:51:40,720
WHO SERVED ON ACTIVE DUTY AND 

1101
00:51:40,720 --> 00:51:41,920
AIR FORCE RESERVE AND THE WIFE 

1102
00:51:41,920 --> 00:51:45,440
AN ACTIVE DUTY AIR FORCE OFFICER

1103
00:51:45,440 --> 00:51:46,720
SHE'S BEEN MARRIED TO FOR 21 

1104
00:51:46,720 --> 00:51:49,960
YEARS AND THEY HAVE A SON, 

1105
00:51:49,960 --> 00:51:52,720
DAUGHTER AND GRANDDAUGHTER.

1106
00:51:52,720 --> 00:51:54,920
BESIDES HAVING PROUDLY WORN THE 

1107
00:51:54,920 --> 00:51:56,920
UNIFORM 24 YEARS SHE'S BEEN A 

1108
00:51:56,920 --> 00:51:58,840
HOME SCHOOLER AND VOLUNTEERED AS

1109
00:51:58,840 --> 00:52:00,960
A PATIENT ADVOCATE FOR MILITARY 

1110
00:52:00,960 --> 00:52:03,560
FAMILIES IN THE DOD, FAMILY 

1111
00:52:03,560 --> 00:52:09,920
MEMBER PROGRAM AND MENTOR IN THE

1112
00:52:09,920 --> 00:52:12,840
KEY SPOUSE PROGRAM.

1113
00:52:12,840 --> 00:52:17,880
AND THE REASON KONNIE WILL SPEAK

1114
00:52:17,880 --> 00:52:19,880
TODAY IS SHE'S A SPEAKER.

1115
00:52:19,880 --> 00:52:24,480
SHE OVERCAME A MULTITUDE OF 

1116
00:52:24,480 --> 00:52:28,720
INJURIES AND TRAUMAS AND WHAT 

1117
00:52:28,720 --> 00:52:29,480
STARTED AS CHRONIC CHEST PAIN 

1118
00:52:29,480 --> 00:52:32,720
AND COMPOUNDED BY MULTIPLE 

1119
00:52:32,720 --> 00:52:34,040
SURGERIES AND A CAR ACCIDENT AND

1120
00:52:34,040 --> 00:52:40,720
HAS CHEST PAIN, BACK PAIN, JOINT

1121
00:52:40,720 --> 00:52:46,720
PAIN, SPORADIC PARALYSIS AND 645

1122
00:52:46,720 --> 00:52:48,640
APPOINTMENTS AND PROVIDERS LATER

1123
00:52:48,640 --> 00:52:50,080
STILL HAS NO DIAGNOSIS.

1124
00:52:50,080 --> 00:52:53,160
SHE HOPES HER JOURNEY WILL SHED 

1125
00:52:53,160 --> 00:52:54,880
LIGHT ON THE IMPACT ON NOT JUST 

1126
00:52:54,880 --> 00:52:57,240
THE PATIENT BUT ALL AROUND THE 

1127
00:52:57,240 --> 00:52:57,480
PATIENT.

1128
00:52:57,480 --> 00:52:59,000
THANK YOU SO MUCH, KONNIE, FOR 

1129
00:52:59,000 --> 00:53:05,040
JOINING US AND OVER TO YOU.

1130
00:53:05,040 --> 00:53:06,360
>> THANK YOU FOR THE 

1131
00:53:06,360 --> 00:53:06,760
OPPORTUNITY.

1132
00:53:06,760 --> 00:53:08,720
I'VE BEEN LISTENING TO THE 

1133
00:53:08,720 --> 00:53:09,640
PANELISTS.

1134
00:53:09,640 --> 00:53:11,560
IT'S HUMBLING TO BE IN THE 

1135
00:53:11,560 --> 00:53:13,000
PRESENCE OF SO MANY AMAZING 

1136
00:53:13,000 --> 00:53:14,920
PEOPLE WITH POWERFUL STUDIES 

1137
00:53:14,920 --> 00:53:20,480
THAT WILL BENEFIT SO MANY.

1138
00:53:20,480 --> 00:53:22,520
I CAN'T THANK YOU ENOUGH TO 

1139
00:53:22,520 --> 00:53:23,640
ENCOMPASS MY BRIEFING WHICH IS 

1140
00:53:23,640 --> 00:53:26,920
THAT OF THE WHOLE PERSON.

1141
00:53:26,920 --> 00:53:31,960
IF I CAN SUMMARIZE ONE ASPECT 

1142
00:53:31,960 --> 00:53:34,080
BEEN THE MOST CHALLENGING DURING

1143
00:53:34,080 --> 00:53:38,640
MY MEDICAL JOURNEY IS MY ISSUES 

1144
00:53:38,640 --> 00:53:40,720
HAVE BEEN VIEWED AS A SEPARATE 

1145
00:53:40,720 --> 00:53:43,720
FISH INSTEAD OF HOW THEY 

1146
00:53:43,720 --> 00:53:44,160
INTERRELATE.

1147
00:53:44,160 --> 00:53:45,160
THANK YOU AGAIN FOR EVERYTHING 

1148
00:53:45,160 --> 00:53:46,040
YOU ARE DOING TO HELP PATIENTS 

1149
00:53:46,040 --> 00:53:52,600
SUCH AS MYSELF.

1150
00:53:52,600 --> 00:53:56,640
 MOST ITEMS YOU ALREADY HEARD 

1151
00:53:56,640 --> 00:54:00,280
BUT I HAVE A SYNOPSIS OF THE 

1152
00:54:00,280 --> 00:54:01,880
ITEMS OF WHO I AM AS A PERSON 

1153
00:54:01,880 --> 00:54:06,720
AND ACUTE VERSUS CHRONIC PAIN.

1154
00:54:06,720 --> 00:54:10,000
SOME OF MY MANY COMORBIDITIES 

1155
00:54:10,000 --> 00:54:11,440
AND THE IMPACT OF CHRONIC PAIN 

1156
00:54:11,440 --> 00:54:13,960
ON MY LIFE AND MANY TECHNIQUES 

1157
00:54:13,960 --> 00:54:21,200
I'VE TRIED, CONVENTIONAL AND 

1158
00:54:21,200 --> 00:54:22,720
UNCONVENTIONAL AND WISH LIST FOR

1159
00:54:22,720 --> 00:54:25,680
OTHER PAIN PATIENTS AND FINALLY 

1160
00:54:25,680 --> 00:54:27,840
MY PROPOSAL WHAT WOULD BE A 

1161
00:54:27,840 --> 00:54:30,280
REALLY GREAT WHOLE-PERSON HEALTH

1162
00:54:30,280 --> 00:54:32,680
CARE FORMULA.

1163
00:54:32,680 --> 00:54:34,480
MOST OF THESE ASPECTS YOU 

1164
00:54:34,480 --> 00:54:36,360
ALREADY HEARD IN MY INTRODUCTION

1165
00:54:36,360 --> 00:54:37,880
BUT I WANT TO EMPHASIZE THEM 

1166
00:54:37,880 --> 00:54:38,880
HERE AGAIN BECAUSE IN THE LAST 

1167
00:54:38,880 --> 00:54:41,720
EIGHT YEARS AS I'VE BEEN ON MY 

1168
00:54:41,720 --> 00:54:43,680
CHRONIC PAIN JOURNEY, IT'S 

1169
00:54:43,680 --> 00:54:45,760
FASCINATING TO ME HOW READILY 

1170
00:54:45,760 --> 00:54:47,520
PEOPLE WILL LOOK ONLY AT ONE 

1171
00:54:47,520 --> 00:54:50,040
GIVEN COMPONENT OF A PERSON.

1172
00:54:50,040 --> 00:54:51,400
NOT NECESSARILY WHO THE PERSON 

1173
00:54:51,400 --> 00:54:51,560
IS.

1174
00:54:51,560 --> 00:54:52,880
A LOT OF THAT IS DUE TO THE FACT

1175
00:54:52,880 --> 00:54:54,680
THAT OUR CLINICIANS ARE OVER 

1176
00:54:54,680 --> 00:54:56,960
TASKED AND UNDER MANNED AND MAY 

1177
00:54:56,960 --> 00:54:59,680
ONLY HAVE 10 MINUTES WITH A 

1178
00:54:59,680 --> 00:55:00,920
GIVEN PATIENT.

1179
00:55:00,920 --> 00:55:02,040
MANY GENUINELY WANT TO HELP A 

1180
00:55:02,040 --> 00:55:03,400
PATIENT BUT DON'T HAVE THE TIME 

1181
00:55:03,400 --> 00:55:05,000
OR THE RESOURCES AVAILABLE TO DO

1182
00:55:05,000 --> 00:55:05,280
SO.

1183
00:55:05,280 --> 00:55:07,880
AND SO OFTEN TIMES I DON'T HAVE 

1184
00:55:07,880 --> 00:55:09,040
THE LUXURY OF ASKING THE 

1185
00:55:09,040 --> 00:55:11,440
QUESTIONS THAT WILL FORM THE 

1186
00:55:11,440 --> 00:55:13,160
WHOLE PERSON UNDERSTANDING OF A 

1187
00:55:13,160 --> 00:55:13,480
GIVEN PATIENT.

1188
00:55:13,480 --> 00:55:15,400
WHAT I'VE TRIED TO DO AND ONE OF

1189
00:55:15,400 --> 00:55:18,120
MY COPING MECHANISMS HAS BEEN TO

1190
00:55:18,120 --> 00:55:22,320
TRY AND DEFINE A NARRATIVE 

1191
00:55:22,320 --> 00:55:23,960
SPECIFICALLY THAT MY PAIN IS NOT

1192
00:55:23,960 --> 00:55:24,520
FOR NOTHING.

1193
00:55:24,520 --> 00:55:26,440
HOW CAN I TAKE MY EXPERIENCE AND

1194
00:55:26,440 --> 00:55:28,320
UTILIZE IT AND TRY TO HELP 

1195
00:55:28,320 --> 00:55:29,360
OTHERS.

1196
00:55:29,360 --> 00:55:31,400
THAT'S IS WHY WHEN I FOUND 

1197
00:55:31,400 --> 00:55:32,600
MYSELF IN THE EXCEPTIONAL MEMBER

1198
00:55:32,600 --> 00:55:35,160
PROGRAM AS A MILITARY MEMBER AND

1199
00:55:35,160 --> 00:55:36,480
THE SPOUSE OF A MILITARY MEMBER,

1200
00:55:36,480 --> 00:55:40,160
MY HUSBAND'S ASSIGNMENTS ARE NOW

1201
00:55:40,160 --> 00:55:42,080
IMPACTED BECAUSE OF MY MANY 

1202
00:55:42,080 --> 00:55:44,200
MEDICAL LIMITATIONS AND CERTAIN 

1203
00:55:44,200 --> 00:55:45,520
SPECIALISTS I MUST HAVE ACCESS 

1204
00:55:45,520 --> 00:55:46,480
TO AT ALL TIMES.

1205
00:55:46,480 --> 00:55:48,920
I LEARNED EIGHT OF LESSONS WHEN 

1206
00:55:48,920 --> 00:55:51,240
I WAS FIRST INTRODUCED TO THE 

1207
00:55:51,240 --> 00:55:53,320
PROGRAM AND TRIED TO APPLY THEM 

1208
00:55:53,320 --> 00:55:58,040
TO HELP OTHER FAMILIES IN THE 

1209
00:55:58,040 --> 00:55:58,360
PROGRAM.

1210
00:55:58,360 --> 00:56:01,600
SIMILARLY, BECAUSE I'M IN A 

1211
00:56:01,600 --> 00:56:04,720
UNIQUE SITUATION AS HAVING BEEN 

1212
00:56:04,720 --> 00:56:07,520
I RECENTLY RETIRED HAVING WORN 

1213
00:56:07,520 --> 00:56:09,040
THE UNIFORM AND HAVING A SPOUSE 

1214
00:56:09,040 --> 00:56:10,720
OF ONE WHO WEARS THE UNIFORM 

1215
00:56:10,720 --> 00:56:13,320
I'VE TRIED TO BE A MENTOR TO 

1216
00:56:13,320 --> 00:56:14,680
HELP AIRMEN AND THEIR FAMILIES 

1217
00:56:14,680 --> 00:56:16,720
AS THEY NEGOTIATE THE UNIQUE 

1218
00:56:16,720 --> 00:56:17,880
CHALLENGES OF MILITARY LIFE.

1219
00:56:17,880 --> 00:56:20,080
AS ALREADY MENTIONED AND WHY I'M

1220
00:56:20,080 --> 00:56:22,040
HERE I'M ALSO A CHRONIC PAIN 

1221
00:56:22,040 --> 00:56:23,960
SUFFERER AND A MEDICAL ENIGMA.

1222
00:56:23,960 --> 00:56:30,800
I COULD SPEAK FOR HOURS ABOUT 

1223
00:56:30,800 --> 00:56:32,800
THE RATHER TUMULTIOUOUS JOURNEY 

1224
00:56:32,800 --> 00:56:33,920
BUT I KNOW THE DIFFERENCE 

1225
00:56:33,920 --> 00:56:35,000
BETWEEN ACUTE AND CHRONIC PAIN.

1226
00:56:35,000 --> 00:56:43,200
BURY -- I BEFORE GRADUATING I 

1227
00:56:43,200 --> 00:56:46,040
HAD UNDER GONE MANY SURGERIES 

1228
00:56:46,040 --> 00:56:51,160
INCLUDING ENDO MEET ROSE IS AND 

1229
00:56:51,160 --> 00:56:54,040
AND AN UNDERWENT OR SUSTAIN A 

1230
00:56:54,040 --> 00:56:55,680
MINIMUM OF 21 DIFFERENT 

1231
00:56:55,680 --> 00:56:59,440
INJURY/TRAUMAS ING FROM THE 

1232
00:56:59,440 --> 00:57:02,840
AFOREMENTIONED TO CHILD BIRTH, 

1233
00:57:02,840 --> 00:57:06,840
C-SECTION AND EVEN A BOUT OF 

1234
00:57:06,840 --> 00:57:08,280
PERI CARDITIS AND WE WERE ABLE 

1235
00:57:08,280 --> 00:57:11,400
TO IDENTIFY WHAT THE CAUSAL 

1236
00:57:11,400 --> 00:57:13,800
ISSUE WAS AND TREAT IT AND MOVE 

1237
00:57:13,800 --> 00:57:15,840
ON AND IN EVERY CASE THERE WAS A

1238
00:57:15,840 --> 00:57:20,480
FINISH LINE.

1239
00:57:20,480 --> 00:57:22,360
THEN 2014 HAPPENED.

1240
00:57:22,360 --> 00:57:25,600
I WAS AT THE AIR FORCE BASE IN 

1241
00:57:25,600 --> 00:57:27,720
LOUISIANA ON MY ACTIVE DUTY 

1242
00:57:27,720 --> 00:57:30,920
ORDERS AND MY HUSBAND WAS IN 

1243
00:57:30,920 --> 00:57:33,040
CALIFORNIA AND THAT'S WHERE OUR 

1244
00:57:33,040 --> 00:57:35,880
FAMILY WAS STATIONED AND 

1245
00:57:35,880 --> 00:57:37,440
COMMUTED TO MY AIR FORCE BASE.

1246
00:57:37,440 --> 00:57:45,800
I HAD FLOWN FROM MONTEREY, 

1247
00:57:45,800 --> 00:57:51,640
CALIFORNIA AND DRIVEN TO 

1248
00:57:51,640 --> 00:57:53,320
LOUISIANA AND IT WAS THE LAST 

1249
00:57:53,320 --> 00:57:55,920
DAY OF DUTY I LIFTED WEIGHTS AND

1250
00:57:55,920 --> 00:57:57,280
GONE RUNNING THAT MORNING.

1251
00:57:57,280 --> 00:57:59,600
EVERYTHING WAS THE SAME AS IT 

1252
00:57:59,600 --> 00:58:02,320
TYPICALLY WAS UNTIL I WAS AT 

1253
00:58:02,320 --> 00:58:04,400
WORK I HAD A SUDDEN ONSET OF 

1254
00:58:04,400 --> 00:58:06,320
CHEST PAIN.

1255
00:58:06,320 --> 00:58:12,600
IT MIMICKED MY 2009 BOUGHT OF 

1256
00:58:12,600 --> 00:58:15,560
PERICARDITIS EXCEPT I ALSO LOST 

1257
00:58:15,560 --> 00:58:18,400
FEELING IN MY LEFT ARM AND NECK 

1258
00:58:18,400 --> 00:58:18,920
AND JAW.

1259
00:58:18,920 --> 00:58:22,040
RATHER CONCERNING SO I WENT TO 

1260
00:58:22,040 --> 00:58:24,560
URGENT CARE, WENT TO THE E.R.

1261
00:58:24,560 --> 00:58:26,720
THEY RULED OUT HEART ATTACK AND 

1262
00:58:26,720 --> 00:58:27,200
DISMISSED ME.

1263
00:58:27,200 --> 00:58:29,840
I WAS BY MYSELF IN LOUISIANA, 

1264
00:58:29,840 --> 00:58:32,280
NEW UNIT, NO SUPPORT SYSTEM.

1265
00:58:32,280 --> 00:58:34,720
MY HUSBAND BOUGHT A ONE-WAY 

1266
00:58:34,720 --> 00:58:36,560
TICKET FROM CALIFORNIA TO 

1267
00:58:36,560 --> 00:58:37,880
LOUISIANA BECAUSE I WAS 

1268
00:58:37,880 --> 00:58:40,160
INCAPABLE OF DRIVING BACK TO 

1269
00:58:40,160 --> 00:58:42,160
FLORIDA WHERE THE KIDS WERE.

1270
00:58:42,160 --> 00:58:46,040
ALONG THE DRIVE BACK TO FLORIDA 

1271
00:58:46,040 --> 00:58:50,040
WE LEARNED THAT SUSTAINED 

1272
00:58:50,040 --> 00:58:52,520
FREQUENCY VIBRATIONS EXACERBATED

1273
00:58:52,520 --> 00:58:55,040
THE CONDITION AND CONTACTED A 

1274
00:58:55,040 --> 00:59:01,360
NURSE AND THEY RECOMMENDED I BE 

1275
00:59:01,360 --> 00:59:06,280
SEEN IN JACKSONVILLE, FLORIDA.

1276
00:59:06,280 --> 00:59:09,240
I SPENT A WEEK CURLED UP IN THE 

1277
00:59:09,240 --> 00:59:11,200
FETAL CONDITION NEW TO THIS 

1278
00:59:11,200 --> 00:59:12,840
EXTREME DIFFICULTY BREATHING AND

1279
00:59:12,840 --> 00:59:15,880
THEY PRESCRIBED PAIN 

1280
00:59:15,880 --> 00:59:19,840
MEDICATIONS, DILAUDID AND SAID 

1281
00:59:19,840 --> 00:59:22,800
GOOD LUCK TO YOU.

1282
00:59:22,800 --> 00:59:24,000
SO I SAID I HAVE THREE FLIGHTS 

1283
00:59:24,000 --> 00:59:26,880
TO TAKE BACK TO MONTEREY.

1284
00:59:26,880 --> 00:59:29,400
WILL THAT BE IN ISSUE, THEY SAID

1285
00:59:29,400 --> 00:59:29,560
NO.

1286
00:59:29,560 --> 00:59:32,640
I MADE IT THROUGH THE FIRST WEEK

1287
00:59:32,640 --> 00:59:43,120
AND THE FIRST ASSENT AND I 

1288
00:59:44,000 --> 00:59:46,080
PASSED OUT AND SINCE THAT DAY 

1289
00:59:46,080 --> 00:59:49,440
JUNE 20 OF THIS YEAR WILL MARK 

1290
00:59:49,440 --> 00:59:50,040
EIGHT YEARS.

1291
00:59:50,040 --> 00:59:52,560
I HAVE NOT BEEN ABLE TO TAKE A 

1292
00:59:52,560 --> 00:59:53,480
SINGLE BREATH WITHOUT PAIN.

1293
00:59:53,480 --> 00:59:55,800
THE FIRST YEAR I WAS ON 

1294
00:59:55,800 --> 00:59:58,040
SUPPLEMENTAL OXYGEN BECAUSE 

1295
00:59:58,040 --> 01:00:00,120
AFTER I KEPT TELLING PEOPLE I'M 

1296
01:00:00,120 --> 01:00:03,360
HAVING DIFFICULTY BREATHING THEY

1297
01:00:03,360 --> 01:00:05,760
IDENTIFIED THE FACT I WAS AT 

1298
01:00:05,760 --> 01:00:06,440
86%.

1299
01:00:06,440 --> 01:00:07,600
WE STILL DON'T KNOW WHY THAT 

1300
01:00:07,600 --> 01:00:10,720
HAPPENED FOR A YEAR AND A HALF 

1301
01:00:10,720 --> 01:00:13,560
OR WHAT RESOLVED IT BUT BEGAN 

1302
01:00:13,560 --> 01:00:15,440
THE LONG JOURNEY AND BECAUSE 

1303
01:00:15,440 --> 01:00:18,040
WE'RE IN MONTEREY, CALIFORNIA I 

1304
01:00:18,040 --> 01:00:19,920
WAS SEEING BY CARDIOLOGY IN 

1305
01:00:19,920 --> 01:00:22,280
STANFORD AND SAW INFECTIOUS 

1306
01:00:22,280 --> 01:00:24,160
DISEASE AND A MULTITUDE OF 

1307
01:00:24,160 --> 01:00:24,720
ENTITIES.

1308
01:00:24,720 --> 01:00:28,320
WE HAD TO MOVE ON MY HUSBAND'S 

1309
01:00:28,320 --> 01:00:30,120
ACTIVE DUTY ORDERS AND HAD TO GO

1310
01:00:30,120 --> 01:00:30,760
TO WASHINGTON, D.C.

1311
01:00:30,760 --> 01:00:33,880
ONCE MOVED AND SINCE THEN WE 

1312
01:00:33,880 --> 01:00:35,760
HAVE MOVED FOUR DIFFERENT TIMES 

1313
01:00:35,760 --> 01:00:37,760
SO THIS NUMBER, 625 APPOINTMENTS

1314
01:00:37,760 --> 01:00:39,040
IS NO TYPO.

1315
01:00:39,040 --> 01:00:42,280
ONCE WE REALIZED IT WOULD NOT BE

1316
01:00:42,280 --> 01:00:45,040
A SHORT-TERM BUT LONG-TERM I 

1317
01:00:45,040 --> 01:00:47,520
STARTED BUILDING SPREAD SHEETS 

1318
01:00:47,520 --> 01:00:50,880
TRYING TO REDUCE REDUNDANCY IN 

1319
01:00:50,880 --> 01:00:53,120
EFFORTS AND TESTING TO SAVE TIME

1320
01:00:53,120 --> 01:00:54,600
AND FACILITATE COMMUNICATION.

1321
01:00:54,600 --> 01:00:56,800
IN THE BEGINNING IT WAS I HADN'T

1322
01:00:56,800 --> 01:00:58,720
SEEN ENOUGH DOCTORS NOW IT'S 

1323
01:00:58,720 --> 01:01:00,840
THAT I'VE SEEN SO MANY YOU'VE 

1324
01:01:00,840 --> 01:01:02,040
FIGURED IT OUT BY NOW AND IT'S 

1325
01:01:02,040 --> 01:01:03,120
NOT THE CASE.

1326
01:01:03,120 --> 01:01:04,720
WHAT THE CIRCUMSTANCE HAS HAD IN

1327
01:01:04,720 --> 01:01:07,720
COMMON IS IT'S A NON LINEAR 

1328
01:01:07,720 --> 01:01:08,040
PROGRESSION.

1329
01:01:08,040 --> 01:01:09,560
YESTERDAY WE TALKED ABOUT THE 

1330
01:01:09,560 --> 01:01:12,200
FACT AS THE DISJOINTED AND NEED 

1331
01:01:12,200 --> 01:01:14,720
TO INTEGRATE THE MANY 

1332
01:01:14,720 --> 01:01:15,040
COMPONENTS.

1333
01:01:15,040 --> 01:01:17,000
THAT IS WHAT'S HAPPENING TO ME.

1334
01:01:17,000 --> 01:01:19,880
I'VE HAD MORE AND MORE SYMPTOMS 

1335
01:01:19,880 --> 01:01:23,680
BUT THE BOTTOM LINE IS I HAVE NO

1336
01:01:23,680 --> 01:01:25,120
FINISH LINE.

1337
01:01:25,120 --> 01:01:28,840
A MARATHON EVEN AN ULTRA 

1338
01:01:28,840 --> 01:01:31,280
MARATHON STILL HAS A FINISH 

1339
01:01:31,280 --> 01:01:31,720
LINE.

1340
01:01:31,720 --> 01:01:38,040
FOR ME I DON'T KNOW IF OR WHEN 

1341
01:01:38,040 --> 01:01:38,680
THAT WILL BE.

1342
01:01:38,680 --> 01:01:42,080
MY LIST OF COMORBIDITIES IS TO 

1343
01:01:42,080 --> 01:01:46,480
LONG SO I ONLY PICKED A FEW.

1344
01:01:46,480 --> 01:01:48,840
INCESSANT CHEST PAIN AND SKIN 

1345
01:01:48,840 --> 01:01:49,080
CANCER.

1346
01:01:49,080 --> 01:01:51,320
MOST PEOPLE ARE FAMILIAR WITH 

1347
01:01:51,320 --> 01:01:52,560
SMALL PATCHES OF SKIN.

1348
01:01:52,560 --> 01:01:55,760
I HAD A PATCH OF SKIN CANCER ON 

1349
01:01:55,760 --> 01:02:00,560
THE TOP OF MY SCALP AND THE SKIN

1350
01:02:00,560 --> 01:02:02,400
CANCER OCCURRED REGRESSIVELY AND

1351
01:02:02,400 --> 01:02:04,560
I NEEDED A SCALP RESECTION THAT 

1352
01:02:04,560 --> 01:02:08,160
REQUIRED 27 STAPLES ACROSS MY 

1353
01:02:08,160 --> 01:02:08,360
HEAD.

1354
01:02:08,360 --> 01:02:13,400
ONLY THANKS TO A PHENOMENAL 

1355
01:02:13,400 --> 01:02:23,880
PLASTIC SURGEON YOU DON'T SEE 

1356
01:02:25,040 --> 01:02:26,000
THE SCAR.

1357
01:02:26,000 --> 01:02:30,040
THE CAR ACCIDENT PRIECHZ  

1358
01:02:30,040 --> 01:02:30,280
PREVIOUSLY 

1359
01:02:32,280 --> 01:02:36,480
PREVIOUSLY MENTIONED AND THE 

1360
01:02:36,480 --> 01:02:37,960
IMPACT OF ORAL FACIAL P.D.

1361
01:02:37,960 --> 01:02:40,280
I EXPERIENCE THAT ON A REGULAR 

1362
01:02:40,280 --> 01:02:40,480
BASIS.

1363
01:02:40,480 --> 01:02:42,920
WE DON'T UNDERSTAND WHY ALL MY 

1364
01:02:42,920 --> 01:02:44,520
TEETH ARE CRACKING.

1365
01:02:44,520 --> 01:02:47,280
I'VE HAD TO HAVE TWO EXTRACTIONS

1366
01:02:47,280 --> 01:02:49,840
FOR REASONS OF YET HAVE NOT BEEN

1367
01:02:49,840 --> 01:02:50,960
IDENTIFIED.

1368
01:02:50,960 --> 01:02:52,160
ENDOMETRIOSIS I'M ALSO FAMILIAR 

1369
01:02:52,160 --> 01:02:57,800
WITH AND I'VE HAD A HISTORY OF 

1370
01:02:57,800 --> 01:02:59,280
MALIGNANT OVARIAN CYSTS.

1371
01:02:59,280 --> 01:03:02,040
SO I COULD GO ON ALL DAY ABOUT 

1372
01:03:02,040 --> 01:03:04,720
THE MANY COMORBIDITIES I HAVE 

1373
01:03:04,720 --> 01:03:06,960
BUT THE BOTTOM LINE IS I'M 

1374
01:03:06,960 --> 01:03:08,040
FAMILIAR WITH MANY TYPES OF PAIN

1375
01:03:08,040 --> 01:03:10,320
AND SENSATIONS OF PAIN AND WHEN 

1376
01:03:10,320 --> 01:03:12,080
HAVE YOU ONE LAYERED UPON 

1377
01:03:12,080 --> 01:03:14,040
ANOTHER YOU HAVE YOUR BACK PAIN 

1378
01:03:14,040 --> 01:03:19,400
AND CHEST PAIN AND SOMETIMES I 

1379
01:03:19,400 --> 01:03:21,240
LOSE MY VISION I NEVER KNOW FROM

1380
01:03:21,240 --> 01:03:23,240
ONE DAY TO THE NEXT WHETHER I'LL

1381
01:03:23,240 --> 01:03:32,760
BE ABLE TO FUNCTION FULLY.

1382
01:03:32,760 --> 01:03:37,720
IT'S BEEN UNDESCRIBABLE.

1383
01:03:37,720 --> 01:03:40,320
SO CHRONIC PAIN IMPACT.

1384
01:03:40,320 --> 01:03:43,920
IT'S OBVIOUS IT IMPACTS PEOPLE'S

1385
01:03:43,920 --> 01:03:54,280
LIVES AND THERE'S RELIABILITY.

1386
01:03:54,280 --> 01:03:54,680
FOL

1387
01:03:54,680 --> 01:03:55,840
I WAS IN THE HOSPITAL PARALYZED 

1388
01:03:55,840 --> 01:03:58,720
ON THE RIGHT HALF OF MY BODY 

1389
01:03:58,720 --> 01:04:00,840
AGAIN FOR REASONS UNKNOWN MONTHS

1390
01:04:00,840 --> 01:04:02,520
AGO AND I NEVER KNOW WHETHER 

1391
01:04:02,520 --> 01:04:04,600
I'LL BE ABLE TO FULFILL THE 

1392
01:04:04,600 --> 01:04:05,360
COMMITMENTS I'VE ASSIGNED 

1393
01:04:05,360 --> 01:04:06,120
MYSELF.

1394
01:04:06,120 --> 01:04:12,320
TIME.

1395
01:04:12,320 --> 01:04:13,960
THE TIME IT TAKES TO NOT ONLY GO

1396
01:04:13,960 --> 01:04:16,240
TO DIFFERENT APPOINTMENTS BUT TO

1397
01:04:16,240 --> 01:04:17,440
COORDINATE AND FACILITATE 

1398
01:04:17,440 --> 01:04:19,040
COMMUNICATION BETWEEN PROVIDERS,

1399
01:04:19,040 --> 01:04:20,560
DEVELOP ON THE REFERRALS, 

1400
01:04:20,560 --> 01:04:21,200
ETCETERA.

1401
01:04:21,200 --> 01:04:25,840
IT'S A SHOCKING AMOUNT AND 

1402
01:04:25,840 --> 01:04:28,720
IRONIC YOU'RE IN A LOT PAIN SO 

1403
01:04:28,720 --> 01:04:31,640
IT MAKES IT MORE DIFFICULT TO 

1404
01:04:31,640 --> 01:04:34,400
ACCOMPLISH ADDRESSING IT.

1405
01:04:34,400 --> 01:04:36,680
INSOMNIA WAS DISCUSSED YESTERDAY

1406
01:04:36,680 --> 01:04:37,680
IN LENGTH.

1407
01:04:37,680 --> 01:04:40,080
I'VE NOT BEEN ALLOWED SINCE 

1408
01:04:40,080 --> 01:04:40,520
2014.

1409
01:04:40,520 --> 01:04:43,920
I COULDN'T JUST JUMP ON A PLANE 

1410
01:04:43,920 --> 01:04:45,360
WHEN MY GRANDDAUGHTER WAS BORN 

1411
01:04:45,360 --> 01:04:48,360
AND ALTERED HOW MY FAMILY AND I 

1412
01:04:48,360 --> 01:04:53,320
GO ABOUT OUR LIVES.

1413
01:04:53,320 --> 01:04:57,760
AND I WAS ABLE TO FLY AND WE 

1414
01:04:57,760 --> 01:05:02,040
CAME UP WITH ALTERNATE NEEDS TO 

1415
01:05:02,040 --> 01:05:07,160
SUPPORT BUT I RETIRED EARLIER 

1416
01:05:07,160 --> 01:05:17,720
THAN I WANT TO FRUSTRATION AND 

1417
01:05:19,720 --> 01:05:29,640
GUILT COMMON TO ALL BUT AND IT 

1418
01:05:29,640 --> 01:05:31,600
TOOK AWAY THE MEANS OF COPING 

1419
01:05:31,600 --> 01:05:32,520
WITH STRESS.

1420
01:05:32,520 --> 01:05:39,640
MY KIDS DON'T KNOW WHO I WAS 

1421
01:05:39,640 --> 01:05:42,680
CHRONIC PAIN AND MY SON HAD TO 

1422
01:05:42,680 --> 01:05:45,080
EXPLAIN TO FRIENDS MY MOMMY HAD 

1423
01:05:45,080 --> 01:05:46,040
HOSES IN HER KNOWS AND THE 

1424
01:05:46,040 --> 01:05:48,920
SUFFERING.

1425
01:05:48,920 --> 01:05:51,680
I CAN'T EXPLAIN WHAT IT'S LIKE 

1426
01:05:51,680 --> 01:05:55,280
TO BREATHE EVERY BREATH AND IT 

1427
01:05:55,280 --> 01:05:56,360
HURTS.

1428
01:05:56,360 --> 01:05:59,600
IT TEACHES YOU HUMILITY.

1429
01:05:59,600 --> 01:06:02,200
WHEN I WAS DOING PULMONARY 

1430
01:06:02,200 --> 01:06:04,520
THERAPIES WITH OXYGENARIANS AND 

1431
01:06:04,520 --> 01:06:07,320
I WAS 36 WAS HUMBLING.

1432
01:06:07,320 --> 01:06:12,840
WE RECENTLY LOST EVERYTHING WE 

1433
01:06:12,840 --> 01:06:16,160
OWNED AND WE'RE STILL COPING 

1434
01:06:16,160 --> 01:06:18,040
WITH THAT BUT BECAUSE OF THE 

1435
01:06:18,040 --> 01:06:20,040
RESILIENCE IN COPING WITH MY 

1436
01:06:20,040 --> 01:06:21,440
CHRONIC PAIN AND HOW IT AFFECTS 

1437
01:06:21,440 --> 01:06:23,320
MY FAMILY WE'RE ABLE TO APPLY 

1438
01:06:23,320 --> 01:06:32,960
THOSE COPING SKILLS TO OUR 

1439
01:06:32,960 --> 01:06:34,080
ONGOING SITUATION NOBODY WILL 

1440
01:06:34,080 --> 01:06:36,760
KNOW WHAT ME AND MY FAMILY HAVE 

1441
01:06:36,760 --> 01:06:37,760
BEEN THROUGH OR SEE THE 

1442
01:06:37,760 --> 01:06:38,600
SUFFERING PART OF THE HEALING 

1443
01:06:38,600 --> 01:06:46,040
PROCESS FOLLOWING A GIVEN 

1444
01:06:46,040 --> 01:06:49,440
SURG

1445
01:06:49,440 --> 01:06:49,680
SURGERY.

1446
01:06:49,680 --> 01:06:53,520
MY CHILDREN HAVE HAD TO GROW UP 

1447
01:06:53,520 --> 01:06:58,040
EARLY AND ARE EXTREMELY 

1448
01:06:58,040 --> 01:07:00,120
COMPASSIONATE PEOPLE.

1449
01:07:00,120 --> 01:07:02,040
I'M CHOOSING TO SMILE.

1450
01:07:02,040 --> 01:07:03,560
JOY IS A CHOICE.

1451
01:07:03,560 --> 01:07:09,440
AND I AM THANKFUL FOR EACH AND 

1452
01:07:09,440 --> 01:07:10,600
EVERY DAY I'M HERE AND THE 

1453
01:07:10,600 --> 01:07:12,400
INCREDIBLE PEOPLE IN MY LIFE AND

1454
01:07:12,400 --> 01:07:16,240
THANKFUL TO BE WHERER AND FOR 

1455
01:07:16,240 --> 01:07:17,680
THE KINDS OF OPPORTUNITIES AND 

1456
01:07:17,680 --> 01:07:19,200
VOICE THE GRATITUDE IN A WHOLE 

1457
01:07:19,200 --> 01:07:24,400
NEW WAY AND ENHANCED MY FAITH.

1458
01:07:24,400 --> 01:07:26,040
IN THE MIDDLE OF THE NIGHT WHEN 

1459
01:07:26,040 --> 01:07:27,280
EVERYBODY ELSE SLEEPING AND 

1460
01:07:27,280 --> 01:07:30,160
DON'T KNOW HOW YOU CAN STAND A 

1461
01:07:30,160 --> 01:07:31,360
MINUTE OF THAT PAIN IT'S A GREAT

1462
01:07:31,360 --> 01:07:40,800
TIME TO ENHANCE YOUR FAITH.

1463
01:07:40,800 --> 01:07:43,880
PAIN AFFECTS EVERYONE IN THE 

1464
01:07:43,880 --> 01:07:44,280
PATIENT'S SPHERE.

1465
01:07:44,280 --> 01:07:45,360
LOVED ONES, FRIENDS, WORK, 

1466
01:07:45,360 --> 01:07:46,040
COMMUNITY.

1467
01:07:46,040 --> 01:07:50,760
ETCETERA.

1468
01:07:50,760 --> 01:07:52,720
THESE ARE SOME OF THE MANY 

1469
01:07:52,720 --> 01:07:54,520
DIFFERENT PAIN TECHNIQUES I HAVE

1470
01:07:54,520 --> 01:08:02,680
TRIED, MEDITATION, ONE OF THEM.

1471
01:08:02,680 --> 01:08:03,160
WISH LIST.

1472
01:08:03,160 --> 01:08:07,200
THESE FIVE ITEMS ARE THINGS, 

1473
01:08:07,200 --> 01:08:07,840
COMPASSION HAS BEEN MENTIONED 

1474
01:08:07,840 --> 01:08:08,440
SEVERAL TIMES YESTERDAY AND 

1475
01:08:08,440 --> 01:08:10,040
TODAY AND I THANK YOU FOR THAT.

1476
01:08:10,040 --> 01:08:12,160
THAT'S PROBABLY THE NUMBER ONE 

1477
01:08:12,160 --> 01:08:13,520
ASPECT I WOULD WITH OF ANY 

1478
01:08:13,520 --> 01:08:16,040
CLINICIAN INTERACTING WITH A 

1479
01:08:16,040 --> 01:08:16,280
PATIENT.

1480
01:08:16,280 --> 01:08:18,480
LISTEN TO THEM AND LOOK AT THEM 

1481
01:08:18,480 --> 01:08:20,720
AS A WHOLE PERSON AND NOT JUST 

1482
01:08:20,720 --> 01:08:23,200
THE ONE SMALL PIECE IN FRONT OF 

1483
01:08:23,200 --> 01:08:26,640
YOU.

1484
01:08:26,640 --> 01:08:33,880
A FULL DIAGNOSIS.

1485
01:08:33,880 --> 01:08:36,120
A FULL DIAGNOSIS IS CRITICAL.

1486
01:08:36,120 --> 01:08:37,920
PEOPLE DON'T WANT A LABEL BUT AS

1487
01:08:37,920 --> 01:08:41,040
A PATIENT YOU DON'T HAVE A LABEL

1488
01:08:41,040 --> 01:08:42,440
AND YOU DON'T HAVE BUILT IN 

1489
01:08:42,440 --> 01:08:43,640
SUPPORT OR NETWORKS OR 

1490
01:08:43,640 --> 01:08:44,040
RESOURCES.

1491
01:08:44,040 --> 01:08:46,080
YOU'RE ALL ALONE.

1492
01:08:46,080 --> 01:08:48,920
GETTING A FULL DIAGNOSIS IS 

1493
01:08:48,920 --> 01:08:52,400
PARAMOUNT.

1494
01:08:52,400 --> 01:08:55,280
COMMUNICATION BETWEEN PROVIDERS.

1495
01:08:55,280 --> 01:09:00,800
AND THERE'S INTEGRATED 

1496
01:09:00,800 --> 01:09:05,000
MANAGEMENT.

1497
01:09:05,000 --> 01:09:08,320
I WAS AT THE PAIN MANAGEMENT AND

1498
01:09:08,320 --> 01:09:12,440
NATIONAL JEWISH HEALTH HOSPITAL 

1499
01:09:12,440 --> 01:09:16,040
THERE DURING INITIAL DIAGNOSIS 

1500
01:09:16,040 --> 01:09:22,040
OF MY DISORDER.

1501
01:09:22,040 --> 01:09:28,240
THE OTHER 600 SOME APPOINTMENTS 

1502
01:09:28,240 --> 01:09:33,320
WAS ON ME AND I'VE E-MAILED CAN 

1503
01:09:33,320 --> 01:09:34,480
SOMEONE PROVIDE THOUGHTS ON THE 

1504
01:09:34,480 --> 01:09:36,560
WAY AHEAD TO NO AVAIL.

1505
01:09:36,560 --> 01:09:40,720
IF THERE'S A ONE CHART TO ALLOW 

1506
01:09:40,720 --> 01:09:41,320
COMMUNICATIONS COMMUNICATE 

1507
01:09:41,320 --> 01:09:43,520
BETWEEN FACILITIES THAT WOULD BE

1508
01:09:43,520 --> 01:09:43,960
FANTASTIC.

1509
01:09:43,960 --> 01:09:47,440
AS IT IS, I RECEIVED CARE IN 

1510
01:09:47,440 --> 01:09:49,520
OMAHA IN SEVEN DIFFERENT 

1511
01:09:49,520 --> 01:09:50,680
ENTITIES AND THEY'RE NOT ABLE TO

1512
01:09:50,680 --> 01:09:52,320
COMMUNICATE WITH ONE ANOTHER AND

1513
01:09:52,320 --> 01:09:56,480
FOR PROVIDERS TO HELP PATIENTS, 

1514
01:09:56,480 --> 01:09:58,080
YOU NEVER KNOW HOW ONE KIND WORD

1515
01:09:58,080 --> 01:10:00,920
YOU PROVIDE TO THAT PATIENT CAN 

1516
01:10:00,920 --> 01:10:02,040
COMPLETELY ALTER HOW THEY VIEW 

1517
01:10:02,040 --> 01:10:10,040
THEIR JOURNEY.

1518
01:10:10,040 --> 01:10:12,280
I MENTIONED SOME RESOURCES.

1519
01:10:12,280 --> 01:10:15,400
I'VE BEEN SHOCKED HOW SOME 

1520
01:10:15,400 --> 01:10:16,720
DOCTORS AND ENTITIES AREN'T 

1521
01:10:16,720 --> 01:10:19,080
AWARE OF THEIR RESOURCES SUCH AS

1522
01:10:19,080 --> 01:10:20,760
CASE MANAGERS AND PATIENT 

1523
01:10:20,760 --> 01:10:22,760
ADVOCATES AND REFERRAL MANAGERS 

1524
01:10:22,760 --> 01:10:26,040
AND VARIOUS PLATFORMS THERE.

1525
01:10:26,040 --> 01:10:36,640
THE ONUS IS ON THE PATIENTS AND 

1526
01:10:37,840 --> 01:10:40,040
THERE'S COMPASSION.

1527
01:10:40,040 --> 01:10:41,040
LISTEN TO THE PATIENT AND 

1528
01:10:41,040 --> 01:10:43,880
DIAGNOSE THEM AND REMEMBER PAIN 

1529
01:10:43,880 --> 01:10:45,080
IS RELATIVE.

1530
01:10:45,080 --> 01:10:52,720
MY 5 PAIN TODAY WOULD HAVE BEEN 

1531
01:10:52,720 --> 01:11:03,000
MY 10 YEARS AGO.

1532
01:11:04,480 --> 01:11:06,000
ONE FINAL NOTE, YOU MIGHT BE 

1533
01:11:06,000 --> 01:11:07,840
THAT SOURCE OF ENCOURAGEMENT 

1534
01:11:07,840 --> 01:11:09,480
THAT SINGLE RESOURCE THAT KEEPS 

1535
01:11:09,480 --> 01:11:11,240
SOMEONE GOING.

1536
01:11:11,240 --> 01:11:14,120
A WISE WOMAN I KNOW ONCE TOLD ME

1537
01:11:14,120 --> 01:11:15,960
ACCEPTING YOUR SITUATION DOES 

1538
01:11:15,960 --> 01:11:17,280
NOT MEAN YOU'RE GIVING UP.

1539
01:11:17,280 --> 01:11:20,480
THAT SIMPLE STATEMENT SHE SHARED

1540
01:11:20,480 --> 01:11:24,560
WITH ME HELPED ME KEEP MOVING 

1541
01:11:24,560 --> 01:11:24,800
FORWARD.

1542
01:11:24,800 --> 01:11:26,040
THANK YOU ALL FOR THE POWERFUL 

1543
01:11:26,040 --> 01:11:28,760
FORUM AND EVERYTHING YOU ALL ARE

1544
01:11:28,760 --> 01:11:30,480
DOING TO HELP PAIN PATIENTS ME 

1545
01:11:30,480 --> 01:11:34,040
LIVE OUR BEST LIVES.

1546
01:11:34,040 --> 01:11:43,920
THANK YOU SO MUCH.

1547
01:11:43,920 --> 01:11:46,720
>> THANK YOU, LIEUTENANT
COLONEL

1548
01:11:46,720 --> 01:11:48,000
SNYDER AND HAPPY YOU'LL BE ABLE 

1549
01:11:48,000 --> 01:11:49,680
TO JOIN US FOR THE NETWORKING 

1550
01:11:49,680 --> 01:11:52,520
SESSION LATER.

1551
01:11:52,520 --> 01:11:57,760
WE ARE GOING TO MOVE INTO THE 

1552
01:11:57,760 --> 01:12:03,320
THIRD AND FINAL JUNIOR 

1553
01:12:03,320 --> 01:12:04,160
INVESTIGATOR SESSION NOW.

1554
01:12:04,160 --> 01:12:09,200
WE HAVE FOUR SPEAKERS.

1555
01:12:09,200 --> 01:12:19,440
DR.  TAGERIN.

1556
01:12:25,280 --> 01:12:35,480
AND DR.  BANARU.

1557
01:12:42,120 --> 01:12:42,920
ACHIEVING TREATMENT RESPONSE IN 

1558
01:12:42,920 --> 01:12:45,480
INDIVIDUAL PARTICIPANT 

1559
01:12:45,480 --> 01:12:46,040
META-ANALYSIS DISCUSSING 

1560
01:12:46,040 --> 01:12:51,520
EFFECTIVENESS OF MIND, BODY FOR 

1561
01:12:51,520 --> 01:12:56,720
KNEE AND OSTEOARTHRITIS AND 

1562
01:12:56,720 --> 01:12:57,280
NEUROPATHIC PAIN.

1563
01:12:57,280 --> 01:13:00,760
I'LL START THE VIDEO NOW AND BE 

1564
01:13:00,760 --> 01:13:02,200
BACK TO FACILITATE QUESTIONS 

1565
01:13:02,200 --> 01:13:02,520
AFTERWARDS.

1566
01:13:02,520 --> 01:13:12,680
THANK YOU.

1567
01:13:20,240 --> 01:13:23,880
>> HELLO.

1568
01:13:23,880 --> 01:13:28,400
I'LL BE TALKING HOW THE EXTRA 

1569
01:13:28,400 --> 01:13:29,600
CELLULAR MATRIX CAN AFFECT 

1570
01:13:29,600 --> 01:13:29,960
PLASTICITY.

1571
01:13:29,960 --> 01:13:32,960
EVEN IF YOU HAVE AN INJURY 

1572
01:13:32,960 --> 01:13:33,960
THAT'S PERIPHERAL AND FAR FROM 

1573
01:13:33,960 --> 01:13:35,760
THE BRAIN IT CAN CHARGE THE 

1574
01:13:35,760 --> 01:13:38,720
BRAIN AND PLASTICITY IN 

1575
01:13:38,720 --> 01:13:40,120
DIFFERENT BRAIN AREAS INCLUDING 

1576
01:13:40,120 --> 01:13:41,400
THE HIPPOCAMPUS AND THIS IS NOT 

1577
01:13:41,400 --> 01:13:42,400
LIMITED TO CELLS.

1578
01:13:42,400 --> 01:13:45,400
THEY HAVE SHOWN THEY MAY AFFECT 

1579
01:13:45,400 --> 01:13:51,040
EXTRA CELLULAR MATRIX ITSELF IN 

1580
01:13:51,040 --> 01:13:55,120
TERMS OF THE ORGANIZATION AND SO

1581
01:13:55,120 --> 01:13:59,840
THE QUESTION IS THEN HOW IS THE 

1582
01:13:59,840 --> 01:14:01,520
ENVIRONMENT INFLUENCED GLIAL 

1583
01:14:01,520 --> 01:14:03,840
STRUCTURE IN THE CONTEXT OF 

1584
01:14:03,840 --> 01:14:07,480
PAINFUL INJURIES.

1585
01:14:07,480 --> 01:14:16,480
WE USED THE MOUSE MODEL GOING TO

1586
01:14:16,480 --> 01:14:18,040
20 WEEKS AFTER INJURY.

1587
01:14:18,040 --> 01:14:21,120
WHAT WE FOUND IS THERE'S 

1588
01:14:21,120 --> 01:14:24,160
INCREASE IN THE AVAILABILITY 

1589
01:14:24,160 --> 01:14:25,920
THAT PARALLELS THE EXTRA 

1590
01:14:25,920 --> 01:14:27,200
CELLULAR MATRIX CHANGES IN TERMS

1591
01:14:27,200 --> 01:14:34,720
OF ASTROCYTES AND MICROGLIA.

1592
01:14:34,720 --> 01:14:38,640
IT'S NOT JUST THE SHEER NUMBERS 

1593
01:14:38,640 --> 01:14:41,600
BUT THEIR MORPHOLOGY.

1594
01:14:41,600 --> 01:14:47,400
WE HAVE DATA FROM OUR ASTROCYTES

1595
01:14:47,400 --> 01:14:50,040
WHERE THE PROCESSES CHANGES AND 

1596
01:14:50,040 --> 01:15:00,480
THEY BECOME LESS COMPLEX YOU MAY

1597
01:15:00,480 --> 01:15:02,960
SAY WHO CARES IF THE CELL LOOKS 

1598
01:15:02,960 --> 01:15:03,720
DIFFERENT.

1599
01:15:03,720 --> 01:15:06,120
WHY WOULD THAT MAKE ANY 

1600
01:15:06,120 --> 01:15:06,800
DIFFERENCE?

1601
01:15:06,800 --> 01:15:08,880
CELLS THAT LOOK DIFFERENT ALSO 

1602
01:15:08,880 --> 01:15:09,680
FUNCTION DIFFERENTLY.

1603
01:15:09,680 --> 01:15:10,680
THERE'S RELATIONSHIP BETWEEN 

1604
01:15:10,680 --> 01:15:14,880
STRUCTURE AND FUNCTION.

1605
01:15:14,880 --> 01:15:16,480
WE'RE CURRENTLY DOING 

1606
01:15:16,480 --> 01:15:17,120
EXPERIMENTS WHERE WE'RE TRYING 

1607
01:15:17,120 --> 01:15:23,480
TO SEE IF WE CAN LOCALIZE THE 

1608
01:15:23,480 --> 01:15:26,040
DENDRITES INSIDE GLIAL CELLS 

1609
01:15:26,040 --> 01:15:27,480
IMPACTING THE CELLS.

1610
01:15:27,480 --> 01:15:30,880
AND WHAT WE ARE TRYING TO SEE IS

1611
01:15:30,880 --> 01:15:34,000
TRYING TO SEE WHETHER THESE 

1612
01:15:34,000 --> 01:15:37,440
MOR

1613
01:15:37,440 --> 01:15:38,240
MORPHOLOGICAL CHANGES ARE 

1614
01:15:38,240 --> 01:15:39,400
AFFECTED IN THE MICROGLIA.

1615
01:15:39,400 --> 01:15:43,600
WE WANT TO BE ABLE TO TEASE 

1616
01:15:43,600 --> 01:15:46,720
APART THE AFFECTS OF THE EXTRA 

1617
01:15:46,720 --> 01:15:49,040
CELLULAR MATRIX AND MOVED TO IN 

1618
01:15:49,040 --> 01:15:54,040
VITRO CULTURE SYSTEMS TO GET TO 

1619
01:15:54,040 --> 01:16:02,040
MICROGLIAL CELLS AND GOING TO 

1620
01:16:02,040 --> 01:16:06,040
MORPHOLOGY CHANGES AND THE CELL 

1621
01:16:06,040 --> 01:16:09,880
AREA BECOMES LARGER WITH INDUCED

1622
01:16:09,880 --> 01:16:18,160
RIGIDITY AND YOU SEE THAT THE 

1623
01:16:18,160 --> 01:16:25,120
CELLS ENGULF MORE AND MORE OF 

1624
01:16:25,120 --> 01:16:25,480
THESE SPHERES.

1625
01:16:25,480 --> 01:16:29,280
THIS CAN INFLUENCE THE STRUCTURE

1626
01:16:29,280 --> 01:16:35,400
AND FUNCTION OF GLIAL CELLS AND 

1627
01:16:35,400 --> 01:16:39,400
THIS CAN HAVE IMPLICATIONS IN 

1628
01:16:39,400 --> 01:16:43,400
THE CONTEXT OF CHRONIC PAIN AS 

1629
01:16:43,400 --> 01:16:44,000
WELL AS UNDERSTANDING THE 

1630
01:16:44,000 --> 01:16:44,640
HEALTHY BRAIN.

1631
01:16:44,640 --> 01:16:47,440
WITH THAT I'D LIKE TO THANK THE 

1632
01:16:47,440 --> 01:16:49,920
MEMBERS OF THE LAB AND THANK YOU

1633
01:16:49,920 --> 01:16:50,480
FOR YOUR TIME.

1634
01:16:50,480 --> 01:16:51,680
>> THANK YOU FOR THE
OPPORTUNITY

1635
01:16:51,680 --> 01:16:56,720
TO PRESENT OUR RESEARCH.

1636
01:16:56,720 --> 01:17:04,880
I'M SARA TILL.

1637
01:17:04,880 --> 01:17:13,640
 PELVIC PAIN CAN HAVE WELL 

1638
01:17:13,640 --> 01:17:14,560
DOCUMENTED.

1639
01:17:14,560 --> 01:17:16,640
CHRONIC PELVIC PAIN IS 

1640
01:17:16,640 --> 01:17:20,800
HETEROGENEOUS AND PATIENTS MAY 

1641
01:17:20,800 --> 01:17:22,440
HAVE CONTRIBUTIONS FROM ONE OR 

1642
01:17:22,440 --> 01:17:25,080
MORE CONDITIONS DEPRESSION AND 

1643
01:17:25,080 --> 01:17:26,960
ANXIETY AND MALADAPTIVE PAIN 

1644
01:17:26,960 --> 01:17:28,040
AVOIDANCE BEHAVIORS ARE COMMON 

1645
01:17:28,040 --> 01:17:29,640
AND CONTRIBUTE TO THE NEGATIVE 

1646
01:17:29,640 --> 01:17:34,160
IMPACT ON QUALITY OF LIFE.

1647
01:17:34,160 --> 01:17:37,920
THAT CONTRIBUTES TO DEVELOPING 

1648
01:17:37,920 --> 01:17:41,440
STRATEGY FOR DEALING WITH PAIN.

1649
01:17:41,440 --> 01:17:52,000
THERAPY AND PHYSICAL THERAPY AND

1650
01:17:53,040 --> 01:17:55,280
ACCU PRESSURE MAY HELP SYMPTOMS 

1651
01:17:55,280 --> 01:17:55,760
OF CHRONIC PAIN.

1652
01:17:55,760 --> 01:17:57,600
MOST STRATEGIES CAN BE DIFFICULT

1653
01:17:57,600 --> 01:18:01,080
FOR PATIENTS TO ACCESS DUE TO 

1654
01:18:01,080 --> 01:18:03,120
AVAILABILITY AND COST.

1655
01:18:03,120 --> 01:18:08,560
WEB-BASED INTERVENTIONS MAY HELP

1656
01:18:08,560 --> 01:18:10,600
MITIGATE CHALLENGES AND THERE'S 

1657
01:18:10,600 --> 01:18:12,880
MODEST EFFECT SIZES BUT 

1658
01:18:12,880 --> 01:18:15,400
INTERVENTIONS WITH MULTIPLE 

1659
01:18:15,400 --> 01:18:18,800
MODALITIES APPEAR TO HAVE 

1660
01:18:18,800 --> 01:18:20,080
IMPROVED EFFICACY AFFECTS.

1661
01:18:20,080 --> 01:18:23,240
FINALLY, THE HETEROGENEITY MEANS

1662
01:18:23,240 --> 01:18:26,240
IT'S UNLIKELY WE'LL IDENTIFY A 

1663
01:18:26,240 --> 01:18:27,720
SINGLE STRATEGY EFFECTIVE FOR 

1664
01:18:27,720 --> 01:18:29,080
ALL PATIENTS AND RATHER WE 

1665
01:18:29,080 --> 01:18:32,840
SHOULD FOCUS ON CREATING A 

1666
01:18:32,840 --> 01:18:33,760
TAILORED PLAN THAT MEETS 

1667
01:18:33,760 --> 01:18:35,360
INDIVIDUAL NEEDS.

1668
01:18:35,360 --> 01:18:40,400
TO THAT END OUR PROJECT AIMS TO 

1669
01:18:40,400 --> 01:18:47,520
DEVELOP A WEB-BASED PROGRAM TO 

1670
01:18:47,520 --> 01:18:52,080
HAVE A CLINICAL TRIAL TO LOOK AT

1671
01:18:52,080 --> 01:18:53,640
THE RESPONSES OF THE 

1672
01:18:53,640 --> 01:18:54,760
INTERVENTION.

1673
01:18:54,760 --> 01:19:02,680
OUR HYPOTHESIS IS PATIENTS WILL 

1674
01:19:02,680 --> 01:19:04,200
IMPROVE PHYSICAL FUNCTION AND 

1675
01:19:04,200 --> 01:19:05,880
QUALITY OF LIFE COMPARED TO 

1676
01:19:05,880 --> 01:19:07,880
THOSE UNDERGOING CARE ALONE.

1677
01:19:07,880 --> 01:19:10,600
WE CREATE THE PROGRAM IN 

1678
01:19:10,600 --> 01:19:12,640
MULTIPLE WITH CONTENT EXPERTS 

1679
01:19:12,640 --> 01:19:15,560
ACROSS MANY DISCIPLINES AND 

1680
01:19:15,560 --> 01:19:16,160
CREATING PATIENTS FOR FOCUS 

1681
01:19:16,160 --> 01:19:17,920
GROUP AND USING THE FEEDBACK TO 

1682
01:19:17,920 --> 01:19:18,600
APPLY THE PROGRAM.

1683
01:19:18,600 --> 01:19:20,560
WE PLAN THE RANDOMIZED CONTROL 

1684
01:19:20,560 --> 01:19:21,520
TRIAL LATER THIS YEAR.

1685
01:19:21,520 --> 01:19:25,920
WE WOULD USE THE DATA FOR 

1686
01:19:25,920 --> 01:19:29,320
FURTHER REFINEMENT AND PATIENT 

1687
01:19:29,320 --> 01:19:31,640
PHENOTYPES MORE ROBUSTLY 

1688
01:19:31,640 --> 01:19:34,240
EVALUATED WITH FOCUS OF 

1689
01:19:34,240 --> 01:19:37,280
DEVELOPMENT OF PERSONALIZED 

1690
01:19:37,280 --> 01:19:38,280
STRATEGIES FOR CHRONIC PELVIC 

1691
01:19:38,280 --> 01:19:38,480
PAIN.

1692
01:19:38,480 --> 01:19:40,600
THANK YOU AND I'LL BE HAPPY TO 

1693
01:19:40,600 --> 01:19:49,200
ANSWER ANY QUESTIONS.

1694
01:19:49,200 --> 01:19:52,400
>> THANK YOU.

1695
01:19:52,400 --> 01:19:57,600
RECENTLY MIND BODY EXERCISES 

1696
01:19:57,600 --> 01:20:02,520
INCLUDING TAI CHI AND YOGA WERE 

1697
01:20:02,520 --> 01:20:07,000
LOOKED AT HOWEVER IT'S A LIMITED

1698
01:20:07,000 --> 01:20:09,880
EVIDENCE BASE AND OFFER 

1699
01:20:09,880 --> 01:20:15,960
GUIDANCE.

1700
01:20:15,960 --> 01:20:19,120
THE DOSE AND TREATMENT RESPONSE 

1701
01:20:19,120 --> 01:20:21,920
REMAINS UNCLEAR.

1702
01:20:21,920 --> 01:20:28,040
THE FACTORS ASSOCIATED WE 

1703
01:20:28,040 --> 01:20:32,200
INTRODUCED OUR STUDY AND LOOK AT

1704
01:20:32,200 --> 01:20:37,880
MIND BODY INTERVENTIONS FOR 

1705
01:20:37,880 --> 01:20:39,680
OSTEOARTHRITIS AND TO IDENTIFY 

1706
01:20:39,680 --> 01:20:42,880
THE IDEAL DOSE AND DURATION OF 

1707
01:20:42,880 --> 01:20:46,600
EXERCISE WHICH WOULD INDUCE 

1708
01:20:46,600 --> 01:20:48,000
TREATMENT RESPONSE.

1709
01:20:48,000 --> 01:20:52,160
WE OBTAINED INDIVIDUAL DATA FROM

1710
01:20:52,160 --> 01:20:54,120
RANDOMIZED CONTROL TRIALS FOR 

1711
01:20:54,120 --> 01:20:57,400
TAI CHI AND YOGA AND THE 

1712
01:20:57,400 --> 01:21:01,280
OUTCOMES FOR PAIN AND FUNCTION.

1713
01:21:01,280 --> 01:21:04,640
WE PERFORMED A META-ANALYSIS 

1714
01:21:04,640 --> 01:21:08,200
USING MIXED LINEAR REGRESSION 

1715
01:21:08,200 --> 01:21:18,680
MODELS ON INDIVIDUAL STUDIES.

1716
01:21:20,440 --> 01:21:23,880
WE OBTAINED AND TAI CHI WAS THE 

1717
01:21:23,880 --> 01:21:25,880
MOST EFFECTIVE INTERVENTION AND 

1718
01:21:25,880 --> 01:21:30,560
YOGA WAS COMPARABLE TO PHYSICAL 

1719
01:21:30,560 --> 01:21:31,040
THERAPY.

1720
01:21:31,040 --> 01:21:33,360
FOR AIM TWO, TREATMENT 

1721
01:21:33,360 --> 01:21:36,000
REPUBLICANS WAS DEFINED USING 

1722
01:21:36,000 --> 01:21:37,440
THE RCS CRITERIA.

1723
01:21:37,440 --> 01:21:39,800
AND REGRESSION MODELS FOR 

1724
01:21:39,800 --> 01:21:41,200
CLUSTERING INDIVIDUAL STUDIES 

1725
01:21:41,200 --> 01:21:43,040
WERE USED.

1726
01:21:43,040 --> 01:21:49,880
WE FOUND THAT 21% OF PATIENTS 

1727
01:21:49,880 --> 01:21:51,080
RESPONDED TO THE TREATMENT.

1728
01:21:51,080 --> 01:21:53,880
THERE WAS AN EFFECT ON THE BMI 

1729
01:21:53,880 --> 01:21:56,080
AND PHYSICAL FUNCTION REMAIN 

1730
01:21:56,080 --> 01:21:57,920
SIGNIFICANTLY ASSOCIATED WITH 

1731
01:21:57,920 --> 01:22:00,200
TREATMENT RESPONSE.

1732
01:22:00,200 --> 01:22:02,880
FOR EVERY 10-POINT IMPROVEMENT 

1733
01:22:02,880 --> 01:22:04,600
IN FUNCTION THE CHANCE OF 

1734
01:22:04,600 --> 01:22:07,560
TREATMENT RESPONSE GOES UP FOR 

1735
01:22:07,560 --> 01:22:10,080
AIM 3, DURATION OF INTERVENTION 

1736
01:22:10,080 --> 01:22:12,800
WAS CATEGORIZED IN THREE DOSE 

1737
01:22:12,800 --> 01:22:15,160
AND THE DOSE WAS CATEGORIZED 

1738
01:22:15,160 --> 01:22:16,640
BASED ON TOTAL AMOUNT OF 

1739
01:22:16,640 --> 01:22:19,480
EXERCISE PER WEEK.

1740
01:22:19,480 --> 01:22:22,880
WE FOUND THAT 10-12 WEEKS OF 

1741
01:22:22,880 --> 01:22:24,920
EXERCISE HAS MORE TREATMENT 

1742
01:22:24,920 --> 01:22:28,600
RESPONSE COMPARED TO 6-8 WEEKS 

1743
01:22:28,600 --> 01:22:30,720
OF INTERVENTION.

1744
01:22:30,720 --> 01:22:32,840
WE ALSO FOUND 60-120 MINUTES OF 

1745
01:22:32,840 --> 01:22:36,240
EXERCISE A WEEK WAS ASSOCIATED 

1746
01:22:36,240 --> 01:22:38,280
WITH FIVE TIMES HIGHER ODDS OF 

1747
01:22:38,280 --> 01:22:40,640
TREATMENT RESPONSE COMPARED TO 

1748
01:22:40,640 --> 01:22:42,320
120 MINUTES PER WEEK OF 

1749
01:22:42,320 --> 01:22:42,600
EXERCISE.

1750
01:22:42,600 --> 01:22:47,200
THE OVERALL CONCLUSIONS AND 

1751
01:22:47,200 --> 01:22:49,880
IMPLICATIONS WERE MIND BODY 

1752
01:22:49,880 --> 01:22:52,640
INTERVENTIONS PRODUCE SIMILAR 

1753
01:22:52,640 --> 01:22:56,080
AFFECTS TO THOSE OF STANDARD 

1754
01:22:56,080 --> 01:22:58,200
PHYSICAL THERAPY AND TREATMENT 

1755
01:22:58,200 --> 01:23:02,680
OF OSTEOARTHRITIS AND THOSE WITH

1756
01:23:02,680 --> 01:23:06,440
LOWER BMI ARE MORE LIKELY TO 

1757
01:23:06,440 --> 01:23:09,520
RESPOND TO EXERCISE-BASED 

1758
01:23:09,520 --> 01:23:10,160
INTERVENTIONS.

1759
01:23:10,160 --> 01:23:12,240
60 TO 120 MINUTES A WEEK OF 

1760
01:23:12,240 --> 01:23:15,600
EXERCISE FOR FOUR WEEKS IS THE 

1761
01:23:15,600 --> 01:23:18,600
IDEAL DOSAGE TO ILLICIT A 

1762
01:23:18,600 --> 01:23:19,320
TREATMENT RESPONSE IN 

1763
01:23:19,320 --> 01:23:20,800
INDIVIDUALS WITH OSTEOARTHRITIS.

1764
01:23:20,800 --> 01:23:21,400
THANK YOU FOR YOUR ATTENTION AND

1765
01:23:21,400 --> 01:23:31,200
TIME.

1766
01:23:31,200 --> 01:23:34,280
>> I'D LIKE TO FIRST THANK
THE 

1767
01:23:34,280 --> 01:23:37,920
ORGANIZERS FOR THE OPPORTUNITY 

1768
01:23:37,920 --> 01:23:40,320
TO SHARE OUR WORK.

1769
01:23:40,320 --> 01:23:46,600
AND THIS FOLLOWED THE NEURONS 

1770
01:23:46,600 --> 01:23:49,360
AND THE BRAIN PERFORMS 

1771
01:23:49,360 --> 01:23:51,800
PERCEPTIONS OF PAIN, ITCH, TOUCH

1772
01:23:51,800 --> 01:23:54,800
AND TEMPERATURE AND RESPOND.

1773
01:23:54,800 --> 01:23:57,440
IN PAIN STATES ABNORMAL ACTIVITY

1774
01:23:57,440 --> 01:24:01,240
OF THE ALT HAS INAPPROPRIATE 

1775
01:24:01,240 --> 01:24:04,960
PERCEPTION OF PAIN AND WE AIM TO

1776
01:24:04,960 --> 01:24:06,760
VISUALIZE ACTIVITY WITH THE TIME

1777
01:24:06,760 --> 01:24:08,920
SCALES OF WEEKS TO MONTHS 

1778
01:24:08,920 --> 01:24:09,520
RELEVANT FOR CHRONIC PAIN 

1779
01:24:09,520 --> 01:24:09,800
CONDITIONS.

1780
01:24:09,800 --> 01:24:12,120
THE GOAL OF THE PROJECT IS TO 

1781
01:24:12,120 --> 01:24:12,880
DEFINE HOW THE FUNCTION OF THE 

1782
01:24:12,880 --> 01:24:15,000
SPECIFIC CHANGES AND THE 

1783
01:24:15,000 --> 01:24:17,160
TRANSITION FROM THE NOCICEPTIVE 

1784
01:24:17,160 --> 01:24:18,600
PAIN TO A NEUROPATHIC FUNCTION.

1785
01:24:18,600 --> 01:24:22,600
TO ADDRESS THIS QUESTION I 

1786
01:24:22,600 --> 01:24:25,480
DEVELOPED TECHNIQUES FOR CHRONIC

1787
01:24:25,480 --> 01:24:27,520
NEURONS IN THE DORSAL HORN WHICH

1788
01:24:27,520 --> 01:24:33,880
IS WHERE THEY ARE AT AND HAVE 

1789
01:24:33,880 --> 01:24:37,680
CALCIUM INDICATORS AND THE 

1790
01:24:37,680 --> 01:24:40,600
STRONGEST PROTECTION TARGET OR 

1791
01:24:40,600 --> 01:24:43,160
BY TRANSGENIC EXPRESSION.

1792
01:24:43,160 --> 01:24:47,320
THE LONG-TERM ACCESS TO THE 

1793
01:24:47,320 --> 01:24:50,520
NEURONS AND CREATED A WINDOW 

1794
01:24:50,520 --> 01:24:53,920
OVER THE LUMBAR AND SPINAL CORD.

1795
01:24:53,920 --> 01:24:59,360
WE EXAMINED THE REPRESENTATION 

1796
01:24:59,360 --> 01:25:00,960
OF TEMPERATURE AND RESPOND TO 

1797
01:25:00,960 --> 01:25:07,040
THERMAL STIMULATION OF THE IPSO 

1798
01:25:07,040 --> 01:25:08,360
LATERAL PORTION.

1799
01:25:08,360 --> 01:25:12,440
AND TEMPERATURES IN THE CENS SE 

1800
01:25:12,440 --> 01:25:14,640
TO COLD, WARM OR HOT TEMPERATURE

1801
01:25:14,640 --> 01:25:20,200
AND ALL RESPONSE TOUCHES ARE 

1802
01:25:20,200 --> 01:25:21,160
PRESENT IN THE PROJECTION.

1803
01:25:21,160 --> 01:25:23,760
IN THE ABSENCE OF INJURY WE 

1804
01:25:23,760 --> 01:25:25,920
OBSERVED TEMPERATURE ACTIVITY 

1805
01:25:25,920 --> 01:25:27,280
REMAIN STABLE OVER PERIODS OF 

1806
01:25:27,280 --> 01:25:31,320
WEEKS AND ACCORDINGLY THE 

1807
01:25:31,320 --> 01:25:33,400
ACTIVITY AND SENSITIVITY OF 

1808
01:25:33,400 --> 01:25:34,600
TEMPERATURE SENSITIVE NEURONS 

1809
01:25:34,600 --> 01:25:39,720
BETWEEN AWAKE AND ANESTHETIZED 

1810
01:25:39,720 --> 01:25:42,840
CONDITIONS AND WE CAN ASK HOW 

1811
01:25:42,840 --> 01:25:45,880
THIS CHANGES AFTER THE PAIN AND 

1812
01:25:45,880 --> 01:25:49,000
WE LOOKED AT THE INJURY OF THE 

1813
01:25:49,000 --> 01:25:49,200
NERVE.

1814
01:25:49,200 --> 01:25:56,840
WE OBSERVED PROFOUND CHANGES IN 

1815
01:25:56,840 --> 01:26:02,440
LOSS OF THE SENSING AND 

1816
01:26:02,440 --> 01:26:04,600
RESPONSIVE TO HEAT AND HOT AND 

1817
01:26:04,600 --> 01:26:05,640
COLD TEMPERATURES.

1818
01:26:05,640 --> 01:26:08,480
THESE SUPPORT THE POTENTIAL OF 

1819
01:26:08,480 --> 01:26:10,640
THIS APPROACH AND CAN LOOKING AT

1820
01:26:10,640 --> 01:26:13,440
THE STIMULI AND IDENTIFY CHANGES

1821
01:26:13,440 --> 01:26:16,200
IN CIRCUITS ASSOCIATED WITH 

1822
01:26:16,200 --> 01:26:16,840
MALADAPTIVE PAIN.

1823
01:26:16,840 --> 01:26:22,680
WE'RE EXTENDING THIS WORK TO 

1824
01:26:22,680 --> 01:26:23,320
PLASTICITY AS WELL.

1825
01:26:23,320 --> 01:26:25,920
AND THANK YOU TO THE NIH AND FOR

1826
01:26:25,920 --> 01:26:36,200
YOUR ATTENTION.

1827
01:27:00,680 --> 01:27:01,840
>> PUT YOUR QUESTIONS IN
THE 

1828
01:27:01,840 --> 01:27:03,320
CHAT.

1829
01:27:03,320 --> 01:27:05,960
I'LL START WITH A QUESTION FOR 

1830
01:27:05,960 --> 01:27:08,560
DR. TAJERIAN.

1831
01:27:08,560 --> 01:27:10,400
FIRST, I'M SORRY IF I 

1832
01:27:10,400 --> 01:27:11,040
MISPRONOUNCED YOUR NAME.

1833
01:27:11,040 --> 01:27:12,120
>> THAT WAS PERFECT,
ACTUALLY.

1834
01:27:12,120 --> 01:27:15,880
>> WONDERFUL.

1835
01:27:15,880 --> 01:27:20,960
>> SO I WAS CURIOUS THE 

1836
01:27:20,960 --> 01:27:22,760
ARTIFICIAL MATRICES YOU USED FOR

1837
01:27:22,760 --> 01:27:27,720
YOUR CELL CULTURES, HOW DID YOU 

1838
01:27:27,720 --> 01:27:32,680
DETERMINE THE APPROPRIATE 

1839
01:27:32,680 --> 01:27:33,920
DENSITIES AND APPROPRIATE -- I'M

1840
01:27:33,920 --> 01:27:42,760
SORRY, I CANNOT THINK OF THE 

1841
01:27:42,760 --> 01:27:42,960
WORD.

1842
01:27:42,960 --> 01:27:45,680
>> SO THERE'S A COUPLE OF 

1843
01:27:45,680 --> 01:27:45,960
REASONS.

1844
01:27:45,960 --> 01:27:49,560
OF COURSE PART IS THE LOGISTICS 

1845
01:27:49,560 --> 01:27:50,440
ARE THESE READILY AVAILABLE 

1846
01:27:50,440 --> 01:27:52,640
THOUGH WE HAVE A COLLABORATOR 

1847
01:27:52,640 --> 01:27:55,880
WHO COULD HELP US MAKE CUSTOM 

1848
01:27:55,880 --> 01:27:56,880
MATRICES IT'S KIND OF NOT THE 

1849
01:27:56,880 --> 01:28:07,320
FIRST STEP IN OUR WORK.

1850
01:28:12,120 --> 01:28:13,240
THERE'S A CRUDE AND GENERAL WAY 

1851
01:28:13,240 --> 01:28:19,040
TO DO IT AND IT'S A WIDE RANGE 

1852
01:28:19,040 --> 01:28:29,560
BECAUSE WE WANTED TO COVERING 

1853
01:28:30,560 --> 01:28:31,320
EVERYTHING YOU MAY HAVE 

1854
01:28:31,320 --> 01:28:32,000
DIFFERENT NUMBERS DEPENDING ON 

1855
01:28:32,000 --> 01:28:35,080
THE STUDIES YOU'RE LOOKING AT.

1856
01:28:35,080 --> 01:28:38,560
IN FACT WE'VE DONE MICRO SCSCOP 

1857
01:28:38,560 --> 01:28:46,280
AND MEASURE D RIGIDITY AND 

1858
01:28:46,280 --> 01:28:49,320
DEPENDING ON THE COURSE OF THE 

1859
01:28:49,320 --> 01:28:55,440
INJURY AND DEPENDING ON RECOVERY

1860
01:28:55,440 --> 01:28:56,360
YOU MAY GET DIFFERENT NUMBERS SO

1861
01:28:56,360 --> 01:29:01,440
WE WANTED TO COVER A WIDE RANGE.

1862
01:29:01,440 --> 01:29:04,120
AS THE FIRST LOOK WE PICKED A 

1863
01:29:04,120 --> 01:29:04,680
LARGE RANGE.

1864
01:29:04,680 --> 01:29:08,920
DOWN THE ROAD WE'D LIKE TO FOCUS

1865
01:29:08,920 --> 01:29:11,520
MORE ON THE RANGE AND WE THINK 

1866
01:29:11,520 --> 01:29:15,600
THAT'S THE MOST PHYSIOLOGICALLY 

1867
01:29:15,600 --> 01:29:16,360
RELEVANT BALLPARK AND THEN WE'LL

1868
01:29:16,360 --> 01:29:22,080
BE CLOSER TO LOOKING AT THE 

1869
01:29:22,080 --> 01:29:23,320
DIFFERENT BIO CHEMICAL 

1870
01:29:23,320 --> 01:29:23,640
COMPOSITIONS.

1871
01:29:23,640 --> 01:29:24,240
>> THANK YOU.

1872
01:29:24,240 --> 01:29:29,920
AS A FOLLOW-UP, HOW DOES THE 

1873
01:29:29,920 --> 01:29:33,600
PERIPHERAL INJURY ALTER THE 

1874
01:29:33,600 --> 01:29:33,840
FIRING?

1875
01:29:33,840 --> 01:29:35,200
>> IF WE ONLY KNEW.

1876
01:29:35,200 --> 01:29:37,480
IT'S FUNNY BECAUSE WHEN I 

1877
01:29:37,480 --> 01:29:39,400
STARTED THINKING ABOUT THIS, 

1878
01:29:39,400 --> 01:29:42,120
PEOPLE HAD BEEN LOOKING AT THIS 

1879
01:29:42,120 --> 01:29:44,080
IN THE CONTEXT OF STROKE, 

1880
01:29:44,080 --> 01:29:45,920
CANCER, DEVELOPMENT BUT NOT IN 

1881
01:29:45,920 --> 01:29:48,960
THE CONTEXT OF CHRONIC PAIN IN 

1882
01:29:48,960 --> 01:29:51,440
THE ADULT BRAIN ESPECIALLY WHEN 

1883
01:29:51,440 --> 01:29:54,560
INJURY IS NOT IN THE BRAIN.

1884
01:29:54,560 --> 01:29:56,120
SO PEOPLE AT FIRST DIDN'T 

1885
01:29:56,120 --> 01:29:57,880
BELIEVE ME LIKE WHAT'S CHANGING 

1886
01:29:57,880 --> 01:29:58,400
THESE THINGS?

1887
01:29:58,400 --> 01:30:05,280
SO IN MY OPINION, THE OVER 

1888
01:30:05,280 --> 01:30:08,640
ARCHING MECHANICS THERE IS THAT 

1889
01:30:08,640 --> 01:30:11,360
YOU HAVE NEUROINFLAMMATION IN 

1890
01:30:11,360 --> 01:30:16,600
THE HIPPOCAMPUS AND WE KNOW THE 

1891
01:30:16,600 --> 01:30:21,000
ECM IS REGULATED HEAVILY BY 

1892
01:30:21,000 --> 01:30:21,920
GLIAL CELLS.

1893
01:30:21,920 --> 01:30:24,720
MY OPINION IS SOMETHING IS 

1894
01:30:24,720 --> 01:30:25,400
HAPPENING IN THE PERIPHERY 

1895
01:30:25,400 --> 01:30:28,320
CROSSING OVER TO THE BRAIN.

1896
01:30:28,320 --> 01:30:30,040
IT COULD BE DUE TO NEURON 

1897
01:30:30,040 --> 01:30:31,160
COMMUNICATION AND WE'RE STILL 

1898
01:30:31,160 --> 01:30:34,040
LOOKING AT THAT.

1899
01:30:34,040 --> 01:30:35,320
ONCE HAVE YOU THE NEURAL 

1900
01:30:35,320 --> 01:30:37,400
INFLAMMATION IN THE BRAIN YOU 

1901
01:30:37,400 --> 01:30:40,080
HAVE THE CHANGING ENVIRONMENT OF

1902
01:30:40,080 --> 01:30:43,640
EXTRA CELLULAR MATRIX CHANGING 

1903
01:30:43,640 --> 01:30:48,160
NEURONAL FUNCTION AND GLIAL ARE 

1904
01:30:48,160 --> 01:30:50,440
CHANGING AND ONCE IN THE CYCLE 

1905
01:30:50,440 --> 01:30:52,520
THOUGH THE PERIPHERY IS HEALED 

1906
01:30:52,520 --> 01:30:55,960
YOU CREATE THIS ENVIRONMENT 

1907
01:30:55,960 --> 01:30:56,280
MALADAPTIVE.

1908
01:30:56,280 --> 01:30:59,920
SO YOU CAN'T JUST TARGET THE 

1909
01:30:59,920 --> 01:31:02,000
CELLS BUT THE CELLULAR 

1910
01:31:02,000 --> 01:31:02,440
ENVIRONMENT.

1911
01:31:02,440 --> 01:31:04,000
WE STILL DON'T KNOW EXACTLY 

1912
01:31:04,000 --> 01:31:07,760
WHAT'S CAUSING IT.

1913
01:31:07,760 --> 01:31:10,880
WE HAVE SOME CLUES TO IDENTIFY A

1914
01:31:10,880 --> 01:31:13,920
SPECIFIC MATRIX OF PROTEINS AND 

1915
01:31:13,920 --> 01:31:17,400
WE THINK THAT PLAYS AN IMPORTANT

1916
01:31:17,400 --> 01:31:27,920
ROLE BUT THERE COULD BE OTHERS.

1917
01:31:51,040 --> 01:31:53,000
>> IS IT IMPORTANT FOR
PEOPLE TO

1918
01:31:53,000 --> 01:31:56,440
PROVIDE THE INTERVENTION AS A 

1919
01:31:56,440 --> 01:31:59,400
MEAN OF ENTRY INTO THE HEALTH 

1920
01:31:59,400 --> 01:32:00,600
CARE SYSTEM.

1921
01:32:00,600 --> 01:32:03,560
>> WE MODELLED OUR
INTERVENTION 

1922
01:32:03,560 --> 01:32:06,960
AND LEVERAGED AN INTERVENTION BY

1923
01:32:06,960 --> 01:32:09,880
MENTORS PRIMARILY WEB BASED AND 

1924
01:32:09,880 --> 01:32:12,560
WHERE THE DATA WAS THAT EFFICACY

1925
01:32:12,560 --> 01:32:14,920
IS ESSENTIALLY FAIRLY EQUIVALENT

1926
01:32:14,920 --> 01:32:17,040
I CERTAINLY DON'T MEAN TO 

1927
01:32:17,040 --> 01:32:20,000
MINIMIZE THE REALLY SUBSTANTIAL 

1928
01:32:20,000 --> 01:32:24,160
IMPACT THAT OUR THERAPISTS 

1929
01:32:24,160 --> 01:32:25,320
PERFORMING BEHAVIORAL THERAPY OR

1930
01:32:25,320 --> 01:32:29,640
PHYSICAL THERAPISTS WHO ARE I 

1931
01:32:29,640 --> 01:32:32,640
THINK MAGIC WITH THEIR PATIENTS 

1932
01:32:32,640 --> 01:32:34,760
WITH CHRONIC PELVIC PAIN.

1933
01:32:34,760 --> 01:32:40,680
I DON'T MEAN TO MINIMIZE THEIR 

1934
01:32:40,680 --> 01:32:42,640
CONTRIBUTION AND OUR GOAL IS TO 

1935
01:32:42,640 --> 01:32:44,480
LOOK AT A POPULATION IN MICHIGAN

1936
01:32:44,480 --> 01:32:47,800
AND HAVE PATIENTS WHO ARE LOCAL 

1937
01:32:47,800 --> 01:32:49,120
AND PATIENTS COMING FROM DETROIT

1938
01:32:49,120 --> 01:32:52,120
AND HAVE DIFFERENT ACCESS ISSUES

1939
01:32:52,120 --> 01:32:53,200
RELATIVE TO THAT LOCATION AND WE

1940
01:32:53,200 --> 01:32:56,000
HAVE A LOT OF PATIENTS WHO COME 

1941
01:32:56,000 --> 01:32:58,480
FROM RURAL AREAS EVEN UPPER 

1942
01:32:58,480 --> 01:32:59,280
PENINSULA DRIVING POTENTIALLY 

1943
01:32:59,280 --> 01:33:01,480
EIGHT HOURS TO SEE US AND GIVEN 

1944
01:33:01,480 --> 01:33:06,920
THAT, IT'S REALLY CHALLENGING TO

1945
01:33:06,920 --> 01:33:11,520
FIND A COGNITIVE BEHAVIORAL 

1946
01:33:11,520 --> 01:33:15,520
THERAPIST OR ACUPUNCTURIST AND 

1947
01:33:15,520 --> 01:33:18,800
OUR SOLUTION WAS TO SAY HE'S AN 

1948
01:33:18,800 --> 01:33:21,400
INTRODUCTION TO THESE THINGS AND

1949
01:33:21,400 --> 01:33:23,240
USUAL CARE AND WE'RE 

1950
01:33:23,240 --> 01:33:25,280
RECOMMENDING THINGS LIKE 

1951
01:33:25,280 --> 01:33:26,920
COGNITIVE BEHAVIORAL THERAPY IF 

1952
01:33:26,920 --> 01:33:28,600
POSSIBLE AND RECOMMENDING THINGS

1953
01:33:28,600 --> 01:33:31,920
LIKE PHYSICAL THERAPY IF PATIENT

1954
01:33:31,920 --> 01:33:33,840
CAN ACCESS BUT IF YOU CAN'T 

1955
01:33:33,840 --> 01:33:36,920
ACCESS THESE THINGS HOW DOES 

1956
01:33:36,920 --> 01:33:40,080
THIS MULTI-MODAL WEB-BASED 

1957
01:33:40,080 --> 01:33:41,920
THERAPY DOES IT SERVE AS AN 

1958
01:33:41,920 --> 01:33:44,760
ADJUNCT AND OUR HOPE IS THEY CAN

1959
01:33:44,760 --> 01:33:49,040
USE IT FOR PAIN EXACERBATION AND

1960
01:33:49,040 --> 01:33:53,960
INFORMING THEIR INTEREST IN 

1961
01:33:53,960 --> 01:34:02,040
VARIOUS THINGS.

1962
01:34:02,040 --> 01:34:04,520
>> AS A FOLLOW-UP, HOW DO
YOU 

1963
01:34:04,520 --> 01:34:07,280
MANAGE THE FACT THAT PEOPLE HAVE

1964
01:34:07,280 --> 01:34:08,960
DIFFERENT ACCESS?

1965
01:34:08,960 --> 01:34:13,840
I MYSELF AM HAVING INTERNET 

1966
01:34:13,840 --> 01:34:15,960
CONNECTIVITY ISSUES AND I'M IN 

1967
01:34:15,960 --> 01:34:16,360
WASHINGTON, D.C.

1968
01:34:16,360 --> 01:34:19,960
>> SUCH AN IMPORTANT
QUESTION 

1969
01:34:19,960 --> 01:34:20,160
ALSO.

1970
01:34:20,160 --> 01:34:23,560
I THINK THIS IS SOMETHING WE'RE 

1971
01:34:23,560 --> 01:34:24,960
STRUGGLING WITH.

1972
01:34:24,960 --> 01:34:27,480
AND THE WEB BASED OPTIONS ARE 

1973
01:34:27,480 --> 01:34:28,640
BETTER THAN ASKING SOMEONE TO 

1974
01:34:28,640 --> 01:34:30,920
DRIVE EIGHT HOURS TO SEE A 

1975
01:34:30,920 --> 01:34:33,920
PHYSICAL THERAPIST BUT IT 

1976
01:34:33,920 --> 01:34:35,520
CERTAINLY DOESN'T FIX THE ACCESS

1977
01:34:35,520 --> 01:34:37,320
PROBLEM FOR A LOT OF PEOPLE.

1978
01:34:37,320 --> 01:34:41,880
I FEEL IT'S A BIGGER ISSUE AND 

1979
01:34:41,880 --> 01:34:43,520
WE HAVE TRIED TO MAKE A LOT OF 

1980
01:34:43,520 --> 01:34:44,920
HAND OUTS AND THINGS AVAILABLE 

1981
01:34:44,920 --> 01:34:46,480
AS PART OF OUR USUAL CARE 

1982
01:34:46,480 --> 01:34:47,040
PRACTICE.

1983
01:34:47,040 --> 01:34:49,400
WE'RE DOING TELEMEDICINE 

1984
01:34:49,400 --> 01:34:51,880
APPOINTMENTS AND SOMETIMES CAN 

1985
01:34:51,880 --> 01:34:53,960
DO TELEPHONE VISITS AND NOT 

1986
01:34:53,960 --> 01:34:55,920
APPLICABLE DIRECTLY TO THE 

1987
01:34:55,920 --> 01:34:57,600
INTERVENTION BUT I THINK IT'S A 

1988
01:34:57,600 --> 01:35:03,200
CRITICAL THING TO MANAGE.

1989
01:35:03,200 --> 01:35:04,600
>> I'M GLAD YOU'RE
THINKING OF 

1990
01:35:04,600 --> 01:35:11,240
ALL THE DIFFERENT ASPECTS.

1991
01:35:11,240 --> 01:35:12,880
I WOULD LIKE TO MOVE ON FOR 

1992
01:35:12,880 --> 01:35:19,720
INTEREST OF TIME TO DR. BANNURU.

1993
01:35:19,720 --> 01:35:24,640
WE HAVE A FEW QUESTIONS.

1994
01:35:24,640 --> 01:35:32,800
ONE QUESTION CAME IN WAS THERE A

1995
01:35:32,800 --> 01:35:36,480
TYPE OF TAI CHI THAT WAS MOST 

1996
01:35:36,480 --> 01:35:38,000
EFFECTIVE AND DO YOU HAVE 

1997
01:35:38,000 --> 01:35:39,640
THEORIES WHERE IT WAS MORE 

1998
01:35:39,640 --> 01:35:40,080
EFFECTIVE THAN OTHER 

1999
01:35:40,080 --> 01:35:45,760
INTERVENTIONS?

2000
01:35:45,760 --> 01:35:53,160
>> IN ALL THE STUDIES SOME
WERE 

2001
01:35:53,160 --> 01:36:03,680
MODIFIED IN STYLES OF TAI CHI 

2002
01:36:04,880 --> 01:36:07,600
AND AND ONE OF THE MAIN 

2003
01:36:07,600 --> 01:36:10,880
HYPOTHESIS WAS THE MIND-BODY 

2004
01:36:10,880 --> 01:36:11,120
EFFECT.

2005
01:36:11,120 --> 01:36:16,280
AS WE KNOW IT'S NOT JUST PAIN 

2006
01:36:16,280 --> 01:36:21,920
THEY HAVE ANXIETY, STRESS, AND 

2007
01:36:21,920 --> 01:36:22,520
MOSTLY DEPRESSION.

2008
01:36:22,520 --> 01:36:26,880
IN STUDIES WHERE WE WERE 

2009
01:36:26,880 --> 01:36:29,520
EVALUATING THOSE ON DEPRESSION 

2010
01:36:29,520 --> 01:36:33,280
AND ANXIETY, TAI CHI AND TO 

2011
01:36:33,280 --> 01:36:35,160
CERTAINLY EXTENT YOGA WERE MORE 

2012
01:36:35,160 --> 01:36:37,960
EFFECTIVE IN THOSE AND PROBABLY 

2013
01:36:37,960 --> 01:36:42,200
ONE OF THE REASONS TAI CHI WAS 

2014
01:36:42,200 --> 01:36:45,240
SLIGHTLY MORE EFFECTIVE FOR YOGA

2015
01:36:45,240 --> 01:36:48,920
WE WILL LOOK AT IT.

2016
01:36:48,920 --> 01:36:49,920
THEY WERE PRETTY CLOSE IN 

2017
01:36:49,920 --> 01:37:00,120
EFFICACY.

2018
01:37:07,880 --> 01:37:13,880
>> ABOUT WHAT EVALUATING
THE 

2019
01:37:13,880 --> 01:37:14,200
INTERVENTIONS?

2020
01:37:14,200 --> 01:37:16,960
>> TO BE HONEST WE DID ONE

2021
01:37:16,960 --> 01:37:17,920
CLINICAL TRIAL AT OUR SITE BUT 

2022
01:37:17,920 --> 01:37:21,560
THE REST OF OUR STUDIES WE HAVE 

2023
01:37:21,560 --> 01:37:23,440
COLLECTED DATA FROM PEOPLE WHO 

2024
01:37:23,440 --> 01:37:26,840
DID THESE RANDOMIZED TRIALS.

2025
01:37:26,840 --> 01:37:30,120
I WOULDN'T EXACTLY KNOW BUT ONE 

2026
01:37:30,120 --> 01:37:32,920
DIFFERENCE I NOTICED ARE LIKE WE

2027
01:37:32,920 --> 01:37:39,120
HAD ALMOST ALL THE MIND-BODY 

2028
01:37:39,120 --> 01:37:40,520
INTERVENTIONS WERE GROUP BASED 

2029
01:37:40,520 --> 01:37:43,560
AND OTHERS WERE ONE-ON-ONE AND 

2030
01:37:43,560 --> 01:37:45,960
THAT WAS ONE OF THE MAJOR 

2031
01:37:45,960 --> 01:37:51,600
DIFFERENCES BETWEEN THESE.

2032
01:37:51,600 --> 01:37:52,560
>> THAT'S VERY
INTERESTING.

2033
01:37:52,560 --> 01:37:54,600
WOULD YOU MIND REPEATING THE 

2034
01:37:54,600 --> 01:37:58,120
NAME OF THE TAI CHI YOU USED.

2035
01:37:58,120 --> 01:38:01,920
>> IT WAS SUN STYLE.

2036
01:38:01,920 --> 01:38:02,160
>> OKAY.

2037
01:38:02,160 --> 01:38:09,720
THANK YOU.

2038
01:38:09,720 --> 01:38:11,600
>> THERE WAS AN EFFECT OF
RACE 

2039
01:38:11,600 --> 01:38:16,680
ON EFFECTIVENESS?

2040
01:38:16,680 --> 01:38:20,200
>> I WOULA

2041
01:38:20,200 --> 01:38:23,520
>> I WOULD SAYFFECT OF
RACE ON

2042
01:38:23,520 --> 01:38:24,320
EFFECTIVENESS

2043
01:38:24,320 --> 01:38:24,920
>> I WOULD SAYAFFECT OF
RACE 

2044
01:38:24,920 --> 01:38:25,280
ON EFFECTIVENESS

2045
01:38:25,280 --> 01:38:29,200
>> I WOULD SAY IF I HAD
MORE 

2046
01:38:29,200 --> 01:38:31,400
POWER WE WOULD HAVE MORE 

2047
01:38:31,400 --> 01:38:32,880
PATIENTS BUT THERE SEEMED TO BE 

2048
01:38:32,880 --> 01:38:36,280
NO EFFECT ON RACE AND MORE THAN 

2049
01:38:36,280 --> 01:38:39,120
20% WERE ASIAN AND WE HAD SOME 

2050
01:38:39,120 --> 01:38:43,120
STUDY DONE IN ASIA.

2051
01:38:43,120 --> 01:38:47,720
SO WHEN WE CAN HAVE ENOUGH 

2052
01:38:47,720 --> 01:38:50,760
DIVERSITY OR PANELS OF POWER TO 

2053
01:38:50,760 --> 01:38:50,960
TEST.

2054
01:38:50,960 --> 01:38:53,200
>> THANK YOU.

2055
01:38:53,200 --> 01:39:00,480
MOVING ON TO DR. YAMOLINSKY.

2056
01:39:00,480 --> 01:39:04,040
HAVE YOU USED YOUR TECHNIQUE TO 

2057
01:39:04,040 --> 01:39:08,080
STUDY THE EFFECT OF NEUROPATHIC 

2058
01:39:08,080 --> 01:39:13,960
PAIN ON RESPONSES?

2059
01:39:13,960 --> 01:39:24,360
YOU SEEM TO BE MUTED.

2060
01:39:30,560 --> 01:39:32,480
SARAH, HE SEEMS TO HAVE TROUBLE 

2061
01:39:32,480 --> 01:39:33,440
WITH HIS AUDIO.

2062
01:39:33,440 --> 01:39:35,400
CAN WE DO SOMETHING TO ADDRESS 

2063
01:39:35,400 --> 01:39:36,040
THAT?

2064
01:39:36,040 --> 01:39:38,880
>> CAN YOU LOOK AT THE MIC
AT 

2065
01:39:38,880 --> 01:39:42,640
THE BOTTOM LEFT OF YOUR SCREEN 

2066
01:39:42,640 --> 01:39:46,680
WHEREVER IT SHOWS THAT.

2067
01:39:46,680 --> 01:39:49,480
CLICK ON THE CARROT AND MAKE 

2068
01:39:49,480 --> 01:39:50,560
SURE THE CORRECT MICROPHONE IS 

2069
01:39:50,560 --> 01:39:54,560
CLICKED ON.

2070
01:39:54,560 --> 01:39:55,760
>> CAN YOU HEAR ME NOW?

2071
01:39:55,760 --> 01:40:01,080
>> YES, WE CAN.

2072
01:40:01,080 --> 01:40:04,840
>> GREAT.

2073
01:40:04,840 --> 01:40:10,440
WE LOOK AT RESPONSES AS WELL.

2074
01:40:10,440 --> 01:40:15,520
ONE CAVEAT IS RESPONDING TO PIN 

2075
01:40:15,520 --> 01:40:21,800
AND A NNESTHESIA AND WE SEE GOO 

2076
01:40:21,800 --> 01:40:22,800
RESPONSE.

2077
01:40:22,800 --> 01:40:33,360
IT SEEMS THERE'S AN EFFECT AND 

2078
01:40:42,000 --> 01:40:47,160
>> SORRY.

2079
01:40:47,160 --> 01:40:49,920
CAN YOU COMMENT ON THE FATE OF 

2080
01:40:49,920 --> 01:40:55,320
THE INNOCUOUS SENSING NEURONS?

2081
01:40:55,320 --> 01:41:05,840
>> AND WE THINK IT'S STILL
THERE

2082
01:41:22,400 --> 01:41:26,360
SO WE'RE TRYING TO LOOK AT 

2083
01:41:26,360 --> 01:41:29,480
WHETHER THERE IS POTENTIALLY THE

2084
01:41:29,480 --> 01:41:34,760
PROCESSING AFTER SCANNING.

2085
01:41:34,760 --> 01:41:35,240
>> THANK YOU.

2086
01:41:35,240 --> 01:41:37,360
I ALSO NEGLECTED TO MENTION THAT

2087
01:41:37,360 --> 01:41:39,160
QUESTION STARTED BY SAYING THAT 

2088
01:41:39,160 --> 01:41:42,320
YOUR WORK IS REALLY BEAUTIFUL.

2089
01:41:42,320 --> 01:41:48,000
ONE MORE QUESTION FOR YOU.

2090
01:41:48,000 --> 01:41:58,400
YOUR DATA SEEMS TO SHOW 

2091
01:42:03,280 --> 01:42:04,520
DIFFERENCES.

2092
01:42:04,520 --> 01:42:05,600
>> THERE'S SEGREGATION OF 

2093
01:42:05,600 --> 01:42:10,320
THERMAL CELL ACTIVITY AND IT 

2094
01:42:10,320 --> 01:42:16,440
BECOMES MUCH MORE MODAL.

2095
01:42:16,440 --> 01:42:25,320
MANY ARE SENSITIVE SO WE CAN 

2096
01:42:25,320 --> 01:42:31,840
LOOK AT THESE TOGETHER.

2097
01:42:31,840 --> 01:42:32,680
>> THANK YOU.

2098
01:42:32,680 --> 01:42:36,960
ANOTHER QUESTION JUST CAME IN 

2099
01:42:36,960 --> 01:42:40,000
FOR DR. BANNURU.

2100
01:42:40,000 --> 01:42:43,600
IT'S INTERESTING MORE MINUTES OF

2101
01:42:43,600 --> 01:42:47,200
TAI CHI WOULD IMPACT BETTER.

2102
01:42:47,200 --> 01:42:47,600
ANY THOUGHTS?

2103
01:42:47,600 --> 01:42:52,640
>> IT'S A GREAT QUESTION.

2104
01:42:52,640 --> 01:42:55,720
WHAT WE OBSERVED ACROSS ANY 

2105
01:42:55,720 --> 01:43:03,920
INTERVENTION IS THAT ESPECIALLY 

2106
01:43:03,920 --> 01:43:09,960
WE NOTICED IN OUR TRIAL WITH 

2107
01:43:09,960 --> 01:43:20,280
PATIENTS WE NOTICED 

2108
01:43:49,880 --> 01:43:56,120
ACROSS ALL INTERVENTIONS.

2109
01:43:56,120 --> 01:43:58,840
>> THANK YOU.

2110
01:43:58,840 --> 01:44:00,680
THAT'S VERY INTERESTING.

2111
01:44:00,680 --> 01:44:05,080
HAVE ANY PANELISTS INCLUDED 

2112
01:44:05,080 --> 01:44:07,160
TECHNIQUE BASED COGNITIVE 

2113
01:44:07,160 --> 01:44:08,880
EMBODIMENT PROGRAMS FOR PATIENTS

2114
01:44:08,880 --> 01:44:19,360
LIVING WITH PERSISTENT PAIN?

2115
01:44:29,840 --> 01:44:33,680
ANOTHER QUESTION FOR DR

2116
01:44:33,680 --> 01:44:35,520
DRDR

2117
01:44:35,520 --> 01:44:38,600
DRDR

2118
01:44:38,600 --> 01:44:39,160
DRDR

2119
01:44:39,160 --> 01:44:45,920
DR. YAMOLINSKY, HAVE YOU LOOKED 

2120
01:44:45,920 --> 01:44:47,240
AT PORTIONS?

2121
01:44:47,240 --> 01:44:49,960
>> EVERYTHING IN THE
RAMDEL 1.

2122
01:44:49,960 --> 01:44:50,000
 

2123
01:45:15,240 --> 01:45:18,080
>> WE'RE GOING TO MOVE ON.

2124
01:45:18,080 --> 01:45:20,160
DOES ANYONE HAVE ANY LAST THING 

2125
01:45:20,160 --> 01:45:23,560
THEY'D LIKE TO SAY?

2126
01:45:23,560 --> 01:45:24,760
YOU CAN SAY NO.

2127
01:45:24,760 --> 01:45:25,560
THANK YOU ALL AGAIN AND THANK 

2128
01:45:25,560 --> 01:45:27,640
YOU SO MUCH FOR PARTICIPATING IN

2129
01:45:27,640 --> 01:45:32,040
OUR SYMPOSIUM THIS YEAR.

2130
01:45:32,040 --> 01:45:32,520
>> THANK YOU FOR THE 

2131
01:45:32,520 --> 01:45:41,440
OPPORTUNITY.

2132
01:45:41,440 --> 01:45:51,800
>> THANK YOU SO MUCH.

2133
01:45:53,720 --> 01:45:56,640
AS YOU ALL SAW THAT WAS THE 

2134
01:45:56,640 --> 01:45:58,840
THIRD OF THREE POSTER SESSIONS.

2135
01:45:58,840 --> 01:46:01,560
AND IN ADDITION TO THE POSTER 

2136
01:46:01,560 --> 01:46:05,760
SESSION, WE PRESENT AN AWARD 

2137
01:46:05,760 --> 01:46:08,160
NAMED AFTER DR. MITCHELL MAX.

2138
01:46:08,160 --> 01:46:12,840
AND I AM NOW GOING TO INTRODUCE 

2139
01:46:12,840 --> 01:46:13,920
A BRIEF PRESENTATION PUT 

2140
01:46:13,920 --> 01:46:17,680
TOGETHER TO TELL YOU MORE ABOUT 

2141
01:46:17,680 --> 01:46:22,760
DR. MAX THE PERSON BEHIND THE 

2142
01:46:22,760 --> 01:46:23,000
AWARD.

2143
01:46:23,000 --> 01:46:26,880
ONCE THE VIDEO PRESENTATION IS 

2144
01:46:26,880 --> 01:46:28,440
OVER, DR. SHANNON ZENK FROM THE 

2145
01:46:28,440 --> 01:46:29,520
NATIONAL INSTITUTE OF NURSING 

2146
01:46:29,520 --> 01:46:30,560
RESEARCH WILL PRESENT THE ACTUAL

2147
01:46:30,560 --> 01:46:32,160
AWARD AND THE AWARDEE WILL GIVE 

2148
01:46:32,160 --> 01:46:33,960
A PRESENTATION.

2149
01:46:33,960 --> 01:46:44,120
THANK YOU.

2150
01:46:47,280 --> 01:46:51,320
>> THE NIH PAIN CONSORTIUM

2151
01:46:51,320 --> 01:46:53,280
HONORS DR. MITCHELL MAX FOR HIS 

2152
01:46:53,280 --> 01:46:55,120
LIFE TIME CONTRIBUTION TO PAIN 

2153
01:46:55,120 --> 01:46:55,400
RESEARCH.

2154
01:46:55,400 --> 01:47:00,160
IT'S AWARDED ANNUALLY TO THE 

2155
01:47:00,160 --> 01:47:02,880
BEST POSTER PRESENTATION FROM 

2156
01:47:02,880 --> 01:47:05,000
THE YOUNG INVESTIGATOR PAIN 

2157
01:47:05,000 --> 01:47:06,760
CONSORTIUM AND IT'S MY PRIVILEGE

2158
01:47:06,760 --> 01:47:11,440
TO REMIND YOU OF DR. MITCHELL 

2159
01:47:11,440 --> 01:47:11,600
MAX.

2160
01:47:11,600 --> 01:47:20,240
HE WAS RECRUITED TO NIH IN 1983 

2161
01:47:20,240 --> 01:47:24,360
BY THE DIRECTOR OF CRANIOFACIAL 

2162
01:47:24,360 --> 01:47:27,280
RESEARCH TO DEVELOP A CLINICAL 

2163
01:47:27,280 --> 01:47:29,920
RESEARCH PROGRAM IN ANALGESIC 

2164
01:47:29,920 --> 01:47:32,800
STUDIES AT NIDCR.

2165
01:47:32,800 --> 01:47:38,760
HE SERVED AS MEDICAL DIRECTOR OF

2166
01:47:38,760 --> 01:47:40,160
THE PAIN CLINIC.

2167
01:47:40,160 --> 01:47:44,160
IN 2005 HE WAS APPOINTED CHIEF 

2168
01:47:44,160 --> 01:47:47,440
OF THE NIDCR.

2169
01:47:47,440 --> 01:47:57,960
HE WAS ALSO A CAPTAIN IN THE 

2170
01:47:59,360 --> 01:47:59,680
COMMISSION CORPS.

2171
01:47:59,680 --> 01:48:05,160
HE WAS A MAN OF VISION AND 

2172
01:48:05,160 --> 01:48:08,160
ESTABLISHED STANDARDS FOR 

2173
01:48:08,160 --> 01:48:11,480
CLINICAL TRIALS METHODOLOGY AND 

2174
01:48:11,480 --> 01:48:13,600
PUBLISHED THE DESIGN OF A TRIAL 

2175
01:48:13,600 --> 01:48:20,160
ADVANCES IN PAIN RESEARCH AND 

2176
01:48:20,160 --> 01:48:20,600
THERAPY.

2177
01:48:20,600 --> 01:48:25,920
THE FIGURE BELOW SHOWS THE 

2178
01:48:25,920 --> 01:48:30,400
CITATION GROWING FROM 49 TO OVER

2179
01:48:30,400 --> 01:48:30,640
700.

2180
01:48:30,640 --> 01:48:35,640
AND THEY APPLIED IT TO THE 

2181
01:48:35,640 --> 01:48:39,880
DIFFICULT AREA OF PAIN AN 

2182
01:48:39,880 --> 01:48:43,320
CONDUCTED TRIALS AND STUDY THE 

2183
01:48:43,320 --> 01:48:49,960
EFFICACY FOR NEURO PATHIC PAIN 

2184
01:48:49,960 --> 01:48:57,920
DEMONSTRATING IT WAS EFFECTIVE 

2185
01:48:57,920 --> 01:48:58,920
IN METHODS.

2186
01:48:58,920 --> 01:49:03,160
HE WAS A LEADER OF PAIN 

2187
01:49:03,160 --> 01:49:04,080
RESEARCH.

2188
01:49:04,080 --> 01:49:06,960
HE HELPED STRATEGIZE THE WORLD 

2189
01:49:06,960 --> 01:49:08,160
HEALTH ORGANIZATION CANCER UNITS

2190
01:49:08,160 --> 01:49:14,280
PROGRAM IN CANCER PAIN RELIEF.

2191
01:49:14,280 --> 01:49:20,280
ALSO, HE LOOKED AT ACUTE PAIN 

2192
01:49:20,280 --> 01:49:25,920
AND CANCER PAIN.

2193
01:49:25,920 --> 01:49:30,640
HIS PUBLICATION FOR THE 

2194
01:49:30,640 --> 01:49:35,840
ATTENTION OF COMMUNITY AND 

2195
01:49:35,840 --> 01:49:46,400
CONTRIBUTIONS TO PAIN AND IN 19

2196
01:49:46,920 --> 01:49:53,720
 -- 1988 HE PUBLISHED A PAPER ON

2197
01:49:53,720 --> 01:50:00,800
THE EFFICACY OF THE RESPONSE AND

2198
01:50:00,800 --> 01:50:03,800
PAINFUL NEUROPATHY.

2199
01:50:03,800 --> 01:50:08,720
IN 2002 HE PUBLISHED AN ARTICLE 

2200
01:50:08,720 --> 01:50:10,360
IN THE JOURNAL OF PAIN HOW TO 

2201
01:50:10,360 --> 01:50:12,280
MOVE PAIN AND SYMPTOMS RESEARCH 

2202
01:50:12,280 --> 01:50:18,360
FROM TO THE MAINSTREAM.

2203
01:50:18,360 --> 01:50:23,120
HE WAS A PIONEER IN PAIN 

2204
01:50:23,120 --> 01:50:23,360
GENETICS.

2205
01:50:23,360 --> 01:50:33,560
IN 1998 HE STUDIED PATIENTS AND 

2206
01:50:33,560 --> 01:50:36,160
HE PUBLISHED 24 PAPERS ON THE 

2207
01:50:36,160 --> 01:50:39,720
TOPIC FROM THE STUDIES ON 

2208
01:50:39,720 --> 01:50:46,400
CANDIDATE GENE POLYMORPHISMS AND

2209
01:50:46,400 --> 01:50:51,200
ASIEBING APPLICATION STUDIES AND

2210
01:50:51,200 --> 01:50:53,920
LOOK AT THE PAIN AS A NEW 

2211
01:50:53,920 --> 01:50:57,960
DISCIPLINE FOR PAIN DISCOVERY 

2212
01:50:57,960 --> 01:51:00,000
AND LED TO MANY DISCOVERIES 

2213
01:51:00,000 --> 01:51:05,520
DURING THE PAST 15 YEARS.

2214
01:51:05,520 --> 01:51:07,960
HE WAS VERY SUPPORTIVE AND 

2215
01:51:07,960 --> 01:51:13,280
ALWAYS GENEROUS WITH HIS TIME TO

2216
01:51:13,280 --> 01:51:19,120
TRAIN AND MENTOR DOZENS OF YOUNG

2217
01:51:19,120 --> 01:51:25,080
INVESTIGATORS AND HE DEVELOPED A

2218
01:51:25,080 --> 01:51:28,760
STUDY DESIGN AND RESEARCH 

2219
01:51:28,760 --> 01:51:34,760
METHODS AND ALWAYS HELPED 

2220
01:51:34,760 --> 01:51:38,600
MAINTAIN WORK AND LIFE.

2221
01:51:38,600 --> 01:51:41,920
I HOPE YOU ALL AND ESPECIALLY 

2222
01:51:41,920 --> 01:51:43,960
YOUNG INVESTIGATORS IN PAIN 

2223
01:51:43,960 --> 01:51:45,920
RESEARCH ARE INSPIRED BY HIS 

2224
01:51:45,920 --> 01:51:50,960
GROUNDBREAKING ACHIEVEMENTS.

2225
01:51:50,960 --> 01:51:54,320
I BELIEVE THAT THE RESEARCH 

2226
01:51:54,320 --> 01:51:55,440
EXCELLENCE NAMED AFTER 

2227
01:51:55,440 --> 01:51:58,760
DR. MITCHELL MAX WILL HELP 

2228
01:51:58,760 --> 01:51:59,600
ADVANCE YOUR CAREER.

2229
01:51:59,600 --> 01:52:10,160
THANK YOU FOR THE INTRODUCTION.

2230
01:52:18,160 --> 01:52:20,200
>> HI, GOOD AFTERNOON
EVERYONE.

2231
01:52:20,200 --> 01:52:21,640
THE PAIN CONSORTIUM RECOGNIZE 

2232
01:52:21,640 --> 01:52:23,240
THE IMPORTANCE OF SUPPORTING 

2233
01:52:23,240 --> 01:52:26,120
EARLY STAGE INVESTIGATORS AND OF

2234
01:52:26,120 --> 01:52:28,080
HIGHLIGHTING THEIR WORK.

2235
01:52:28,080 --> 01:52:29,800
DR. MITCHELL MAX WAS NOT ONLY 

2236
01:52:29,800 --> 01:52:31,200
COMMITTED TO PAIN RESEARCH BUT 

2237
01:52:31,200 --> 01:52:34,160
ALSO TO THE TRAINING OF YOUNG 

2238
01:52:34,160 --> 01:52:34,760
INVESTIGATORS.

2239
01:52:34,760 --> 01:52:38,160
FOR THIS YEAR'S AWARD A PANEL OF

2240
01:52:38,160 --> 01:52:41,160
PAIN CONSORTIUM MEMBERS FROM 

2241
01:52:41,160 --> 01:52:43,720
ACROSS NIH JUDGED THREE JUNIOR 

2242
01:52:43,720 --> 01:52:44,880
INVESTIGATOR PRESENTATION.

2243
01:52:44,880 --> 01:52:46,240
THE JUDGES HAD AN EXTREMELY 

2244
01:52:46,240 --> 01:52:49,920
DIFFICULT TASK OF SELECTING AN 

2245
01:52:49,920 --> 01:52:51,320
AWARDEE BASED ON THE QUALITY OF 

2246
01:52:51,320 --> 01:52:53,800
THE PRESENTATION, THE INNOVATIVE

2247
01:52:53,800 --> 01:52:55,040
NATURE OF THE WORK AND THE DEPTH

2248
01:52:55,040 --> 01:52:57,320
OF KNOWLEDGE OF THE PRESENTER.

2249
01:52:57,320 --> 01:53:00,800
ALL THREE OF THIS YEAR'S 

2250
01:53:00,800 --> 01:53:01,960
PRESENTERS ARE DESERVING OF 

2251
01:53:01,960 --> 01:53:03,480
RECOGNITION AND I KNOW YOU'LL 

2252
01:53:03,480 --> 01:53:08,000
JOIN ME IN CONGRATULATING ALL OF

2253
01:53:08,000 --> 01:53:08,880
THEM.

2254
01:53:08,880 --> 01:53:14,160
YOU SAW THE TWO FINALISTS AT THE

2255
01:53:14,160 --> 01:53:15,480
END OF THE SESSION AND I'LL 

2256
01:53:15,480 --> 01:53:17,960
BRIEFLY INTRODUCE THEM AND 

2257
01:53:17,960 --> 01:53:20,000
INVITE TO YOU VIEW THEIR FULL 

2258
01:53:20,000 --> 01:53:29,840
BIO GR

2259
01:53:29,840 --> 01:53:30,120
B

2260
01:53:30,120 --> 01:53:30,440
BIOGRAPHIES.

2261
01:53:30,440 --> 01:53:37,920
AND DR. BANNURU HE'S WORK 

2262
01:53:37,920 --> 01:53:45,960
FOCUSSED ON NON-PHARMACOLOGICAL 

2263
01:53:45,960 --> 01:53:46,880
MANAGEMENT OF PAIN.

2264
01:53:46,880 --> 01:53:52,600
AND DR. YAMOLINSKY IS IN NEURO 

2265
01:53:52,600 --> 01:53:55,400
BIOLOGY AT BOSTON CHILDREN'S 

2266
01:53:55,400 --> 01:53:55,760
HOSPITAL.

2267
01:53:55,760 --> 01:53:56,440
HIS RESEARCH INTERESTS INCLUDE 

2268
01:53:56,440 --> 01:53:58,680
THE FUNCTION, PLASTICITY AND 

2269
01:53:58,680 --> 01:54:02,480
DYSFUNCTION OF MAMMALIAN SENSORY

2270
01:54:02,480 --> 01:54:02,880
SYSTEMS.

2271
01:54:02,880 --> 01:54:05,080
IT'S MY PLEASURE TO INTRODUCE 

2272
01:54:05,080 --> 01:54:07,960
THIS YEAR'S MITCHELL MAX 

2273
01:54:07,960 --> 01:54:10,880
AWARDEE, DR. EDWINA ROKI.

2274
01:54:10,880 --> 01:54:13,920
HE'S AN ASSOCIATE PROFESSOR AND 

2275
01:54:13,920 --> 01:54:16,120
DIRECTOR OF THE Ph.D. PROGRAM AT

2276
01:54:16,120 --> 01:54:18,600
THE UNIVERSITY OF ALABAMA AT 

2277
01:54:18,600 --> 01:54:21,960
BIRMINGHAM SCHOOL OF NURSING.

2278
01:54:21,960 --> 01:54:26,200
DR. AROKE GRADUATE FROM THE DUKE

2279
01:54:26,200 --> 01:54:28,880
UNIVERSITY NURSE ANESTHESIA 

2280
01:54:28,880 --> 01:54:30,600
PROGRAM AND EARNED HIS Ph.D. 

2281
01:54:30,600 --> 01:54:33,920
FROM THE MASSACHUSETTS MEDICAL 

2282
01:54:33,920 --> 01:54:35,320
SCHOOL.

2283
01:54:35,320 --> 01:54:36,320
HIS PROGRAM OF RESEARCH EXAMINES

2284
01:54:36,320 --> 01:54:40,120
THE MECHANISMS THAT CAUSE AND 

2285
01:54:40,120 --> 01:54:41,920
SUSTAIN CHRONIC PAIN AND RACIAL 

2286
01:54:41,920 --> 01:54:43,640
PAIN DISPARITY.

2287
01:54:43,640 --> 01:54:46,480
DR. AROKE HAS RECEIVED NUMEROUS 

2288
01:54:46,480 --> 01:54:47,920
PRESTIGIOUS AWARDS INCLUDING 

2289
01:54:47,920 --> 01:54:49,920
RESEARCHER OF THE YEAR FROM THE 

2290
01:54:49,920 --> 01:54:53,960
AMERICAN ASSOCIATION OF NURSE 

2291
01:54:53,960 --> 01:54:55,960
ANESTHESIOLOGY FOUNDATION AND 

2292
01:54:55,960 --> 01:54:57,120
DIDACTIC FACULTY OF THE YEAR 

2293
01:54:57,120 --> 01:54:59,720
FROM THE AANA.

2294
01:54:59,720 --> 01:55:01,160
HE'S ALSO A FELLOW IN THE 

2295
01:55:01,160 --> 01:55:02,720
AMERICAN ACADEMY OF NURSING.

2296
01:55:02,720 --> 01:55:08,160
TODAY HE'LL PRESENT HIS WORK 

2297
01:55:08,160 --> 01:55:13,920
GENOMIC PATHWAYS ENRICHED BY 

2298
01:55:13,920 --> 01:55:18,320
DIFFERENTIALLY METHYLATED GENES 

2299
01:55:18,320 --> 01:55:20,160
ARE LINKED TO RACIAL DISPARITIES

2300
01:55:20,160 --> 01:55:23,960
IN CHRONIC LOW BACK PAIN.

2301
01:55:23,960 --> 01:55:25,960
THERE'LL BE TIME FOR QUESTIONS 

2302
01:55:25,960 --> 01:55:28,840
AT THE END AND THANK YOU TO 

2303
01:55:28,840 --> 01:55:30,360
DR. AROKE AND THE FINALISTS FOR 

2304
01:55:30,360 --> 01:55:32,560
ALL THEIR GREAT WORK.

2305
01:55:32,560 --> 01:55:33,960
>> THANK YOU SO MUCH, DR.
ZENK 

2306
01:55:33,960 --> 01:55:35,000
FOR THAT INTRODUCTION.

2307
01:55:35,000 --> 01:55:40,960
AGAIN, CONGRATULATIONS TO ALL 

2308
01:55:40,960 --> 01:55:43,440
THE FINALISTS.

2309
01:55:43,440 --> 01:55:45,480
I'M HONORED TO RECEIVE THIS 

2310
01:55:45,480 --> 01:55:49,280
AWARD AND HUMBLING TO RECEIVE AN

2311
01:55:49,280 --> 01:55:54,360
WARD NAMED AFTER DR. MITCHELL 

2312
01:55:54,360 --> 01:55:56,680
MAX AND FOCUSSING ON THE WHOLE 

2313
01:55:56,680 --> 01:56:07,200
PERSON THEME, NO ONE CAN ARGUE 

2314
01:56:11,160 --> 01:56:12,120
IS ONE OF THE REASONS FOR 

2315
01:56:12,120 --> 01:56:15,840
DISABILITIES WHEN YOU LOOK AT 

2316
01:56:15,840 --> 01:56:18,560
THE REASONS WHERE PEOPLE LOOK AT

2317
01:56:18,560 --> 01:56:20,440
THIS, LOW BACK PAIN IS THE 

2318
01:56:20,440 --> 01:56:24,920
SECOND LEADING CAUSE SECOND ONLY

2319
01:56:24,920 --> 01:56:28,120
TO RESPIRATORY DISEASES.

2320
01:56:28,120 --> 01:56:31,640
AS MOST OF US SIT HERE CHANCES 

2321
01:56:31,640 --> 01:56:33,680
ARE YOU MAY BE A LITTLE SORE IN 

2322
01:56:33,680 --> 01:56:34,960
YOUR BACK AND A LITTLE STIFFNESS

2323
01:56:34,960 --> 01:56:36,560
BUT THE GOOD NEWS IS IT'S GOING 

2324
01:56:36,560 --> 01:56:38,840
GO AWAY.

2325
01:56:38,840 --> 01:56:40,800
UNFORTUNATELY FOR SOME IT WILL 

2326
01:56:40,800 --> 01:56:43,800
PROGRESS TO CHRONIC AND LOW BACK

2327
01:56:43,800 --> 01:56:45,600
PAIN MEANING LASTING MORE THAN 

2328
01:56:45,600 --> 01:56:46,200
12 WEEKS.

2329
01:56:46,200 --> 01:56:50,880
FOR 80% OF PEOPLE WITH CHRONIC 

2330
01:56:50,880 --> 01:56:52,040
LOW BACK PAIN WE DON'T KNOW THEY

2331
01:56:52,040 --> 01:56:54,120
HAVE IT IN THE FIRST PLACE.

2332
01:56:54,120 --> 01:56:57,040
THEY HAVE NON-SPECIFIC CHRONIC 

2333
01:56:57,040 --> 01:56:59,720
LOW BACK PAIN.

2334
01:56:59,720 --> 01:57:07,520
IT'S NOT LINKED TO TRAUMA OR A 

2335
01:57:07,520 --> 01:57:07,760
DISEASE.

2336
01:57:07,760 --> 01:57:08,320
DIAGNOSING THIS IS A MAJOR 

2337
01:57:08,320 --> 01:57:16,120
CHALLENGE.

2338
01:57:16,120 --> 01:57:21,760
CHRONIC LOW BACK PAIN 

2339
01:57:21,760 --> 01:57:23,240
DISPROPORTIONATELY AFFECTS 

2340
01:57:23,240 --> 01:57:25,920
AFRICAN AMERICANS AND PEOPLE OF 

2341
01:57:25,920 --> 01:57:31,240
LOW SOCIO ECONOMIC STATUS.

2342
01:57:31,240 --> 01:57:33,920
SPECIFICALLY IDENTIFIED AS 

2343
01:57:33,920 --> 01:57:35,400
NON-HISPANIC WHITE OR 

2344
01:57:35,400 --> 01:57:37,840
NON-HISPANIC AFRICAN AMERICAN.

2345
01:57:37,840 --> 01:57:40,560
YOU CAN SEE HERE AGAIN AFRICAN 

2346
01:57:40,560 --> 01:57:42,360
AMERICANS HAVE HIGHER PAIN 

2347
01:57:42,360 --> 01:57:46,400
SEVERITY AND INTERFERENCE 

2348
01:57:46,400 --> 01:57:48,600
MEANING THE PAIN AFFECTS THEIR 

2349
01:57:48,600 --> 01:57:50,560
ACTIVITIES OF DAILY LIVING.

2350
01:57:50,560 --> 01:57:52,120
THAT BRINGS TO MIND THE KEY 

2351
01:57:52,120 --> 01:57:56,160
QUESTION OF THE DAY FOR ME WHICH

2352
01:57:56,160 --> 01:57:58,240
IS RACE IS SOMETHING THAT WE USE

2353
01:57:58,240 --> 01:57:59,880
SO MUCH IN OUR RESEARCH.

2354
01:57:59,880 --> 01:58:01,480
YOU KEEP HEARING THE QUESTION 

2355
01:58:01,480 --> 01:58:03,080
WHERE THERE'S RACIAL DIFFERENCES

2356
01:58:03,080 --> 01:58:05,680
BUT WITH NO DOUBT RACE IS NOT A 

2357
01:58:05,680 --> 01:58:07,080
BIOLOGICAL VARIABLE.

2358
01:58:07,080 --> 01:58:08,520
THERE'S NO GENE THAT CODES FOR 

2359
01:58:08,520 --> 01:58:09,560
SOMEBODY'S RACE.

2360
01:58:09,560 --> 01:58:13,960
RACE IS A SOCIAL CONSTRUCT AND 

2361
01:58:13,960 --> 01:58:16,040
IT'S A CLASSIFICATION OF PEOPLE.

2362
01:58:16,040 --> 01:58:17,880
SUCH THAT YOU CAN HAVE TWO 

2363
01:58:17,880 --> 01:58:20,200
INDIVIDUALS OF THE SAME 

2364
01:58:20,200 --> 01:58:20,600
BIOLOGICAL PARENT.

2365
01:58:20,600 --> 01:58:24,400
ONE CHOOSE TO IDENTIFY AS WHITE,

2366
01:58:24,400 --> 01:58:25,960
WHILE ANOTHER CHOOSE TO IDENTIFY

2367
01:58:25,960 --> 01:58:26,880
AS BLACK DEPENDING ON THE SKIN 

2368
01:58:26,880 --> 01:58:34,080
COLOR.

2369
01:58:34,080 --> 01:58:36,600
 MORE SHAPE OF NOSE.

2370
01:58:36,600 --> 01:58:41,280
SO HOW DOES A SOCIAL CONSTRUCT 

2371
01:58:41,280 --> 01:58:43,360
DEVELOP WHETHER YOU'RE AT HIGHER

2372
01:58:43,360 --> 01:58:45,320
RISK OF DEVELOPING A PAIN OVER 

2373
01:58:45,320 --> 01:58:45,800
ANOTHER PERSON?

2374
01:58:45,800 --> 01:58:48,480
THE OBJECTIVE OF MY WORK REALLY 

2375
01:58:48,480 --> 01:58:51,960
IS LOOK AT THE ROLE OF 

2376
01:58:51,960 --> 01:58:52,240
EPIGENETICS.

2377
01:58:52,240 --> 01:58:57,840
COULD THEY BE PLAYING A ROLE?

2378
01:58:57,840 --> 01:59:04,280
YOU MAY BE ASKING, WHY 

2379
01:59:04,280 --> 01:59:04,560
EPIGENETICS?

2380
01:59:04,560 --> 01:59:09,920
JUST TO UNDERSTAND IT'S A STUDY 

2381
01:59:09,920 --> 01:59:14,720
OF HERITABLE CHANGES CHANGING 

2382
01:59:14,720 --> 01:59:16,120
EXPRESSION WITHOUT THE SEQUENCE.

2383
01:59:16,120 --> 01:59:17,960
EPIGENETICS IS A STUDY OF HOW 

2384
01:59:17,960 --> 01:59:21,480
ENVIRONMENTAL FACTORS OR 

2385
01:59:21,480 --> 01:59:22,560
ENVIRONMENTAL EXPOSURES REGULATE

2386
01:59:22,560 --> 01:59:24,960
GENE EXPRESSION WITHOUT CHANGING

2387
01:59:24,960 --> 01:59:27,560
THE DNA SEQUENCE.

2388
01:59:27,560 --> 01:59:33,920
THIS IS A PROCESS AND HOW WE GO 

2389
01:59:33,920 --> 01:59:36,400
FROM STEM CELLS TO COMORBIDITY 

2390
01:59:36,400 --> 01:59:39,160
CELLS IN THE BODY BUT CAN ALSO 

2391
01:59:39,160 --> 01:59:40,080
CHANGE PHENOTYPE AND WE LOOK AT 

2392
01:59:40,080 --> 01:59:43,440
THE LIFE CYCLE OF A BUTTERFLY.

2393
01:59:43,440 --> 01:59:45,160
AS IT GOES TO THE FORMING 

2394
01:59:45,160 --> 01:59:47,960
EXCHANGES FROM THE EGG, LARVA, 

2395
01:59:47,960 --> 01:59:50,520
PUPA SO THE FULL BUTTERFLY, THE 

2396
01:59:50,520 --> 01:59:53,880
GENOME HASN'T CHANGED BUT THE 

2397
01:59:53,880 --> 01:59:56,240
EXPRESSION OF THOSE GENES 

2398
01:59:56,240 --> 02:00:00,640
CHANGES TO AN EPIGENTIC 

2399
02:00:00,640 --> 02:00:01,200
MECHANISM.

2400
02:00:01,200 --> 02:00:03,080
IT IS POSSIBLE CHANGES IN THE 

2401
02:00:03,080 --> 02:00:04,520
EPIGENOME IS WHAT DRIVES THE 

2402
02:00:04,520 --> 02:00:06,040
PHENOTYPE THAT LEADS TO RACIAL 

2403
02:00:06,040 --> 02:00:16,240
DISPARITIES?

2404
02:00:22,520 --> 02:00:24,720
SO IF YOU WERE TO SEQUENCE IT IT

2405
02:00:24,720 --> 02:00:26,480
WOULD LOOK SIMILAR.

2406
02:00:26,480 --> 02:00:29,520
AS WE GO THROUGH LIFE WE'LL HAVE

2407
02:00:29,520 --> 02:00:30,480
DIFFERENT ENVIRONMENTAL 

2408
02:00:30,480 --> 02:00:31,600
EXPOSURES, SPECIFICALLY 

2409
02:00:31,600 --> 02:00:32,720
DIFFERENT STRESSORS.

2410
02:00:32,720 --> 02:00:33,960
HAVE YOU THE STRESS OF 

2411
02:00:33,960 --> 02:00:41,440
EDUCATION, WORK AND FAMILIES.

2412
02:00:41,440 --> 02:00:43,840
FOR THE BLACK INDIVIDUAL THERE'S

2413
02:00:43,840 --> 02:00:45,080
THE ADDITIONAL STRESS OF RACIAL 

2414
02:00:45,080 --> 02:00:49,000
DISCRIMINATION AND INJUSTICE.

2415
02:00:49,000 --> 02:00:53,120
IF YOU WERE TO RE-EXAMINE THE 

2416
02:00:53,120 --> 02:00:56,120
EPIGENOME IT WOULD BE DIFFERENT 

2417
02:00:56,120 --> 02:00:57,960
BETWEEN THE BLACK AND WHITE 

2418
02:00:57,960 --> 02:00:58,880
INDIVIDUAL AND PERHAPS FOLLOWING

2419
02:00:58,880 --> 02:01:02,880
A TRAUMATIC EVENT.

2420
02:01:02,880 --> 02:01:05,960
SO TO TEST THIS HYPOTHESIS WE 

2421
02:01:05,960 --> 02:01:09,480
RECRUITED 50 ADULTS WITH CHRONIC

2422
02:01:09,480 --> 02:01:12,560
LOW BACK PAIN AND A FEW WITHOUT.

2423
02:01:12,560 --> 02:01:13,040
50.

2424
02:01:13,040 --> 02:01:15,040
BLACK AND 50 WHITE.

2425
02:01:15,040 --> 02:01:18,240
WE DROPPED ONE FROM THE ANALYSIS

2426
02:01:18,240 --> 02:01:20,880
BECAUSE THEY SELECTED 

2427
02:01:20,880 --> 02:01:21,200
MULTIRACIAL.

2428
02:01:21,200 --> 02:01:22,440
WE USED REPRESENTATION BY 

2429
02:01:22,440 --> 02:01:26,640
SEQUENCING TO LOOK AT THE 

2430
02:01:26,640 --> 02:01:26,960
MANIPULATION.

2431
02:01:26,960 --> 02:01:28,280
IT'S IMPORTANT TO KNOW IT'S ONE 

2432
02:01:28,280 --> 02:01:30,120
TYPE OF EPIGENETIC CHANGE.

2433
02:01:30,120 --> 02:01:34,400
THE OTHER TYPE OF EPIGENETIC 

2434
02:01:34,400 --> 02:01:36,760
CHANGES SUCH AS HISTONE 

2435
02:01:36,760 --> 02:01:37,400
MODIFICATIONS AND CIRCULATION 

2436
02:01:37,400 --> 02:01:46,600
AND MICRO RNA WE LOOKED AT THE 

2437
02:01:46,600 --> 02:01:51,760
MOST STABLE EPIGENETIC CHANGE 

2438
02:01:51,760 --> 02:01:53,760
SHOWED TO TRANSFER FROM ONE 

2439
02:01:53,760 --> 02:01:55,800
GENERATION TO THE OTHER AND LOOK

2440
02:01:55,800 --> 02:01:56,760
AT EXPRESSED GENES.

2441
02:01:56,760 --> 02:01:58,400
THE TOP IS THE FIRST COMPARISON.

2442
02:01:58,400 --> 02:02:00,360
WE LOOKED AT THE INDIVIDUALS WHO

2443
02:02:00,360 --> 02:02:05,520
HAVE CHRONIC LOW BACK PAIN AND 

2444
02:02:05,520 --> 02:02:13,920
IDENTIFIED OVER 2800 WITH THIS 

2445
02:02:13,920 --> 02:02:19,280
LOCI AND  WE DECIDED TO COMPARE 

2446
02:02:19,280 --> 02:02:20,040
BLACKS WITH CHRONIC LOW BACK 

2447
02:02:20,040 --> 02:02:21,440
PAIN AND WITHOUT CHRONIC LOW 

2448
02:02:21,440 --> 02:02:21,920
BACK PAIN.

2449
02:02:21,920 --> 02:02:25,920
AND WE HAD DIFFERENT ELEMENTS 

2450
02:02:25,920 --> 02:02:32,240
AND LOCI AND WE HAD DIFFERENCES.

2451
02:02:32,240 --> 02:02:38,680
SO THESE ARE THE TOP 20 PATHWAYS

2452
02:02:38,680 --> 02:02:42,840
BY THE GENES AND INTRODUCED THE 

2453
02:02:42,840 --> 02:02:43,040
LOCI.

2454
02:02:43,040 --> 02:02:45,120
AS WE SEE WHEN WE COMPARE BLACKS

2455
02:02:45,120 --> 02:02:51,640
WITH WHITES WITH NON-SPECIFIC 

2456
02:02:51,640 --> 02:02:52,480
CHRONIC LOW BACK PAIN THERE'S A 

2457
02:02:52,480 --> 02:02:54,120
CALCIUM SIGNALLING PATHWAY.

2458
02:02:54,120 --> 02:02:57,760
WE KNOW THE DETECTION AND 

2459
02:02:57,760 --> 02:03:02,080
PROCESSING OF PAINFUL STIMULI IS

2460
02:03:02,080 --> 02:03:05,080
DEPENDENT ON STANDARDS INCLUDING

2461
02:03:05,080 --> 02:03:08,920
THE CALCIUM AND SODIUM CHANNELS 

2462
02:03:08,920 --> 02:03:11,560
AND EVEN OTHER CHANNELS AND 

2463
02:03:11,560 --> 02:03:13,360
LONG-TERM CHANGES IN THE CHANNEL

2464
02:03:13,360 --> 02:03:16,360
EXPRESSION AND FUNCTION 

2465
02:03:16,360 --> 02:03:17,960
CONTRIBUTES TO CHRONIC PAIN 

2466
02:03:17,960 --> 02:03:19,240
ESPECIALLY NEUROPATHIC PAIN.

2467
02:03:19,240 --> 02:03:21,000
THAT MAY BE WHAT COULD BE 

2468
02:03:21,000 --> 02:03:21,880
CONTRIBUTING FOR RACIAL 

2469
02:03:21,880 --> 02:03:23,280
DISPARITIES IN PAIN.

2470
02:03:23,280 --> 02:03:26,720
AS WE SEE THE SECOND PATHWAY 

2471
02:03:26,720 --> 02:03:31,160
THERE'S A DOPAMINE DARPP32.

2472
02:03:31,160 --> 02:03:33,920
THAT PLAYS A CRITICAL ROLE IN 

2473
02:03:33,920 --> 02:03:44,480
THE INTEGRATION OF NEURO SIGNALS

2474
02:03:45,280 --> 02:03:47,720
AND THERE'S RESPONSIVE TO 

2475
02:03:47,720 --> 02:03:49,440
DOPAMINE AND GLUTAMINE.

2476
02:03:49,440 --> 02:03:51,800
WE KNOW THEY BOTH PLAY ESSENTIAL

2477
02:03:51,800 --> 02:03:54,680
ROLES IN PAIN TRANSMISSION AND 

2478
02:03:54,680 --> 02:03:55,000
MODULATION.

2479
02:03:55,000 --> 02:04:00,720
WE ALSO SEE THE RECEPTORS, 

2480
02:04:00,720 --> 02:04:02,240
OPIATE SIGNALLING PATHWAYS.

2481
02:04:02,240 --> 02:04:05,640
MOST HAVE BEEN SHOWN TO PLAY A 

2482
02:04:05,640 --> 02:04:06,240
ROLE IN PAIN MODULATION AND 

2483
02:04:06,240 --> 02:04:09,280
PERCEPTION.

2484
02:04:09,280 --> 02:04:12,480
THEN WE DID A COMPARISON LOOKING

2485
02:04:12,480 --> 02:04:14,560
AT DIFFERENT PATHWAYS TO LOOK AT

2486
02:04:14,560 --> 02:04:17,160
WHICH PATHWAYS ARE ENRICHED IN 

2487
02:04:17,160 --> 02:04:18,000
BLACK AND WHITE.

2488
02:04:18,000 --> 02:04:20,600
THIS WAS VERY CRITICAL BECAUSE 

2489
02:04:20,600 --> 02:04:25,720
ONE OF THE KEY CRITICS OF THE 

2490
02:04:25,720 --> 02:04:27,400
EXISTING DISPARITIES RESEARCH IS

2491
02:04:27,400 --> 02:04:29,920
WE ALWAYS PROVIDE AS A 

2492
02:04:29,920 --> 02:04:31,240
COMPARISON GROUP AND ASSUMING 

2493
02:04:31,240 --> 02:04:33,120
ALL BLACKS ARE THE SAME AND ALL 

2494
02:04:33,120 --> 02:04:34,320
WHITES ARE THE SAME.

2495
02:04:34,320 --> 02:04:35,840
IT WAS IMPORTANT TO TEASE OUT 

2496
02:04:35,840 --> 02:04:38,040
THE WORK AND WHY IS IT NOT ALL 

2497
02:04:38,040 --> 02:04:39,880
BLACKS DO DEVELOP PAIN?

2498
02:04:39,880 --> 02:04:42,440
WHY DO NOT ALL WHITES DEVELOP 

2499
02:04:42,440 --> 02:04:42,640
PAIN.

2500
02:04:42,640 --> 02:04:43,680
WE COMPARED BLACKS WITH PAIN AND

2501
02:04:43,680 --> 02:04:45,920
WITHOUT PAIN AND WHITES WITH 

2502
02:04:45,920 --> 02:04:48,760
PAIN AND WITHOUT PAIN.

2503
02:04:48,760 --> 02:04:50,720
AND IT BECOMES MORE CLEARER.

2504
02:04:50,720 --> 02:04:54,160
THE KEY PATHWAYS IN WHICH BLACKS

2505
02:04:54,160 --> 02:04:57,920
PLAY A CRITICAL ROLE IN STRESS 

2506
02:04:57,920 --> 02:05:01,880
AND STRESS DEREGULATION.

2507
02:05:01,880 --> 02:05:03,880
THE PATHWAYS IN WHITES INCLUDING

2508
02:05:03,880 --> 02:05:05,840
THE NON-SIGNALLING PATHWAY AND 

2509
02:05:05,840 --> 02:05:08,160
THESE PATHWAYS PLAY A CRITICAL 

2510
02:05:08,160 --> 02:05:09,040
ROLE IN NEUROINFLAMMATORY 

2511
02:05:09,040 --> 02:05:09,280
PROCESSES.

2512
02:05:09,280 --> 02:05:11,720
SO WE DECIDED NOW TO, OKAY, 

2513
02:05:11,720 --> 02:05:13,920
LET'S LOOK AT THE SIDE BY SIDE 

2514
02:05:13,920 --> 02:05:22,680
COMPARISON.

2515
02:05:22,680 --> 02:05:24,440
THIS SHOWS HOW SIGNIFICANT ARE 

2516
02:05:24,440 --> 02:05:25,320
THE DIFFERENT PATHWAYS.

2517
02:05:25,320 --> 02:05:29,960
THE LEVEL OF SIGNIFICANCE 

2518
02:05:29,960 --> 02:05:32,200
DOESN'T NECESSARILY TRANSLATE TO

2519
02:05:32,200 --> 02:05:36,200
EFFECT SIZE.

2520
02:05:36,200 --> 02:05:39,720
HOWEVER, WHEN YOU HAVE 

2521
02:05:39,720 --> 02:05:41,440
EQUIVALENT SIZES FROM THE TOP 

2522
02:05:41,440 --> 02:05:45,920
PATHWAYS WHICH PLAY A CRITICAL 

2523
02:05:45,920 --> 02:05:50,440
ROLE IN STRESS AND RELEASING 

2524
02:05:50,440 --> 02:05:53,840
HORMONE SIGNALLING AND DOPAMINE 

2525
02:05:53,840 --> 02:05:54,920
SIGNALLING, THEY'RE MORE 

2526
02:05:54,920 --> 02:05:57,000
SIGNIFICANT IN BLACK INDIVIDUALS

2527
02:05:57,000 --> 02:06:00,240
THAN IN WHITE INDIVIDUALS.

2528
02:06:00,240 --> 02:06:02,840
AND WE NOTICE THE 

2529
02:06:02,840 --> 02:06:07,280
NEUROINFLAMMATORY PROCESSES, 

2530
02:06:07,280 --> 02:06:09,440
SIGNALLING AND ALL THESE 

2531
02:06:09,440 --> 02:06:11,080
PATHWAYS APPEAR TO BE MOST 

2532
02:06:11,080 --> 02:06:12,240
SIGNIFICANT IN WHITE INDIVIDUALS

2533
02:06:12,240 --> 02:06:20,160
THAN IN BLACK INDIVIDUALS.

2534
02:06:20,160 --> 02:06:26,360
SO WHAT DOES ALL THIS MEAN?

2535
02:06:26,360 --> 02:06:28,240
THE LIVED EXPERIENCE OF BLACK 

2536
02:06:28,240 --> 02:06:29,920
INDIVIDUALS IS SIGNIFICANTLY 

2537
02:06:29,920 --> 02:06:31,520
MORE STRESSED THAN WHITES AND 

2538
02:06:31,520 --> 02:06:34,760
EPIGENETICS HAS GIVEN US A 

2539
02:06:34,760 --> 02:06:36,720
WINDOW INTO SOME OF THE 

2540
02:06:36,720 --> 02:06:37,760
EXPERIENCES MAY LEAD TO WORSE 

2541
02:06:37,760 --> 02:06:43,200
PAIN FOR BLACKS THAN WHITES.

2542
02:06:43,200 --> 02:06:48,000
OF COURSE, THESE ARE NAUGHT 

2543
02:06:48,000 --> 02:06:48,320
CAUSATIONAL.

2544
02:06:48,320 --> 02:06:50,240
FUTURE STUDIES INCLUDING WHAT IS

2545
02:06:50,240 --> 02:06:55,880
GOING ON IN MY LAB WILL LOOK AT 

2546
02:06:55,880 --> 02:06:57,000
GENE EXPRESSION AND PROTEINS AND

2547
02:06:57,000 --> 02:07:00,520
I ALWAYS LOVE TO SAY I FOCUS ON 

2548
02:07:00,520 --> 02:07:02,240
EPIGENETICS BECAUSE THE CHANGES 

2549
02:07:02,240 --> 02:07:03,520
ARE REVERSIBLE.

2550
02:07:03,520 --> 02:07:04,760
MAYBE IN THE FUTURE WE CAN 

2551
02:07:04,760 --> 02:07:07,800
REVERSE SOME OF THE EPIGENETIC 

2552
02:07:07,800 --> 02:07:09,960
CHANGES AND TRICK PAIN.

2553
02:07:09,960 --> 02:07:16,320
AND I JUST WANT TO EXPRESS 

2554
02:07:16,320 --> 02:07:18,120
SINCERE GRATITUDE FOR ALL WHO 

2555
02:07:18,120 --> 02:07:19,360
SUPPORTED MY WORK AND LAB 

2556
02:07:19,360 --> 02:07:20,000
PARTICIPANTS AND COLLABORATORS.

2557
02:07:20,000 --> 02:07:26,120
THANK YOU.

2558
02:07:26,120 --> 02:07:28,120
>> THANK YOU SO MUCH.

2559
02:07:28,120 --> 02:07:32,200
THAT WAS REALLY GREAT.

2560
02:07:32,200 --> 02:07:33,760
I'M SURE THAT MITCHELL MAX WOULD

2561
02:07:33,760 --> 02:07:37,320
BE THRILLED TO HEAR THIS VERY 

2562
02:07:37,320 --> 02:07:40,360
INTERESTING GENETIC AND GENOMIC 

2563
02:07:40,360 --> 02:07:40,720
DATA.

2564
02:07:40,720 --> 02:07:44,200
NOW WE HAVE A FEW MINUTES FOR 

2565
02:07:44,200 --> 02:07:46,920
QUESTION TO OUR WINNERS.

2566
02:07:46,920 --> 02:07:48,280
AND TO FACILITATE THE DISCUSSION

2567
02:07:48,280 --> 02:07:53,840
I WOULD LIKE TO START WITH THE 

2568
02:07:53,840 --> 02:07:56,240
QUESTION WHAT ARE THE CRITICAL 

2569
02:07:56,240 --> 02:07:58,320
GAPS IN OUR KNOWLEDGE FOR 

2570
02:07:58,320 --> 02:08:01,920
IMPLEMENTING THESE GENOMIC 

2571
02:08:01,920 --> 02:08:12,480
APPROACHES TO PAIN DISPARITIES?

2572
02:08:13,560 --> 02:08:19,200
>> WE ALWAYS THINK OF
SOCIAL 

2573
02:08:19,200 --> 02:08:21,640
DETERMINATES OF HEALTH BUT 

2574
02:08:21,640 --> 02:08:23,560
THEY'RE UNDERGIRDED THIS TO 

2575
02:08:23,560 --> 02:08:24,760
WHERE WE ARE TODAY AND THOUGH 

2576
02:08:24,760 --> 02:08:29,840
YOU MAY BE COMPARING TWO GROUPS,

2577
02:08:29,840 --> 02:08:35,240
THERE'S MORE GOING ON BEYOND THE

2578
02:08:35,240 --> 02:08:44,760
SKIN COLK KCOLOR AND HOW DO WE 

2579
02:08:44,760 --> 02:08:51,800
INTEGRATE THE MEC MOLECULAR 

2580
02:08:51,800 --> 02:08:53,920
PARTS AND LOOK AT LIVED 

2581
02:08:53,920 --> 02:08:56,880
EXPERIENCE AND HOW MUCH 

2582
02:08:56,880 --> 02:08:57,600
DISCRIMINATION SOMEONE FACES OR 

2583
02:08:57,600 --> 02:09:00,720
HOW MUCH INJUSTICE OR 

2584
02:09:00,720 --> 02:09:02,080
INTERNALIZED STIGMA DOES SOMEONE

2585
02:09:02,080 --> 02:09:03,560
FACE?

2586
02:09:03,560 --> 02:09:06,000
DO WE HAVE GOOD MEASURES?

2587
02:09:06,000 --> 02:09:13,160
GENOMIC AND EPIGO GOGONE  -- 

2588
02:09:13,160 --> 02:09:14,360
EPIGENOMIC RESEARCH IS FOCUSSED 

2589
02:09:14,360 --> 02:09:16,120
ON PHENOTYPE.

2590
02:09:16,120 --> 02:09:17,640
IF YOU DON'T PHENOTYPE WELL YOU 

2591
02:09:17,640 --> 02:09:19,160
WILL NOT HAVE THE ANSWER.

2592
02:09:19,160 --> 02:09:21,240
SO COMING UP WITH VERY GOOD 

2593
02:09:21,240 --> 02:09:21,880
PHENOTYPES IS GOING TO BE VERY 

2594
02:09:21,880 --> 02:09:25,920
CRITICAL.

2595
02:09:25,920 --> 02:09:27,200
THEN IF YOU HAVE GOOD 

2596
02:09:27,200 --> 02:09:29,000
PHENOTYPES, WE CAN NOW 

2597
02:09:29,000 --> 02:09:32,240
UNDERSTAND LINK AND THE GENOMIC 

2598
02:09:32,240 --> 02:09:33,640
AND EPIGENOMIC WORKS.

2599
02:09:33,640 --> 02:09:37,040
ONCE YOU FIGURE THAT OUT WE 

2600
02:09:37,040 --> 02:09:38,240
TALKED ABOUT PERSONALIZED 

2601
02:09:38,240 --> 02:09:39,760
MEDICINE FOR QUITE A WHILE.

2602
02:09:39,760 --> 02:09:43,320
HOW DO WE NOW START TAILORING 

2603
02:09:43,320 --> 02:09:46,720
THIS TO THE INDIVIDUAL SO WE CAN

2604
02:09:46,720 --> 02:09:47,440
ADDRESS SPECIFIC CONCERNS AND 

2605
02:09:47,440 --> 02:09:51,080
SAY IT APPEARS AS IF STRESS 

2606
02:09:51,080 --> 02:09:52,760
PLAYS AN IMPORTANT ROLE.

2607
02:09:52,760 --> 02:09:54,960
IT APPEARS FINANCIAL STRESS AND 

2608
02:09:54,960 --> 02:09:56,200
HOW CAN WE ADDRESS THIS?

2609
02:09:56,200 --> 02:10:00,600
BRING THE SOCIAL WORKER IN?

2610
02:10:00,600 --> 02:10:03,320
BEING ABLE TO PHENOTYPE AND LINK

2611
02:10:03,320 --> 02:10:04,800
THE INFORMATION THEN PERSONALIZE

2612
02:10:04,800 --> 02:10:05,520
CARE ARE CRITICAL AREAS TO LOOK 

2613
02:10:05,520 --> 02:10:11,160
AT.

2614
02:10:11,160 --> 02:10:14,240
>> GREAT, THANK YOU.

2615
02:10:14,240 --> 02:10:16,800
SO WHAT IS YOUR IDEA ON NEW 

2616
02:10:16,800 --> 02:10:21,520
METHODS THAT ARE NEEDED TO FILL 

2617
02:10:21,520 --> 02:10:22,360
THE GAPS YOU JUST DESCRIBED IN 

2618
02:10:22,360 --> 02:10:25,960
THE SHORT TERM AND IN THE LONG 

2619
02:10:25,960 --> 02:10:26,760
TERM?

2620
02:10:26,760 --> 02:10:30,120
>> IN PLI VIEW I THINK 

2621
02:10:30,120 --> 02:10:31,600
COLLABORATION WILL BE VERY 

2622
02:10:31,600 --> 02:10:32,320
CRITICAL.

2623
02:10:32,320 --> 02:10:33,920
THESE ARE MAJOR QUESTIONS WILL 

2624
02:10:33,920 --> 02:10:37,400
CANNOT BE SOLVED BY ANY 

2625
02:10:37,400 --> 02:10:37,680
INDIVIDUAL.

2626
02:10:37,680 --> 02:10:38,920
I COLLABORATE QUITE A BIT WITH A

2627
02:10:38,920 --> 02:10:40,360
PSYCHOLOGIST AND HE LOOK AT THE 

2628
02:10:40,360 --> 02:10:48,280
PSYCHOSOCIAL ASPECTS OF PAIN.

2629
02:10:48,280 --> 02:10:51,160
ONE RESEARCHER WILL LOOK AT BIO 

2630
02:10:51,160 --> 02:10:51,600
SOCIAL ASPECTS.

2631
02:10:51,600 --> 02:10:57,480
THE EFFECT OF DEPRESSION AND 

2632
02:10:57,480 --> 02:10:59,160
CATASTROPHIZING AND DO THEY HAVE

2633
02:10:59,160 --> 02:11:08,200
SUPPORT AND LOOK AT SOCIO 

2634
02:11:08,200 --> 02:11:08,640
ECONOMIC STATUS.

2635
02:11:08,640 --> 02:11:10,560
SO COMING UP WITH COLLABORATIONS

2636
02:11:10,560 --> 02:11:12,520
BETWEEN INVESTIGATORS SO YOU ARE

2637
02:11:12,520 --> 02:11:14,240
ASKING THE SAME QUESTION FROM 

2638
02:11:14,240 --> 02:11:18,360
THE SAME SAMPLE SO THAT WE CAN 

2639
02:11:18,360 --> 02:11:21,320
TIE IT TOGETHER TO SAY HEY, WHEN

2640
02:11:21,320 --> 02:11:23,680
WE SEE GREATER PAIN SEVERITY, 

2641
02:11:23,680 --> 02:11:25,560
HOW DOES IT LOOK LIKE WHEN WE 

2642
02:11:25,560 --> 02:11:29,200
LOOK AT DEPRESSIVE SYMPTOMS IN 

2643
02:11:29,200 --> 02:11:30,520
THESE SAMPLE?

2644
02:11:30,520 --> 02:11:34,640
WHAT ARE THE EPIGE GENGENOMIC C 

2645
02:11:34,640 --> 02:11:36,200
THEY CAN PLAY AND THAT WILL GO A

2646
02:11:36,200 --> 02:11:37,360
LONG WAY IN THE QUESTIONS WE 

2647
02:11:37,360 --> 02:11:38,200
FACE TODAY.

2648
02:11:38,200 --> 02:11:40,800
AND OF COURSE FUNDING IS ALWAYS 

2649
02:11:40,800 --> 02:11:42,800
AN UNDERLYING PROBLEM.

2650
02:11:42,800 --> 02:11:44,200
IF WE HAVE MORE MONEY, WE CAN 

2651
02:11:44,200 --> 02:11:54,560
SOLVE MORE PROBLEMS.

2652
02:11:58,920 --> 02:12:00,760
>> DID YOU SEE DIFFERENCES
IN 

2653
02:12:00,760 --> 02:12:03,920
THE GENE PATHWAYS AND IF YES, 

2654
02:12:03,920 --> 02:12:08,040
WHAT IS THE REASON FOR THE 

2655
02:12:08,040 --> 02:12:08,560
GENDER BASE?

2656
02:12:08,560 --> 02:12:10,680
>> FOR THIS ANALYSIS WE
DID 

2657
02:12:10,680 --> 02:12:12,160
CONTROL FOR AGE, WE CONTROLLED 

2658
02:12:12,160 --> 02:12:14,080
FOR GENDER DIFFERENCES AND WE 

2659
02:12:14,080 --> 02:12:17,880
ALSO CONTROLLED FOR SOCIO 

2660
02:12:17,880 --> 02:12:19,440
ECONOMIC STATUS IN OUR ANALYSIS.

2661
02:12:19,440 --> 02:12:22,120
WE HAVE -- I HAVE LOOKED AT 

2662
02:12:22,120 --> 02:12:23,560
GENDER DIFFERENCES BECAUSE FROM 

2663
02:12:23,560 --> 02:12:26,920
THE PHENOTYPING, WE DID NOT SEE 

2664
02:12:26,920 --> 02:12:29,920
ANY GENDER DIFFERENCES IN OUR 

2665
02:12:29,920 --> 02:12:35,520
PHENOTYPE.

2666
02:12:35,520 --> 02:12:37,120
SO WHEN WE COMPARED PAIN 

2667
02:12:37,120 --> 02:12:37,880
SEVERITY BETWEEN MALES AND 

2668
02:12:37,880 --> 02:12:39,360
FEMALES THAT WASN'T A 

2669
02:12:39,360 --> 02:12:39,640
DIFFERENCE.

2670
02:12:39,640 --> 02:12:41,440
I HAVEN'T LOOKED AT THE 

2671
02:12:41,440 --> 02:12:42,560
EPIGENETIC PART OF IT.

2672
02:12:42,560 --> 02:12:48,120
PART COULD BE BECAUSE IN THE 

2673
02:12:48,120 --> 02:12:51,040
REDUCED REPRESENTATION ANALYSIS 

2674
02:12:51,040 --> 02:12:53,520
WE REMOVED THE X AND Y 

2675
02:12:53,520 --> 02:12:55,440
CHROMOSOMES AND ONLY FOCUSSED ON

2676
02:12:55,440 --> 02:13:02,240
THE AUTOSOMES.

2677
02:13:02,240 --> 02:13:05,520
SO AGAIN SEX AND GENDER 

2678
02:13:05,520 --> 02:13:08,320
DIFFERENCES REQUIRES FURTHER 

2679
02:13:08,320 --> 02:13:08,560
INQUIRY.

2680
02:13:08,560 --> 02:13:13,560
THAT LINKS ITSELF TO DIFFERENCES

2681
02:13:13,560 --> 02:13:15,960
IN SEXUAL MINORITIES AND LOOKING

2682
02:13:15,960 --> 02:13:20,200
AT TRANSGENDER MINORITIES.

2683
02:13:20,200 --> 02:13:24,200
HOW DOES TREATMENT AFFECT PAIN 

2684
02:13:24,200 --> 02:13:26,240
AND THESE ARE QUESTION WHICH 

2685
02:13:26,240 --> 02:13:30,600
REQUIRE OUR ATTENTION.

2686
02:13:30,600 --> 02:13:37,920
>> THIS IS A VERY
INTERESTING 

2687
02:13:37,920 --> 02:13:43,200
AREA IN THE GENOMIC RESEARCH AND

2688
02:13:43,200 --> 02:13:45,960
WHEN YOU LOOK INTO THAT YOU CAN 

2689
02:13:45,960 --> 02:13:47,960
SEE VERY DIFFERENT PATHWAYS, 

2690
02:13:47,960 --> 02:13:52,520
GENETIC PATHWAYS.

2691
02:13:52,520 --> 02:13:58,280
I THINK ONE OF THE INSIGHT IN 

2692
02:13:58,280 --> 02:14:01,640
PAIN IN GENERAL WERE IN 

2693
02:14:01,640 --> 02:14:02,800
GENETICS.

2694
02:14:02,800 --> 02:14:04,600
I WOULD BET IN EPIGENOMIC 

2695
02:14:04,600 --> 02:14:06,680
STUDIES IT WOULD BE THE SAME.

2696
02:14:06,680 --> 02:14:08,200
WE HAVE ANOTHER QUESTION.

2697
02:14:08,200 --> 02:14:13,920
HAS THERE BEEN STUDY HOW 

2698
02:14:13,920 --> 02:14:17,720
DISCRIMINATION AND STRESS MIGHT 

2699
02:14:17,720 --> 02:14:20,960
RELATE TO OR PREDICT THE 

2700
02:14:20,960 --> 02:14:22,480
EPIGENETIC BASED RESULTS?

2701
02:14:22,480 --> 02:14:27,840
>> WE HAVE DONE THAT DATA.

2702
02:14:27,840 --> 02:14:29,920
WE HAVE SELF-PERCEIVED STRESS 

2703
02:14:29,920 --> 02:14:32,240
AND INTERNALIZED STIGMA.

2704
02:14:32,240 --> 02:14:34,400
I'M FINISHING UP WRITING THAT 

2705
02:14:34,400 --> 02:14:34,960
PAPER.

2706
02:14:34,960 --> 02:14:36,600
I ONLY HAD 10 MINUTES SO I 

2707
02:14:36,600 --> 02:14:38,240
DIDN'T GO INTO THAT.

2708
02:14:38,240 --> 02:14:43,800
YES, ONCE YOU CONTROL FOR RACE 

2709
02:14:43,800 --> 02:14:49,600
AND RACIAL DIFFERENCES WE SEE 

2710
02:14:49,600 --> 02:14:50,920
CHANGES IN THE EPIGENETIC 

2711
02:14:50,920 --> 02:14:53,160
DIFFERENCES AND THE RELATED 

2712
02:14:53,160 --> 02:15:01,920
PATHWAYS APPEAR TO BE CAN'T.

2713
02:15:01,920 --> 02:15:06,040
SPECIFICALLY LOOKING AT THE 

2714
02:15:06,040 --> 02:15:07,440
DOPAMINE SIGNALLING PATHWAY AND 

2715
02:15:07,440 --> 02:15:09,200
ONE PATHWAY THAT APPEARS TO COME

2716
02:15:09,200 --> 02:15:13,920
UP WHICH WE HAVE SEEN INITIALLY 

2717
02:15:13,920 --> 02:15:19,520
WHERE WE JUST LOOKED AT PATHWAYS

2718
02:15:19,520 --> 02:15:28,960
INVOLVED IN REMODELLING AND 

2719
02:15:28,960 --> 02:15:34,080
LOOKING AT WHAT THE RELATIONSHIP

2720
02:15:34,080 --> 02:15:36,720
IS BETWEEN ALL THE PATHWAYS AND 

2721
02:15:36,720 --> 02:15:39,560
IT'S ONE WAY TO SEE THE PATHWAYS

2722
02:15:39,560 --> 02:15:41,640
ENRICHED SO WHAT IS THE NETWORK 

2723
02:15:41,640 --> 02:15:42,120
INTERACTION GOING ON?

2724
02:15:42,120 --> 02:15:45,320
THAT'S PART OF THE WORK WE'RE 

2725
02:15:45,320 --> 02:15:49,920
TRYING TO DO IN DECIPHERING THE 

2726
02:15:49,920 --> 02:15:50,600
INTERACTION BETWEEN FOR INSTANCE

2727
02:15:50,600 --> 02:15:54,080
THE STRESS AND DOPAMINE PATHWAYS

2728
02:15:54,080 --> 02:16:00,760
AND BONE OSSIFICATION AND 

2729
02:16:00,760 --> 02:16:03,120
REMODELLING AND LOOKING AT HOW 

2730
02:16:03,120 --> 02:16:08,400
THEY CROSS EACH OTHER IS ALSO 

2731
02:16:08,400 --> 02:16:11,720
IMPORTANT.

2732
02:16:11,720 --> 02:16:14,840
THE ROLE OF STRESS I THINK WILL 

2733
02:16:14,840 --> 02:16:16,920
BE PUBLISHED SOON.

2734
02:16:16,920 --> 02:16:20,160
>> DO YOU YOUR TEAM OR 

2735
02:16:20,160 --> 02:16:21,920
COLLEAGUES HAVE PLANS TO LOOK 

2736
02:16:21,920 --> 02:16:28,200
SEE IF POTENTIAL INTERVENTIONS 

2737
02:16:28,200 --> 02:16:31,800
CAN IMPROVE OR WORSEN THE 

2738
02:16:31,800 --> 02:16:32,720
EPIGENETIC RESULTS IN PATIENTS 

2739
02:16:32,720 --> 02:16:34,560
BEYOND THE PATIENT OUTCOME.

2740
02:16:34,560 --> 02:16:38,200
>> MY HOPE IS I KNOW THAT
SOME 

2741
02:16:38,200 --> 02:16:40,160
OF THE WORK NOT IN LOW BACK PAIN

2742
02:16:40,160 --> 02:16:44,160
BUT THINGS LIKE EXERCISE, 

2743
02:16:44,160 --> 02:16:45,960
MINDFULNESS, ACTIVITIES LIKE WE 

2744
02:16:45,960 --> 02:16:48,760
SAW WITH ONE OF THE FINALISTS DO

2745
02:16:48,760 --> 02:16:51,800
INDUCE EPIGENETIC CHANGES.

2746
02:16:51,800 --> 02:16:54,880
PEOPLE ENROLLED IN EXERCISE, I 

2747
02:16:54,880 --> 02:16:57,920
THINK THAT WAS DONE BY ANGELA 

2748
02:16:57,920 --> 02:17:01,920
AND SAW EXERCISE DOES AFFECT 

2749
02:17:01,920 --> 02:17:04,120
GENE EXPRESSION.

2750
02:17:04,120 --> 02:17:06,440
WE KNOW MINDFULNESS OR 

2751
02:17:06,440 --> 02:17:08,280
MEDITATION DOES AFFECT GENE 

2752
02:17:08,280 --> 02:17:08,560
EXPRESSION.

2753
02:17:08,560 --> 02:17:12,800
MY HUNCH IS IF WE WERE TO ENROLL

2754
02:17:12,800 --> 02:17:16,240
PEOPLE IN MINDFULNESS 

2755
02:17:16,240 --> 02:17:17,200
INTERVENTION WE SHOULD START 

2756
02:17:17,200 --> 02:17:23,040
SEEING CHANGES IN THE EPIGENETIC

2757
02:17:23,040 --> 02:17:25,760
LEVEL WOULD CHANGE AND IT'S A 

2758
02:17:25,760 --> 02:17:27,280
MATTER OF NOW CONNECTING THE 

2759
02:17:27,280 --> 02:17:29,920
DOTS IN MY OPINION.

2760
02:17:29,920 --> 02:17:30,880
I DON'T THINK THERE'S ANYTHING 

2761
02:17:30,880 --> 02:17:35,240
OUT YET.

2762
02:17:35,240 --> 02:17:36,760
THAT'S MY HYPOTHESIS 

2763
02:17:36,760 --> 02:17:39,200
>> GREAT, YOU WERE TALKING
ABOUT

2764
02:17:39,200 --> 02:17:42,720
MIND-BODY INTERVENTION.

2765
02:17:42,720 --> 02:17:47,200
WHAT ABOUT IS RELATED LIFESTYLE 

2766
02:17:47,200 --> 02:17:49,920
POSSIBLE UNDERLYING FACTORS FOR 

2767
02:17:49,920 --> 02:17:51,120
THE EPIGENETIC RESEARCH?

2768
02:17:51,120 --> 02:17:52,480
>> TWO-MINUTE WARNING.

2769
02:17:52,480 --> 02:17:56,240
>> THERE IS A WHOLE AREA
OF 

2770
02:17:56,240 --> 02:17:58,200
NEUTRAL EPIGENETICS COMING UP 

2771
02:17:58,200 --> 02:17:59,400
ESPECIALLY WHEN YOU LOOK AT 

2772
02:17:59,400 --> 02:18:02,480
THINGS LIKE THE INTERSECTION OF 

2773
02:18:02,480 --> 02:18:04,680
PAIN AND OBESITY AND 

2774
02:18:04,680 --> 02:18:06,720
INFLAMMATORY DIET AND 

2775
02:18:06,720 --> 02:18:08,160
NON-INFLAMMATORY DIET.

2776
02:18:08,160 --> 02:18:09,920
AGAIN, THESE ARE THINGS WHICH 

2777
02:18:09,920 --> 02:18:11,600
ARE DONE OUTSIDE THE REALM OF 

2778
02:18:11,600 --> 02:18:16,280
PAIN RESEARCH.

2779
02:18:16,280 --> 02:18:18,560
MY HOPE IS THAT WE MAY BE 

2780
02:18:18,560 --> 02:18:20,600
INTERESTED IN COLLABORATING AND 

2781
02:18:20,600 --> 02:18:23,880
LOOK AT SOME OF THE PHENOTYPES.

2782
02:18:23,880 --> 02:18:25,920
NOW, NUTRITION DEFINITELY 

2783
02:18:25,920 --> 02:18:29,440
AFFECTS HOW MUCH PAIN AND I KNOW

2784
02:18:29,440 --> 02:18:34,280
WE HAVE NUTRITION OR DIET AND 

2785
02:18:34,280 --> 02:18:35,800
WHEN PEOPLE EAT PLEASURABLE 

2786
02:18:35,800 --> 02:18:37,760
FOODS THEY HAVE LESS PAIN.

2787
02:18:37,760 --> 02:18:39,640
DIET AFFECTS EPIGENETICS.

2788
02:18:39,640 --> 02:18:41,920
NOW CAN WE LINK THOSE AND LOOK 

2789
02:18:41,920 --> 02:18:44,200
AT SOMEBODY'S DIET, LOOK AT PAIN

2790
02:18:44,200 --> 02:18:46,640
AND EPIGENETICS?

2791
02:18:46,640 --> 02:18:51,040
AND EVEN MORE IMPORTANT, CAN WE 

2792
02:18:51,040 --> 02:18:55,000
REVERSE SO THAT WE CAN SEE IF WE

2793
02:18:55,000 --> 02:18:57,040
CAN GIVE THE APPROPRIATE DIET TO

2794
02:18:57,040 --> 02:18:59,200
INDUCE MORE COMFORT AND SEE IF 

2795
02:18:59,200 --> 02:19:03,760
WE INDUCE THE EPIGENETIC CHANGES

2796
02:19:03,760 --> 02:19:06,000
THAT COULD DECREASE PAIN 

2797
02:19:06,000 --> 02:19:08,600
SEVERITY AND IT'S VERY EXCITING 

2798
02:19:08,600 --> 02:19:09,640
TO THE FUTURE.

2799
02:19:09,640 --> 02:19:11,640
I LOOK FORWARD TO SEEING WHAT 

2800
02:19:11,640 --> 02:19:12,720
OTHERS WILL DO AND JOINING ME IN

2801
02:19:12,720 --> 02:19:13,920
THIS AREA.

2802
02:19:13,920 --> 02:19:14,920
>> THANK YOU.

2803
02:19:14,920 --> 02:19:17,640
THANK YOU SO MUCH, DR. AROKE.

2804
02:19:17,640 --> 02:19:20,600
AGAIN, CONGRATULATIONS ON YOUR 

2805
02:19:20,600 --> 02:19:21,840
AWARD AND THANK YOU FOR SHARING 

2806
02:19:21,840 --> 02:19:24,000
YOUR IDEAS WITH US.

2807
02:19:24,000 --> 02:19:25,920
WE HAVE MORE QUESTIONS SO 

2808
02:19:25,920 --> 02:19:28,000
HOPEFULLY THOSE QUESTIONS WILL 

2809
02:19:28,000 --> 02:19:30,920
COME AT OUR NETWORKING SESSION 

2810
02:19:30,920 --> 02:19:34,440
THAT WILL START AT 3:45.

2811
02:19:34,440 --> 02:19:37,920
NOW WE'LL HAVE A 30-MINUTE BREAK

2812
02:19:37,920 --> 02:19:40,280
AND RETURN AT 1:40 P.M. EASTERN 

2813
02:19:40,280 --> 02:19:44,080
TIME FOR OUR THIRD AND LAST 

2814
02:19:44,080 --> 02:19:45,920
PANEL SESSION IMPLEMENTATION OF 

2815
02:19:45,920 --> 02:19:46,560
WHOLE-PERSON APPROACHES TO PAIN 

2816
02:19:46,560 --> 02:19:54,520
MANAGEMENT.

2817
02:19:54,520 --> 02:19:55,520
>>WELCOME BACK.

2818
02:19:55,520 --> 02:20:01,600
I'M PLEASED TO INTRODUCE OUR 

2819
02:20:01,600 --> 02:20:09,960
MODERATOR OF THE FINAL SESSION.

2820
02:20:09,960 --> 02:20:13,640
HE RESEARCH PORTFOLIO IS 

2821
02:20:13,640 --> 02:20:21,640
CLINICAL ARTHRITIS AND MANAGES 

2822
02:20:21,640 --> 02:20:24,440
THE CONSORTIUM PROGRAM PART OF 

2823
02:20:24,440 --> 02:20:29,120
THE NIH HELPING TO END ADDICTION

2824
02:20:29,120 --> 02:20:30,760
LONG-TERM AND PATIENT-CENTERED 

2825
02:20:30,760 --> 02:20:33,120
EFFORTS TO ADDRESS THE NEED FOR 

2826
02:20:33,120 --> 02:20:36,960
EFFECTIVE AND PERSONALIZED 

2827
02:20:36,960 --> 02:20:38,200
THERAPIES FOR CHRONIC LOW BACK 

2828
02:20:38,200 --> 02:20:38,880
PAIN.

2829
02:20:38,880 --> 02:20:40,600
HE GOT HIS Ph.D. IN PATHOLOGY 

2830
02:20:40,600 --> 02:20:43,320
FROM THE OHIO STATE UNIVERSITY 

2831
02:20:43,320 --> 02:20:47,840
AND M.D. DEGREE FROM CHINA.

2832
02:20:47,840 --> 02:20:49,520
DR. ZHENG, THE FLOOR IS YOURS.

2833
02:20:49,520 --> 02:20:52,640
>> THANK YOU.

2834
02:20:52,640 --> 02:20:54,080
WE'RE MOVING TO THE SESSION 

2835
02:20:54,080 --> 02:20:54,520
THREE.

2836
02:20:54,520 --> 02:20:57,640
PANEL SESSION THREE, IMPLEM

2837
02:20:57,640 --> 02:20:59,120
IMPLEMENTATION OF THE WHOLE 

2838
02:20:59,120 --> 02:21:04,240
PERSON APPROACHES TO PAIN 

2839
02:21:04,240 --> 02:21:04,560
MANAGEMENT.

2840
02:21:04,560 --> 02:21:06,120
I'LL A PROGRAM DIRECTOR.

2841
02:21:06,120 --> 02:21:08,920
IN THIS SESSION WE'LL START WITH

2842
02:21:08,920 --> 02:21:10,080
FOUR SPEAKERS.

2843
02:21:10,080 --> 02:21:12,800
PRESENTATION FROM FOUR SPEAKERS.

2844
02:21:12,800 --> 02:21:17,240
EACH SPEAKER WILL HAVE 15 

2845
02:21:17,240 --> 02:21:18,600
MINUTES.

2846
02:21:18,600 --> 02:21:21,040
WE'LL HOLD QUESTIONS TO THE END 

2847
02:21:21,040 --> 02:21:22,520
WHEN WE MOVE TO THE Q&A
SESSION 

2848
02:21:22,520 --> 02:21:25,640
SO THERE'S NO QUESTIONS IN 

2849
02:21:25,640 --> 02:21:27,680
BETWEEN THE TALKS.

2850
02:21:27,680 --> 02:21:32,080
AND WHEN WE GET TO THE Q&A 

2851
02:21:32,080 --> 02:21:33,360
SESSION, WE'LL ANSWER QUESTIONS 

2852
02:21:33,360 --> 02:21:36,920
IN THE CHAT BOX FOR OUR SPEAKERS

2853
02:21:36,920 --> 02:21:38,320
AND THEN WE'LL HAVE TWO 

2854
02:21:38,320 --> 02:21:39,960
COLLEAGUES LEAD THE PANEL 

2855
02:21:39,960 --> 02:21:44,000
DISCUSSION AFTER THAT.

2856
02:21:44,000 --> 02:21:47,160
SO THE FIRST SPEAKER IS 

2857
02:21:47,160 --> 02:21:47,680
MR. DAVID WHITE.

2858
02:21:47,680 --> 02:21:51,960
MR. WHITE IS A FORMER DIALYSIS 

2859
02:21:51,960 --> 02:21:55,440
PATIENT AND GRATEFUL KIDNEY 

2860
02:21:55,440 --> 02:21:57,640
TRANSPLANT RECIPIENT.

2861
02:21:57,640 --> 02:22:00,080
HE SITS ON MANY ADVISORY BOARD 

2862
02:22:00,080 --> 02:22:03,680
AND WORKING GROUP INCLUDING NIH,

2863
02:22:03,680 --> 02:22:07,760
NIDDK HEMODIALYSIS OPIATE 

2864
02:22:07,760 --> 02:22:09,920
PRESCRIPTION EFFORT HOPE 

2865
02:22:09,920 --> 02:22:11,000
CONSORTIUM AND NIH HEAL 

2866
02:22:11,000 --> 02:22:14,560
INITIATIVE PATIENT ENGAGEMENT 

2867
02:22:14,560 --> 02:22:15,960
WORK GROUP.

2868
02:22:15,960 --> 02:22:18,960
PATIENT ADVOCATE FOUNDATION AND 

2869
02:22:18,960 --> 02:22:21,640
NATIONAL ADVOCATE FOUNDATION 

2870
02:22:21,640 --> 02:22:24,440
BOARD AND THE PART OF THE 

2871
02:22:24,440 --> 02:22:25,240
PATIENT-CENTERED OUTCOME 

2872
02:22:25,240 --> 02:22:26,600
INSTITUTE ADVISORY PANEL ON 

2873
02:22:26,600 --> 02:22:29,960
PATIENT ENGAGEMENT.

2874
02:22:29,960 --> 02:22:33,640
AND HIS PRESENTATION THE TOPIC 

2875
02:22:33,640 --> 02:22:37,240
OF HIS PRESENTATION IS MEMORIES 

2876
02:22:37,240 --> 02:22:39,720
AND LESSONS LEARNED FROM 

2877
02:22:39,720 --> 02:22:40,120
DIALYSIS GRADUATE.

2878
02:22:40,120 --> 02:22:42,640
DAVID, WELCOME.

2879
02:22:42,640 --> 02:22:45,640
>> THANK YOU ZHENG, THANK
YOU 

2880
02:22:45,640 --> 02:22:51,280
FOR THE WARM INTRODUCTION.

2881
02:22:51,280 --> 02:22:52,400
HELLO, EVERYONE.

2882
02:22:52,400 --> 02:22:54,880
I'M GRATEFUL TO BE HERE AND 

2883
02:22:54,880 --> 02:22:56,400
NEVER THOUGHT I'D BE SPEAKING 

2884
02:22:56,400 --> 02:22:59,840
ABOUT MY EXPERIENCE ON DIALYSIS 

2885
02:22:59,840 --> 02:23:00,520
AND WITH PAIN.

2886
02:23:00,520 --> 02:23:03,600
I'LL TALK ABOUT MY CRASH INTO 

2887
02:23:03,600 --> 02:23:06,000
KIDNEY FAILURE AND DIALYSIS.

2888
02:23:06,000 --> 02:23:06,880
IF YOU NEVER HEARD THE TERM 

2889
02:23:06,880 --> 02:23:09,240
CRASH IT MEANS YOU DIDN'T KNOW 

2890
02:23:09,240 --> 02:23:12,320
YOU HAD KIDNEY DISEASE UNTIL 

2891
02:23:12,320 --> 02:23:13,640
YOUR KIDNEYS STOP WORKING 

2892
02:23:13,640 --> 02:23:15,000
COMPLETELY AND THAT'S WHAT 

2893
02:23:15,000 --> 02:23:16,880
HAPPENED TO ME IN 2009.

2894
02:23:16,880 --> 02:23:18,360
I'M ALSO GOING TO SPEAK ABOUT 

2895
02:23:18,360 --> 02:23:21,320
LIVING WITH PAIN AS A DIALYSIS 

2896
02:23:21,320 --> 02:23:24,920
PATIENT AND A LITTLE BIT ABOUT 

2897
02:23:24,920 --> 02:23:26,040
MY INVOLVEMENT WITH PAIN STUDIES

2898
02:23:26,040 --> 02:23:36,600
IN THE HEMODIALYSIS POPULATION.

2899
02:23:50,120 --> 02:23:53,640
AND WE MAKE URINE AND THAT WAS 

2900
02:23:53,640 --> 02:23:56,600
THE FOR ALMOST SIX YEARS AND AS 

2901
02:23:56,600 --> 02:23:58,440
FAR AS THE PROCESS RATHER THAN 

2902
02:23:58,440 --> 02:24:00,600
GOING INTO DETAIL I'LL JUST SHOW

2903
02:24:00,600 --> 02:24:02,400
YOU MY ACCESS LIVE AND IN COLOR.

2904
02:24:02,400 --> 02:24:08,840
THIS IS THE ARM WHY TWO .16 

2905
02:24:08,840 --> 02:24:10,440
GAUGE NEEDLES WERE PUT INTO ME 

2906
02:24:10,440 --> 02:24:14,280
BETWEEN 1,000 AND 1500 TIMES 

2907
02:24:14,280 --> 02:24:16,480
OVER SIX YEARS AND THIS WAS MY 

2908
02:24:16,480 --> 02:24:17,520
LIFE LINE.

2909
02:24:17,520 --> 02:24:20,000
IF YOU'RE INTERESTED IN HOW MY 

2910
02:24:20,000 --> 02:24:21,880
KIDNEYS FAILED, BASICALLY I 

2911
02:24:21,880 --> 02:24:23,800
WOULD SAY POOR HEALTH HABITS.

2912
02:24:23,800 --> 02:24:25,040
I WAS NOT VERY HEALTH CONSCIOUS 

2913
02:24:25,040 --> 02:24:27,200
FOR A LONG TIME AND OVERWEIGHT 

2914
02:24:27,200 --> 02:24:28,080
FOR A LONG TIME.

2915
02:24:28,080 --> 02:24:31,280
I SMOKED CIGARETTES FOR OVER 30 

2916
02:24:31,280 --> 02:24:34,720
YEARS AND PROBABLY INDUCED 

2917
02:24:34,720 --> 02:24:35,480
HYPERTENSION AND ALSO ATE A LOT 

2918
02:24:35,480 --> 02:24:36,560
OF UNHEALTHY FOODS.

2919
02:24:36,560 --> 02:24:38,520
MOST IMPORTANTLY I DIDN'T GO TO 

2920
02:24:38,520 --> 02:24:40,960
THE DOCTOR FOR A VERY LONG TIME 

2921
02:24:40,960 --> 02:24:42,840
AND THAT ALL CAUGHT UP TO ME IN 

2922
02:24:42,840 --> 02:24:44,000
THE FALL OF 2009 IN THE 

2923
02:24:44,000 --> 02:24:45,920
EMERGENCY ROOM I FOUND OUT MY 

2924
02:24:45,920 --> 02:24:49,160
KIDNEYS WERE NO LONGER WORKING.

2925
02:24:49,160 --> 02:24:49,760
THAT HAPPENED A LOT TO BLACK 

2926
02:24:49,760 --> 02:24:58,400
PEOPLE.

2927
02:24:58,400 --> 02:25:00,600
KIDNEY FAILURE HAPPENS FIVE 

2928
02:25:00,600 --> 02:25:02,880
TIMES AS MUCH AS FOR WHITE 

2929
02:25:02,880 --> 02:25:04,360
AMERICANS AND IT'S A ONE SIZE 

2930
02:25:04,360 --> 02:25:04,880
FITS ALL TREATMENT.

2931
02:25:04,880 --> 02:25:07,600
IMAGINE GOING TO A BARBERSHOP 

2932
02:25:07,600 --> 02:25:09,600
AND HAIR SALON AND EVERYONE 

2933
02:25:09,600 --> 02:25:11,600
WALKS OUT WITH THE SAME HAIRCUT.

2934
02:25:11,600 --> 02:25:12,760
THAT'S NOT COOL.

2935
02:25:12,760 --> 02:25:13,320
ESPECIALLY WHEN IT COMES TO 

2936
02:25:13,320 --> 02:25:21,280
HEALTH CARE.

2937
02:25:21,280 --> 02:25:28,600
THE FIRST TIME I WALKED INTO THE

2938
02:25:28,600 --> 02:25:37,080
CLINICAL IT WAS A SHOCK AND 

2939
02:25:37,080 --> 02:25:38,600
THERE WERE TUBES FILLED WITH 

2940
02:25:38,600 --> 02:25:40,160
BLOOD FROM A BODY TO A MACHINE 

2941
02:25:40,160 --> 02:25:44,200
AND IT WAS KIND OF QUIET EXCEPT 

2942
02:25:44,200 --> 02:25:45,640
FOR THE MACHINES AND ALARMS.

2943
02:25:45,640 --> 02:25:51,880
IT WAS A FEAR-INDUCING AT 

2944
02:25:51,880 --> 02:25:53,320
ATMOSPHERE.

2945
02:25:53,320 --> 02:25:55,880
SOME SIDE EFFECTS OF LOW BLOOD 

2946
02:25:55,880 --> 02:25:56,960
PRESSURE FROM HAVING FLUID 

2947
02:25:56,960 --> 02:26:00,360
PULLED FROM YOUR BODY TOO 

2948
02:26:00,360 --> 02:26:00,600
QUICKLY.

2949
02:26:00,600 --> 02:26:01,720
NAUSEA, CRAMPING, WHICH I'LL 

2950
02:26:01,720 --> 02:26:03,680
DISCUSS IN A COUPLE MINUTES AND 

2951
02:26:03,680 --> 02:26:06,160
WHAT'S CALLED A DIALYSIS 

2952
02:26:06,160 --> 02:26:08,200
HANGOVER WHICH IS SORT OF 

2953
02:26:08,200 --> 02:26:09,920
FEELING WASHED OUT AND WANTING 

2954
02:26:09,920 --> 02:26:13,600
TO EAT AND SLEEP AFTER A 

2955
02:26:13,600 --> 02:26:14,080
SESSION.

2956
02:26:14,080 --> 02:26:17,600
IT'S JUST NOT A VERY PLEASANT 

2957
02:26:17,600 --> 02:26:27,000
LIFESTYLE VERY OFTEN.

2958
02:26:27,000 --> 02:26:30,480
AND I WAS GOING DIALYSIS 

2959
02:26:30,480 --> 02:26:31,640
SOMETIMES ONLY ONCE A WEEK.

2960
02:26:31,640 --> 02:26:33,880
ONE, I FLAT OUT DIDN'T WANT TO.

2961
02:26:33,880 --> 02:26:35,160
I DIDN'T LIKE IT.

2962
02:26:35,160 --> 02:26:36,720
SECOND REASON WAS IT WAS OFTEN 

2963
02:26:36,720 --> 02:26:44,840
TOO EXPENSIVE FOR ME TO GO.

2964
02:26:44,840 --> 02:26:45,880
THAT ISSUE WASN'T ADDRESSED FOR 

2965
02:26:45,880 --> 02:26:46,360
SIX MONTHS.

2966
02:26:46,360 --> 02:26:49,120
INMS OF PAIN, I HAD 

2967
02:26:49,120 --> 02:26:51,640
DIFFERENT TYPES AND FROM A 

2968
02:26:51,640 --> 02:26:53,240
PHYSICAL PERSPECTIVE AT THE 

2969
02:26:53,240 --> 02:26:54,040
BEGINNING IT SORT OF HURT ALL 

2970
02:26:54,040 --> 02:26:54,480
OVER.

2971
02:26:54,480 --> 02:26:57,480
I DIDN'T KNOW HOW TO EXPLAIN IT 

2972
02:26:57,480 --> 02:27:07,560
BETTER THAN THAT.

2973
02:27:07,560 --> 02:27:11,400
IT WOULD HURT SITTING ON A CHAIR

2974
02:27:11,400 --> 02:27:13,600
FOR FOUR HOURS AND IMAGINE GOING

2975
02:27:13,600 --> 02:27:17,000
ON A CROSS COUNTRY FLIGHT WITH A

2976
02:27:17,000 --> 02:27:20,080
NEEDLE AND I HAD PAIN FROM THE 

2977
02:27:20,080 --> 02:27:22,920
NEEDLE IN MY ARM THREE TIMES A 

2978
02:27:22,920 --> 02:27:24,120
WEEK FOR YEARS.

2979
02:27:24,120 --> 02:27:29,480
PAIN FROM CLOTTING AND CRAMPING 

2980
02:27:29,480 --> 02:27:34,320
FROM HAVING TOO MUCH FLUID 

2981
02:27:34,320 --> 02:27:41,280
PULLED TOO QUICKLY AND A 

2982
02:27:41,280 --> 02:27:42,960
DISEQUILIBRIUM AND SOMETIMES IT 

2983
02:27:42,960 --> 02:27:44,000
HAPPENED IN THE FOURTH HOUR 

2984
02:27:44,000 --> 02:27:45,760
SOMETIMES WITH TINGLING IN MY 

2985
02:27:45,760 --> 02:27:48,440
HAND AND SOMETIMES MY FEET WOULD

2986
02:27:48,440 --> 02:27:50,760
CRAMP, SOMETIMES MY LEGS.

2987
02:27:50,760 --> 02:27:51,760
SOMETIMES MY ABDOMEN.

2988
02:27:51,760 --> 02:27:53,840
SOMETIMES MY CHEST.

2989
02:27:53,840 --> 02:27:56,160
I WOULD RESOLVE TO CRAMPING IF I

2990
02:27:56,160 --> 02:28:00,160
COULD BY HAVING SOMETHING SALTY 

2991
02:28:00,160 --> 02:28:03,040
LIKE PRETZELS OR ASK THE 

2992
02:28:03,040 --> 02:28:04,880
TECHNICIAN TO STOP THE MUCH FROM

2993
02:28:04,880 --> 02:28:05,240
PULLING FLUID.

2994
02:28:05,240 --> 02:28:07,880
THAT COULD ALLEVIATE THE 

2995
02:28:07,880 --> 02:28:09,080
CRAMPING SOMETIMES.

2996
02:28:09,080 --> 02:28:12,920
USUALLY I'D TRY TO ALLEVIATE IT 

2997
02:28:12,920 --> 02:28:14,320
BY STRETCHING THE CRAMPED MUSCLE

2998
02:28:14,320 --> 02:28:17,520
AND SOMETIMES WHEN I DID THAT 

2999
02:28:17,520 --> 02:28:19,680
FIXING ONE CRAMP WOULD CAUSE 

3000
02:28:19,680 --> 02:28:20,560
CRAMPING SOMEWHERE ELSE.

3001
02:28:20,560 --> 02:28:21,560
I'LL NEVER FORGET ONE TIME WHERE

3002
02:28:21,560 --> 02:28:24,160
I HAD TO LAUGH TO MYSELF BECAUSE

3003
02:28:24,160 --> 02:28:25,480
THE SITUATION WAS SO FUTILE WHEN

3004
02:28:25,480 --> 02:28:35,080
THAT HAPPENED.

3005
02:28:35,080 --> 02:28:37,440
THERE'S ALSO EMOTIONAL AND 

3006
02:28:37,440 --> 02:28:38,120
SITUATIONAL PAIN CAUSED BY 

3007
02:28:38,120 --> 02:28:38,680
FRUSTRATION.

3008
02:28:38,680 --> 02:28:40,960
THE PAINFUL FAMILY DISCUSSIONS I

3009
02:28:40,960 --> 02:28:48,440
HAD WITH MY WIFE REGARDING OUR 

3010
02:28:48,440 --> 02:28:49,040
SITUAT

3011
02:28:49,040 --> 02:28:49,320
SITUATION.

3012
02:28:49,320 --> 02:28:50,920
THE PAIN THAT COMES FROM THE 

3013
02:28:50,920 --> 02:28:53,160
STIGMA OF A DIALYSIS PATIENT 

3014
02:28:53,160 --> 02:28:56,320
HAVING TO TELL FRIENDS I WAS ON 

3015
02:28:56,320 --> 02:28:57,520
DIALYSIS AND WATCHING THEIR 

3016
02:28:57,520 --> 02:28:59,200
REACTION GO FROM PITY TO 

3017
02:28:59,200 --> 02:29:01,880
DISAPPEARING OFF THE RADAR.

3018
02:29:01,880 --> 02:29:04,400
I LOST MORE THAN ONE FRIEND THAT

3019
02:29:04,400 --> 02:29:05,040
WAY.

3020
02:29:05,040 --> 02:29:09,040
THERE'S PAIN THAT COMES WITH 

3021
02:29:09,040 --> 02:29:10,840
STARTING YOUR LIFE AT AGE 47 

3022
02:29:10,840 --> 02:29:17,520
WITH A CHRONIC ILLNESS, NO JOB, 

3023
02:29:17,520 --> 02:29:20,520
INCOME OR HEALTH INSURANCE AND 

3024
02:29:20,520 --> 02:29:21,720
THE SYSTEM THAT IS SUPPOSED TO 

3025
02:29:21,720 --> 02:29:24,360
RELIEF PAIN DOES THE OPPOSITE.

3026
02:29:24,360 --> 02:29:25,960
THERE'S UNANECDOTE I WILL NEVER 

3027
02:29:25,960 --> 02:29:29,480
FORGET WHEN AT THE END OF MY 

3028
02:29:29,480 --> 02:29:30,640
SESSION, SOMETIMES ON OCCASION 

3029
02:29:30,640 --> 02:29:36,000
AT THE END OF A SESSION, THE 

3030
02:29:36,000 --> 02:29:38,920
PERSON'S HEART WILL CONTINUE TO 

3031
02:29:38,920 --> 02:29:39,280
RACE.

3032
02:29:39,280 --> 02:29:43,000
MY HEART RATE WAS AT ABOUT 135.

3033
02:29:43,000 --> 02:29:44,840
THE ONLY RESOLUTION FOR THAT IS 

3034
02:29:44,840 --> 02:29:47,680
TO WAIT FOR IT TO COME DOWN.

3035
02:29:47,680 --> 02:29:49,880
THAT HAPPENED TO ME MORE THAN 

3036
02:29:49,880 --> 02:29:59,280
ONCE BUT THIS ONE TIME A NURSE 

3037
02:29:59,280 --> 02:30:00,560
SAID MAYBE THAT WOULDN'T HAPPEN 

3038
02:30:00,560 --> 02:30:02,280
IF YOU STOP DOING THE THINGS 

3039
02:30:02,280 --> 02:30:07,280
YOU'RE DOING AND I KNEW SHE WAS 

3040
02:30:07,280 --> 02:30:09,040
INSINUATING I WAS DOING DRUGS 

3041
02:30:09,040 --> 02:30:12,760
AND I WAS NOT AND IT STICKS TO 

3042
02:30:12,760 --> 02:30:15,880
ME TO THIS DAY TO THAT MOMENT 

3043
02:30:15,880 --> 02:30:18,480
WHEN IT WAS MOST VULNERABLE A 

3044
02:30:18,480 --> 02:30:19,080
HEALTH CARE PROFESSIONAL CHOSE 

3045
02:30:19,080 --> 02:30:21,360
TO STICK ANOTHER KNIFE IN ME.

3046
02:30:21,360 --> 02:30:23,600
THAT'S PLAIN WRONG.

3047
02:30:23,600 --> 02:30:26,920
I OFTEN END TO END DIALYSIS 

3048
02:30:26,920 --> 02:30:29,360
EARLY BECAUSE OF PAIN BEFORE IT 

3049
02:30:29,360 --> 02:30:31,360
GOT BETTER AND THAT SORT OF 

3050
02:30:31,360 --> 02:30:33,360
BLUNTS THE EFFECTIVENESS OF THE 

3051
02:30:33,360 --> 02:30:39,320
THERAPY.

3052
02:30:39,320 --> 02:30:42,000
I WAS FORTUNATE TO HAVE A CARE 

3053
02:30:42,000 --> 02:30:44,520
PLAN MEETING SIX MONTHS INTO MY 

3054
02:30:44,520 --> 02:30:46,240
DIALYSIS JOURNEY THAT CHANGED MY

3055
02:30:46,240 --> 02:30:46,680
TRAJECTORY.

3056
02:30:46,680 --> 02:30:49,720
FOR YEARS I THOUGHT THAT WAS MY 

3057
02:30:49,720 --> 02:30:51,480
FIRST CARE PLAN MEETING BUT 

3058
02:30:51,480 --> 02:30:52,960
ACTUALLY IT WAS MY SECOND.

3059
02:30:52,960 --> 02:30:57,360
I WANT TO DO A SHOW AND TELL 

3060
02:30:57,360 --> 02:30:59,920
WEDGE YOU RIGHT NOW.

3061
02:30:59,920 --> 02:31:02,760
THE FIRST WAS IN MARCH OF 2010.

3062
02:31:02,760 --> 02:31:05,720
THIS IS A THREE-PAGE PRINTOUT 

3063
02:31:05,720 --> 02:31:09,360
AND I'M GOING READ ONE SECTION 

3064
02:31:09,360 --> 02:31:14,080
OF IT TO YOU.

3065
02:31:14,080 --> 02:31:15,640
THE PATIENT WILL BE COMPLIANT 

3066
02:31:15,640 --> 02:31:19,360
WITH TX, WHATEVER THAT MEANS, 

3067
02:31:19,360 --> 02:31:21,360
REGIME AND WILL EXPERIENCE 

3068
02:31:21,360 --> 02:31:22,760
LONG-TERM ADAPTATION EVIDENCED 

3069
02:31:22,760 --> 02:31:25,280
BY ONE COMPLETING ALL PRESCRIBED

3070
02:31:25,280 --> 02:31:28,520
DIALYSIS TREATMENTS, TWO, LAB 

3071
02:31:28,520 --> 02:31:29,160
RESULTS INDICATING COMPLIANCE 

3072
02:31:29,160 --> 02:31:34,520
WITH DIET AND MEDICATIONS AND 

3073
02:31:34,520 --> 02:31:35,080
LESSER HOSPITALIZATION.

3074
02:31:35,080 --> 02:31:37,120
THAT MEANT NOTHING TO ME AT THE 

3075
02:31:37,120 --> 02:31:37,720
TIME.

3076
02:31:37,720 --> 02:31:41,160
I SIGNED IT BUT I HAD NO IDEA 

3077
02:31:41,160 --> 02:31:41,680
WHAT IT MEANT.

3078
02:31:41,680 --> 02:31:43,160
IT WASN'T WRITTEN FOR ME BUT FOR

3079
02:31:43,160 --> 02:31:43,520
A SYSTEM.

3080
02:31:43,520 --> 02:31:45,800
IT DIDN'T HELP ME AT ALL.

3081
02:31:45,800 --> 02:31:47,160
VERY FORTUNATELY ABOUT THREE 

3082
02:31:47,160 --> 02:31:50,600
WEEKS AFTER THAT, I HAD A SECOND

3083
02:31:50,600 --> 02:31:53,840
CARE PLAN MEETING THAT ADDRESSED

3084
02:31:53,840 --> 02:31:55,760
SOME SOCIAL ISSUES THAT SHOULD 

3085
02:31:55,760 --> 02:31:59,320
HAVE BEEN TAKEN CARE OF FROM DAY

3086
02:31:59,320 --> 02:32:00,120
ONE.

3087
02:32:00,120 --> 02:32:02,080
I HAVE THAT FEAR AS WELL.

3088
02:32:02,080 --> 02:32:05,400
THIS IS TWO PAGES, 73 WORDS 

3089
02:32:05,400 --> 02:32:06,960
INCLUDING NAMES AND IT ADDRESSED

3090
02:32:06,960 --> 02:32:08,520
WHAT SHOULD HAVE BEEN ADDRESSED 

3091
02:32:08,520 --> 02:32:11,800
WHEN I STARTED DIALYSIS 

3092
02:32:11,800 --> 02:32:13,360
TRANSPORTATION WAS THE FIRST 

3093
02:32:13,360 --> 02:32:13,560
ISSUE.

3094
02:32:13,560 --> 02:32:20,320
ALSO GETTING ME SIGNED UP FOR 

3095
02:32:20,320 --> 02:32:26,440
SSDI, GETTING ME NUTRITION 

3096
02:32:26,440 --> 02:32:29,320
SUPPLEMENTS AND WITH STATE AND 

3097
02:32:29,320 --> 02:32:30,600
NUTRITIONAL SERVICES SO I CAN 

3098
02:32:30,600 --> 02:32:33,960
FOCUS ON GETTING BACK TO WORK.

3099
02:32:33,960 --> 02:32:36,480
THESE ISSUES SHOWED THAT 

3100
02:32:36,480 --> 02:32:38,280
FINALLY, MY CLINIC CARES ABOUT 

3101
02:32:38,280 --> 02:32:38,520
ME.

3102
02:32:38,520 --> 02:32:40,720
I'LL NEVER FORGET AT THE END OF 

3103
02:32:40,720 --> 02:32:42,120
THE MEETING THE CHARGE NURSE 

3104
02:32:42,120 --> 02:32:45,760
SAID, WE CAN HELP YOU WITH THIS 

3105
02:32:45,760 --> 02:32:47,240
DAVID BUT TWO THINGS.

3106
02:32:47,240 --> 02:32:48,080
ONE, YOU'RE NOT GOING TO BE 

3107
02:32:48,080 --> 02:32:49,760
AROUND MUCH LONGER IF YOU DON'T 

3108
02:32:49,760 --> 02:32:54,760
START COMING TO DIALYSIS.

3109
02:32:54,760 --> 02:32:55,720
ALSO, YOU HAVE TO WE CAN HELP 

3110
02:32:55,720 --> 02:32:58,720
YOU BUT YOU HAVE TO DO YOUR 

3111
02:32:58,720 --> 02:32:58,920
PART.

3112
02:32:58,920 --> 02:33:01,040
YOU HAVE TO BE THE CAPTAIN OF 

3113
02:33:01,040 --> 02:33:06,280
YOUR OWN CARE TEAM AND A TOOK 

3114
02:33:06,280 --> 02:33:11,520
THAT TO HEART THAT VERY DAY AND 

3115
02:33:11,520 --> 02:33:14,600
I STOPPED MISSING DIALYSIS 

3116
02:33:14,600 --> 02:33:16,840
TREATMENTS COLD AND I KNEW 

3117
02:33:16,840 --> 02:33:17,520
PEOPLE CARED AND DIDN'T WASTE 

3118
02:33:17,520 --> 02:33:18,280
TIME PUTTING IN THE WORK THAT 

3119
02:33:18,280 --> 02:33:22,480
NEEDED TO BE DONE.

3120
02:33:22,480 --> 02:33:23,840
MONTHS LATER AT THE END OF THAT 

3121
02:33:23,840 --> 02:33:27,600
YEAR I FINALLY DID STOP SMOKING,

3122
02:33:27,600 --> 02:33:29,600
NEW YEAR'S EVE 2010 AND STARTED 

3123
02:33:29,600 --> 02:33:30,440
EXERCISING THE NEXT DAY AND 

3124
02:33:30,440 --> 02:33:32,080
DISCOVERED I COULDN'T DO A 

3125
02:33:32,080 --> 02:33:34,520
SINGLE PUSH-UP AND THAT SET ME 

3126
02:33:34,520 --> 02:33:37,360
ON A MISSION AND THANKS TO 

3127
02:33:37,360 --> 02:33:39,640
EXERCISE, MY PAIN EXPERIENCE 

3128
02:33:39,640 --> 02:33:40,440
IMPROVED.

3129
02:33:40,440 --> 02:33:43,080
IT MADE DIALYSIS MORE BEARABLE 

3130
02:33:43,080 --> 02:33:48,720
AND MADE PAIN -- I TOOK A ROLE 

3131
02:33:48,720 --> 02:33:52,320
IN MANAGING HEALTH PAIN AND 

3132
02:33:52,320 --> 02:33:54,160
INTERACTING WITH THE WAY I 

3133
02:33:54,160 --> 02:33:55,880
APPROACHED MY REHABILITATION.

3134
02:33:55,880 --> 02:33:57,160
EVERY MORNING I WAS ASK MYSELF 

3135
02:33:57,160 --> 02:34:02,120
TWO QUESTIONS.

3136
02:34:02,120 --> 02:34:05,400
ONE, WAS AND THE SECOND QUESTION

3137
02:34:05,400 --> 02:34:08,000
IS AM I PHYSICALLY ABLE TO 

3138
02:34:08,000 --> 02:34:08,840
EXERCISE.

3139
02:34:08,840 --> 02:34:10,880
I HAD TO DO AN INVENTORY OF MY 

3140
02:34:10,880 --> 02:34:12,680
BODY PARTS TO DO WHAT WAS 

3141
02:34:12,680 --> 02:34:14,720
HURTING AND WHAT WASN'T AND IF 

3142
02:34:14,720 --> 02:34:16,120
SOMETHING WAS HURTING TO JUST 

3143
02:34:16,120 --> 02:34:18,760
NOT EXERCISE THAT DAY AND I WAS 

3144
02:34:18,760 --> 02:34:29,280
VERY CONSCIENTIOUS ABOUT THAT.

3145
02:34:48,720 --> 02:34:52,280
AT SOME POINT THAT MORNING I 

3146
02:34:52,280 --> 02:34:55,320
SAID I KIND OF FEEL OKAY TODAY 

3147
02:34:55,320 --> 02:34:58,120
AND IT TOOK ME A WHILE TO FIGURE

3148
02:34:58,120 --> 02:35:01,360
OUT WHY AND I THOUGHT OH, I'M 

3149
02:35:01,360 --> 02:35:11,560
NOT IN PAIN.

3150
02:35:12,120 --> 02:35:15,080
AND THERE WAS A MINDFULNESS AND 

3151
02:35:15,080 --> 02:35:17,400
DEEP BREATHING STUDY THAT 

3152
02:35:17,400 --> 02:35:19,160
REQUIRED IN-CENTER 

3153
02:35:19,160 --> 02:35:19,480
PARTICIPATION.

3154
02:35:19,480 --> 02:35:22,280
UNFORTUNATELY, THAT PART DIDN'T 

3155
02:35:22,280 --> 02:35:23,680
WORK OUT FOR ME BECAUSE I 

3156
02:35:23,680 --> 02:35:27,120
COULDN'T GET WITH THE IDEA OF 

3157
02:35:27,120 --> 02:35:29,560
RELAXING AND CLOSING MY EYES AND

3158
02:35:29,560 --> 02:35:31,520
FOCUSSING ON BODY PARTS.

3159
02:35:31,520 --> 02:35:35,560
ONE OF THEM BEING AN ARM WITH 

3160
02:35:35,560 --> 02:35:38,960
TWO .16 GAUGE NEEDLES STUCK IN 

3161
02:35:38,960 --> 02:35:39,280
ME.

3162
02:35:39,280 --> 02:35:41,920
THAT DIDN'T WORK OUT FOR ME.

3163
02:35:41,920 --> 02:35:46,240
AS THE PAIN ADVISER FOR THE HOPE

3164
02:35:46,240 --> 02:35:47,440
CONSORTIUM IT'S BEEN A BETTER 

3165
02:35:47,440 --> 02:35:55,400
EXPERIENCE AS AN ADVISER.

3166
02:35:55,400 --> 02:36:05,960
HEMODIALYSIS THE EXPERIENCE WE 

3167
02:36:05,960 --> 02:36:07,640
BRING IS REWARDING NOT ONLY TO 

3168
02:36:07,640 --> 02:36:09,360
OURSELVES BUT TO EVERY ASPECT OF

3169
02:36:09,360 --> 02:36:12,520
THE STUDY.

3170
02:36:12,520 --> 02:36:15,280
TRIAL DESIGN AND DEFINITELY 

3171
02:36:15,280 --> 02:36:17,400
RECRUITMENT AND MOST IMPORTANTLY

3172
02:36:17,400 --> 02:36:18,520
REAL CAMARADERIE.

3173
02:36:18,520 --> 02:36:19,640
WE KNOW WE'RE NOT JUST 

3174
02:36:19,640 --> 02:36:19,960
SPECTATORS.

3175
02:36:19,960 --> 02:36:21,360
WE HAVE REAL INPUT AND WE TAKE 

3176
02:36:21,360 --> 02:36:29,360
ADVANTAGE OF THAT OPPORTUNITY.

3177
02:36:29,360 --> 02:36:33,000
IN SUMMARY I'D LIKE TO SAY A 

3178
02:36:33,000 --> 02:36:36,040
WHOLE PARTNER APPROACH REQUIRES 

3179
02:36:36,040 --> 02:36:38,360
PARTNERING WITH THE TEAM AND 

3180
02:36:38,360 --> 02:36:39,360
FAMILY IN THE PROCESS AND IF YOU

3181
02:36:39,360 --> 02:36:41,760
GIVE US THE OPPORTUNITY, 

3182
02:36:41,760 --> 02:36:43,640
RESOURCES AND SUPPORT WE WILL 

3183
02:36:43,640 --> 02:36:44,080
NOT DISAPPOINT YOU.

3184
02:36:44,080 --> 02:36:45,360
THANK YOU VERY MUCH FOR 

3185
02:36:45,360 --> 02:36:48,560
LISTENING.

3186
02:36:48,560 --> 02:36:53,960
 THANK YOU, DAVID FOR SHARING 

3187
02:36:53,960 --> 02:37:00,560
YOUR STORY.

3188
02:37:00,560 --> 02:37:03,280
AND SERVING THE PATIENTS ON THE 

3189
02:37:03,280 --> 02:37:03,720
ADVISORY BOARD.

3190
02:37:03,720 --> 02:37:11,760
THIS IS AN IMPORTANT PART OF THE

3191
02:37:11,760 --> 02:37:15,080
PAIN MANAGEMENT TO TEACH US WHAT

3192
02:37:15,080 --> 02:37:16,040
MATTERS MOST FROM THE PATIENT 

3193
02:37:16,040 --> 02:37:16,480
PERSPECTIVE.

3194
02:37:16,480 --> 02:37:21,120
IT'S MY PLEASURE TO INTRODUCE 

3195
02:37:21,120 --> 02:37:22,440
DR. ARDITH DOORENBOOS FROM 

3196
02:37:22,440 --> 02:37:26,160
UNIVERSITY OF ILLINOIS-CHICAGO.

3197
02:37:26,160 --> 02:37:28,240
SHE IS A PROFESSOR IN THE 

3198
02:37:28,240 --> 02:37:29,840
DEPARTMENT OF BIO BEHAVIORAL 

3199
02:37:29,840 --> 02:37:32,280
NURSING SCIENCE, COGNITIVE 

3200
02:37:32,280 --> 02:37:35,280
NURSING AT UNIVERSITY OF 

3201
02:37:35,280 --> 02:37:36,160
ILLINOIS-CHICAGO AND FELLOW OF 

3202
02:37:36,160 --> 02:37:39,720
THE AMERICAN ACADEMY OF NURSING.

3203
02:37:39,720 --> 02:37:45,360
DR. DOORENBOOS WAS INDUCTED IN 

3204
02:37:45,360 --> 02:37:49,960
THE SIGMA BETA TAO HALL OF FAME 

3205
02:37:49,960 --> 02:37:55,400
AND HER RESEARCH IS CENTERED ON 

3206
02:37:55,400 --> 02:37:58,760
PAIN AND SYMPTOM MANAGEMENT.

3207
02:37:58,760 --> 02:38:01,360
THE FLOOR IS YOURS.

3208
02:38:01,360 --> 02:38:08,720
>> THANK YOU SO MUCH.

3209
02:38:08,720 --> 02:38:11,080
I WANT TO THANK THE NIH FOR THE 

3210
02:38:11,080 --> 02:38:11,800
KIND INVITATION TO PRESENT TO 

3211
02:38:11,800 --> 02:38:14,960
YOU AS PART OF THE ENGAGING 

3212
02:38:14,960 --> 02:38:16,720
STAKEHOLDERS AND IMPLEMENTATION 

3213
02:38:16,720 --> 02:38:19,360
OF APPROACHES TO PAIN 

3214
02:38:19,360 --> 02:38:20,600
MANAGEMENT.

3215
02:38:20,600 --> 02:38:22,240
I'M ESPECIALLY THRILLED TO 

3216
02:38:22,240 --> 02:38:24,360
FOLLOW AFTER DAVID BECAUSE HE 

3217
02:38:24,360 --> 02:38:27,600
REALLY THE STAGE OF WHAT WE'RE 

3218
02:38:27,600 --> 02:38:28,200
TALKING ABOUT IN THIS PANEL 

3219
02:38:28,200 --> 02:38:32,600
TODAY.

3220
02:38:32,600 --> 02:38:35,480
I WANT TO TAKE A MOMENT TO HONOR

3221
02:38:35,480 --> 02:38:37,040
THE LAND WE ALL LIVE AND WORK 

3222
02:38:37,040 --> 02:38:37,240
ON.

3223
02:38:37,240 --> 02:38:42,080
I ACKNOWLEDGE I'M CURRENTLY IN 

3224
02:38:42,080 --> 02:38:47,520
MICHIGAN NAMED FOR MICHIGAMI IN 

3225
02:38:47,520 --> 02:38:50,880
THE HURON WATERSHED AND WHAT HAS

3226
02:38:50,880 --> 02:38:56,160
GROWN THROUGH THE CONNECTIONS OF

3227
02:38:56,160 --> 02:39:01,200
THE LAND BY THE PEOPLE ALONG 

3228
02:39:01,200 --> 02:39:11,880
WITH THEIR NEIGHBORS AND THE 

3229
02:39:20,320 --> 02:39:24,080
FUNDING I RECEIVED IS A K24 IN 

3230
02:39:24,080 --> 02:39:31,280
TRAINING IN NON-OPIOID OPTIONS 

3231
02:39:31,280 --> 02:39:33,000
AND TWO DIFFERENT PROJECTS 

3232
02:39:33,000 --> 02:39:34,920
THROUGH CLINICAL AND PAIN 

3233
02:39:34,920 --> 02:39:36,160
MANAGEMENT ONE YOU HEARD ABOUT 

3234
02:39:36,160 --> 02:39:38,480
INTEGRATING APPROACHES TO PAIN 

3235
02:39:38,480 --> 02:39:41,640
AND OPIOID USE IN HEMODIALYSIS 

3236
02:39:41,640 --> 02:39:45,280
PATIENTS WHICH IS AN UL 1 AND 

3237
02:39:45,280 --> 02:39:46,560
SOMETHING I'LL TALK MORE ABOUT A

3238
02:39:46,560 --> 02:39:50,000
LITTLE LATER ON IS THROUGH THE 

3239
02:39:50,000 --> 02:39:51,480
PRAGMATIC AND IMPLEMENTATION 

3240
02:39:51,480 --> 02:39:53,720
STUDIES FOR THE MANAGEMENT OF 

3241
02:39:53,720 --> 02:39:57,240
PAIN A UH3 MECHANISM AND I'LL BE

3242
02:39:57,240 --> 02:39:59,920
TALKING ABOUT THE HYBRID 

3243
02:39:59,920 --> 02:40:00,520
EFFECTIVENESS IMPLEMENTATION 

3244
02:40:00,520 --> 02:40:06,720
TRIAL OF GUIDED RELAXATION AND 

3245
02:40:06,720 --> 02:40:13,600
ACUPUNCTURE FOR CHRONIC SICKLE 

3246
02:40:13,600 --> 02:40:14,360
CELL DISEASE PAIN.

3247
02:40:14,360 --> 02:40:17,760
WE FIRST NEED TO COME TO AN 

3248
02:40:17,760 --> 02:40:19,640
UNDERSTANDING THAT PAIN IS 

3249
02:40:19,640 --> 02:40:19,880
COMPLEX.

3250
02:40:19,880 --> 02:40:24,120
I FEEL HERE I'M TALKING TO THE 

3251
02:40:24,120 --> 02:40:24,320
CHOIR.

3252
02:40:24,320 --> 02:40:27,520
WE KNOW THAT PAIN IS BOTH A 

3253
02:40:27,520 --> 02:40:29,520
SENSORY AND AN EMOTIONAL 

3254
02:40:29,520 --> 02:40:30,280
EXPERIENCE.

3255
02:40:30,280 --> 02:40:33,280
PAIN CAN BE AN ALARM OF DANGER 

3256
02:40:33,280 --> 02:40:35,960
AND/OR A SIGNAL OF DAMAGE.

3257
02:40:35,960 --> 02:40:39,400
AS SUCH, PAIN ALERTS THE 

3258
02:40:39,400 --> 02:40:42,280
INDIVIDUAL OF THREATENING 

3259
02:40:42,280 --> 02:40:44,880
INTERNAL AND EXTERNAL 

3260
02:40:44,880 --> 02:40:47,240
ENVIRONMENTAL DANGERS AND 

3261
02:40:47,240 --> 02:40:49,400
PERFORMS THE ESSENTIAL LIFE 

3262
02:40:49,400 --> 02:40:52,480
FUNCTION OF SIGNALLING NEED FOR 

3263
02:40:52,480 --> 02:40:53,280
PROTECTION.

3264
02:40:53,280 --> 02:40:56,080
THE PAIN ALARM MAY SOUND IN 

3265
02:40:56,080 --> 02:40:59,800
RESPONSE TO ACTUAL DANGER OR MAY

3266
02:40:59,800 --> 02:41:02,440
ACTIVATE IN ANTICIPATION OF 

3267
02:41:02,440 --> 02:41:02,680
DANGER.

3268
02:41:02,680 --> 02:41:07,360
AND EVEN IF DAMAGE CAN'T BE D

3269
02:41:07,360 --> 02:41:17,880
DEMONSTRATED WITH A PHYSICAL 

3270
02:41:18,120 --> 02:41:20,560
EXAM PAIN IS A PHYSICAL 

3271
02:41:20,560 --> 02:41:21,000
EXPERIENCE.

3272
02:41:21,000 --> 02:41:23,760
PAIN AFFECTS ALL ASPECTS OF A 

3273
02:41:23,760 --> 02:41:24,120
PERSON'S LIFE.

3274
02:41:24,120 --> 02:41:27,560
I WANT TO ACKNOWLEDGE THE NIH 

3275
02:41:27,560 --> 02:41:30,720
FOR FOCUSSING THIS YEAR ON THE 

3276
02:41:30,720 --> 02:41:32,640
WHOLE PERSON HEALTH.

3277
02:41:32,640 --> 02:41:33,920
BECAUSE PAIN REALLY IS 

3278
02:41:33,920 --> 02:41:42,360
MULTI-DIMENSIONAL.

3279
02:41:42,360 --> 02:41:46,480
ESPECIALLY WHEN IT'S CHRONIC 

3280
02:41:46,480 --> 02:41:51,520
PAIN IT TAKES A TOLL AN AN 

3281
02:41:51,520 --> 02:41:53,160
INDIVIDUAL'S LIFE, FUNCTION AND 

3282
02:41:53,160 --> 02:41:55,000
EMOTIONAL STATUS AND LIFE.

3283
02:41:55,000 --> 02:41:56,920
YOU MAY SEE SUFFERING IN 

3284
02:41:56,920 --> 02:41:59,440
RESPONSE TO THE EXPERIENCE OF 

3285
02:41:59,440 --> 02:42:01,840
DIMINISHED CAPACITY AND NEGATIVE

3286
02:42:01,840 --> 02:42:04,480
THOUGHTS AND FEELINGS, 

3287
02:42:04,480 --> 02:42:05,440
HELPLESSNESS, HOPELESSNESS, 

3288
02:42:05,440 --> 02:42:13,160
DESPAIR.

3289
02:42:13,160 --> 02:42:15,160
PAIN CAN BE SOCIALLY DEVASTATING

3290
02:42:15,160 --> 02:42:19,240
LEADING TO LOSS OF JOB, LOSS OF 

3291
02:42:19,240 --> 02:42:23,680
PLAY, ENSTRANGEMENT FROM FAMILY 

3292
02:42:23,680 --> 02:42:25,240
AND FRIENDS AND LOSS OF 

3293
02:42:25,240 --> 02:42:26,440
INTIMACY.

3294
02:42:26,440 --> 02:42:29,840
SO WHY IS THIS IMPORTANT TO 

3295
02:42:29,840 --> 02:42:30,120
KNOW?

3296
02:42:30,120 --> 02:42:31,480
AND WHY HAVE WE BEEN SPENDING 

3297
02:42:31,480 --> 02:42:37,560
TWO DAYS FOCUSSING ON THIS?

3298
02:42:37,560 --> 02:42:39,880
ONCE KNOWN WE CAN THEN 

3299
02:42:39,880 --> 02:42:40,920
MEANINGFULLY INCLUDE ALL THE 

3300
02:42:40,920 --> 02:42:43,040
SKILLS AND EXPERIENCE OF THOSE 

3301
02:42:43,040 --> 02:42:45,400
OTHER HEALTH PROFESSIONALS 

3302
02:42:45,400 --> 02:42:46,160
ESPECIALLY SKILLED TO ADDRESS 

3303
02:42:46,160 --> 02:42:47,760
THESE DOMAINS.

3304
02:42:47,760 --> 02:42:50,360
AND FOR PATIENTS, THE KNOWLEDGE 

3305
02:42:50,360 --> 02:42:51,560
THAT A WHOLE PERSON APPROACH IS 

3306
02:42:51,560 --> 02:42:54,760
NEEDED FOR PAIN.

3307
02:42:54,760 --> 02:42:58,000
WE JUST ARE NOT ABLE TO JUST 

3308
02:42:58,000 --> 02:42:59,360
FOCUS ON ONE PIECE.

3309
02:42:59,360 --> 02:43:01,240
WE NEED TO LOOK AT THE WHOLE 

3310
02:43:01,240 --> 02:43:09,240
PERSON.

3311
02:43:09,240 --> 02:43:13,840
SO THE RECOMMENDATIONS FOR 

3312
02:43:13,840 --> 02:43:15,520
ADDRESSING COMPLEX CHRONIC PAIN 

3313
02:43:15,520 --> 02:43:18,360
ARE INTEGRATED APPROACHES THAT 

3314
02:43:18,360 --> 02:43:21,240
PRIORITIZE NON-PHARMACOLOGIC 

3315
02:43:21,240 --> 02:43:22,360
THERAPY.

3316
02:43:22,360 --> 02:43:24,640
BUT HOW DO WE GET BUY-IN FOR 

3317
02:43:24,640 --> 02:43:26,800
THIS TYPE OF RESEARCH?

3318
02:43:26,800 --> 02:43:29,240
AND WE DO THAT BY ENGAGING 

3319
02:43:29,240 --> 02:43:32,320
STAKEHOLDERS.

3320
02:43:32,320 --> 02:43:35,720
THERE ARE A VARIETY OF 

3321
02:43:35,720 --> 02:43:37,680
STAKEHOLDERS INCLUDING INSURANCE

3322
02:43:37,680 --> 02:43:41,280
AGENCIES, GOVERNMENT, HEALTH 

3323
02:43:41,280 --> 02:43:43,880
CARE ADMINISTRATORS, CLINICIANS,

3324
02:43:43,880 --> 02:43:45,280
PATIENTS, FAMILY CAREGIVERS TO 

3325
02:43:45,280 --> 02:43:51,920
JUST NAME A FEW.

3326
02:43:51,920 --> 02:43:54,120
FOR TODAY'S PRESENTATION I'M 

3327
02:43:54,120 --> 02:43:55,720
GOING TO FOCUS ON THE PATIENT 

3328
02:43:55,720 --> 02:43:56,360
STAKEHOLDER ENGAGEMENT ON SOME 

3329
02:43:56,360 --> 02:44:06,640
OF THESE STUDIES.

3330
02:44:08,720 --> 02:44:10,600
WHY SHOULD WE ENGAGE 

3331
02:44:10,600 --> 02:44:10,920
STAKEHOLDERS?

3332
02:44:10,920 --> 02:44:11,600
WHAT'S THE IMPORTANCE HERE?

3333
02:44:11,600 --> 02:44:14,480
THE IMPORTANCE IS IF YOU DON'T, 

3334
02:44:14,480 --> 02:44:15,040
THERE ARE DISPARITIES THAT 

3335
02:44:15,040 --> 02:44:25,160
EMERGE.

3336
02:44:29,160 --> 02:44:30,000
AND THROUGH COLLABORATION AND 

3337
02:44:30,000 --> 02:44:31,960
DECISION MAKING THROUGH 

3338
02:44:31,960 --> 02:44:33,160
IMPLEMENTATION AND 

3339
02:44:33,160 --> 02:44:34,000
DISSEMINATION.

3340
02:44:34,000 --> 02:44:37,240
YOU HAVE A MUCH MORE RICHER 

3341
02:44:37,240 --> 02:44:42,200
EVIDENCE BASE AND YOU BUILD 

3342
02:44:42,200 --> 02:44:45,240
TRUST WITH THE POPULATION YOU 

3343
02:44:45,240 --> 02:44:49,640
WANT TO IMPROVE THE QUALITY OF 

3344
02:44:49,640 --> 02:44:49,920
LIFE FOR.

3345
02:44:49,920 --> 02:44:52,680
FOR THE PURPOSES OF THIS PANEL 

3346
02:44:52,680 --> 02:44:56,920
DISCUSSION I'VE CHOSEN TWO 

3347
02:44:56,920 --> 02:45:01,000
EXAMPLES OF PATIENT STAKEHOLDER 

3348
02:45:01,000 --> 02:45:02,320
ENGAGEMENT.

3349
02:45:02,320 --> 02:45:04,600
FIRST, THERE'S INPUT INTO 

3350
02:45:04,600 --> 02:45:09,520
INTERVENTION CHOICE FOR THE 

3351
02:45:09,520 --> 02:45:20,000
GRACE TRIAL WHICH IS TRIAL 

3352
02:45:21,480 --> 02:45:23,000
FOCUSSING ON SICKLE CELL DISEASE

3353
02:45:23,000 --> 02:45:26,720
AND THEY LOOKED AT 68 ADULTS 

3354
02:45:26,720 --> 02:45:27,360
WITH SICKLE CELL DISEASE 

3355
02:45:27,360 --> 02:45:28,400
ATTENDING THE CLINIC.

3356
02:45:28,400 --> 02:45:30,720
WE HONESTLY SAT WITH THEM IN THE

3357
02:45:30,720 --> 02:45:35,920
WAITING ROOM WHILE THEY WERE 

3358
02:45:35,920 --> 02:45:37,560
WAITING TO BE BROUGHT INTO THE 

3359
02:45:37,560 --> 02:45:39,120
CLINIC ROOM AND TALK TO THEM AND

3360
02:45:39,120 --> 02:45:45,240
SAID TELL US ABOUT YOUR PAIN 

3361
02:45:45,240 --> 02:45:45,560
EXPERIENCE.

3362
02:45:45,560 --> 02:45:48,720
DO YOU HAVE PAIN TODAY.

3363
02:45:48,720 --> 02:45:51,520
WE SAID, WHAT WE WOULD LIKE TO 

3364
02:45:51,520 --> 02:45:54,880
DO IS HELP WORK WITH YOU HAND IN

3365
02:45:54,880 --> 02:45:57,880
HAND ABOUT HOW WE CAN MAYBE HELP

3366
02:45:57,880 --> 02:45:59,400
WITH SOME OF THIS PAIN.

3367
02:45:59,400 --> 02:46:03,160
WHAT ARE SOME INTERVENTIONS THAT

3368
02:46:03,160 --> 02:46:06,640
YOU MIGHT BE INTERESTED IN 

3369
02:46:06,640 --> 02:46:07,880
TRYING OUT FOR YOUR PAIN?

3370
02:46:07,880 --> 02:46:13,720
FROM THAT WORK WITH THE PATIENTS

3371
02:46:13,720 --> 02:46:14,800
SITTING IN THE SICKLE CELL 

3372
02:46:14,800 --> 02:46:16,440
CLINIC WE FOUND RELAXATION OR 

3373
02:46:16,440 --> 02:46:19,280
MEDICATION AND ACUPUNCTURE WERE 

3374
02:46:19,280 --> 02:46:21,400
TWO INTERVENTIONS THAT THEY WERE

3375
02:46:21,400 --> 02:46:28,080
INTERESTED IN TRYING OUT.

3376
02:46:28,080 --> 02:46:29,360
AND WE'LL TALK ABOUT THE 

3377
02:46:29,360 --> 02:46:31,280
PRIVILEGE WE HAVE OF ONGOING 

3378
02:46:31,280 --> 02:46:33,920
PARTNERSHIP WITH TWO DIFFERENT 

3379
02:46:33,920 --> 02:46:39,760
GROUPS OF PATIENT STAKEHOLDERS.

3380
02:46:39,760 --> 02:46:41,160
AND THE FIRST GROUP THAT I'D 

3381
02:46:41,160 --> 02:46:44,360
LIKE TO INTRODUCE YOU TO IS THE 

3382
02:46:44,360 --> 02:46:45,320
PATIENT BRIGADE.

3383
02:46:45,320 --> 02:46:49,280
AND THIS CAME ABOUT AS AN 

3384
02:46:49,280 --> 02:46:52,160
INSPIRATION OF THE PATIENTS.

3385
02:46:52,160 --> 02:46:54,760
PATIENT STAKEHOLDER INITIATIVE 

3386
02:46:54,760 --> 02:46:59,240
CREATED TO REFLECT THE DIVERSE 

3387
02:46:59,240 --> 02:46:59,880
SOCIO ECONOMIC GROUPS IN THE 

3388
02:46:59,880 --> 02:47:02,080
CHICAGO AREA.

3389
02:47:02,080 --> 02:47:04,360
AND THE MISSION OF THE PATIENT 

3390
02:47:04,360 --> 02:47:06,880
BRIGADE IS TO PROVIDE AN ACTIVE 

3391
02:47:06,880 --> 02:47:09,280
VOICE TO PATIENTS AND 

3392
02:47:09,280 --> 02:47:10,520
COMMUNITIES AND IT'S GUIDED BY 

3393
02:47:10,520 --> 02:47:12,840
THE PRINCIPLES OF 

3394
02:47:12,840 --> 02:47:15,520
COMMUNITY-BASED PARTICIPATORY 

3395
02:47:15,520 --> 02:47:15,760
RESEARCH.

3396
02:47:15,760 --> 02:47:19,520
AND THE CREATION BRIGADE WALKS 

3397
02:47:19,520 --> 02:47:20,600
SIDE BY SIDE WITH US REVIEWING 

3398
02:47:20,600 --> 02:47:23,520
PATIENT RECRUITMENT MATERIALS, 

3399
02:47:23,520 --> 02:47:27,920
PROVIDING ADVICE ON IMPROVING 

3400
02:47:27,920 --> 02:47:29,200
RATES AND DISSEMINATING 

3401
02:47:29,200 --> 02:47:34,160
INFORMATION ABOUT RESEARCH 

3402
02:47:34,160 --> 02:47:44,600
RESULTS TO THE COMMUNITY.

3403
02:47:45,320 --> 02:47:51,480
CITIZEN SCIENTISTS UNDERTAKE THE

3404
02:47:51,480 --> 02:48:02,040
WORK AND SERVE ON OUR AND LOOK 

3405
02:48:09,160 --> 02:48:15,360
AT MEASUREMENT TOOLS AND DESIGN 

3406
02:48:15,360 --> 02:48:17,560
CHANG

3407
02:48:17,560 --> 02:48:20,520
CHANGES AND HAVING AN ACTIVE 

3408
02:48:20,520 --> 02:48:22,960
VOICE IN ALL PHASES OF RESEARCH 

3409
02:48:22,960 --> 02:48:26,280
IS A KEY FACTOR TO ENSURING NOT 

3410
02:48:26,280 --> 02:48:29,400
ONLY DIVERSITY AND INCLUSIVENESS

3411
02:48:29,400 --> 02:48:32,640
IN CLINICAL TRIALS BUT ALSO IN 

3412
02:48:32,640 --> 02:48:33,800
EXPANDING THE RESEARCH OF 

3413
02:48:33,800 --> 02:48:42,480
CUTTING-EDGE DISCOVERIES.

3414
02:48:42,480 --> 02:48:44,880
TO THE CITIZEN SCIENTISTS WERE 

3415
02:48:44,880 --> 02:48:45,480
INSTRUMENTAL IN RECOMMENDING 

3416
02:48:45,480 --> 02:48:55,760
DESIGN CHANGES.

3417
02:49:06,120 --> 02:49:08,360
AND WE CAME UP WITH USING THE 

3418
02:49:08,360 --> 02:49:11,320
DESIGN WHICH WAS CALLED THE 

3419
02:49:11,320 --> 02:49:14,480
SMART DESIGN WHICH IS SEQUENTIAL

3420
02:49:14,480 --> 02:49:16,000
MULTIPLE ASSIGNMENT 

3421
02:49:16,000 --> 02:49:18,880
RANDOMIZATION.

3422
02:49:18,880 --> 02:49:20,520
AND WHAT HAPPENS IS THAT IT 

3423
02:49:20,520 --> 02:49:23,120
CONSIDERED SOME OF THE REAL 

3424
02:49:23,120 --> 02:49:26,960
WORLD CLINICAL SITUATIONS.

3425
02:49:26,960 --> 02:49:29,240
FOR EXAMPLE, IF I'M SEEING 

3426
02:49:29,240 --> 02:49:30,560
SOMEONE IN CLINIC AND THEY'RE 

3427
02:49:30,560 --> 02:49:32,800
HAVING PAIN, WHAT I WOULD SAY TO

3428
02:49:32,800 --> 02:49:35,200
THEM IS YOU KNOW, FOR A NUMBER 

3429
02:49:35,200 --> 02:49:38,160
OF PEOPLE LIKE YOU, ACUPUNCTURE 

3430
02:49:38,160 --> 02:49:40,040
HAS WORKED VERY WELL AND THEN I 

3431
02:49:40,040 --> 02:49:41,240
DESCRIBE A LITTLE BIT ABOUT 

3432
02:49:41,240 --> 02:49:41,640
THAT.

3433
02:49:41,640 --> 02:49:43,600
DO YOU THINK THAT MIGHT BE OF 

3434
02:49:43,600 --> 02:49:45,400
INTEREST TO YOU?

3435
02:49:45,400 --> 02:49:46,520
AND IF THE PERSON SAYS YES, I 

3436
02:49:46,520 --> 02:49:48,320
SAY, OKAY, WELL, WHY DON'T WE 

3437
02:49:48,320 --> 02:49:51,480
GIVE IT A TRY FOR FIVE, SIX 

3438
02:49:51,480 --> 02:49:52,680
WEEKS AND AT YOUR NEXT 

3439
02:49:52,680 --> 02:49:55,520
APPOINTMENT WE'LL TAKE A LOOK AT

3440
02:49:55,520 --> 02:49:55,720
IT GIN.

3441
02:49:55,720 --> 02:49:56,160
-- AGAIN.

3442
02:49:56,160 --> 02:49:57,960
SO IN SIX WEEKS WHEN THEY COME 

3443
02:49:57,960 --> 02:49:59,120
BACK FOR THEIR FOLLOW-UP 

3444
02:49:59,120 --> 02:50:01,800
APPOINTMENT WHAT I DO IS SAY, SO

3445
02:50:01,800 --> 02:50:02,720
HOW ARE YOU DOING AND CHECK IN 

3446
02:50:02,720 --> 02:50:03,840
ON THEIR PAIN.

3447
02:50:03,840 --> 02:50:06,440
IF THEY'RE PAIN HAS IMPROVED I 

3448
02:50:06,440 --> 02:50:08,800
SAY HALLELUJAH.

3449
02:50:08,800 --> 02:50:10,800
THIS IS WORKING.

3450
02:50:10,800 --> 02:50:13,040
IF IT ISN'T, I'LL SAY MAYBE WE 

3451
02:50:13,040 --> 02:50:18,320
NEED TO TRY THIS A LITTLE BIT 

3452
02:50:18,320 --> 02:50:24,040
LONGER OR IT'S ADAPTIVE AND 

3453
02:50:24,040 --> 02:50:26,120
THAT'S WHAT THE SMART DESIGN 

3454
02:50:26,120 --> 02:50:26,600
DOES.

3455
02:50:26,600 --> 02:50:32,760
IT IS ADAPTIVE BASED ON THE 

3456
02:50:32,760 --> 02:50:37,320
PATIENT'S RESPONSE.

3457
02:50:37,320 --> 02:50:40,680
THEY ALSO HELP US WITH MODIFYING

3458
02:50:40,680 --> 02:50:41,320
OUR DESIGN.

3459
02:50:41,320 --> 02:50:43,400
SO THIS IS OUR ORIGINAL DESIGN 

3460
02:50:43,400 --> 02:50:53,480
WE HAD AND YOU CAN SEE AT THE 

3461
02:50:53,480 --> 02:50:56,680
BEGINNING WE HAD ACUPUNCTURE OR 

3462
02:50:56,680 --> 02:50:58,080
CARE IN THE SICKLE CELL CLINIC.

3463
02:50:58,080 --> 02:51:00,840
THEN AT THE SIX-WEEK POINT WHEN 

3464
02:51:00,840 --> 02:51:05,800
THEY COME INTO THE CLINIC VISIT 

3465
02:51:05,800 --> 02:51:07,960
AGAIN IF THEIR PAIN HASN'T 

3466
02:51:07,960 --> 02:51:10,000
IMPROVED, THEN WHAT WE WERE 

3467
02:51:10,000 --> 02:51:11,960
DOING IS EITHER RANDOMIZING TO 

3468
02:51:11,960 --> 02:51:17,800
THE OTHER INTERVENTION OR ADDING

3469
02:51:17,800 --> 02:51:19,760
AND OUR CITIZEN SCIENTISTS SAID 

3470
02:51:19,760 --> 02:51:21,920
IT'S TOO MUCH TO DO 

3471
02:51:21,920 --> 02:51:23,360
INTERVENTIONS THAT MUCH.

3472
02:51:23,360 --> 02:51:27,000
MY LIFE IS SO DIFFICULT AS IT IS

3473
02:51:27,000 --> 02:51:30,360
ADDING TWO INTERVENTIONS REALLY 

3474
02:51:30,360 --> 02:51:31,920
IS GOING TO BE SO MUCH.

3475
02:51:31,920 --> 02:51:32,640
TOO MUCH.

3476
02:51:32,640 --> 02:51:38,080
SO IN WORK WITH THEM A LITTLE 

3477
02:51:38,080 --> 02:51:48,600
BIT MORE WE CAME UP WITH THE 

3478
02:51:48,880 --> 02:51:50,480
FINAL DESIGN SO IF AT SIX WEEKS 

3479
02:51:50,480 --> 02:51:52,440
WE COME UP WITH THE SAME 

3480
02:51:52,440 --> 02:51:54,200
INTERVENTION TO SEE IF THERE'S 

3481
02:51:54,200 --> 02:51:56,480
AN ABILITY TO GET A BETTER 

3482
02:51:56,480 --> 02:51:57,840
RESPONSE WITH A LARGER DOSE OR 

3483
02:51:57,840 --> 02:51:58,280
SWITCH TO THE OTHER 

3484
02:51:58,280 --> 02:52:08,520
INTERVENTION.

3485
02:52:11,120 --> 02:52:11,520
THO

3486
02:52:11,520 --> 02:52:13,760
THESE ARE A FOCUS ON 

3487
02:52:13,760 --> 02:52:14,640
PATIENT-ENGAGEMENT AND OUR TWO 

3488
02:52:14,640 --> 02:52:17,160
DIFFERENT GROUPS OF ADVISORS OR 

3489
02:52:17,160 --> 02:52:19,160
STAKEHOLDERS HAVE INFORMED THIS 

3490
02:52:19,160 --> 02:52:22,720
PARTICULAR STUDY AND HOW THIS 

3491
02:52:22,720 --> 02:52:26,840
HAS BEEN SUCH A MUCH BETTER 

3492
02:52:26,840 --> 02:52:29,440
PATIENT-FOCUSSED STUDY NOW 

3493
02:52:29,440 --> 02:52:31,160
BECAUSE OF THE RICH WONDERFUL 

3494
02:52:31,160 --> 02:52:38,280
INPUT WE HAVE HAD FROM OUR 

3495
02:52:38,280 --> 02:52:39,080
PATIENTS.

3496
02:52:39,080 --> 02:52:40,360
THANK YOU SO MUCH AND I LOOK 

3497
02:52:40,360 --> 02:52:42,120
FORWARD TO QUESTIONS AND ONGOING

3498
02:52:42,120 --> 02:52:44,800
DIALOGUE AFTER THE REST OF OUR 

3499
02:52:44,800 --> 02:52:50,800
PRESENTATIONS.

3500
02:52:50,800 --> 02:52:56,200
>> THANK YOU, LET'S MOVE
FORWARD

3501
02:52:56,200 --> 02:53:04,800
TO THE NEXT PRESENTATION FROM 

3502
02:53:04,800 --> 02:53:10,640
LINSEY McKERNAN.

3503
02:53:10,640 --> 02:53:11,440
>> GOOD AFTERNOON.

3504
02:53:11,440 --> 02:53:13,280
>> SHE'S AN ASSOCIATE
PROFESSOR 

3505
02:53:13,280 --> 02:53:14,840
IN THE DEPARTMENT OF PSYCHIATRY 

3506
02:53:14,840 --> 02:53:16,800
AND BEHAVIORAL SCIENCE AT 

3507
02:53:16,800 --> 02:53:19,800
VANDERBILT UNIVERSITY MEDICAL 

3508
02:53:19,800 --> 02:53:20,760
CENTER.

3509
02:53:20,760 --> 02:53:24,360
CLINICALLY, SHE SPECIALIZES IN 

3510
02:53:24,360 --> 02:53:26,760
TREATING THE INTERSECTION 

3511
02:53:26,760 --> 02:53:28,320
BETWEEN CO-OCCURRING CHRONIC 

3512
02:53:28,320 --> 02:53:30,440
HEALTH CONDITIONS AND MENTAL 

3513
02:53:30,440 --> 02:53:30,920
HEALTH.

3514
02:53:30,920 --> 02:53:34,040
HER AREA OF RESEARCH FOCUSES ON 

3515
02:53:34,040 --> 02:53:36,640
INFORMING TREATMENT AND 

3516
02:53:36,640 --> 02:53:38,880
INTERVENTION DELIVERY THROUGH 

3517
02:53:38,880 --> 02:53:41,000
APPLYING PATIENT-INFORMED 

3518
02:53:41,000 --> 02:53:44,280
APPROACHES TO CARE AND 

3519
02:53:44,280 --> 02:53:45,080
PATIENT-LEVEL FACTORS THAT 

3520
02:53:45,080 --> 02:53:49,040
INFLUENCE EXPANDING TREATMENT TO

3521
02:53:49,040 --> 02:53:52,040
A WIDER AUDIENCE USING DATA 

3522
02:53:52,040 --> 02:53:52,280
SCIENCE.

3523
02:53:52,280 --> 02:53:58,040
LINSEY, WELCOME.

3524
02:53:58,040 --> 02:54:02,920
>> GOOD AFTERNOON,
EVERYONE.

3525
02:54:02,920 --> 02:54:05,200
LINSEY McKERNAN FROM VANDERBILT 

3526
02:54:05,200 --> 02:54:05,680
MEDICAL CENTER.

3527
02:54:05,680 --> 02:54:08,600
I'M EXCITED TO TALK ABOUT 

3528
02:54:08,600 --> 02:54:10,800
PERSONALIZING INTERVENTIONS FOR 

3529
02:54:10,800 --> 02:54:11,920
CHRONIC PAIN PERFECT THE 

3530
02:54:11,920 --> 02:54:12,440
PSYCHOLOGY PERSPECTIVE.

3531
02:54:12,440 --> 02:54:14,120
THERE'S THREE THINGS I WANT TO 

3532
02:54:14,120 --> 02:54:16,280
TALK ABOUT IN MY TIME.

3533
02:54:16,280 --> 02:54:18,320
THE FIRST IS THE OPPORTUNITY WE 

3534
02:54:18,320 --> 02:54:22,880
HAVE TO ADAPT OUR APPROACHES FOR

3535
02:54:22,880 --> 02:54:24,080
PSYCHOLOGICAL EVENTS OF PAIN AND

3536
02:54:24,080 --> 02:54:26,760
AN EXAMPLE AT HOW WE WORKED AT 

3537
02:54:26,760 --> 02:54:32,320
THING WITH POPULATION AND THE 

3538
02:54:32,320 --> 02:54:33,560
THIRD IS THE CLINICAL 

3539
02:54:33,560 --> 02:54:35,240
IMPLICATIONS AND WHAT WE'RE 

3540
02:54:35,240 --> 02:54:36,200
DOING NEXT WITH THE WORK.

3541
02:54:36,200 --> 02:54:39,080
LET'S TALK ABOUT EVOLVING 

3542
02:54:39,080 --> 02:54:42,440
PSYCHOLOGICAL INTERVENTIONS FOR 

3543
02:54:42,440 --> 02:54:43,640
CHRONIC PAIN.

3544
02:54:43,640 --> 02:54:44,800
THERE HAVE BEEN META-ANALYSES 

3545
02:54:44,800 --> 02:54:48,880
LOOKING AT THE RCTs DONE FOR 

3546
02:54:48,880 --> 02:54:50,040
PSYCH INTERVENTIONS FOR CHRONIC 

3547
02:54:50,040 --> 02:54:51,640
PAIN AND HAVE SHOWN AS A WHOLE 

3548
02:54:51,640 --> 02:54:54,560
THEY MAY HAVE SMALL EFFECTS ON 

3549
02:54:54,560 --> 02:54:56,760
REDUCING PAIN, DISABILITY AND 

3550
02:54:56,760 --> 02:54:57,040
DISTRESS.

3551
02:54:57,040 --> 02:54:58,320
AND SO RESEARCHERS AND 

3552
02:54:58,320 --> 02:54:59,040
CLINICIANS BOTH HAVE BEEN ASKING

3553
02:54:59,040 --> 02:55:00,760
THE QUESTION WHAT CAN WE DO 

3554
02:55:00,760 --> 02:55:02,240
DIFFERENTLY OR HOW CAN WE MAKE 

3555
02:55:02,240 --> 02:55:03,120
THIS BETTER.

3556
02:55:03,120 --> 02:55:04,800
AND ONE OF THE LINES OF THINKING

3557
02:55:04,800 --> 02:55:07,200
IS WE CAN DO BETTER IN REALLY 

3558
02:55:07,200 --> 02:55:08,600
ATTENDING TO ALL THE LAYERS THAT

3559
02:55:08,600 --> 02:55:10,960
ARE INVOLVED IN A PERSON'S LIFE 

3560
02:55:10,960 --> 02:55:13,040
THAT ARE AFFECTED BY CHRONIC 

3561
02:55:13,040 --> 02:55:13,360
PAIN.

3562
02:55:13,360 --> 02:55:15,520
IN PARTICULAR, LOOKING AT HOW 

3563
02:55:15,520 --> 02:55:16,960
THE SPECIFIC TYPE OF PAIN THAT A

3564
02:55:16,960 --> 02:55:20,400
PERSON EXPERIENCES MIGHT BE 

3565
02:55:20,400 --> 02:55:22,000
DIFFERENT FROM ONE TO ANOTHER IN

3566
02:55:22,000 --> 02:55:23,600
AFFECTING THESE LAYERS.

3567
02:55:23,600 --> 02:55:25,880
FOR EXAMPLE, SOMEBODY WHO HAS 

3568
02:55:25,880 --> 02:55:27,680
PAIN IN THEIR PELVIS THAT COMES 

3569
02:55:27,680 --> 02:55:29,960
AND GOES MAY HAVE VERY DIFFERENT

3570
02:55:29,960 --> 02:55:31,400
IMPLICATIONS FOR THEIR 

3571
02:55:31,400 --> 02:55:33,560
RELATIONSHIPS AND THEIR WORK 

3572
02:55:33,560 --> 02:55:34,960
LIFE THAN SOMEBODY WHO HAS 

3573
02:55:34,960 --> 02:55:36,920
NEUROPATHIC PAIN IN THEIR HAND 

3574
02:55:36,920 --> 02:55:39,120
OR SHOULDER.

3575
02:55:39,120 --> 02:55:42,400
SO LETS DIG INTO THIS MORE USING

3576
02:55:42,400 --> 02:55:49,640
THE UROLOGY AND UROLOGIC PAIN 

3577
02:55:49,640 --> 02:55:50,800
AROUND HOW THE PAIN CAN DIFFER 

3578
02:55:50,800 --> 02:55:57,440
BASED ON THE CONDITION YOU HAVE 

3579
02:55:57,440 --> 02:56:01,600
AND LETS TALK ABOUT 

3580
02:56:01,600 --> 02:56:06,080
INTERSTITIALCYTIT

3581
02:56:06,080 --> 02:56:06,520
INTERSTITIALCYTITIS.

3582
02:56:06,520 --> 02:56:07,640
IT'S A CHRONIC PAIN CONDITION 

3583
02:56:07,640 --> 02:56:09,560
THAT AFFECTS MEN AND WOMEN IN 

3584
02:56:09,560 --> 02:56:12,080
THE U.S. AND CHARACTERIZED BY 

3585
02:56:12,080 --> 02:56:13,960
PAIN AND DISCOMFORT AND PRESSURE

3586
02:56:13,960 --> 02:56:15,240
IN THE PELVIC REGION.

3587
02:56:15,240 --> 02:56:18,960
AND IT'S OFTEN AS A BURNING 

3588
02:56:18,960 --> 02:56:19,160
PAIN.

3589
02:56:19,160 --> 02:56:21,520
IT'S ACCOMPANIED BY URINARY 

3590
02:56:21,520 --> 02:56:21,800
SYMPTOMS.

3591
02:56:21,800 --> 02:56:24,040
A SENSE OF NEEDING TO GO VERY 

3592
02:56:24,040 --> 02:56:25,200
QUICKLY TO THE BATHROOM AND 

3593
02:56:25,200 --> 02:56:26,240
AFTER HAVING GONE TO THE 

3594
02:56:26,240 --> 02:56:28,480
BATHROOM, FEELING LIKE YOU NEED 

3595
02:56:28,480 --> 02:56:30,440
TO GO AGAIN.

3596
02:56:30,440 --> 02:56:32,680
IT'S REFERRED TO AS URINARY 

3597
02:56:32,680 --> 02:56:33,200
FREQUENCY AND URGENCY.

3598
02:56:33,200 --> 02:56:35,120
PEOPLE COMPARE IT TO HAVING A 

3599
02:56:35,120 --> 02:56:36,400
BLADDER INFECTION THAT NEVER 

3600
02:56:36,400 --> 02:56:38,320
REALLY GOES AWAY.

3601
02:56:38,320 --> 02:56:41,720
AND CAN OFTEN UNPREDICTABLY 

3602
02:56:41,720 --> 02:56:43,320
INCREASE PERIODICALLY.

3603
02:56:43,320 --> 02:56:45,080
AS YOU CAN IMAGINE IF YOU'VE 

3604
02:56:45,080 --> 02:56:46,400
EVER HAD SOMETHING LIKE THAT IN 

3605
02:56:46,400 --> 02:56:48,800
YOUR LIFE, HAVING THAT BLADDER 

3606
02:56:48,800 --> 02:56:56,960
PAIN CAN IMPACT YOUR DAY.

3607
02:56:56,960 --> 02:56:58,160
SOMEBODY WITH CONSTANT SYMPTOMS 

3608
02:56:58,160 --> 02:57:00,880
CAN IMPACT SOMEBODY'S ABILITY TO

3609
02:57:00,880 --> 02:57:05,920
WORK, MAINTAIN SOCIAL 

3610
02:57:05,920 --> 02:57:08,120
RELATIONSHIPS AND THEIR OVERALL 

3611
02:57:08,120 --> 02:57:08,800
HAPPINESS.

3612
02:57:08,800 --> 02:57:10,160
NOT SURPRISINGLY THERE'S A 

3613
02:57:10,160 --> 02:57:13,560
STRONG PSYCHOLOGICAL OVERLAY 

3614
02:57:13,560 --> 02:57:15,720
WITH I.C. WHERE ANXIETY, 

3615
02:57:15,720 --> 02:57:16,920
DEPRESSION AND SUICIDALITY ARE 

3616
02:57:16,920 --> 02:57:20,280
PRESENT AND WHEN THEY'RE COUPLED

3617
02:57:20,280 --> 02:57:21,360
WITH THE CONDITION THEY'RE 

3618
02:57:21,360 --> 02:57:23,800
ASSOCIATED WITH MORE REDUCED 

3619
02:57:23,800 --> 02:57:24,560
FUNCTION.

3620
02:57:24,560 --> 02:57:29,800
AND THE AMERICAN UROLOGIC 

3621
02:57:29,800 --> 02:57:33,160
ASSOCIATIONS AND GYNECOLOGISTS 

3622
02:57:33,160 --> 02:57:35,600
WORK WITH THIS A LOT RECOMMEND 

3623
02:57:35,600 --> 02:57:42,920
STRESS MANAGEMENT PRACTICES AND 

3624
02:57:42,920 --> 02:57:43,320
SEL

3625
02:57:43,320 --> 02:57:44,720
SELF-MANAGEMENT PRACTICES 

3626
02:57:44,720 --> 02:57:47,080
HOWEVER, THERE'S A LACK OF 

3627
02:57:47,080 --> 02:57:49,040
RESEARCH IN THE AREA WHERE THERE

3628
02:57:49,040 --> 02:57:50,840
HAVEN'T BEEN AT THE TIME WHEN WE

3629
02:57:50,840 --> 02:57:53,200
START THE PROJECT THERE WEREN'T 

3630
02:57:53,200 --> 02:57:54,960
RANDOMIZED TRIALS ON THE SUBJECT

3631
02:57:54,960 --> 02:57:59,320
AND IT'S REALLY AN UNDER USED 

3632
02:57:59,320 --> 02:58:02,440
SERVICE IN UROLOGY AND WE 

3633
02:58:02,440 --> 02:58:04,320
WEREN'T SURE PATIENTS WOULD BE 

3634
02:58:04,320 --> 02:58:05,440
OPEN TO IT BECAUSE THERE'S 

3635
02:58:05,440 --> 02:58:07,840
STIGMA ASSOCIATED WITH THE 

3636
02:58:07,840 --> 02:58:10,080
CONDITION WHERE PEOPLE FEEL IF 

3637
02:58:10,080 --> 02:58:11,160
PSYCHOLOGICAL ASPECT OF THINGS 

3638
02:58:11,160 --> 02:58:13,320
ARE ATTENDED TO THEIR PAIN WOULD

3639
02:58:13,320 --> 02:58:15,680
GO AWAY OR NO LONGER REAL.

3640
02:58:15,680 --> 02:58:17,120
SO WE WERE CONCERNED ABOUT WHAT 

3641
02:58:17,120 --> 02:58:20,080
PATIENTS WOULD THINK ABOUT IT.

3642
02:58:20,080 --> 02:58:23,200
SO THERE WEREN'T REALLY ANY 

3643
02:58:23,200 --> 02:58:24,520
TRANSLATABLE APPROACHES TO 

3644
02:58:24,520 --> 02:58:26,080
PSYCHOLOGICAL INTERVENTIONS FOR 

3645
02:58:26,080 --> 02:58:26,760
PATIENTS AND WEREN'T SURE 

3646
02:58:26,760 --> 02:58:28,080
WHETHER THEY'D BE RECEPTIVE TO 

3647
02:58:28,080 --> 02:58:29,240
IT.

3648
02:58:29,240 --> 02:58:31,000
WE STARTED OUT HERE BY TALKING 

3649
02:58:31,000 --> 02:58:32,080
WITH PATIENTS.

3650
02:58:32,080 --> 02:58:33,440
WE WANTED TO GO TO THE SOURCE 

3651
02:58:33,440 --> 02:58:35,880
AND TO LEARN ABOUT WHAT PATIENTS

3652
02:58:35,880 --> 02:58:38,200
NEEDED AND WOULD THEY BE OPEN TO

3653
02:58:38,200 --> 02:58:40,680
THE STYLE OF INTERVENTION SINCE 

3654
02:58:40,680 --> 02:58:41,760
THERE REALLY WASN'T ANYTHING 

3655
02:58:41,760 --> 02:58:44,680
THAT HAD YET TO BE DEVELOPED FOR

3656
02:58:44,680 --> 02:58:45,280
THEM.

3657
02:58:45,280 --> 02:58:48,680
SO THE PCT PROJECT WAS TO LOOK 

3658
02:58:48,680 --> 02:58:49,960
AT THE TREATMENT NEEDS WITH I.C.

3659
02:58:49,960 --> 02:58:51,960
BY TALKING WITH PATIENTS AND ASK

3660
02:58:51,960 --> 02:58:54,600
ABOUT THEIR OPENNESS TO, WHAT 

3661
02:58:54,600 --> 02:58:56,680
THE APPROPRIATENESS WAS OF 

3662
02:58:56,680 --> 02:58:57,920
PSYCHOLOGY INTERVENTIONS AND 

3663
02:58:57,920 --> 02:58:59,240
MAKE SURE THAT WE WERE TARGETING

3664
02:58:59,240 --> 02:59:01,600
WHAT THEY NEEDED IN THOSE 

3665
02:59:01,600 --> 02:59:02,360
INTERVENTIONS BECAUSE THAT'S 

3666
02:59:02,360 --> 02:59:03,760
WHAT OUR PURPOSE WAS.

3667
02:59:03,760 --> 02:59:07,960
WE WANTED TO DEVELOP A PROTOCOL 

3668
02:59:07,960 --> 02:59:09,000
HIGHLY PATIENT CENTRIC.

3669
02:59:09,000 --> 02:59:11,120
IT WAS A MIXED METHOD STUDY.

3670
02:59:11,120 --> 02:59:13,160
IT HAD A QUALITATIVE ELEMENT TO 

3671
02:59:13,160 --> 02:59:15,880
IT WHERE WE BROUGHT PEOPLE IN 

3672
02:59:15,880 --> 02:59:17,480
FOR A SINGLE TIME POINT FOCUS 

3673
02:59:17,480 --> 02:59:19,960
GROUP AND AT THE BEGINNING OF 

3674
02:59:19,960 --> 02:59:21,280
THE FOCUS GROUP THEY TOOK A 

3675
02:59:21,280 --> 02:59:23,120
SERIES OF MEASURES AND WENT 

3676
02:59:23,120 --> 02:59:24,680
THROUGH A STRUCTURED DISCUSSION 

3677
02:59:24,680 --> 02:59:26,960
WITH SOME EXPERTS AS WELL.

3678
02:59:26,960 --> 02:59:27,960
LET ME TALK ABOUT WHAT'S 

3679
02:59:27,960 --> 02:59:29,720
INVOLVED IN CONDUCTING THE FOCUS

3680
02:59:29,720 --> 02:59:30,080
GROUP.

3681
02:59:30,080 --> 02:59:31,920
SO WHEN PEOPLE COME IN, 

3682
02:59:31,920 --> 02:59:33,120
EVERYBODY'S INDIVIDUALLY 

3683
02:59:33,120 --> 02:59:34,080
CONSENTED AND IN PARTICULAR 

3684
02:59:34,080 --> 02:59:37,480
THEY'RE ASKED ABOUT AUDIOTAPING,

3685
02:59:37,480 --> 02:59:39,000
INDIVIDUALLY AND THEN AGAIN AS A

3686
02:59:39,000 --> 02:59:41,840
GROUP TO MAKE SURE EVERYBODY 

3687
02:59:41,840 --> 02:59:42,080
AGREES.

3688
02:59:42,080 --> 02:59:44,480
AND THE FOCUS GROUP FACILITATOR 

3689
02:59:44,480 --> 02:59:46,320
GOES OVER WHAT WE'RE DOING, WHAT

3690
02:59:46,320 --> 02:59:47,840
THE PURPOSE OF THE STUDY IS AND 

3691
02:59:47,840 --> 02:59:49,080
THE GROUND RULES FOR THE GROUP 

3692
02:59:49,080 --> 02:59:52,000
TO MAKE SURE EVERYBODY'S ON 

3693
02:59:52,000 --> 02:59:52,280
BOARD.

3694
02:59:52,280 --> 02:59:57,960
AND THERE'S A PRE-STRUCTURED 

3695
02:59:57,960 --> 03:00:00,280
INTERVIEW GUIDE WITH TWO 

3696
03:00:00,280 --> 03:00:00,960
QUALITATIVE EXPERT 

3697
03:00:00,960 --> 03:00:01,480
COLLABORATORS.

3698
03:00:01,480 --> 03:00:03,840
THOSE QUESTIONS ALSO HAD 

3699
03:00:03,840 --> 03:00:04,080
PROMPTS.

3700
03:00:04,080 --> 03:00:05,520
SO IF THE DISCUSSION DIDN'T GET 

3701
03:00:05,520 --> 03:00:07,200
INTO TOPIC AREAS WE WANTED TO 

3702
03:00:07,200 --> 03:00:09,000
COVER WE WOULD PROMPT WITH 

3703
03:00:09,000 --> 03:00:10,400
ADDITIONAL QUESTIONS TO MAKE 

3704
03:00:10,400 --> 03:00:13,440
SURE TO COVER THAT GROUND.

3705
03:00:13,440 --> 03:00:15,640
THE QUESTIONS COVERED THE 

3706
03:00:15,640 --> 03:00:17,400
PATIENT EXPERIENCE AND THE 

3707
03:00:17,400 --> 03:00:20,360
DISTRESS THAT WENT ALONG WITH 

3708
03:00:20,360 --> 03:00:21,880
LIVING WITH I.C.

3709
03:00:21,880 --> 03:00:22,880
THEY'RE EXPERIENCE WITH 

3710
03:00:22,880 --> 03:00:24,240
TREATMENT AND TREATMENT NEEDS 

3711
03:00:24,240 --> 03:00:29,600
AND OPENNESS TO PSYCHOLOGY 

3712
03:00:29,600 --> 03:00:30,000
INTERVENTIONS.

3713
03:00:30,000 --> 03:00:31,560
HERE'S SOME QUESTIONS WE ASKED 

3714
03:00:31,560 --> 03:00:32,960
FOLKS ON THE RELATIONSHIP 

3715
03:00:32,960 --> 03:00:36,680
BETWEEN EMOTIONAL WELLNESS AND 

3716
03:00:36,680 --> 03:00:44,160
THE I.C.

3717
03:00:44,160 --> 03:00:47,320
WHAT WOULD HELP MANAGE THE 

3718
03:00:47,320 --> 03:00:49,840
SYMPTOMS BETTER AND DID GROUPS 

3719
03:00:49,840 --> 03:00:52,120
SIX WITH SELF-IDENTIFIED WOMEN 

3720
03:00:52,120 --> 03:00:54,600
AND SOME WITH MEN AND THAT WAS 

3721
03:00:54,600 --> 03:00:55,920
SCHEDULED BECAUSE OF THE 

3722
03:00:55,920 --> 03:00:56,640
SENSITIVE NATURE OF THE THINGS 

3723
03:00:56,640 --> 03:00:58,000
WE'D BE TALKING ABOUT.

3724
03:00:58,000 --> 03:01:00,520
THE THEMES THAT CAME OUT OF 

3725
03:01:00,520 --> 03:01:02,960
THESE GROUPS, ALL THE 

3726
03:01:02,960 --> 03:01:05,240
TRANSCRIPTS WERE CODED AND 

3727
03:01:05,240 --> 03:01:07,360
ANALYZED FOR THEMES AND 

3728
03:01:07,360 --> 03:01:10,400
SUBTHEMES AND DID THAT FOR THE 

3729
03:01:10,400 --> 03:01:12,840
OVERALL SAMPLES AND BETWEEN 

3730
03:01:12,840 --> 03:01:13,080
GENDERS.

3731
03:01:13,080 --> 03:01:16,480
THE BURDEN OF MANAGING SYMPTOMS 

3732
03:01:16,480 --> 03:01:18,600
WAS PRESENT JUST HOW MUCH IT 

3733
03:01:18,600 --> 03:01:20,960
INFILTRATED TO EVERY ASPECT OF A

3734
03:01:20,960 --> 03:01:22,520
PERSON'S LIFE.

3735
03:01:22,520 --> 03:01:25,080
IN PARTICULAR THEIR 

3736
03:01:25,080 --> 03:01:26,920
RELATIONSHIPS FROM COLLEAGUES, 

3737
03:01:26,920 --> 03:01:29,920
BOSSES, FRIENDS, LOVED ONES AND 

3738
03:01:29,920 --> 03:01:32,680
INTIMATE RELATIONSHIPS WERE ALL 

3739
03:01:32,680 --> 03:01:36,440
AFFECTED DIFFERENTLY BY THIS 

3740
03:01:36,440 --> 03:01:37,200
CONDITION.

3741
03:01:37,200 --> 03:01:38,960
THERE'S A LOT OF STATEMENTS HOW 

3742
03:01:38,960 --> 03:01:43,840
INTIMACY AND SEXUAL DYSFUNCTION 

3743
03:01:43,840 --> 03:01:45,280
HAPPENED AS A RESULT OF THE I.C.

3744
03:01:45,280 --> 03:01:46,520
AND A LOT OF PEOPLE SAYING I.C. 

3745
03:01:46,520 --> 03:01:48,680
WAS RESPONSIBLE FOR ENDING THEIR

3746
03:01:48,680 --> 03:01:51,440
RELATIONSHIPS OR EVEN A BARRIER 

3747
03:01:51,440 --> 03:01:55,600
TO ENTERING NEW RELATIONSHIPS 

3748
03:01:55,600 --> 03:01:56,720
OUT OF FEAR.

3749
03:01:56,720 --> 03:01:58,440
PAIN CAN OFTEN GET FLARED WITH 

3750
03:01:58,440 --> 03:02:02,880
SEX IN THIS CONDITION SO IT'S A 

3751
03:02:02,880 --> 03:02:04,520
MAJOR PROBLEM WITH WOMEN AND MEN

3752
03:02:04,520 --> 03:02:07,200
AND THE COGNITIVE BURDEN OF 

3753
03:02:07,200 --> 03:02:08,160
MANAGING SYMPTOMS.

3754
03:02:08,160 --> 03:02:09,640
AND WHAT I THOUGHT AFTER 

3755
03:02:09,640 --> 03:02:11,280
LISTENING TO THE INTERVIEWS AND 

3756
03:02:11,280 --> 03:02:12,760
THINKING MORE ABOUT THE IMPACT 

3757
03:02:12,760 --> 03:02:14,160
IT WAS A DECISION FUNNEL PEOPLE 

3758
03:02:14,160 --> 03:02:16,360
WENT THROUGH AS THEY WERE ASKED 

3759
03:02:16,360 --> 03:02:18,360
TO DO SOMETHING DIFFERENT FROM 

3760
03:02:18,360 --> 03:02:20,080
THEIR REGULAR ACTIVITIES OF 

3761
03:02:20,080 --> 03:02:22,200
WHERE IS THE BATHROOM EXIT GOING

3762
03:02:22,200 --> 03:02:22,600
TO BE?

3763
03:02:22,600 --> 03:02:24,600
HOW MUCH TRAVEL TIME AM I GOING 

3764
03:02:24,600 --> 03:02:25,200
TO HAVE?

3765
03:02:25,200 --> 03:02:28,680
HOW WILL I PLAN AROUND A SYMPTOM

3766
03:02:28,680 --> 03:02:32,520
FLARE AND WHAT WILL I NEED TO DO

3767
03:02:32,520 --> 03:02:35,320
EARLY JUST A QUESTION LIKE THAT 

3768
03:02:35,320 --> 03:02:36,560
JUST TO GET TOGETHER WITH 

3769
03:02:36,560 --> 03:02:38,440
FRIENDS AND BECAME OVERWHELMING 

3770
03:02:38,440 --> 03:02:39,960
AND PEOPLE STARTED TO CHOOSE NOT

3771
03:02:39,960 --> 03:02:41,520
TO DO IT BECAUSE THEY DIDN'T 

3772
03:02:41,520 --> 03:02:43,120
FEEL IT WAS WORTH IT.

3773
03:02:43,120 --> 03:02:45,920
IN TERMS OF THE ASSESSMENT WE 

3774
03:02:45,920 --> 03:02:47,160
FOUND ELEVATED RATES OF ANXIETY 

3775
03:02:47,160 --> 03:02:50,000
AND DEPRESSION IN MEN AND WOMEN.

3776
03:02:50,000 --> 03:02:52,160
THEY WERE ASSOCIATED WITH 

3777
03:02:52,160 --> 03:02:52,960
INCREASED SYMPTOM SCORES AND A 

3778
03:02:52,960 --> 03:02:56,680
LITTLE MORE PRONOUNCED FOR 

3779
03:02:56,680 --> 03:03:00,720
WOMEN.

3780
03:03:00,720 --> 03:03:02,480
IN TERMS OF THE BURDEN GOING 

3781
03:03:02,480 --> 03:03:05,720
BACK TO THE PRIMARY FINDINGS IT 

3782
03:03:05,720 --> 03:03:08,200
HIGHLIGHTED WITH I.C. CARRYING A

3783
03:03:08,200 --> 03:03:09,920
SIGNIFICANT PSYCHOSOCIAL BURDEN 

3784
03:03:09,920 --> 03:03:11,280
AND ACKNOWLEDGING THE 

3785
03:03:11,280 --> 03:03:14,320
PSYCHOLOGICAL SYMPTOMS BOTH 

3786
03:03:14,320 --> 03:03:16,320
INITIATED SYMPTOM FLARES AND 

3787
03:03:16,320 --> 03:03:16,920
KEEP THEM GOING.

3788
03:03:16,920 --> 03:03:19,960
THERE WAS A RECIPROCAL 

3789
03:03:19,960 --> 03:03:20,320
RELATIONSHIP.

3790
03:03:20,320 --> 03:03:22,560
I WAS STRUCK BY THE LACK OF 

3791
03:03:22,560 --> 03:03:26,040
KNOWLEDGE ON WHAT I.C. WAS.

3792
03:03:26,040 --> 03:03:27,680
A LOT OF PATIENTS FELT THEY WERE

3793
03:03:27,680 --> 03:03:28,680
NEVER GIVEN EDUCATION AND DIDN'T

3794
03:03:28,680 --> 03:03:30,160
UNDERSTAND IT AND BECAUSE OF 

3795
03:03:30,160 --> 03:03:32,640
THAT IT MADE IT VERY DIFFICULT 

3796
03:03:32,640 --> 03:03:33,800
TO EXPLAIN TO OTHER PEOPLE WHY 

3797
03:03:33,800 --> 03:03:35,480
THEY MAY OR MAY NOT BE ABLE TO 

3798
03:03:35,480 --> 03:03:36,400
DO SOMETHING BECAUSE THEY DIDN'T

3799
03:03:36,400 --> 03:03:38,960
FEEL LIKE THEY HAD A FOUNDATION 

3800
03:03:38,960 --> 03:03:41,720
TO SPEAK FROM.

3801
03:03:41,720 --> 03:03:46,480
THERE WAS A GREAT DESIRE FOR 

3802
03:03:46,480 --> 03:03:48,120
INTERDISCIPLINARY COLLABORATION 

3803
03:03:48,120 --> 03:03:49,360
IN TREATING I.C. AND HAVING 

3804
03:03:49,360 --> 03:03:50,960
PSYCHOLOGY AS PART OF THAT.

3805
03:03:50,960 --> 03:03:52,400
MANY PATIENTS FELT LIKE THEY 

3806
03:03:52,400 --> 03:03:54,600
WASHINGTON GETTING ENOUGH FROM 

3807
03:03:54,600 --> 03:03:54,960
THEIR PROVIDERS.

3808
03:03:54,960 --> 03:03:56,080
THEIR TREATMENT WAS DESCRIBED AS

3809
03:03:56,080 --> 03:03:57,880
A TRIAL AND ERROR PROCESS AND 

3810
03:03:57,880 --> 03:04:00,680
MANY FELT LIKE THEY WERE RUNNING

3811
03:04:00,680 --> 03:04:10,960
OUT OF OPTIONS.

3812
03:04:12,200 --> 03:04:16,080
I'LL TALK ABOUT THE INTERVENTION

3813
03:04:16,080 --> 03:04:19,000
DEVELOPMENT AND HOW IT AFFECTS 

3814
03:04:19,000 --> 03:04:20,720
LAYERS OF A PERSON'S LIFE, IB 

3815
03:04:20,720 --> 03:04:21,840
PARTICULAR THEIR RELATIONSHIPS 

3816
03:04:21,840 --> 03:04:26,400
AND ABILITY TO SPEAK UP ABOUT 

3817
03:04:26,400 --> 03:04:28,480
THE CONDITION AND THEIR MOOD 

3818
03:04:28,480 --> 03:04:30,960
THEIR SENSE OF RETREAT IN 

3819
03:04:30,960 --> 03:04:32,720
RESPONSE TO SYMPTOMS AND WE HAVE

3820
03:04:32,720 --> 03:04:34,520
THE WHAT WE USUALLY DO IN TERMS 

3821
03:04:34,520 --> 03:04:40,320
OF THE STANDARD COMPONENTS OF 

3822
03:04:40,320 --> 03:04:41,920
CBT FOR CHRONIC PAIN AND A 

3823
03:04:41,920 --> 03:04:42,880
STARTING POINT WHATEVER THE 

3824
03:04:42,880 --> 03:04:44,640
SESSIONS WOULD BE ABOUT AND 

3825
03:04:44,640 --> 03:04:47,000
DEVELOPING PROTOCOL AND WHERE WE

3826
03:04:47,000 --> 03:04:48,520
LANDED AFTER SPEAKING WITH 

3827
03:04:48,520 --> 03:04:48,800
PATIENTS.

3828
03:04:48,800 --> 03:04:52,680
WE FELT LIKE HAVING MUCH MORE ON

3829
03:04:52,680 --> 03:04:53,320
ASSERTIVE COMMUNICATION SKILLS 

3830
03:04:53,320 --> 03:04:57,120
WOULD BE HELPFUL FOR PATIENTS.

3831
03:04:57,120 --> 03:05:01,600
DIRECTLY ADDRESSING IN TTIMACY 

3832
03:05:01,600 --> 03:05:04,280
FEARS AND APPROACHING INTIMACY 

3833
03:05:04,280 --> 03:05:08,520
WITH PARTNERS SLOWLY AND 

3834
03:05:08,520 --> 03:05:10,280
COLLABORATIVELY HELPED ADDRESS 

3835
03:05:10,280 --> 03:05:11,000
SEXUAL DYSFUNCTION.

3836
03:05:11,000 --> 03:05:12,040
THE SLEEP WAS INTERESTING 

3837
03:05:12,040 --> 03:05:16,680
BECAUSE IT LAD  -- HAD TO DO 

3838
03:05:16,680 --> 03:05:20,680
WITH WAKING UP AND THE SYMPTOMS 

3839
03:05:20,680 --> 03:05:24,120
HAVE PROTOCOL TO HELP TREAT THEM

3840
03:05:24,120 --> 03:05:27,240
THAT AREN'T IN THE CURRENT CBT 

3841
03:05:27,240 --> 03:05:30,480
FOR INSOMNIA AND TRAIN AND HAD 

3842
03:05:30,480 --> 03:05:32,440
TO INTEGRATE THOSE AND THE 

3843
03:05:32,440 --> 03:05:34,200
COGNITION WORKING WITH THE 

3844
03:05:34,200 --> 03:05:34,960
AUTOMATIC THOUGHTS AROUND PAIN 

3845
03:05:34,960 --> 03:05:37,920
WAS AROUND THE THOUGHTS OF 

3846
03:05:37,920 --> 03:05:40,120
PLANNING AND URGENCY AND 

3847
03:05:40,120 --> 03:05:40,680
PLANNING EXITS, ADDRESSING 

3848
03:05:40,680 --> 03:05:43,800
THROWS COMPONENT AND THE PSYCHO 

3849
03:05:43,800 --> 03:05:48,360
EDUCATION WE WANTED TO INCLUDE 

3850
03:05:48,360 --> 03:05:49,800
PAID NEUROSCIENCE EDUCATION AS 

3851
03:05:49,800 --> 03:05:52,600
DONE WITH I.C. SPECIFIC DETAILS 

3852
03:05:52,600 --> 03:05:54,280
AND THE CONDITION AND THE 

3853
03:05:54,280 --> 03:05:56,680
PHENOTYPES TO GIVE PEOPLE 

3854
03:05:56,680 --> 03:06:02,120
LANGUAGE TO EXPLAIN IT TO THEIR 

3855
03:06:02,120 --> 03:06:04,520
LOVED ONES AND THE NEEDS MAY 

3856
03:06:04,520 --> 03:06:08,640
VARY BASED ON GENDER AND TELL 

3857
03:06:08,640 --> 03:06:09,080
YOU HOW IN A SECOND.

3858
03:06:09,080 --> 03:06:11,320
IN TERMS OF WHAT WE'VE DOING IN 

3859
03:06:11,320 --> 03:06:12,640
RESEARCH, WE PUT THE MANUAL 

3860
03:06:12,640 --> 03:06:13,800
TOGETHER OVER THE COURSE OF 

3861
03:06:13,800 --> 03:06:15,840
ABOUT A YEAR.

3862
03:06:15,840 --> 03:06:18,160
AND WE BUILT IN FLEXIBILITY INTO

3863
03:06:18,160 --> 03:06:18,600
TREATMENT.

3864
03:06:18,600 --> 03:06:24,640
SO ONE PERSON MIGHT HAVE CERTAIN

3865
03:06:24,640 --> 03:06:28,680
ISSUES DRIVING THEIR NEED FOR 

3866
03:06:28,680 --> 03:06:30,120
TREATMENT VERSUS ANOTHER IT 

3867
03:06:30,120 --> 03:06:33,960
COULD BE THEIR EMOTIONAL COPING 

3868
03:06:33,960 --> 03:06:36,240
STYLE AND THE OTHERS IS THE 

3869
03:06:36,240 --> 03:06:38,600
STRESS IS BOTHERING THEM AND 

3870
03:06:38,600 --> 03:06:40,680
THIS WAS BUILT SO TREATMENT 

3871
03:06:40,680 --> 03:06:44,280
SESSIONS COULD BE ORDERED BASED 

3872
03:06:44,280 --> 03:06:44,960
ON PATIENT GOALS AND THE SKILLS 

3873
03:06:44,960 --> 03:06:47,640
COULD BE DIRECTED TO WHAT THEIR 

3874
03:06:47,640 --> 03:06:49,040
EMOTIONAL NEEDS WERE.

3875
03:06:49,040 --> 03:06:51,280
THERE WAS A GREAT DEAL OF 

3876
03:06:51,280 --> 03:06:53,200
ATRAUMA AWARENESS AND EDUCATION 

3877
03:06:53,200 --> 03:06:55,000
BECAUSE OF THE HIGH PREVALENCE 

3878
03:06:55,000 --> 03:06:58,840
OF TRAUMA AND PTSD IN THE 

3879
03:06:58,840 --> 03:07:02,680
POPULATION AND WE ALSO HAVE 

3880
03:07:02,680 --> 03:07:03,560
ASSERTIVE COMMUNICATION AND 

3881
03:07:03,560 --> 03:07:05,240
DYSFUNCTION MODELS BUT WE TOOK 

3882
03:07:05,240 --> 03:07:06,480
IT BACK TO THE PATIENT 

3883
03:07:06,480 --> 03:07:08,040
POPULATION AFTER WE BUILT IT AND

3884
03:07:08,040 --> 03:07:10,400
IN A FINAL FOCUS AND REVIEWED 

3885
03:07:10,400 --> 03:07:12,080
THE MANUAL, THE HANDOUTS AND THE

3886
03:07:12,080 --> 03:07:13,200
TOPICS AND THE ABILITY TO SHIFT 

3887
03:07:13,200 --> 03:07:23,600
AROUND THE SEQUENCING.

3888
03:07:24,520 --> 03:07:26,960
PEOPLE FELT THE CONTENT WAS 

3889
03:07:26,960 --> 03:07:28,360
RELEVANT AND GOT FEEDBACK ON 

3890
03:07:28,360 --> 03:07:30,160
THINGS TO CHANGE ON OUR 

3891
03:07:30,160 --> 03:07:30,480
HANDOUTS.

3892
03:07:30,480 --> 03:07:34,720
WE CHANGED IT BEFORE GOING LIVE.

3893
03:07:34,720 --> 03:07:38,080
IS THIS HAS BEEN PILOTED IN THE 

3894
03:07:38,080 --> 03:07:40,240
CLINICAL TRIALS WHERE WE LOOK AT

3895
03:07:40,240 --> 03:07:42,120
THE INTERVENTION VERSUS THE 

3896
03:07:42,120 --> 03:07:42,720
EIGHT-WEEK CONTROL AND WE'RE 

3897
03:07:42,720 --> 03:07:44,600
TRYING TO FIND OUT WHAT THE 

3898
03:07:44,600 --> 03:07:45,480
INTERVENTION EFFECT MIGHT BE IN 

3899
03:07:45,480 --> 03:07:48,680
ORDER TO DO THIS ON A BIGGER 

3900
03:07:48,680 --> 03:07:50,600
SCALE.

3901
03:07:50,600 --> 03:07:52,640
WITH THE OVERALL GOAL DOING THIS

3902
03:07:52,640 --> 03:07:53,720
ON A WIDER SCALE.

3903
03:07:53,720 --> 03:07:55,560
I CAN TALK MORE ABOUT THIS IN 

3904
03:07:55,560 --> 03:07:57,320
THE Q&A IF IT'S OF INTEREST.

3905
03:07:57,320 --> 03:07:59,360
ANOTHER AREA WE'RE WORKING ON IS

3906
03:07:59,360 --> 03:08:01,840
IN THE CLINIC SIDE OF 

3907
03:08:01,840 --> 03:08:02,640
INTEGRATING PSYCHOLOGY AND 

3908
03:08:02,640 --> 03:08:04,160
UROLOGY SERVICES AND WE FOUND A 

3909
03:08:04,160 --> 03:08:07,960
WAY TO DO THIS AND ALSO BUILD IN

3910
03:08:07,960 --> 03:08:10,960
TRAINEE SERVICE TO AN 

3911
03:08:10,960 --> 03:08:11,840
INTERDISCIPLINARY CLINIC WHICH 

3912
03:08:11,840 --> 03:08:13,480
I'M EXCITED ABOUT AND I CAN TALK

3913
03:08:13,480 --> 03:08:14,960
MORE ABOUT THIS IF THERE'S 

3914
03:08:14,960 --> 03:08:18,480
INTEREST.

3915
03:08:18,480 --> 03:08:20,680
THE LESSONED WE LEARNED ARE TO 

3916
03:08:20,680 --> 03:08:22,640
ENGAGE STAKEHOLDERS FROM THE 

3917
03:08:22,640 --> 03:08:23,360
BEGINNING THROUGH BECAUSE WE 

3918
03:08:23,360 --> 03:08:25,400
KEPT LEARNING AS WE WERE GOING 

3919
03:08:25,400 --> 03:08:27,560
AND UNCOVERED ASSUMPTIONS ABOUT 

3920
03:08:27,560 --> 03:08:29,760
THE EDUCATION PIECE AND OTHER 

3921
03:08:29,760 --> 03:08:30,880
NEEDS THAT WERE THERE WE COULD 

3922
03:08:30,880 --> 03:08:33,640
HAVE MISSED OTHERWISE.

3923
03:08:33,640 --> 03:08:36,320
IT CHANGED OUR AREAS OF EMPHASIS

3924
03:08:36,320 --> 03:08:38,640
AND IMPORTANTLY FOUND OUT 

3925
03:08:38,640 --> 03:08:40,200
THROUGH LEARNING ABOUT THE 

3926
03:08:40,200 --> 03:08:41,880
LAYERS OF HOW IT AFFECT THE 

3927
03:08:41,880 --> 03:08:43,640
WHOLE PERSON OTHER OPPORTUNITIES

3928
03:08:43,640 --> 03:08:45,120
FOR INTERVENTION WE MAY NOT HAVE

3929
03:08:45,120 --> 03:08:47,280
OTHERWISE INCLUDED PARTICULARLY 

3930
03:08:47,280 --> 03:08:50,920
AROUND RELATIONSHIPS WITH LOVED 

3931
03:08:50,920 --> 03:08:56,960
ONES, INTIMACY AND HEALTH CARE 

3932
03:08:56,960 --> 03:08:57,160
SYSTEM.

3933
03:08:57,160 --> 03:08:58,960
I'M INVESTED IN INCREASING 

3934
03:08:58,960 --> 03:09:00,160
SERVICES THROUGH UROLOGY.

3935
03:09:00,160 --> 03:09:02,560
IT'S A NEW AREA AND THERE'S A 

3936
03:09:02,560 --> 03:09:04,640
GREAT DEAL OF INTEREST AND 

3937
03:09:04,640 --> 03:09:05,320
EXCITEMENT AROUND IT.

3938
03:09:05,320 --> 03:09:07,760
PART IS EXPANDING TRAUMA 

3939
03:09:07,760 --> 03:09:09,400
AWARENESS AND TRAUMA CARE 

3940
03:09:09,400 --> 03:09:09,800
PROCEEDING.

3941
03:09:09,800 --> 03:09:15,920
SO HAPPY TO TALK MORE ABOUT THIS

3942
03:09:15,920 --> 03:09:17,520
AND THANK YOU ALL FOR HAVING ME 

3943
03:09:17,520 --> 03:09:17,720
TODAY.

3944
03:09:17,720 --> 03:09:19,160
>> THANK YOU.

3945
03:09:19,160 --> 03:09:21,680
OUR LAST SPEAKER IS DR. WALLY 

3946
03:09:21,680 --> 03:09:25,240
SMITH FROM VIRGINIA COMMONWEALTH

3947
03:09:25,240 --> 03:09:26,960
UNIVERSITY.

3948
03:09:26,960 --> 03:09:34,000
HE IS A PROFESSOR OF THE SICKLE 

3949
03:09:34,000 --> 03:09:36,640
CELL PROGRAM AND SERVES AS THE 

3950
03:09:36,640 --> 03:09:38,280
SCIENTIFIC DIRECTOR OF THE VCU 

3951
03:09:38,280 --> 03:09:40,640
CENTER OF HEALTH DISPARITIES.

3952
03:09:40,640 --> 03:09:48,880
DR. SMITH'S AREA OF RESEARCH IS 

3953
03:09:48,880 --> 03:09:56,920
BARRIERS AND IMPLEMENTATION OF 

3954
03:09:56,920 --> 03:10:00,480
WLOEL-PERSON APPROACHES TO PAIN 

3955
03:10:00,480 --> 03:10:02,960
MANAGEMENT AND THEY LOOKED AT 

3956
03:10:02,960 --> 03:10:04,080
THE STRATEGY.

3957
03:10:04,080 --> 03:10:06,160
HIS PRESENTATION THE TOPIC IS 

3958
03:10:06,160 --> 03:10:10,240
BARRIERS TO IMPLEMENTATION OF 

3959
03:10:10,240 --> 03:10:11,920
WHOLE PERSON APPROACHES TO PAIN 

3960
03:10:11,920 --> 03:10:12,200
MANAGEMENT.

3961
03:10:12,200 --> 03:10:13,640
THANK YOU FOR SHARING YOUR 

3962
03:10:13,640 --> 03:10:16,440
EXPERTISE WITH US.

3963
03:10:16,440 --> 03:10:17,200
THE FLOOR IS YOURS.

3964
03:10:17,200 --> 03:10:22,640
>> THANK YOU FOR SETTING
UP WHAT

3965
03:10:22,640 --> 03:10:26,080
I'M GOWHOLE GOING TO SAY.

3966
03:10:26,080 --> 03:10:28,720
I'LL TALK ABOUT MY VIEW AND THE 

3967
03:10:28,720 --> 03:10:33,440
BARRIERS TO THEIME IMPLEMENTATI 

3968
03:10:33,440 --> 03:10:37,400
OF THE WHOLE PERSON APPROACH TO 

3969
03:10:37,400 --> 03:10:39,280
PAIN MANAGEMENT WE HEARD ABOUT 

3970
03:10:39,280 --> 03:10:41,560
IN THE LAST TWO DAYS.

3971
03:10:41,560 --> 03:10:48,760
WE HAVE AN EPIDEMIC OVERUSE 

3972
03:10:48,760 --> 03:10:50,840
MISUSE OR DEATH ACCIDENTAL OR 

3973
03:10:50,840 --> 03:10:52,840
OTHERWISE AND THIS GOES BACK TO 

3974
03:10:52,840 --> 03:10:53,240
2014.

3975
03:10:53,240 --> 03:10:56,520
IT'S CAUSED THE GOVERNMENT TO 

3976
03:10:56,520 --> 03:10:59,160
JUMP INTO HIGH GEAR TO STEM THE 

3977
03:10:59,160 --> 03:11:02,280
TIDE OF LETHAL OPIOID USE AND 

3978
03:11:02,280 --> 03:11:04,200
WHAT'S CAUSING DEATHS AND MORE 

3979
03:11:04,200 --> 03:11:07,240
DEATHS NOW THAN MOTOR VEHICLE 

3980
03:11:07,240 --> 03:11:08,640
ACCIDENTS ANNUALLY.

3981
03:11:08,640 --> 03:11:11,200
AT FIRST THE DEATHS WERE FROM 

3982
03:11:11,200 --> 03:11:13,960
PRESCRIPTION OPIOID USE BUT NOW 

3983
03:11:13,960 --> 03:11:15,640
WE KNOW THE LATEST EPIDEMIC OF 

3984
03:11:15,640 --> 03:11:19,360
DEATH IS FROM MANUFACTURED OR 

3985
03:11:19,360 --> 03:11:20,280
SYNTHETIC OPIOIDS BUT THE 

3986
03:11:20,280 --> 03:11:23,000
PROBLEM STILL LINGERS IN THE 

3987
03:11:23,000 --> 03:11:25,640
MIND OF PRACTITIONERS AND THE 

3988
03:11:25,640 --> 03:11:26,000
GOVERNMENT.

3989
03:11:26,000 --> 03:11:26,600
SIMULTANEOUS TO THE FIRST 

3990
03:11:26,600 --> 03:11:28,280
EPIDEMIC WE HAVE A SECOND THAT 

3991
03:11:28,280 --> 03:11:32,680
OF CHRONIC PAIN, 14.6% OF 

3992
03:11:32,680 --> 03:11:34,640
U.S. ADULTS HAVE CURRENT 

3993
03:11:34,640 --> 03:11:36,640
WIDESPREAD OR LOCALIZED PAIN 

3994
03:11:36,640 --> 03:11:37,840
LASTING FOR AT LEAST THREE 

3995
03:11:37,840 --> 03:11:38,240
MONTHS.

3996
03:11:38,240 --> 03:11:39,960
WE'RE NOT TALKING ABOUT CANCER 

3997
03:11:39,960 --> 03:11:41,400
PAIN, WE'RE TALKING ABOUT 

3998
03:11:41,400 --> 03:11:42,920
NON-CANCER PAIN.

3999
03:11:42,920 --> 03:11:45,720
IN RESPONSE TO THIS TWIN 

4000
03:11:45,720 --> 03:11:47,600
EPIDEMIC, WE HAVE THE NIH HEAL 

4001
03:11:47,600 --> 03:11:50,240
INITIATIVE WHICH IS OUT NOT ONLY

4002
03:11:50,240 --> 03:11:51,400
TO HELP END ADDICTION LONG-TERM 

4003
03:11:51,400 --> 03:11:54,200
WHICH IS ENCODED IN THE NAME, 

4004
03:11:54,200 --> 03:11:55,520
HEAL, BUT ALSO TO HELP STEM 

4005
03:11:55,520 --> 03:11:58,920
CHRONIC PAIN.

4006
03:11:58,920 --> 03:12:00,680
WHAT WE'VE LEARNED FROM HEAL AND

4007
03:12:00,680 --> 03:12:02,200
FROM THE LAST TO DAYS IS THERE'S

4008
03:12:02,200 --> 03:12:02,760
A LOT OF PAIN THERAPIES OUT 

4009
03:12:02,760 --> 03:12:06,080
THERE.

4010
03:12:06,080 --> 03:12:09,520
EVEN SOME WILLING PAIN PROVIDERS

4011
03:12:09,520 --> 03:12:11,120
BUT NOT A LOT OF IMPLEMENTATION 

4012
03:12:11,120 --> 03:12:12,120
TO GET THE APPROPRIATE PAIN 

4013
03:12:12,120 --> 03:12:14,080
THERAPIES INTO THE HANDS OF THE 

4014
03:12:14,080 --> 03:12:16,560
PATIENTS WHO NEED THEM MOST.

4015
03:12:16,560 --> 03:12:20,360
SO ON THIS SLIDE WOULDN'T YOU 

4016
03:12:20,360 --> 03:12:22,440
KNOW IT, THE PROBLEM HAS NOW 

4017
03:12:22,440 --> 03:12:23,880
BEEN BROUGHT TO THE FOREFRONT BY

4018
03:12:23,880 --> 03:12:26,040
OUR FRIENDS AT THE CENTERS FOR 

4019
03:12:26,040 --> 03:12:28,240
MEDICARE AND MEDICAID SERVICES 

4020
03:12:28,240 --> 03:12:30,400
WHICH JUST WEEKS AGO PUBLISHED 

4021
03:12:30,400 --> 03:12:32,360
THIS TELLING PICTURE.

4022
03:12:32,360 --> 03:12:34,600
IT'S WORTH 1,000 WORDS AND I'LL 

4023
03:12:34,600 --> 03:12:39,960
ONLY GIVE YOU 750 TODAY AND SHOW

4024
03:12:39,960 --> 03:12:43,360
YOU DIFFERENT PARTS OF THIS 

4025
03:12:43,360 --> 03:12:45,240
PICTURE OVER AND OVER AN THIS IS

4026
03:12:45,240 --> 03:12:47,080
FOCUSSED ON THOSE LIVING WITH 

4027
03:12:47,080 --> 03:12:47,640
AND TREATING CHRONIC PAIN.

4028
03:12:47,640 --> 03:12:50,360
IT WAS INTENDED TO HIGHLIGHT 

4029
03:12:50,360 --> 03:12:51,360
BARRIERS ABOUT PEOPLE ACCESSING 

4030
03:12:51,360 --> 03:12:53,160
CARE AND THE INFLUENCES ACTING 

4031
03:12:53,160 --> 03:13:00,400
ON THE PROVIDERS AND QUALITY OF 

4032
03:13:00,400 --> 03:13:05,600
QUAR AND LIFE.

4033
03:13:05,600 --> 03:13:08,080
AS SOMEONE ON THE DESCRIBING 

4034
03:13:08,080 --> 03:13:09,280
GUIDE LINES AND THE GROUP ON THE

4035
03:13:09,280 --> 03:13:09,920
HEAL INITIATIVE I WELCOME THIS 

4036
03:13:09,920 --> 03:13:14,280
PICTURE.

4037
03:13:14,280 --> 03:13:16,320
CENTRAL TO THE PROBLEM OF 

4038
03:13:16,320 --> 03:13:20,640
MANAGING CHRONIC PAIN IS THE 

4039
03:13:20,640 --> 03:13:22,760
MISTRUST CREATED BY THE 

4040
03:13:22,760 --> 03:13:25,640
ATMOSPHERE OF THE TWIN EPIDEMICS

4041
03:13:25,640 --> 03:13:28,560
I JUST DESCRIBED.

4042
03:13:28,560 --> 03:13:31,520
SO CLINICIANS WANT TO KNOW CAN I

4043
03:13:31,520 --> 03:13:32,920
TRUST THE PATIENT TO HAVE THE 

4044
03:13:32,920 --> 03:13:34,440
PAIN THEY SAY THEY HAVE AND 

4045
03:13:34,440 --> 03:13:35,760
PATIENTS WANT TO KNOW CAIN TRUST

4046
03:13:35,760 --> 03:13:40,680
THE CLINICIAN IN FRONT OF ME TO 

4047
03:13:40,680 --> 03:13:43,160
GIVE THE ME OPIOIDS OR 

4048
03:13:43,160 --> 03:13:43,880
INTEGRATIVE MEDICINES I NEED?

4049
03:13:43,880 --> 03:13:46,040
WE HAVE LOTS OF EVIDENCE TO IS A

4050
03:13:46,040 --> 03:13:46,800
NO.

4051
03:13:46,800 --> 03:13:48,600
I CANNOT TRUST THE PATIENT OR DO

4052
03:13:48,600 --> 03:13:49,880
NOT TRUST THE PATIENT.

4053
03:13:49,880 --> 03:13:51,880
WE HAVE LOTS EVIDENCE TO SAY, 

4054
03:13:51,880 --> 03:13:52,640
NO.

4055
03:13:52,640 --> 03:14:00,240
I CANNOT TRUST OUR DO NOT TRUST 

4056
03:14:00,240 --> 03:14:09,360
THE CLINICIAN.

4057
03:14:09,360 --> 03:14:12,640
THEY DON'T BELIEVE THE PATIENTS 

4058
03:14:12,640 --> 03:14:13,840
HAVE SPAIN.

4059
03:14:13,840 --> 03:14:14,920
THE NURSES ARE SOMETIMES WORSE 

4060
03:14:14,920 --> 03:14:16,680
THAN THE PHYSICIANS IN NOT 

4061
03:14:16,680 --> 03:14:17,680
BELIEVING PATIENTS WHEN THEY SAY

4062
03:14:17,680 --> 03:14:18,400
THEY'RE IN PAIN.

4063
03:14:18,400 --> 03:14:21,640
THERE'S OFTEN NO OBJECTIVE 

4064
03:14:21,640 --> 03:14:22,880
CORRELATE TO THE CHRONIC PAIN 

4065
03:14:22,880 --> 03:14:25,560
AND THERE'S A DISPUTE ABOUT 

4066
03:14:25,560 --> 03:14:26,480
WHO'S RIGHT ESPECIALLY IN THE 

4067
03:14:26,480 --> 03:14:27,000
EMERGENCY DEPARTMENT AND 

4068
03:14:27,000 --> 03:14:30,920
HOSPITAL.

4069
03:14:30,920 --> 03:14:34,080
ANOTHER PROBLEM IS SCARCE 

4070
03:14:34,080 --> 03:14:36,080
RESOURCES.

4071
03:14:36,080 --> 03:14:40,640
COMPLEMENTARY AND INTEGRATIVE 

4072
03:14:40,640 --> 03:14:43,400
CARE IS WE DON'T THINK OF HAVING

4073
03:14:43,400 --> 03:14:50,920
THE NEED FOR TRANS DISCIPLINARY 

4074
03:14:50,920 --> 03:14:52,800
BIO/SOCIAL CARE FOR THERAPY.

4075
03:14:52,800 --> 03:14:56,800
MOST HAVE JUST A CANCER DOCTOR 

4076
03:14:56,800 --> 03:14:58,920
WITH CANCER AND PEOPLE WITH 

4077
03:14:58,920 --> 03:15:02,200
RHEUMATOLOGY DISEASES JUST HAVE 

4078
03:15:02,200 --> 03:15:04,320
A RHEUMATOLOGIST.

4079
03:15:04,320 --> 03:15:06,120
THESE DOCTORS MAY FEEL TRAPPED 

4080
03:15:06,120 --> 03:15:08,320
INTO MANAGING THE PATIENT'S PAIN

4081
03:15:08,320 --> 03:15:09,480
ESPECIALLY WHEN IT COMES TO 

4082
03:15:09,480 --> 03:15:11,040
DESCRIBING OPIOIDS BECAUSE THEY 

4083
03:15:11,040 --> 03:15:12,160
DIDN'T TRAIN FOR THAT.

4084
03:15:12,160 --> 03:15:14,520
IF THEY'RE LUCKY MAYBE THE 

4085
03:15:14,520 --> 03:15:15,080
PATIENT HAS A BEHAVIORAL 

4086
03:15:15,080 --> 03:15:17,280
THERAPIST BUT THE DISEASE 

4087
03:15:17,280 --> 03:15:19,480
THERAPISTS DON'T FEEL EQUIPPED 

4088
03:15:19,480 --> 03:15:21,880
TO PROVIDE CARE FOR CO-OCCURRING

4089
03:15:21,880 --> 03:15:23,600
SUBSTANCE USE, MENTAL HEALTH 

4090
03:15:23,600 --> 03:15:26,040
DISORDER, OTHER BEHAVIORAL 

4091
03:15:26,040 --> 03:15:28,680
DISORDERS MOST PATIENTS BRING 

4092
03:15:28,680 --> 03:15:30,640
WITH THEM INTO THE 

4093
03:15:30,640 --> 03:15:32,680
DISEASE-SPECIFIC PROVIDERS 

4094
03:15:32,680 --> 03:15:33,400
OFFICES.

4095
03:15:33,400 --> 03:15:35,440
SO THE PATIENTS END UP WITHOUT 

4096
03:15:35,440 --> 03:15:36,440
THE SUPPORT TEAM THEY NEED.

4097
03:15:36,440 --> 03:15:38,680
THEY BURDENED WITH DAY TO DAY 

4098
03:15:38,680 --> 03:15:41,320
TASKS OF MANAGING THEIR LIFE AS 

4099
03:15:41,320 --> 03:15:42,800
A PATIENT, BEARING THE PAIN FROM

4100
03:15:42,800 --> 03:15:45,840
THEIR FAMILY, FAMILY AND FRIENDS

4101
03:15:45,840 --> 03:15:47,960
WHO DON'T BELIEVE THEIR PAIN.

4102
03:15:47,960 --> 03:15:49,520
THEY ALSO BEAR A FINANCIAL 

4103
03:15:49,520 --> 03:15:50,880
BURDEN BECAUSE THEY DIDN'T WORK 

4104
03:15:50,880 --> 03:15:52,640
BECAUSE OF THEIR PAIN EPISODES.

4105
03:15:52,640 --> 03:15:59,440
THEY CAN BE DEPRESSED, ANXIOUS 

4106
03:15:59,440 --> 03:16:01,600
AND MAY RESORT TO 

4107
03:16:01,600 --> 03:16:03,200
CATASTROPHIZING AND PATIENTS 

4108
03:16:03,200 --> 03:16:05,840
DON'T GET THE SUPPORT FROM 

4109
03:16:05,840 --> 03:16:06,560
PROFESSIONAL CAREGIVERS OR HOME 

4110
03:16:06,560 --> 03:16:06,920
CAREGIVERS.

4111
03:16:06,920 --> 03:16:08,960
YOU SEE THE BOTTOM OF THE 

4112
03:16:08,960 --> 03:16:10,240
PICTURE, PATIENTS ARE LOST IN 

4113
03:16:10,240 --> 03:16:11,320
THE MIDDLE.

4114
03:16:11,320 --> 03:16:14,680
WE HEAR TESTIMONIALS ABOUT 

4115
03:16:14,680 --> 03:16:16,600
PATIENTS FEELING LOST AND 

4116
03:16:16,600 --> 03:16:17,200
WEIGHED DOWN WITH THE CHRONIC 

4117
03:16:17,200 --> 03:16:19,160
PAIN EXPERIENCE.

4118
03:16:19,160 --> 03:16:29,640
PAIN IS INDEED ITS OWN DISEASE.

4119
03:16:29,640 --> 03:16:31,200
PATIENTS MAY ALSO BE HEALTH 

4120
03:16:31,200 --> 03:16:31,480
ILLITERATE.

4121
03:16:31,480 --> 03:16:32,920
SO THEY CAN'T TELL THE 

4122
03:16:32,920 --> 03:16:34,280
DIFFERENCE BETWEEN TOLERANCE 

4123
03:16:34,280 --> 03:16:38,920
VERSUS PHYSICAL DEPENDENCE 

4124
03:16:38,920 --> 03:16:40,280
VERSUS ADDICTION.

4125
03:16:40,280 --> 03:16:43,480
THE THINK OF IT AS PHYSICAL 

4126
03:16:43,480 --> 03:16:44,960
WITHDRAWAL AND WHEN THEY THINK 

4127
03:16:44,960 --> 03:16:47,920
OF PAIN THEY CAN'T SAY WHOLE 

4128
03:16:47,920 --> 03:16:50,080
HAVING NOCICEPTIVE PAIN TREAT ME

4129
03:16:50,080 --> 03:16:56,640
WITH A DISEASE MODIFIER OR I 

4130
03:16:56,640 --> 03:17:00,640
NEED A

4131
03:17:00,640 --> 03:17:05,080
>> YOUNT ---AGE  A 

4132
03:17:08,680 --> 03:17:11,360
ADJUVANTS AND PERHAPS THEY'RE 

4133
03:17:11,360 --> 03:17:17,200
PRONE TO BELIEVE PAIN MEANS AN 

4134
03:17:17,200 --> 03:17:21,120
ANALGESIC DEFICIENCY.

4135
03:17:21,120 --> 03:17:23,720
THEY NEED PROVIDERS TO GIVE THEM

4136
03:17:23,720 --> 03:17:24,600
COLLABORATION AND THE 

4137
03:17:24,600 --> 03:17:25,720
APPROPRIATE TREATMENT INCLUDING 

4138
03:17:25,720 --> 03:17:26,960
MEDICATION, THEY NEED, AND NEED 

4139
03:17:26,960 --> 03:17:29,840
TO UNDERSTAND THEY CAN MAKE A 

4140
03:17:29,840 --> 03:17:32,560
PATIENT-CENTERED DECISION 

4141
03:17:32,560 --> 03:17:32,800
PROCESS.

4142
03:17:32,800 --> 03:17:35,240
YOU CAN SEE THERE'S A LOGISTICAL

4143
03:17:35,240 --> 03:17:38,920
ACCESS TO THAT KIND OF SUPPORTER

4144
03:17:38,920 --> 03:17:45,680
IS ABOUT TO BREAK.

4145
03:17:45,680 --> 03:17:47,400
INSURANCE DOES NOT COVER MUCH OF

4146
03:17:47,400 --> 03:17:48,960
THE PAIN CARE PATIENTS NEED.

4147
03:17:48,960 --> 03:17:51,080
COMPLIMENTARY AND INTEGRATIVE 

4148
03:17:51,080 --> 03:17:55,160
CARE PARTICULARLY ARE NOT 

4149
03:17:55,160 --> 03:17:55,520
COVERED.

4150
03:17:55,520 --> 03:17:57,400
AND MENTAL HEALTH DISORDER 

4151
03:17:57,400 --> 03:17:59,400
PATIENTS ARE OFTEN NOT FINDING 

4152
03:17:59,400 --> 03:18:00,000
COVERAGE.

4153
03:18:00,000 --> 03:18:00,960
PATIENTS MAY CHANGE INSURANCE 

4154
03:18:00,960 --> 03:18:02,520
POLICIES TRYING TO GET THAT KIND

4155
03:18:02,520 --> 03:18:04,640
OF COVERAGE OR TRYING TO REDUCE 

4156
03:18:04,640 --> 03:18:05,120
THEIR DEDUCTIBLE.

4157
03:18:05,120 --> 03:18:08,680
YOU CAN SEE THE PERSON ON THE 

4158
03:18:08,680 --> 03:18:09,760
RIGHT CLIEPING UP THIS STEEP 

4159
03:18:09,760 --> 03:18:10,400
MOUNTAIN LOOKING FOR COVERAGE 

4160
03:18:10,400 --> 03:18:12,680
AND FEELING NOT ABLE TO GET THE 

4161
03:18:12,680 --> 03:18:14,400
COVERAGE THEY NEED.

4162
03:18:14,400 --> 03:18:16,080
HOW ABOUT PRIOR AUTHORIZATIONS.

4163
03:18:16,080 --> 03:18:17,120
WHAT A CUSS WORD.

4164
03:18:17,120 --> 03:18:19,200
WHEN IT COMES TO OPIOIDS, YOU 

4165
03:18:19,200 --> 03:18:20,320
HAVE TO HAVE A PRIOR 

4166
03:18:20,320 --> 03:18:22,160
AUTHORIZATION FOR THE USE OF 

4167
03:18:22,160 --> 03:18:25,120
CERTAIN OPIOIDS AND THEN YOU MAY

4168
03:18:25,120 --> 03:18:25,960
NEED A SECOND PRIOR 

4169
03:18:25,960 --> 03:18:29,640
AUTHORIZATION TO GET THE 

4170
03:18:29,640 --> 03:18:29,920
QUANTITY.

4171
03:18:29,920 --> 03:18:32,320
IN OUR EXPERIENCE THAT'S TWO 

4172
03:18:32,320 --> 03:18:33,840
DIFFERENT CALLS FOR TWO 

4173
03:18:33,840 --> 03:18:37,840
DIFFERENT PRE-AUTHORIZATION 

4174
03:18:37,840 --> 03:18:40,400
APPROVALS FROM THE SAME 

4175
03:18:40,400 --> 03:18:42,280
INSURANCE COMPANY IN THE SAME 

4176
03:18:42,280 --> 03:18:43,920
EPISODE OF CARE?

4177
03:18:43,920 --> 03:18:45,120
WHAT PROVIDER WANTS TO TAKE CARE

4178
03:18:45,120 --> 03:18:47,280
OF PATIENTS IN PAIN EVERY DAY 

4179
03:18:47,280 --> 03:18:48,640
ASKING FOR RELIEF EVERY DAY?

4180
03:18:48,640 --> 03:18:49,800
YOU'RE NOT ABLE TO CURE THEM OF 

4181
03:18:49,800 --> 03:18:53,960
THEIR PAIN AND THEN YOU AS A 

4182
03:18:53,960 --> 03:18:55,360
PROVIDER FEEL INADEQUATE OR 

4183
03:18:55,360 --> 03:18:55,920
INEFFECTIVE.

4184
03:18:55,920 --> 03:18:57,080
WANT TO PUNT.

4185
03:18:57,080 --> 03:18:58,400
THAT'S SHOWN ON THE RIGHT SIDE 

4186
03:18:58,400 --> 03:19:00,280
OF THE SLIDE.

4187
03:19:00,280 --> 03:19:02,440
SOME PROVIDERS OPT-OUT.

4188
03:19:02,440 --> 03:19:07,320
THEY REFER IF THE INITIAL TRIAL 

4189
03:19:07,320 --> 03:19:09,640
DOESN'T WORK OR IF THE PATIENTS 

4190
03:19:09,640 --> 03:19:12,640
GIVE INDICATION THEY'RE MISUSING

4191
03:19:12,640 --> 03:19:16,040
THE OPIOIDS, SOME PROVIDERS WHO 

4192
03:19:16,040 --> 03:19:17,840
FORMALLY PROVIDED OPIOIDS OR 

4193
03:19:17,840 --> 03:19:19,080
TREATED PAINS PUT SIGNS UP IN 

4194
03:19:19,080 --> 03:19:20,640
THE WAITING ROOMS OF THEIR 

4195
03:19:20,640 --> 03:19:23,000
OFFICES SAYING, NO OPIOIDS 

4196
03:19:23,000 --> 03:19:24,640
PROSCRIBED HERE OR WE DON'T DO 

4197
03:19:24,640 --> 03:19:26,000
PAIN MANAGEMENT HERE.

4198
03:19:26,000 --> 03:19:26,800
SO IF YOU HAVE PAIN, TURN AROUND

4199
03:19:26,800 --> 03:19:32,400
AND GO THE OTHER WAY.

4200
03:19:32,400 --> 03:19:35,160
THE ATTITUDES OF THESE KINDS OF 

4201
03:19:35,160 --> 03:19:36,520
PROVIDERS HAS BEEN HEAVILY 

4202
03:19:36,520 --> 03:19:38,240
MOTIVATED BY FEAR.

4203
03:19:38,240 --> 03:19:40,240
FEAR OF LOSING OUR LICENSE.

4204
03:19:40,240 --> 03:19:43,400
FEAR OF BEING PROSECUTED FOR 

4205
03:19:43,400 --> 03:19:44,560
BEING A PILL MILL.

4206
03:19:44,560 --> 03:19:47,440
PILL MILL REAL BUT FOR EVERY 

4207
03:19:47,440 --> 03:19:50,800
PILL MILL THERE'S 10 TO 20 

4208
03:19:50,800 --> 03:19:52,680
PROVIDERS WHO GOT OUT OF THE 

4209
03:19:52,680 --> 03:19:55,920
OPIOID PROSCRIBING AND PAIN GAME

4210
03:19:55,920 --> 03:19:56,880
BECAUSE SIMPLY THEY THOUGHT 

4211
03:19:56,880 --> 03:19:59,320
THEY'D BE PERCEIVED AS A PILL 

4212
03:19:59,320 --> 03:19:59,720
MILL.

4213
03:19:59,720 --> 03:20:03,560
SOME OF THE FEAR'S BEEN BROUGHT 

4214
03:20:03,560 --> 03:20:05,360
ON BY AN INAPPROPRIATE RESPONSE 

4215
03:20:05,360 --> 03:20:08,640
AND APPLICATION OF THE 2016 

4216
03:20:08,640 --> 03:20:10,720
OPIOID PRESCRIBING GUIDELINE.

4217
03:20:10,720 --> 03:20:15,800
THE GENERAL RESPONSE WAS 

4218
03:20:15,800 --> 03:20:18,040
ENHANCED OPIATE PHOBIA.

4219
03:20:18,040 --> 03:20:19,680
THERE AROSE TWO CAMPS.

4220
03:20:19,680 --> 03:20:21,960
ONE SAYING WE USE TOO MANY 

4221
03:20:21,960 --> 03:20:23,520
OPIOID AND ONE SAYING WE USE TOO

4222
03:20:23,520 --> 03:20:23,880
FEW.

4223
03:20:23,880 --> 03:20:26,120
THAT BECAME THE CENTRAL 

4224
03:20:26,120 --> 03:20:26,960
ARGUMENT.

4225
03:20:26,960 --> 03:20:29,200
INSTEAD THE ARGUMENT SHOULD BE, 

4226
03:20:29,200 --> 03:20:33,240
WE'RE NOT TRAINED TO CARE FOR 

4227
03:20:33,240 --> 03:20:33,760
PAIN.

4228
03:20:33,760 --> 03:20:36,360
I ONLY GOT ONE HOUR IN PAIN 

4229
03:20:36,360 --> 03:20:38,600
MANAGEMENT IN MEDICAL SCHOOL.

4230
03:20:38,600 --> 03:20:39,960
I NEEDED MORE.

4231
03:20:39,960 --> 03:20:41,240
UNFORTUNATELY WE'RE DEALING WITH

4232
03:20:41,240 --> 03:20:44,400
RACISM AND IMPLICIT BIAS ON TOP 

4233
03:20:44,400 --> 03:20:46,800
OF EVERYTHING ELSE COMPLICATING.

4234
03:20:46,800 --> 03:20:48,320
AFRICAN AMERICANS ARE GETTING 

4235
03:20:48,320 --> 03:20:50,640
LESS PAIN MANAGEMENT FOR SIMILAR

4236
03:20:50,640 --> 03:20:51,720
PRESENTATIONS IN EMERGENCY 

4237
03:20:51,720 --> 03:20:53,560
DEPARTMENTS ESPECIALLY AND IF 

4238
03:20:53,560 --> 03:20:55,960
THE SUBJECTIVE PAIN IS DIFFICULT

4239
03:20:55,960 --> 03:20:57,640
TO CORRELATE OBJECTIVELY WITH 

4240
03:20:57,640 --> 03:21:00,240
BIOMARKERS OF PHYSICAL SIGNS, 

4241
03:21:00,240 --> 03:21:02,400
PATIENTS ARE GETTING BELIEVED 

4242
03:21:02,400 --> 03:21:04,680
LESS OFTEN AND BEING UNDER 

4243
03:21:04,680 --> 03:21:05,800
TREATED.

4244
03:21:05,800 --> 03:21:07,200
SO WHAT ABOUT STRATEGIES?

4245
03:21:07,200 --> 03:21:08,640
ARE THERE STRATEGY TO COMBAT 

4246
03:21:08,640 --> 03:21:09,440
THIS PROBLEM?

4247
03:21:09,440 --> 03:21:16,320
WE CONDUCTING A SICKLE CELL 

4248
03:21:16,320 --> 03:21:17,880
DISEASE WORKSHOP CALLING FOR 

4249
03:21:17,880 --> 03:21:19,560
APPROACHES TO THERAPEUTIC 

4250
03:21:19,560 --> 03:21:23,800
MANAGEMENT OF PAIN FOR PEOPLE 

4251
03:21:23,800 --> 03:21:24,400
WITH SICKLE CELL DISEASE.

4252
03:21:24,400 --> 03:21:27,800
THE MANAGEMENT ROUNDTABLE ASKED 

4253
03:21:27,800 --> 03:21:30,240
THIS QUESTION, WHAT SUCCESSFUL 

4254
03:21:30,240 --> 03:21:31,560
STRATEGIES FROM OTHER FIELDS CAN

4255
03:21:31,560 --> 03:21:33,080
BE EVALUATED IN TRIALS TO 

4256
03:21:33,080 --> 03:21:35,720
ADDRESS STIGMA, ENHANCE ACCESS 

4257
03:21:35,720 --> 03:21:38,960
TO HIGH QUALITY CARE OR OVERCOME

4258
03:21:38,960 --> 03:21:45,160
STRUCTURAL BARRIERS TO ACUTE AND

4259
03:21:45,160 --> 03:21:47,480
CHRONIC PAIN MANAGEMENT.

4260
03:21:47,480 --> 03:21:50,400
THE STRATEGIES INCLUDED 

4261
03:21:50,400 --> 03:21:51,040
CROSS-COLLABORATIVE TEAMS FOR 

4262
03:21:51,040 --> 03:21:55,240
SPECIFIC STRATEGIES.

4263
03:21:55,240 --> 03:21:56,520
SECOND, STRATEGIES INCLUDED 

4264
03:21:56,520 --> 03:21:58,920
PARTNERING WITH COMMUNITY-BASED 

4265
03:21:58,920 --> 03:21:59,280
ORGANIZATIONS.

4266
03:21:59,280 --> 03:22:01,680
THERE ARE A LOT OF COMMUNITY 

4267
03:22:01,680 --> 03:22:02,880
ASSETS AND COMMUNITY CAPITAL 

4268
03:22:02,880 --> 03:22:05,640
THAT ARE UNDER UTILIZED FOR 

4269
03:22:05,640 --> 03:22:06,280
AUGMENTING PAIN MANAGEMENT AND 

4270
03:22:06,280 --> 03:22:11,920
SUPPORT.

4271
03:22:11,920 --> 03:22:13,160
THIRD, IF THE PATIENT CENTER 

4272
03:22:13,160 --> 03:22:14,840
BELIEVED THEM UNLESS THEY GIVE 

4273
03:22:14,840 --> 03:22:17,160
YOU A GOOD OBJECTIVE REASON NOT 

4274
03:22:17,160 --> 03:22:20,920
TO, FOUR, BE EMPATHETIC.

4275
03:22:20,920 --> 03:22:24,600
DON'T USE LANGUAGE LIKE SICKLER 

4276
03:22:24,600 --> 03:22:28,600
BUT REFER TO PATIENTS WITH 

4277
03:22:28,600 --> 03:22:29,880
LIVING WITH SICKLE CELL DISEASE.

4278
03:22:29,880 --> 03:22:32,560
LANGUAGE MATTERS FOR REMOVING I 

4279
03:22:32,560 --> 03:22:43,080
AM PLIS -- IMPLICIT BIAS AND 

4280
03:22:44,040 --> 03:22:44,400
TRUST.

4281
03:22:44,400 --> 03:22:45,520
ADVOCATE WITH YOU.

4282
03:22:45,520 --> 03:22:46,880
HAVE A PAIN ADVISORY COUNCIL IN 

4283
03:22:46,880 --> 03:22:47,960
YOUR HOSPITAL.

4284
03:22:47,960 --> 03:22:51,240
THE CONSENSUS WAS 

4285
03:22:51,240 --> 03:22:52,320
PROVIDER-FACING EDUCATION IS 

4286
03:22:52,320 --> 03:22:53,760
IMPORTANT TO MOVE THE PAIN 

4287
03:22:53,760 --> 03:22:55,120
TREATMENT FIELD ALONG BECAUSE WE

4288
03:22:55,120 --> 03:22:56,880
DIDN'T GET IT IN MEDICAL SCHOOL 

4289
03:22:56,880 --> 03:22:58,600
OR PHARMACY SCHOOL OR NURSING 

4290
03:22:58,600 --> 03:23:00,400
SCHOOL AND NOW WE HAVE TO GET 

4291
03:23:00,400 --> 03:23:00,640
IT.

4292
03:23:00,640 --> 03:23:02,760
WE HAVE TO BECOME AWARE OF OUR 

4293
03:23:02,760 --> 03:23:04,960
OWN BIASES AND GET SOME SKILLS.

4294
03:23:04,960 --> 03:23:07,040
FOR EXAMPLE, ONE TRAINING METHOD

4295
03:23:07,040 --> 03:23:08,960
OF DOING THAT IS VIRTUAL 

4296
03:23:08,960 --> 03:23:11,840
REALITY.

4297
03:23:11,840 --> 03:23:14,000
THERE'S CERTAINLY OTHERS.

4298
03:23:14,000 --> 03:23:16,040
WHERE THERE'S FIELDS THIS IS 

4299
03:23:16,040 --> 03:23:18,920
HAPPENING, THE BELIEF WAS WE 

4300
03:23:18,920 --> 03:23:20,320
SHOULD ADOPT THEM.

4301
03:23:20,320 --> 03:23:22,600
FOR EXAMPLE, IN THE HIV AND AIDS

4302
03:23:22,600 --> 03:23:24,680
FIELD THIS IS HAPPENING.

4303
03:23:24,680 --> 03:23:26,960
CERTAINLY IN THE CANCER FIELD 

4304
03:23:26,960 --> 03:23:28,600
AND IN THE SUBSTANCE ABUSE 

4305
03:23:28,600 --> 03:23:29,800
FIELD, IT'S HAPPENING.

4306
03:23:29,800 --> 03:23:32,200
A SIMILAR QUESTION AND THE ONE I

4307
03:23:32,200 --> 03:23:34,640
WRESTLE WITH IS WHAT ARE 

4308
03:23:34,640 --> 03:23:36,640
BARRIERS TO THE ADOPTION, 

4309
03:23:36,640 --> 03:23:44,360
ADAPTATION, INTEGRATION AND 

4310
03:23:44,360 --> 03:23:47,760
SCALE-UP AND SUSTAINABILITY OF 

4311
03:23:47,760 --> 03:23:49,360
WHOLE A PERPERSON APPROACHES TO.

4312
03:23:49,360 --> 03:23:50,920
I DON'T THINK IT'S TOO MUCH OF A

4313
03:23:50,920 --> 03:23:53,800
STRETCH TO SAY FOR ALL OF 

4314
03:23:53,800 --> 03:23:55,120
CHRONIC PAIN THERE WERE ISSUES 

4315
03:23:55,120 --> 03:23:56,960
THAT PROVIDERS UNIFORMLY 

4316
03:23:56,960 --> 03:23:57,240
ENDORSED.

4317
03:23:57,240 --> 03:24:02,960
YOU CAN SEE BY THE NUMBER OF Xs 

4318
03:24:02,960 --> 03:24:04,640
ACROSS WHICH CATEGORIES GOT THE 

4319
03:24:04,640 --> 03:24:06,200
MOST ENDORSEMENTS.

4320
03:24:06,200 --> 03:24:10,640
POOR ACCESS TO PROVIDERS, TOO 

4321
03:24:10,640 --> 03:24:12,360
POORLY TRAINED PROVIDERS.

4322
03:24:12,360 --> 03:24:13,480
POOR MEASURES AND RESEARCH 

4323
03:24:13,480 --> 03:24:14,040
DATABASES AND FOLLOWED BY 

4324
03:24:14,040 --> 03:24:21,120
RACISM.

4325
03:24:21,120 --> 03:24:24,040
SIMILARLY YOU CAN SEE PROVIDERS 

4326
03:24:24,040 --> 03:24:25,400
AGREED WITH WHAT A SAID ABOUT 

4327
03:24:25,400 --> 03:24:26,520
THE PROBLEMS.

4328
03:24:26,520 --> 03:24:28,960
WHOLE GLAD TO ANNOUNCE WE HAVE 

4329
03:24:28,960 --> 03:24:29,680
HEAL INITIATIVE FUNDING 

4330
03:24:29,680 --> 03:24:31,360
OPPORTUNITY ANNOUNCEMENTS COMING

4331
03:24:31,360 --> 03:24:37,200
OUT THAT DEAL WITH PAIN ON A 

4332
03:24:37,200 --> 03:24:38,280
MULTI-LEVEL BIO PSYCHOSOCIAL 

4333
03:24:38,280 --> 03:24:39,600
MULTI DISCIPLINARY BASIS AND A 

4334
03:24:39,600 --> 03:24:41,440
HOPE WE'LL SEE PROGRAMS THAT 

4335
03:24:41,440 --> 03:24:42,840
DEMONSTRATE APPROACH TO PAIN 

4336
03:24:42,840 --> 03:24:48,280
THAT OVERCOME THESE BARRIERS.

4337
03:24:48,280 --> 03:24:50,920
SO WE'RE BACK TO WHERE WE START.

4338
03:24:50,920 --> 03:24:52,120
YOU CAN PERHAPS LOOK AT THE 

4339
03:24:52,120 --> 03:24:54,360
CHRONIC PAIN EXPERIENCE WITH NEW

4340
03:24:54,360 --> 03:24:56,640
EYES AND A NEW FOCUS.

4341
03:24:56,640 --> 03:24:59,680
WHERE IN THE PICTURE ARE YOU?

4342
03:24:59,680 --> 03:25:02,480
WHERE IS YOUR PATIENT IN THEIR 

4343
03:25:02,480 --> 03:25:04,120
PICTURE.

4344
03:25:04,120 --> 03:25:07,400
WHERE ARE YOU AND YOUR PATIENT 

4345
03:25:07,400 --> 03:25:08,640
ADVOCATE DIAD?

4346
03:25:08,640 --> 03:25:09,000
WHERE ARE YOU?

4347
03:25:09,000 --> 03:25:11,080
WHAT CAN YOU DO TO MAKE THE 

4348
03:25:11,080 --> 03:25:12,360
CHRONIC PAIN EXPERIENCE IN THE 

4349
03:25:12,360 --> 03:25:16,640
UNITED STATES ONE THAT IS MORE 

4350
03:25:16,640 --> 03:25:18,440
ACCEPTABLE AND EQUITABLE AND 

4351
03:25:18,440 --> 03:25:19,560
FAIR FOR THE PATIENT.

4352
03:25:19,560 --> 03:25:22,480
WHAT CAN YOU DO TO TAKE THE 

4353
03:25:22,480 --> 03:25:24,040
FOCUS OFF OPIOIDS YES VERSUS NO 

4354
03:25:24,040 --> 03:25:28,680
AND PUT IT ON LESS PAIN, ON THE 

4355
03:25:28,680 --> 03:25:30,520
ORGANISM AS DR. GAUDET SAID 

4356
03:25:30,520 --> 03:25:30,760
YESTERDAY.

4357
03:25:30,760 --> 03:25:32,200
I THANK YOU FOR YOUR TIME AND 

4358
03:25:32,200 --> 03:25:33,120
LOOKING FORWARD TO THE QUESTION 

4359
03:25:33,120 --> 03:25:35,760
AND ANSWER PERIOD.

4360
03:25:35,760 --> 03:25:40,000
>> THANK YOU, DR. SMITH.

4361
03:25:40,000 --> 03:25:42,400
WE ARE ABOUT FIVE OR SIX MINUTES

4362
03:25:42,400 --> 03:25:43,800
BEHIND THE SCHEDULE.

4363
03:25:43,800 --> 03:25:45,040
LET'S MOVE TO THE SECOND HALF OF

4364
03:25:45,040 --> 03:25:48,760
THE IF HE QUESTION, Q&A AND 

4365
03:25:48,760 --> 03:25:52,480
PANEL DISCUSSION.

4366
03:25:52,480 --> 03:25:53,880
IT'S MY GREAT PLEASURE TO 

4367
03:25:53,880 --> 03:25:57,800
INTRODUCE COLLEAGUES AND FRIENDS

4368
03:25:57,800 --> 03:26:02,960
FROM THE NIH INTRAMURAL 

4369
03:26:02,960 --> 03:26:08,120
COMMUNITY.

4370
03:26:08,120 --> 03:26:13,280
WE HAVE A FACILITATOR AND IS IN 

4371
03:26:13,280 --> 03:26:14,880
THE DIVISION OF INTRAMURAL 

4372
03:26:14,880 --> 03:26:15,960
RESEARCH OF CENTER OF 

4373
03:26:15,960 --> 03:26:19,680
COMPLIMENTARY AND INTEGRATIVE 

4374
03:26:19,680 --> 03:26:20,920
HEALTH.

4375
03:26:20,920 --> 03:26:22,280
MISHA'S CLINICAL AND RESEARCH 

4376
03:26:22,280 --> 03:26:24,400
INTEREST HAS BEEN RELATED TO 

4377
03:26:24,400 --> 03:26:26,840
PAIN INCLUDING NEUROLOGICAL 

4378
03:26:26,840 --> 03:26:33,680
DISORDERS AND CONDUCTS 

4379
03:26:33,680 --> 03:26:34,320
RANDOMIZED CLINICAL TRIALS.

4380
03:26:34,320 --> 03:26:38,800
OUR LEAD DISCUSSANT IS DR. KAREN

4381
03:26:38,800 --> 03:26:40,560
SEAL FROM UCSF.

4382
03:26:40,560 --> 03:26:43,760
A PREVENTION OF MEDICINE AND 

4383
03:26:43,760 --> 03:26:45,960
PSYCHIATRY IN RESIDENCE AT UCSF 

4384
03:26:45,960 --> 03:26:49,840
AND CHIEF OF INTEGRATIVE HEALTH 

4385
03:26:49,840 --> 03:26:52,680
SERVICES OF THE SAN FRANCISCO 

4386
03:26:52,680 --> 03:26:54,400
BAY HEALTH CARE SYSTEM.

4387
03:26:54,400 --> 03:26:56,240
DR. SEAL HAS PARTICULAR INTEREST

4388
03:26:56,240 --> 03:26:57,320
IN DEVELOPING AND TESTING NEW 

4389
03:26:57,320 --> 03:27:01,240
MODELS OF CARE TO PROMOTE 

4390
03:27:01,240 --> 03:27:03,320
NON-PHARMACOLOGIC MEASUREMENTS 

4391
03:27:03,320 --> 03:27:05,200
OF CHRONIC PAIN AND PAIN 

4392
03:27:05,200 --> 03:27:11,640
COMORBIDITIES AND CONDUCTING THE

4393
03:27:11,640 --> 03:27:12,680
MULTI-SITE CLINICAL TRIAL TO 

4394
03:27:12,680 --> 03:27:14,960
LOOK AT THE EFFECTIVENESS OF A 

4395
03:27:14,960 --> 03:27:17,560
WHOLE HEALTH TEAM APPROACH TO 

4396
03:27:17,560 --> 03:27:19,640
CHRONIC PAIN CARE.

4397
03:27:19,640 --> 03:27:21,880
MISHA, SO HOW ABOUT WE START 

4398
03:27:21,880 --> 03:27:24,120
WITH QUESTIONS IN THE CHAT BOX 

4399
03:27:24,120 --> 03:27:26,600
FOR THE SPEAKERS.

4400
03:27:26,600 --> 03:27:30,440
AND ALSO I SAW A QUESTION FROM 

4401
03:27:30,440 --> 03:27:33,800
THE PANELISTS OR SPEAKERS.

4402
03:27:33,800 --> 03:27:34,680
I'LL LET YOU TAKE THE FLOOR.

4403
03:27:34,680 --> 03:27:36,960
>> THANK YOU.

4404
03:27:36,960 --> 03:27:39,760
BEFORE I GO TO QUESTIONS, I'LL 

4405
03:27:39,760 --> 03:27:42,280
TAKE A MINUTE TO SUMMARIZE AT 

4406
03:27:42,280 --> 03:27:46,280
LEAST FOR US TO REFLECT ON THE 

4407
03:27:46,280 --> 03:27:48,720
TOPIC OF TODAY'S SESSION WHICH 

4408
03:27:48,720 --> 03:27:53,000
IS IMPLEMENTING WHOLE PERSON 

4409
03:27:53,000 --> 03:27:53,360
CARE.

4410
03:27:53,360 --> 03:27:56,600
AND WE HAD ON YESTERDAY AND GOOD

4411
03:27:56,600 --> 03:27:59,000
TALK TODAY EXCELLENT REVIEW WHAT

4412
03:27:59,000 --> 03:28:02,400
THE CONCEPTS THAT CONSTITUTE 

4413
03:28:02,400 --> 03:28:07,520
WHOLE PERSON CARE AND THAT 

4414
03:28:07,520 --> 03:28:18,160
CLEARLY PROVIDERS -- PROVIDES 

4415
03:28:20,080 --> 03:28:21,560
IMPORTANCE AND REFLECTION AND 

4416
03:28:21,560 --> 03:28:23,280
EXPERIENCE AND DEMONSTRATE HOW A

4417
03:28:23,280 --> 03:28:24,640
CURRENT SYSTEM IS FAR FROM 

4418
03:28:24,640 --> 03:28:26,840
WHAT'S NEEDED TO DELIVER WHAT 

4419
03:28:26,840 --> 03:28:28,080
WOULD BE CONSIDERED OPTIMAL CARE

4420
03:28:28,080 --> 03:28:38,120
WHICH IS WHOLE PERSON CARE.

4421
03:28:38,120 --> 03:28:41,080
THE PROBLEM IS REFLECTS IN PART 

4422
03:28:41,080 --> 03:28:50,000
WITH DR. SMITH'S SUMMARY OF THE 

4423
03:28:50,000 --> 03:28:52,680
SYSTEM THAT STANDS IN THE WAY 

4424
03:28:52,680 --> 03:28:58,440
AND THIS IS IN COMMENTS 

4425
03:28:58,440 --> 03:29:01,600
REFLECTING THE FACT THAT OUR 

4426
03:29:01,600 --> 03:29:02,680
CURRENT HEALTH CARE SYSTEM 

4427
03:29:02,680 --> 03:29:06,320
DELIVERY IS FAR FROM CONDUCIVE 

4428
03:29:06,320 --> 03:29:08,080
TO WHOLE SYSTEM CARE.

4429
03:29:08,080 --> 03:29:09,920
I'LL TAKE THE PREROGATIVE TO ASK

4430
03:29:09,920 --> 03:29:17,280
A COUPLE PANELISTS, DR. McKERNAN

4431
03:29:17,280 --> 03:29:27,480
MENTIO

4432
03:29:39,000 --> 03:29:39,680
MENTIO

4433
03:29:39,680 --> 03:29:43,600
MENTIONED  AND WHAT IS BEING 

4434
03:29:43,600 --> 03:29:45,880
TAUGHT AND THOSE MENTIONED TODAY

4435
03:29:45,880 --> 03:29:49,280
AND MULTI DISCIPLINARY PAIN 

4436
03:29:49,280 --> 03:29:51,480
CLINICS AND COMING FROM PRACTICE

4437
03:29:51,480 --> 03:29:52,880
IN MULTIDISCIPLINARY CARE.

4438
03:29:52,880 --> 03:29:55,040
PATIENTS ARE ALWAYS GIVEN A LIST

4439
03:29:55,040 --> 03:30:00,480
OF THINGS TO DO AND LOOKS 

4440
03:30:00,480 --> 03:30:03,960
OVERWHELMING TO THE PATIENT.

4441
03:30:03,960 --> 03:30:12,640
THIS IS DISAPPOINTING TO WHOLE 

4442
03:30:12,640 --> 03:30:15,640
PERSON CARE.

4443
03:30:15,640 --> 03:30:18,040
AND GOING FROM MULTIDISCIPLINARY

4444
03:30:18,040 --> 03:30:20,480
TO INTRADISCIPLINARY CARE AND 

4445
03:30:20,480 --> 03:30:25,440
FOLLOW-UP WITH DR. SMITH 

4446
03:30:25,440 --> 03:30:28,640
REGARDING THE COMMENT WHY AND 

4447
03:30:28,640 --> 03:30:31,320
NOW IT'S A MODEL TO DELIVER 

4448
03:30:31,320 --> 03:30:32,440
WHOLE PERSON CARE.

4449
03:30:32,440 --> 03:30:33,240
>> SURE.

4450
03:30:33,240 --> 03:30:34,560
THANK YOU FOR THE QUESTION.

4451
03:30:34,560 --> 03:30:36,640
I'D BE HAPPY TO TALK ABOUT OUR 

4452
03:30:36,640 --> 03:30:37,360
I.C. CLINIC.

4453
03:30:37,360 --> 03:30:38,720
IT'S BEEN RUNNING FIVE OR SIX 

4454
03:30:38,720 --> 03:30:43,200
YEARS AND START ED AS A CONGRES 

4455
03:30:43,200 --> 03:30:47,920
ROOTS EFFORT WITH MYSELF, A 

4456
03:30:47,920 --> 03:30:50,000
NURSE PRACTITIONER AND SURGEON 

4457
03:30:50,000 --> 03:30:51,640
WHO WANTED TO DO MORE FOR THESE 

4458
03:30:51,640 --> 03:30:52,240
PATIENTS.

4459
03:30:52,240 --> 03:30:56,240
THE WAY I STRUCTURE IT IS I RUN 

4460
03:30:56,240 --> 03:31:02,360
DUEL SULT -- CONSULTS WITH THE 

4461
03:31:02,360 --> 03:31:05,400
NURSE AND WE TRY TO SAVE THEM 

4462
03:31:05,400 --> 03:31:06,160
TIME REPEATING THE STORY AND 

4463
03:31:06,160 --> 03:31:07,560
MAKE RECOMMENDATIONS TOGETHER ON

4464
03:31:07,560 --> 03:31:11,840
WHAT WE THINK THE TREATMENT PLAN

4465
03:31:11,840 --> 03:31:13,960
OUGHT TO BE AND THE NURSE 

4466
03:31:13,960 --> 03:31:15,600
PRACTITIONER MAY NEED TO GO NOT 

4467
03:31:15,600 --> 03:31:17,240
NEXT ROOM AND I MAY STAY AND 

4468
03:31:17,240 --> 03:31:18,920
WORK OUT SOMETHING SPECIFIC WITH

4469
03:31:18,920 --> 03:31:20,640
THAT PERSON AND SCHEDULE SOME 

4470
03:31:20,640 --> 03:31:22,440
BRIEF FOLLOW-UPS WITH THEM.

4471
03:31:22,440 --> 03:31:25,120
I WISH ALWAYS WE COULD DO MORE 

4472
03:31:25,120 --> 03:31:26,960
SO IT'S A SHORT PERIOD OF 

4473
03:31:26,960 --> 03:31:27,920
TREATMENT AND WHEN THEY COME 

4474
03:31:27,920 --> 03:31:32,680
BACK TO THEIR RETURN VISITS THEY

4475
03:31:32,680 --> 03:31:33,680
SEE US BOTH AGAIN.

4476
03:31:33,680 --> 03:31:37,800
SO OVER TIME WE INCLUDED AND 

4477
03:31:37,800 --> 03:31:39,320
EXPANDED THE CLINIC TO INCLUDE 

4478
03:31:39,320 --> 03:31:39,560
TRAINEES.

4479
03:31:39,560 --> 03:31:44,640
THAT'S WONDERFUL BECAUSE IT 

4480
03:31:44,640 --> 03:31:51,840
ALLOWS US TO HAVE MORE PSYCH 

4481
03:31:51,840 --> 03:31:52,400
PSYCHOLOGICAL TRAINING AND 

4482
03:31:52,400 --> 03:31:59,640
THERE'S THINGS IN UROLOGY DONE 

4483
03:31:59,640 --> 03:32:04,080
AS AN OUT PATIENT AND WE RUN AN 

4484
03:32:04,080 --> 03:32:05,560
ONLINE GROUND HELPING PEOPLE 

4485
03:32:05,560 --> 03:32:06,480
LEARN RELAXATION STRATEGIES TO 

4486
03:32:06,480 --> 03:32:16,800
MAKE THEM BETTER.

4487
03:32:18,760 --> 03:32:20,040
IF YOU HELP BUILD IT IT WILL 

4488
03:32:20,040 --> 03:32:21,320
GROW AND THE FEEDBACK WE'VE 

4489
03:32:21,320 --> 03:32:24,640
GOTTEN FROM PATIENTS IS 

4490
03:32:24,640 --> 03:32:34,920
WONDERFUL ON IT.

4491
03:32:43,160 --> 03:32:45,200
>> WE HAVE TO GO TO
COMMUNITIES 

4492
03:32:45,200 --> 03:32:46,800
AND SPREAD THE WORD.

4493
03:32:46,800 --> 03:32:48,680
HOW DOES THIS TRANSLATE TO DO 

4494
03:32:48,680 --> 03:32:55,360
MORE IN THIS CASE?

4495
03:32:55,360 --> 03:33:01,120
>> I FEEL LIKE THE POLY
CLINIC 

4496
03:33:01,120 --> 03:33:06,160
IS THE ANSWER WHERE AS THE CASE 

4497
03:33:06,160 --> 03:33:11,000
DISCUSSION AND YOU SEE THE 

4498
03:33:11,000 --> 03:33:12,160
PATIENT AND A TREATMENT PLAN IS 

4499
03:33:12,160 --> 03:33:13,840
RENDERED AFTER YOU SEE THE 

4500
03:33:13,840 --> 03:33:17,280
PATIENT AND THE TEAM COMES UP 

4501
03:33:17,280 --> 03:33:19,440
WITH A TREATMENT PLAN.

4502
03:33:19,440 --> 03:33:20,640
THERE'S DEBATE AMONG MEMBERS OF 

4503
03:33:20,640 --> 03:33:22,720
THE TEAM ABOUT WHAT IS BEST TO 

4504
03:33:22,720 --> 03:33:28,640
TRY AND WE COME TO A UNIFORM 

4505
03:33:28,640 --> 03:33:37,200
AGREEMENT ABOUT A TARGET ED 

4506
03:33:37,200 --> 03:33:38,960
PERHAPS TRIAL AND ERROR TO 

4507
03:33:38,960 --> 03:33:39,440
MANAGE CHRONIC PAIN.

4508
03:33:39,440 --> 03:33:42,440
WE DON'T KNOW WHAT WE'RE DOING A

4509
03:33:42,440 --> 03:33:43,600
LOT OF THE TIMES.

4510
03:33:43,600 --> 03:33:45,560
THE PATIENTS CAN'T TELL US 

4511
03:33:45,560 --> 03:33:50,760
WHAT'S WRONG WITH THEM A LOT OF 

4512
03:33:50,760 --> 03:33:51,960
THE TIMES.

4513
03:33:51,960 --> 03:33:54,840
THESE TEAM MEMBERS CAN HAVE 

4514
03:33:54,840 --> 03:33:55,920
THEIR THEORIES ON WHAT SHOULD BE

4515
03:33:55,920 --> 03:33:57,720
DONE BUT WE TRY TO HAVE A JOINT 

4516
03:33:57,720 --> 03:34:00,680
PROGRAM AND WE TRY TO WRITE IT 

4517
03:34:00,680 --> 03:34:06,600
DOWN AND NOT ALWAYS DONE BUT TRY

4518
03:34:06,600 --> 03:34:08,960
TO HAVE AN INDIVIDUALIZED 

4519
03:34:08,960 --> 03:34:15,240
TREATMENT PLAN LIKE AN ASTHMA 

4520
03:34:15,240 --> 03:34:20,240
TEAM THE PSYCHOLOGISTS AND ALL 

4521
03:34:20,240 --> 03:34:21,680
INVOLVED ARE THE PAIN MANGERS.

4522
03:34:21,680 --> 03:34:24,640
WE DON'T REFER TO PAIN 

4523
03:34:24,640 --> 03:34:31,920
MANAGEMENT FOR OUR PATIENTS.

4524
03:34:31,920 --> 03:34:36,040
A THESE MANAGER HAS TO BE A PAIN

4525
03:34:36,040 --> 03:34:38,000
MANGER FOR DISEASES THAT ARE 

4526
03:34:38,000 --> 03:34:39,920
PAINFUL AND YOU CAN'T ESCAPE THE

4527
03:34:39,920 --> 03:34:44,600
TRAINING YOU NEED TO HAVE A TEAM

4528
03:34:44,600 --> 03:34:46,000
AROUND BUT YOU ARE THE CAPTAIN 

4529
03:34:46,000 --> 03:34:46,640
OF YOUR TEAM BECAUSE YOU KNOW 

4530
03:34:46,640 --> 03:34:56,840
THE DISEASE.

4531
03:35:10,600 --> 03:35:13,280
WE HAVE WAYS OF WHOLE PERSON 

4532
03:35:13,280 --> 03:35:18,520
CARE AND AGAIN THERE WAS A 

4533
03:35:18,520 --> 03:35:20,280
REFERENCE TO THE DOD SYSTEM AS 

4534
03:35:20,280 --> 03:35:20,960
WELL.

4535
03:35:20,960 --> 03:35:25,000
LET'S GO TO SOME SPECIFIC 

4536
03:35:25,000 --> 03:35:25,400
PORTIONS.

4537
03:35:25,400 --> 03:35:28,680
THERE WERE SPECIFIC TO LINSEY 

4538
03:35:28,680 --> 03:35:31,720
McKERNAN.

4539
03:35:31,720 --> 03:35:34,880
MADE REFERENCE TO THE MANUAL.

4540
03:35:34,880 --> 03:35:35,720
IS IT AVAILABLE?

4541
03:35:35,720 --> 03:35:37,520
>> IT WILL BE AT THE END
OF THE 

4542
03:35:37,520 --> 03:35:38,000
STUDY.

4543
03:35:38,000 --> 03:35:38,960
WE'RE IN OUR LAST YEAR.

4544
03:35:38,960 --> 03:35:40,800
I'D BE HAPPY TO SHARE THE FULL 

4545
03:35:40,800 --> 03:35:42,160
MANUAL AND PATIENT MANUAL AND 

4546
03:35:42,160 --> 03:35:43,800
DROP MY E-MAIL IN THE CHAT.

4547
03:35:43,800 --> 03:35:45,640
IT'S FOR CLINICIANS I CAN SHARE 

4548
03:35:45,640 --> 03:35:46,520
IT WITH.

4549
03:35:46,520 --> 03:35:50,760
>> AND ALSO FOLLOW-UP THE 

4550
03:35:50,760 --> 03:35:53,600
QUESTION ALSO RESOURCES THE I.C.

4551
03:35:53,600 --> 03:35:56,680
SUPPORT GROUP INFORMATION AS 

4552
03:35:56,680 --> 03:35:57,880
WELL.

4553
03:35:57,880 --> 03:35:59,600
THAT ONE IS RUN THROUGH OUR 

4554
03:35:59,600 --> 03:36:01,240
MEDICAL CENTER BUT IF YOU'RE A 

4555
03:36:01,240 --> 03:36:02,800
REGISTERED PATIENT YOU CAN 

4556
03:36:02,800 --> 03:36:04,640
ALWAYS JOIN IT.

4557
03:36:04,640 --> 03:36:14,160
I'LL SHARE THAT TOO.

4558
03:36:14,160 --> 03:36:18,920
THERE'S A QUESTION TO WALLY 

4559
03:36:18,920 --> 03:36:20,600
SMITH, ISN'T A MAJOR PROBLEM 

4560
03:36:20,600 --> 03:36:24,320
THERE'S A FOCUS ON SUBSTANCE 

4561
03:36:24,320 --> 03:36:26,680
ABUSE AND THE ADDICTION SHOULD 

4562
03:36:26,680 --> 03:36:28,640
BE THE SECONDARY CONCERN FOR 

4563
03:36:28,640 --> 03:36:31,080
THOSE WITH SIGNIFICANT PAIN.

4564
03:36:31,080 --> 03:36:34,920
ANY COMMENT?

4565
03:36:34,920 --> 03:36:38,440
>> THERE'S AN EXCESSIVE
FOCUS ON

4566
03:36:38,440 --> 03:36:40,120
SUBSTANCE ABUSE BROUGHT ON BY 

4567
03:36:40,120 --> 03:36:41,880
THE ALARMING STATISTICS BY THE 

4568
03:36:41,880 --> 03:36:45,360
FIRST EPIDEMIC I TALKED ABOUT.

4569
03:36:45,360 --> 03:36:48,160
THE CHRONIC PAIN EPIDEMIC IS 

4570
03:36:48,160 --> 03:36:48,600
SIL

4571
03:36:48,600 --> 03:36:48,840
SILENT.

4572
03:36:48,840 --> 03:36:49,800
WE DON'T KNOW IT'S KILLING 

4573
03:36:49,800 --> 03:36:55,160
PEOPLE OR SEE THE STATS.

4574
03:36:55,160 --> 03:36:57,000
THE OPIOID MISUSE AND EPIDEMIC 

4575
03:36:57,000 --> 03:37:00,040
IS ON THE FRONT PAGES.

4576
03:37:00,040 --> 03:37:01,440
IT'S ON THE PRESIDENT'S CAMPAIGN

4577
03:37:01,440 --> 03:37:01,720
PLATFORM.

4578
03:37:01,720 --> 03:37:05,880
IT'S NOT SUBTLE.

4579
03:37:05,880 --> 03:37:10,240
WE FORGOT IT'S NOT LONGER 

4580
03:37:10,240 --> 03:37:11,200
PRESCRIPTION OPIOIDS BUT 

4581
03:37:11,200 --> 03:37:15,760
SYNTHETIC OPIOIDS DRIVING THE 

4582
03:37:15,760 --> 03:37:16,280
EPIDEMIC.

4583
03:37:16,280 --> 03:37:21,400
SO WE HAVE A CONDITION THAT OUR 

4584
03:37:21,400 --> 03:37:24,160
PRESCRIBING IS KILLING PATIENTS.

4585
03:37:24,160 --> 03:37:25,960
MANAGING SOMEBODY WITH 

4586
03:37:25,960 --> 03:37:30,920
CO-EXISTING SUBSTANCE USE IS ONE

4587
03:37:30,920 --> 03:37:37,520
OF THE KEY OPERATING 

4588
03:37:37,520 --> 03:37:38,480
DIFFICULTIES WITHIN THE HEAL 

4589
03:37:38,480 --> 03:37:40,080
INITIATIVE PUTTING FOAs OUT FOR 

4590
03:37:40,080 --> 03:37:45,720
MANAGING THOSE PATIENTS IS A 

4591
03:37:45,720 --> 03:37:49,640
TEAM EFFORT.

4592
03:37:49,640 --> 03:37:51,320
I DIDN'T KNOW ABOUT THIS BUT I 

4593
03:37:51,320 --> 03:37:52,640
DO NOW BECAUSE WHOLE STILL 

4594
03:37:52,640 --> 03:37:58,400
MANAGING PATIENTS WITH 

4595
03:37:58,400 --> 03:38:06,560
CO-EXISTING ADDICTION WITH MORE 

4596
03:38:06,560 --> 03:38:09,240
PATIENT EDUCATION AND THERE IS 

4597
03:38:09,240 --> 03:38:09,880
CO-EXISTING SUBSTANCE USE WITH 

4598
03:38:09,880 --> 03:38:12,680
CHRONIC PAIN AND WE HAVE TO DEAL

4599
03:38:12,680 --> 03:38:17,920
WITH IT.

4600
03:38:17,920 --> 03:38:20,160
AS WE GO FORWARD I HOPE WE GET 

4601
03:38:20,160 --> 03:38:22,000
PREVALENCE ESTIMATES ABOUT THAT 

4602
03:38:22,000 --> 03:38:23,120
SO WE UNDERSTAND THAT MOST 

4603
03:38:23,120 --> 03:38:25,160
PEOPLE WITH CHRONIC PAIN DO NOT 

4604
03:38:25,160 --> 03:38:28,560
HAVE CO-EXISTING SUBSTANCE USE.

4605
03:38:28,560 --> 03:38:30,000
THAT WILL HELP AND I HOPE TO 

4606
03:38:30,000 --> 03:38:31,720
SHOW JUST BECAUSE YOU DO HAVE 

4607
03:38:31,720 --> 03:38:33,040
IT, DOESN'T MEAN YOU DON'T TREAT

4608
03:38:33,040 --> 03:38:38,600
THE CHRONIC PAIN OR ACUTE PAIN.

4609
03:38:38,600 --> 03:38:38,960
IS 

4610
03:38:38,960 --> 03:38:44,680
>> IF OTHER SPEAKERS
WOULDN'T 

4611
03:38:44,680 --> 03:38:46,480
MIND ADDRESSING THIS.

4612
03:38:46,480 --> 03:38:52,640
MAYBE DR. DOORENBOOS IF THERE 

4613
03:38:52,640 --> 03:38:53,960
WAS ANYTHING IN YOUR RESEARCH OR

4614
03:38:53,960 --> 03:39:04,480
GIVE REFLECTIONS ON THE TOPIC.

4615
03:39:05,600 --> 03:39:08,640
IT'S THIS INTERSECTION THAT 

4616
03:39:08,640 --> 03:39:10,960
FAC

4617
03:39:10,960 --> 03:39:18,760
FACES MANY PATIENTS.

4618
03:39:18,760 --> 03:39:24,960
>> WHAT I HEARD IS SPOT
ON.

4619
03:39:24,960 --> 03:39:30,880
HAVING HAVING THE MULTI 

4620
03:39:30,880 --> 03:39:31,680
DISCIPLINARY TEAM AND HAVING TO 

4621
03:39:31,680 --> 03:39:33,240
HAVE THE BACKGROUND IN ADDICTION

4622
03:39:33,240 --> 03:39:36,640
MEDICINE TO PARTNER WITH AND SO 

4623
03:39:36,640 --> 03:39:42,080
WE'RE ABLE TO CO-SEE PATIENTS 

4624
03:39:42,080 --> 03:39:45,440
WHO HAVE SOME OF THESE ISSUES SO

4625
03:39:45,440 --> 03:39:48,920
THE INTERDISCIPLINARY APPROACHES

4626
03:39:48,920 --> 03:39:51,880
I THINK ARE VERY IMPORTANT.

4627
03:39:51,880 --> 03:39:56,640
AND I THINK IT IS SOMETHING THAT

4628
03:39:56,640 --> 03:40:00,640
WILL HAVE TO CONTINUE DEALING 

4629
03:40:00,640 --> 03:40:11,000
WITH GOING FORWARD.

4630
03:40:24,720 --> 03:40:30,040
>> YOU SPOKE ABOUT AN 

4631
03:40:30,040 --> 03:40:31,320
INTERACTION THAT WAS NOT KIND 

4632
03:40:31,320 --> 03:40:33,880
AND NOT HOW WE TEACH NURSING 

4633
03:40:33,880 --> 03:40:35,040
STUDENTS TO COMMUNICATE WITH 

4634
03:40:35,040 --> 03:40:37,080
PATIENTS.

4635
03:40:37,080 --> 03:40:38,280
THIS IS A QUESTION THAT I DON'T 

4636
03:40:38,280 --> 03:40:40,640
KNOW IF YOU HAVE COMMENTS ABOUT 

4637
03:40:40,640 --> 03:40:41,520
WHAT THEY TALKED OTHERWISE I 

4638
03:40:41,520 --> 03:40:46,400
HAVE ONE MORE QUESTION FOR YOU.

4639
03:40:46,400 --> 03:40:48,760
>> THE ONLY THING -- THE
ONE 

4640
03:40:48,760 --> 03:40:50,560
THING THAT SURPRISED ME WAS THE 

4641
03:40:50,560 --> 03:40:51,240
PERSON THAT MADE THAT COMMENT 

4642
03:40:51,240 --> 03:40:57,920
WAS A PERSON OF COLOR.

4643
03:40:57,920 --> 03:40:59,480
JUST THINKING ABOUT IT RIGHT 

4644
03:40:59,480 --> 03:41:02,400
NOW, WHOLE STILL ABSOLUTELY 

4645
03:41:02,400 --> 03:41:07,520
SPEECHLESS THAT SOMEONE WOULD DO

4646
03:41:07,520 --> 03:41:16,280
THAT.

4647
03:41:16,280 --> 03:41:18,280
I THINK IT SPEAKS TO A NEED FOR 

4648
03:41:18,280 --> 03:41:20,640
SENSITIVITY TRAINING AND PEOPLE 

4649
03:41:20,640 --> 03:41:26,880
ARE STRETCHED AND STRESSED.

4650
03:41:26,880 --> 03:41:28,280
THEY NEED TO SEPARATE THEIR 

4651
03:41:28,280 --> 03:41:30,000
PERSONAL OPINIONS FROM THE JOB 

4652
03:41:30,000 --> 03:41:31,280
THEY'RE DOING AND DO A BETTER 

4653
03:41:31,280 --> 03:41:37,760
JOB OF THAT AND POSSIBLY ALSO 

4654
03:41:37,760 --> 03:41:42,800
HAVE THEIR COLLEAGUES SHOULD 

4655
03:41:42,800 --> 03:41:45,040
ALSO HAVE AN EAR OUT PEOPLE TALK

4656
03:41:45,040 --> 03:41:48,680
AND PATIENTS TALK WITH EACH 

4657
03:41:48,680 --> 03:41:56,640
OTHER AND WITH STAFF.

4658
03:41:56,640 --> 03:42:06,800
ING BA 

4659
03:42:22,800 --> 03:42:24,640
>> THERE'S A WHOLE TEAM.

4660
03:42:24,640 --> 03:42:29,560
NOBODY FEELS UNDER THE PRESSURE 

4661
03:42:29,560 --> 03:42:39,880
BECAUSE WE ALL WORK.

4662
03:42:50,280 --> 03:42:57,000
IT LOOKS LIKE THE TOPIC OF 

4663
03:42:57,000 --> 03:43:02,480
IMPLEMENTATION IS SOMETHING THAT

4664
03:43:02,480 --> 03:43:04,480
IS IMPORTANT AND LOOKS LIKE IT 

4665
03:43:04,480 --> 03:43:07,240
STRUCK ACCORD WITH OUR AUDIENCE.

4666
03:43:07,240 --> 03:43:12,360
I HAVE A SPECIFIC QUESTION FROM 

4667
03:43:12,360 --> 03:43:15,520
ONE OF THE MEMBERS OF THE 

4668
03:43:15,520 --> 03:43:17,200
AUDIENCE TO DR. DOORENBOOS, YOUR

4669
03:43:17,200 --> 03:43:19,520
WORK WITH PATIENTS AND 

4670
03:43:19,520 --> 03:43:24,280
STAKEHOLDERS SEEMS TO BE 

4671
03:43:24,280 --> 03:43:26,280
PROVIDING GREAT INPUT TO THE 

4672
03:43:26,280 --> 03:43:27,880
SUCCESS OF THE GRACE STUDY.

4673
03:43:27,880 --> 03:43:33,760
WHAT CAN BE DONE TO EXTEND TO 

4674
03:43:33,760 --> 03:43:36,040
BETTER ENGAGE STUDY PARTICIPANTS

4675
03:43:36,040 --> 03:43:37,680
FROM THE POPULATION TO RECRUIT 

4676
03:43:37,680 --> 03:43:40,200
THEM INTO THE STUDIES?

4677
03:43:40,200 --> 03:43:44,680
AGAIN, JUST TO REFLECT BEFORE WE

4678
03:43:44,680 --> 03:43:48,480
STARTED WE EXCHANGED QUESTIONS 

4679
03:43:48,480 --> 03:43:49,920
AMONG OURSELVES AND PARTICIPANTS

4680
03:43:49,920 --> 03:43:51,920
AND THIS SAY QUESTION THAT DAVID

4681
03:43:51,920 --> 03:43:54,000
WAS SUGGESTING TO US.

4682
03:43:54,000 --> 03:43:57,280
THE QUESTION IS BEING ASKED AND 

4683
03:43:57,280 --> 03:43:58,800
WHEN I ANSWERED AND THERE WERE 

4684
03:43:58,800 --> 03:44:00,160
OTHER MEMBERS CONTRIBUTING TO 

4685
03:44:00,160 --> 03:44:00,560
THE ANSWER AS WELL.

4686
03:44:00,560 --> 03:44:03,040
GO AHEAD.

4687
03:44:03,040 --> 03:44:08,960
>> ACTUALLY I WOULD VERY
MUCH 

4688
03:44:08,960 --> 03:44:17,920
LIKE TO ANSWER ALONG WITH 

4689
03:44:17,920 --> 03:44:23,680
MR. WHITE AND THE HOPE STUDY THE

4690
03:44:23,680 --> 03:44:24,840
DIALYSIS STUDY WAS IN THE AREA 

4691
03:44:24,840 --> 03:44:30,960
OF RECRUITMENT WHERE OUR PATIENT

4692
03:44:30,960 --> 03:44:35,960
STAKEHOLDERS INCLUDING MR. WHITE

4693
03:44:35,960 --> 03:44:38,800
AND OTHERS SHARED IN THE 

4694
03:44:38,800 --> 03:44:40,040
DIALYSIS UNIT FOR POTENTIAL 

4695
03:44:40,040 --> 03:44:40,480
PARTICIPANTS.

4696
03:44:40,480 --> 03:44:44,240
MR. WHITE CAN TALK MORE ABOUT 

4697
03:44:44,240 --> 03:44:45,560
THAT BECAUSE THAT WAS VERY 

4698
03:44:45,560 --> 03:44:48,720
EFFECTIVE IN HELPING WITH 

4699
03:44:48,720 --> 03:44:59,240
RECRUITMENT IN THE HOPE STUDY.

4700
03:45:01,560 --> 03:45:02,720
>> WE WERE GIVEN THE
SUGGESTION 

4701
03:45:02,720 --> 03:45:05,040
AND WE RAN WITH IT.

4702
03:45:05,040 --> 03:45:08,360
WE SORT OF BEGAN DISCUSSING THE 

4703
03:45:08,360 --> 03:45:14,280
TOPIC AND FIGURING OUT HOW THE 

4704
03:45:14,280 --> 03:45:19,480
VIDEO WOULD BE BEST DESIGNED AND

4705
03:45:19,480 --> 03:45:28,160
THROUGH OUR DISCUSSION WE 

4706
03:45:28,160 --> 03:45:31,000
DECIDED ON QUESTIONS BACK ON OUR

4707
03:45:31,000 --> 03:45:33,560
OWN EXPERIENCES AND HAVING THE 

4708
03:45:33,560 --> 03:45:34,720
INTERVIEWER ASK US THESE 

4709
03:45:34,720 --> 03:45:38,960
QUESTIONS AND IT TURNED OUT SO 

4710
03:45:38,960 --> 03:45:40,120
GENUINE AND SO PERSONALIZED I 

4711
03:45:40,120 --> 03:45:42,920
THINK THERE WERE THREE OF US AND

4712
03:45:42,920 --> 03:45:49,760
OUT OF THE THREE WE GOT A LOT OF

4713
03:45:49,760 --> 03:45:55,480
DIVERSITY INTO THAT GROUP?

4714
03:45:55,480 --> 03:45:59,400
IT'S THE CHALLENGE IN GETTING 

4715
03:45:59,400 --> 03:46:02,920
THE PAIN TREATED AND THE FRESH 

4716
03:46:02,920 --> 03:46:04,120
AIR WE FELT BEING A PATIENT 

4717
03:46:04,120 --> 03:46:08,160
ADVISORS FOR THE HOPE STUDY ALL 

4718
03:46:08,160 --> 03:46:10,440
CAME THROUGH SO WELL.

4719
03:46:10,440 --> 03:46:13,640
IT WAS WIDELY APPLAUDED BOTH 

4720
03:46:13,640 --> 03:46:16,640
WITHIN THE HOPE CONSORTIUM AND 

4721
03:46:16,640 --> 03:46:18,760
WE ACTUALLY GET A LOT OF REQUEST

4722
03:46:18,760 --> 03:46:21,440
TO HAVE IT SHOWN ELSEWHERE.

4723
03:46:21,440 --> 03:46:22,920
NOT THAT WHOLE PUTTING A PLUG IN

4724
03:46:22,920 --> 03:46:24,640
FOR THAT BUT WE'RE PROUD OF OUR 

4725
03:46:24,640 --> 03:46:27,800
WORK.

4726
03:46:27,800 --> 03:46:29,400
>> I DON'T KNOW IF WE CAN
MAYBE 

4727
03:46:29,400 --> 03:46:31,680
DROP A LINK TO THAT VIDEO IN THE

4728
03:46:31,680 --> 03:46:33,760
CHAT OR SHARE THAT WITH 

4729
03:46:33,760 --> 03:46:34,080
PARTICIPANTS.

4730
03:46:34,080 --> 03:46:39,600
I WOULD AGREE WITH MR. WHITE.

4731
03:46:39,600 --> 03:46:44,480
IT WAS A WONDERFUL WAY THE 

4732
03:46:44,480 --> 03:46:47,520
PATIENTS AS PART OF OUR TEAM ON 

4733
03:46:47,520 --> 03:46:48,240
THE PROJECT DEVELOPED THIS 

4734
03:46:48,240 --> 03:46:49,600
INCREDIBLE VIDEO THAT HELPS WITH

4735
03:46:49,600 --> 03:46:52,600
RECRUIT MANY FOR THE STUDY.

4736
03:46:52,600 --> 03:46:53,200
ONE EXCELLENT ILLUSTRATIVE 

4737
03:46:53,200 --> 03:47:00,080
EXAMPLE.

4738
03:47:00,080 --> 03:47:03,120
>> I'LL PUT AN E-MAIL IN
THE 

4739
03:47:03,120 --> 03:47:04,240
CHAT IN CASE ANYONE WOULD LIKE 

4740
03:47:04,240 --> 03:47:06,960
TO SEE THE VIDEO AND I CAN 

4741
03:47:06,960 --> 03:47:07,960
FACILITATE THAT HAPPENING.

4742
03:47:07,960 --> 03:47:11,120
>> AS SOMEBODY WHO HAS
BEEN 

4743
03:47:11,120 --> 03:47:16,560
DEALING WITH CHALLENGES OVER THE

4744
03:47:16,560 --> 03:47:19,040
STUDIES AND DO YOU WANT TO 

4745
03:47:19,040 --> 03:47:19,760
ADDRESS THAT ISSUE AND SHARE 

4746
03:47:19,760 --> 03:47:23,040
WITH US WHAT YOU HAD IN MIND 

4747
03:47:23,040 --> 03:47:26,400
SHARING YOUR CURRENT WORK.

4748
03:47:26,400 --> 03:47:34,280
 >> WHOLE NOT SURE EXACTLY
WHAT 

4749
03:47:34,280 --> 03:47:36,080
YOU WOULD LIKE ME TO SHARE 

4750
03:47:36,080 --> 03:47:40,880
REGARDING RECRUITMENT BUT 

4751
03:47:40,880 --> 03:47:43,120
HONESTLY I FEEL LIKE IT WOULD BE

4752
03:47:43,120 --> 03:47:45,840
NICE TO RECOGNIZE THE SPEAKERS 

4753
03:47:45,840 --> 03:47:47,200
THAT SPOKE TODAY AND SAY A 

4754
03:47:47,200 --> 03:47:49,080
LITTLE BIT ABOUT THEY SPOKE ON 

4755
03:47:49,080 --> 03:47:50,640
AND TRY TO TIE IT TOGETHER AND 

4756
03:47:50,640 --> 03:47:52,640
THE ORDER OF THE PRESENTATIONS 

4757
03:47:52,640 --> 03:47:53,040
WAS PERFECT.

4758
03:47:53,040 --> 03:47:56,640
I JUST DID WANT TO SAY A LITTLE 

4759
03:47:56,640 --> 03:48:03,480
BIT I WANTED TO START WITH DAVID

4760
03:48:03,480 --> 03:48:06,200
WHITE AND WHEN YOU TALK ABOUT 

4761
03:48:06,200 --> 03:48:08,160
RECRUITMENT, WE HAVE TO START 

4762
03:48:08,160 --> 03:48:11,280
WITH THE PATIENT EXPERIENCE AND 

4763
03:48:11,280 --> 03:48:14,200
I APPRECIATED HEARING HIS 

4764
03:48:14,200 --> 03:48:15,520
EXPERIENCE.

4765
03:48:15,520 --> 03:48:19,400
I THINK HIS STUDY IS CALLED HOPE

4766
03:48:19,400 --> 03:48:21,400
WITH AN H AND IT'S A WONDERFUL 

4767
03:48:21,400 --> 03:48:21,720
STUDY.

4768
03:48:21,720 --> 03:48:27,560
WHOLE AWARE OF THAT STUDY.

4769
03:48:27,560 --> 03:48:31,040
IT'S A POPULATION OF PATIENTS 

4770
03:48:31,040 --> 03:48:32,280
YOU DON'T THINK OF HAVING 

4771
03:48:32,280 --> 03:48:35,200
CHRONIC PAIN AND HEMODIALYSIS 

4772
03:48:35,200 --> 03:48:38,960
PATIENTS SUFFER A LOT OF PAIN 

4773
03:48:38,960 --> 03:48:41,320
AND PAIN INTERFERENCE WITH 

4774
03:48:41,320 --> 03:48:42,200
FUNCTIONING AND QUALITY OF LIFE.

4775
03:48:42,200 --> 03:48:47,480
AND HIS EXPERIENCE AS A PATIENT 

4776
03:48:47,480 --> 03:48:48,920
DEALING WITH CHRONIC PAIN AND 

4777
03:48:48,920 --> 03:48:50,160
DEALING WITH PROVIDERS NOT 

4778
03:48:50,160 --> 03:48:55,680
LISTENING TO HIM AND NOT 

4779
03:48:55,680 --> 03:49:00,640
UNDERSTANDING HIS PAIN 

4780
03:49:00,640 --> 03:49:02,360
POTENTIALLY ARGUING WITH HIM AND

4781
03:49:02,360 --> 03:49:03,440
SEEKING PAIN MEDICATION IS 

4782
03:49:03,440 --> 03:49:06,640
IMPORTANT TO LISTEN TO.

4783
03:49:06,640 --> 03:49:14,960
THERE'S A HUGE PROBLEM THAT IT'S

4784
03:49:14,960 --> 03:49:20,640
BEEN IN THE LITERATURE THAT 

4785
03:49:20,640 --> 03:49:23,160
BLACK AFRICAN AMERICANS HAVE 

4786
03:49:23,160 --> 03:49:25,320
BEEN LEAST PRESCRIBED AND THIS 

4787
03:49:25,320 --> 03:49:28,680
GETS TO THE STRUGGLE THAT WALLY 

4788
03:49:28,680 --> 03:49:29,920
SMITH, DR. SMITH BROUGHT UP 

4789
03:49:29,920 --> 03:49:35,760
ABOUT PROVIDERS NOT LISTENING TO

4790
03:49:35,760 --> 03:49:36,640
PATIEN

4791
03:49:36,640 --> 03:49:38,200
PATIENTS STRUGGLING WITH PAIN 

4792
03:49:38,200 --> 03:49:40,240
AND THE CULTURE OF MISTRUST 

4793
03:49:40,240 --> 03:49:41,200
WHICH IS UNFORTUNATE.

4794
03:49:41,200 --> 03:49:43,400
IT'S GREAT TO HEAR THE PATIENT 

4795
03:49:43,400 --> 03:49:46,080
EXPERIENCE FIRST.

4796
03:49:46,080 --> 03:49:48,200
I APPRECIATED HEARING 

4797
03:49:48,200 --> 03:49:50,960
DR. DOORENBOOS' EXPERIENCE OF 

4798
03:49:50,960 --> 03:49:54,400
THE PRE-IMPLEMENTATION PHASE OF 

4799
03:49:54,400 --> 03:49:58,720
HER TRIAL IN WHICH SHE REALLY 

4800
03:49:58,720 --> 03:50:01,480
STARTED -- IT ALMOST SOUNDED TO 

4801
03:50:01,480 --> 03:50:02,960
ME, YOU CAN COMMENT, 

4802
03:50:02,960 --> 03:50:05,440
DR. DOORENBOOS, BUT YOU DIDN'T 

4803
03:50:05,440 --> 03:50:06,760
SPECIFICALLY HAVE ANY 

4804
03:50:06,760 --> 03:50:07,840
PRE-CONCEIVED INTERVENTIONS IN 

4805
03:50:07,840 --> 03:50:10,400
MIND AND WENT TO PATIENTS AND 

4806
03:50:10,400 --> 03:50:12,640
SAID, WHAT PAIN MANAGEMENT 

4807
03:50:12,640 --> 03:50:18,480
APPROACHES MIGHT WORK BEST FOR 

4808
03:50:18,480 --> 03:50:23,880
YOU IN MANAGING PAIN RELATED TO 

4809
03:50:23,880 --> 03:50:24,520
SICKLE CELL DISEASE AND WENT 

4810
03:50:24,520 --> 03:50:27,600
WITH THE INTERVENTIONS YOU HEARD

4811
03:50:27,600 --> 03:50:29,920
AND THE NIH HAS BEEN -- I HAVE 

4812
03:50:29,920 --> 03:50:33,720
BEEN THE RECIPIENT OF A UH3 

4813
03:50:33,720 --> 03:50:34,880
GRANT MECHANISM WHERE I THINK 

4814
03:50:34,880 --> 03:50:41,320
RIGHT NOW WE WERE GIVEN TWO 

4815
03:50:41,320 --> 03:50:43,320
YEARS FROM SOME RESEARCHERS HAVE

4816
03:50:43,320 --> 03:50:46,120
A PRE-IMPLEMENTATION PHASE TO 

4817
03:50:46,120 --> 03:50:48,760
SURVEY PATIENTS SO YOU'RE ABLE 

4818
03:50:48,760 --> 03:50:51,280
TO ACTUALLY DEVELOP AN 

4819
03:50:51,280 --> 03:50:52,000
INTERVENTION THAT TAKES INTO 

4820
03:50:52,000 --> 03:50:53,120
ACCOUNT WHAT PATIENTS WANT AND 

4821
03:50:53,120 --> 03:50:55,600
NEED AND THEIR PREFERENCES.

4822
03:50:55,600 --> 03:50:58,560
I THOUGHT YOUR DESCRIPTION OF 

4823
03:50:58,560 --> 03:51:01,040
THAT WAS LAUDABLE AND GREAT AND 

4824
03:51:01,040 --> 03:51:04,520
THE ACTUAL DESIGN YOU SETTLED ON

4825
03:51:04,520 --> 03:51:05,600
THE SMART TRIAL DESIGN ALSO 

4826
03:51:05,600 --> 03:51:08,560
ALLOWS FOR PATIENTS TO HAVE A 

4827
03:51:08,560 --> 03:51:10,320
VOICE IN THE COURSE OF THE 

4828
03:51:10,320 --> 03:51:11,760
INTERVENTION AND CONTEXT OF 

4829
03:51:11,760 --> 03:51:13,520
RESEARCH WHERE THEY SAID THIS 

4830
03:51:13,520 --> 03:51:16,440
ISN'T WORKING AND THEY'RE 

4831
03:51:16,440 --> 03:51:17,240
RE-RANDOMIZED TO SOMETHING THAT 

4832
03:51:17,240 --> 03:51:18,840
POTENTIALLY MIGHT WORK BETTER 

4833
03:51:18,840 --> 03:51:21,880
FOR THEM SO I REALLY LIKED HOW 

4834
03:51:21,880 --> 03:51:23,640
YOU BAKED IN PATIENT PREFERENCE 

4835
03:51:23,640 --> 03:51:24,840
AND PATIENT EXPERIENCE INTO THE 

4836
03:51:24,840 --> 03:51:26,640
DESIGN OF YOUR TRIAL.

4837
03:51:26,640 --> 03:51:31,680
I THOUGHT THAT WAS GREAT.

4838
03:51:31,680 --> 03:51:40,400
AND THEN DR. McKERNAN TALKED 

4839
03:51:40,400 --> 03:51:42,000
ABOUT THE BIO PSYCHOSOCIAL MODEL

4840
03:51:42,000 --> 03:51:43,040
IN WORKING WITH PATIENTS WITH 

4841
03:51:43,040 --> 03:51:43,360
CHRONIC PAIN.

4842
03:51:43,360 --> 03:51:45,640
I THINK THOSE OF US WHO HAVE 

4843
03:51:45,640 --> 03:51:48,680
BEEN DOING THIS FOR MANY YEARS 

4844
03:51:48,680 --> 03:51:56,640
UNDERSTAND THAT CYCLE OF CHRONIC

4845
03:51:56,640 --> 03:52:01,320
PAIN AND THE CHRONIC PAIN MAKES 

4846
03:52:01,320 --> 03:52:02,720
THE MENTAL HEALTH PROBLEMS 

4847
03:52:02,720 --> 03:52:03,440
WORSE.

4848
03:52:03,440 --> 03:52:06,880
IF WE DON'T MEET THOSE PATIENTS 

4849
03:52:06,880 --> 03:52:08,360
WITH APPROPRIATE BIO 

4850
03:52:08,360 --> 03:52:09,320
PSYCHOSOCIAL IN THE DISCIPLINARY

4851
03:52:09,320 --> 03:52:12,640
PAIN CARE MODELS, WE ARE REALLY 

4852
03:52:12,640 --> 03:52:15,080
NOT GOING TO FUNDAMENTALLY BE 

4853
03:52:15,080 --> 03:52:25,360
ABLE TO STOP OR BREAK OR STOP 

4854
03:52:25,360 --> 03:52:26,600
THE CIRCLE OF PAIN.

4855
03:52:26,600 --> 03:52:30,200
IN THE V.A. WE HAVE ABOUT 2019 

4856
03:52:30,200 --> 03:52:36,680
WE'VE HAD AN INTERDISCIPLINARY 

4857
03:52:36,680 --> 03:52:43,480
BIO PSYCHOSOCIAL CLINICAL WITH A

4858
03:52:43,480 --> 03:52:48,680
PHARMACIST WHO SIT WITH A 

4859
03:52:48,680 --> 03:52:49,320
PATIENT CHRONIC PAIN.

4860
03:52:49,320 --> 03:52:52,640
THAT MODEL HAS BEEN IN EFFECT 

4861
03:52:52,640 --> 03:52:57,560
MANY YEARS AND HAS GOTTEN A 

4862
03:52:57,560 --> 03:53:07,920
BOOST AND DR. SMITH BROUGHT IN A

4863
03:53:07,920 --> 03:53:09,680
LARGER SOCIO POLITICAL CONTEXT 

4864
03:53:09,680 --> 03:53:11,200
FOR WHAT HAS HAPPENED IN THE 

4865
03:53:11,200 --> 03:53:13,200
WORLD OF PAIN CARE AND 

4866
03:53:13,200 --> 03:53:13,480
ADDICTION.

4867
03:53:13,480 --> 03:53:15,320
I THINK I WENT THROUGH MEDICAL 

4868
03:53:15,320 --> 03:53:20,640
SCHOOL AT A TIME WHERE WE WERE 

4869
03:53:20,640 --> 03:53:24,080
ACTUALLY ADMONISHED TO MAKE SURE

4870
03:53:24,080 --> 03:53:24,760
WE WERE NOT UNDER TREATING 

4871
03:53:24,760 --> 03:53:26,720
PATIENT'S PAIN AND ENCOURAGED TO

4872
03:53:26,720 --> 03:53:29,400
PRESCRIBE OPIOIDS AND PROBABLY A

4873
03:53:29,400 --> 03:53:32,800
LOT OF THOSE TALKS WERE FUNDED 

4874
03:53:32,800 --> 03:53:36,600
BY PHARMA -- BIG PHARMA AT THE 

4875
03:53:36,600 --> 03:53:39,040
TIME AND THEN THE PENDULUM SWUNG

4876
03:53:39,040 --> 03:53:42,600
AND ALL OF A SUDDEN WE'RE TOLD, 

4877
03:53:42,600 --> 03:53:43,800
NO, WE'RE OVER TREATING AND 

4878
03:53:43,800 --> 03:53:45,400
CREATING ADDICTION.

4879
03:53:45,400 --> 03:53:48,680
A LOT OF US RUSHED TO RAPIDLY 

4880
03:53:48,680 --> 03:53:52,120
TAPER OUR PATIENT'S OPIOIDS AND 

4881
03:53:52,120 --> 03:53:55,680
WHO'S THE VICTIM IN THAT?

4882
03:53:55,680 --> 03:54:00,160
NOT US OR BIG PHARMA BUT THE 

4883
03:54:00,160 --> 03:54:00,440
PATIENTS.

4884
03:54:00,440 --> 03:54:02,760
IF YOU'RE BLACK OR A PERSON OF 

4885
03:54:02,760 --> 03:54:03,400
COLOR IT COULD HAVE HAPPENED 

4886
03:54:03,400 --> 03:54:04,640
MORE ABRUPTLY FOR YOU THAN 

4887
03:54:04,640 --> 03:54:11,080
OTHERS.

4888
03:54:11,080 --> 03:54:21,640
AND AROUND 20 AND WE'RE GOING TO

4889
03:54:24,640 --> 03:54:27,000
MODALITIES FOR PATIENTS WITH 

4890
03:54:27,000 --> 03:54:29,320
CHRONIC PAIN AND THIS WAS AN 

4891
03:54:29,320 --> 03:54:32,520
ATTEMPT TO TRY TO BRIDGE THE GAP

4892
03:54:32,520 --> 03:54:34,360
IN THE PENDULUM SWINGING TO TRY 

4893
03:54:34,360 --> 03:54:36,640
AND OFFER NON-PHARMACOLOGIC 

4894
03:54:36,640 --> 03:54:39,200
MODALITIES TO PATIENTS WHO WERE 

4895
03:54:39,200 --> 03:54:41,200
ACTUALLY HAVING THEIR OPIOIDS 

4896
03:54:41,200 --> 03:54:43,200
TAPERED AND THIS INCLUDED 

4897
03:54:43,200 --> 03:54:46,960
MODALITIES LIKE YOGA AND TAI CHI

4898
03:54:46,960 --> 03:54:48,640
AND MINDFULNESS AND EXERCISE AND

4899
03:54:48,640 --> 03:54:51,360
SLEEP AND WHAT NOT.

4900
03:54:51,360 --> 03:54:52,840
THAT WAS VERY HELPFUL.

4901
03:54:52,840 --> 03:54:54,880
THE OTHER PIECE OF THE CARE 

4902
03:54:54,880 --> 03:54:58,480
LEGISLATION WAS ACTUALLY REALLY 

4903
03:54:58,480 --> 03:55:00,640
THE ENCOURAGEMENT OF THE USE 

4904
03:55:00,640 --> 03:55:11,200
CALLED BUPRENORPHINE IN PATIENTS

4905
03:55:13,800 --> 03:55:18,240
WITH QUOTE, ADDICTION AND WE 

4906
03:55:18,240 --> 03:55:20,360
WERE PRESCRIBING SUBOXUM AND WE 

4907
03:55:20,360 --> 03:55:23,000
FIND A LOT OF THE PATIENTS DON'T

4908
03:55:23,000 --> 03:55:24,640
HAVE ADDICTION, PSYCHOLOGICAL 

4909
03:55:24,640 --> 03:55:28,640
ADDICTION PER SE, THEY HAVE A 

4910
03:55:28,640 --> 03:55:32,400
PHYSICAL DEPENDENCE THAT STILL 

4911
03:55:32,400 --> 03:55:33,200
REQUIRES A TYPE OF OPIOID 

4912
03:55:33,200 --> 03:55:33,760
SUBSTITUTION TO FUNCTION IN 

4913
03:55:33,760 --> 03:55:42,600
THEIR LIVES.

4914
03:55:42,600 --> 03:55:44,960
CARE ACT LEGISLATION WAS A HUGE 

4915
03:55:44,960 --> 03:55:46,800
BOON FOR FEDERAL SYSTEMS LIKE 

4916
03:55:46,800 --> 03:55:50,480
THE V.A. IN WHICH I WORK A 

4917
03:55:50,480 --> 03:55:51,960
SINGLE-PAIR SYSTEM MANDATED TO 

4918
03:55:51,960 --> 03:55:55,000
ENROLL ALL VETERANS ENROLLED IN 

4919
03:55:55,000 --> 03:55:56,680
CARE WITH A COMPLIMENTARY 

4920
03:55:56,680 --> 03:55:58,280
INTEGRATIVE HEALTH MODALITIES.

4921
03:55:58,280 --> 03:55:58,920
WHAT WHOLE HEARING FROM 

4922
03:55:58,920 --> 03:56:02,080
DR. SMITH AND OTHERS IN THIS 

4923
03:56:02,080 --> 03:56:04,840
SESSION IS THAT SADLY IN THE 

4924
03:56:04,840 --> 03:56:08,320
PRIVATE SECTOR WHERE PATIENTS 

4925
03:56:08,320 --> 03:56:10,360
ARE DEPENDENT ON INSURANCE 

4926
03:56:10,360 --> 03:56:11,960
COMPANIES TO PAY FOR 

4927
03:56:11,960 --> 03:56:17,200
COMPLIMENTARY INTEGRATIVE HEALTH

4928
03:56:17,200 --> 03:56:20,000
MODALITIES, PATIENCE ARE NOT 

4929
03:56:20,000 --> 03:56:21,600
ABLE TO ACCESS THOSE MODALITIES 

4930
03:56:21,600 --> 03:56:23,280
AND SO THERE'S AN ACCESS 

4931
03:56:23,280 --> 03:56:23,640
PROBLEM.

4932
03:56:23,640 --> 03:56:25,200
ON ONE HAND WE'RE BEING 

4933
03:56:25,200 --> 03:56:27,360
ENCOURAGED TO DO THIS OUTSIDE OF

4934
03:56:27,360 --> 03:56:28,720
THE FEDERAL SYSTEMS LIKE V.A. 

4935
03:56:28,720 --> 03:56:32,040
AND DOD BUT THERE'S STILL NO 

4936
03:56:32,040 --> 03:56:35,840
INCENTIVE TO PAY FOR BIO 

4937
03:56:35,840 --> 03:56:36,640
PSYCHOSOCIAL INTERDISCIPLINARY 

4938
03:56:36,640 --> 03:56:40,360
CARE LIKE YOU CAN IN 

4939
03:56:40,360 --> 03:56:42,800
SINGLE-PAYER SYSTEM.

4940
03:56:42,800 --> 03:56:45,280
I WANTED TO HONOR THESE 

4941
03:56:45,280 --> 03:56:46,640
DIFFERENT PERSPECTIVES AND 

4942
03:56:46,640 --> 03:56:49,000
WELCOME ANY FURTHER QUESTIONS OR

4943
03:56:49,000 --> 03:56:50,960
DISCUSSIONS EITHER FROM THEM OR 

4944
03:56:50,960 --> 03:56:57,560
FROM THE AUDIENCE.

4945
03:56:57,560 --> 03:56:57,880
>> THANK YOU.

4946
03:56:57,880 --> 03:56:59,760
GOING BACK TO THE TOPIC OF THE 

4947
03:56:59,760 --> 03:57:02,800
SESSION WHICH IS IMPLEMENTATION 

4948
03:57:02,800 --> 03:57:04,480
OF WHOLE PERSON CARE.

4949
03:57:04,480 --> 03:57:11,960
YOU AND YOUR TEAM HAVE DONE SOME

4950
03:57:11,960 --> 03:57:12,840
OF THE WORK.

4951
03:57:12,840 --> 03:57:18,760
SO 

4952
03:57:18,760 --> 03:57:21,440
>> WHOLE LOOKING AT THE
TIME AND

4953
03:57:21,440 --> 03:57:25,400
WONDERING IF ANYONE FROM THE 

4954
03:57:25,400 --> 03:57:27,840
AUDIENCE HAS ANY QUESTIONS FROM 

4955
03:57:27,840 --> 03:57:29,000
THE SPEAKERS HERE TODAY.

4956
03:57:29,000 --> 03:57:30,480
IT'S A BROAD AND IMPORTANT TOPIC

4957
03:57:30,480 --> 03:57:36,680
ON SO MANY DIFFERENT LEVELS.

4958
03:57:36,680 --> 03:57:39,680
>> WOULD YOU PLACE THE
CARE ACT 

4959
03:57:39,680 --> 03:57:41,400
LEGISLATION LINK IN THE CHAT.

4960
03:57:41,400 --> 03:57:44,200
>> I'LL GOOGLE THAT AND
DROP IT 

4961
03:57:44,200 --> 03:57:46,760
IN THE CHAT.

4962
03:57:46,760 --> 03:57:49,320
ANYONE CAN GOOGLE IT.

4963
03:57:49,320 --> 03:57:50,360
KARA LEGISLATION OF 2016.

4964
03:57:50,360 --> 03:57:52,640
WHOLE HAPPY TO SEARCH THAT AND 

4965
03:57:52,640 --> 03:58:03,080
DROP IT THAT IN THE CHAT.

4966
03:58:21,400 --> 03:58:26,400
>> THERE'S AN INTERESTING 

4967
03:58:26,400 --> 03:58:32,320
QUESTION AND IT'S WORTH READING 

4968
03:58:32,320 --> 03:58:40,640
OUT LOUD.

4969
03:58:40,640 --> 03:58:42,280
AND MY ANSWER TO WHAT I KNOW AND

4970
03:58:42,280 --> 03:58:48,200
THIS IS NOT THE PURVIEW OF NIH 

4971
03:58:48,200 --> 03:58:50,680
BUT OF THE PUBLIC REQUESTING A 

4972
03:58:50,680 --> 03:58:51,200
TYPE OF CARE.

4973
03:58:51,200 --> 03:58:53,760
WHAT NIH CAN DO IS FUND THE 

4974
03:58:53,760 --> 03:58:55,320
RESEARCH TO PROVIDER EVIDENCE 

4975
03:58:55,320 --> 03:58:56,640
FOR THIS TYPE OF CARE BUT AGAIN 

4976
03:58:56,640 --> 03:59:00,960
IT'S THE AUDIENCE LIKE THIS THAT

4977
03:59:00,960 --> 03:59:11,520
CAN GO AND ADVOCATE AND DEMAND 

4978
03:59:15,040 --> 03:59:19,680
AND ACTUALLY THERE'S A COMMENT 

4979
03:59:19,680 --> 03:59:21,280
BY KONNIE SNYDER.

4980
03:59:21,280 --> 03:59:22,880
I DON'T KNOW IF YOU WANT TO SAY 

4981
03:59:22,880 --> 03:59:26,520
IT OR WANT ME TO READ IT BUT 

4982
03:59:26,520 --> 03:59:28,640
IT'S INTERESTING ALSO THE 

4983
03:59:28,640 --> 03:59:31,800
COMMENT IS NOT MANY MEDICAL 

4984
03:59:31,800 --> 03:59:32,960
FACILITIES HAVE EXPERIENCED DOD 

4985
03:59:32,960 --> 03:59:36,880
AND CIVILIAN OFFE ENTITY WHO

4986
03:59:36,880 --> 03:59:39,600
CAN PIECE TOGETHER THE ASPECTS 

4987
03:59:39,600 --> 03:59:43,200
OF THE PATIENT'S MULTI-SYSTEM 

4988
03:59:43,200 --> 03:59:43,880
PUZZLE.

4989
03:59:43,880 --> 03:59:45,480
CASE MANAGERS AND PATIENT 

4990
03:59:45,480 --> 03:59:50,400
ADVOCATED AREN'T EQUIPPED AND 

4991
03:59:50,400 --> 03:59:50,920
UNDERSTANDING WIDESPREAD 

4992
03:59:50,920 --> 03:59:51,960
IMPLEMENTATION OF HEALTH AND 

4993
03:59:51,960 --> 03:59:56,480
CLINICS WILL TAKE YEARS AND AN 

4994
03:59:56,480 --> 04:00:05,760
INTERMEDIARY STEP CAN BE TO HAVE

4995
04:00:05,760 --> 04:00:08,160
MD TO I.D. COMPLEX SITUATIONS 

4996
04:00:08,160 --> 04:00:09,160
SUCH AS A PATIENT'S CHRONIC PAIN

4997
04:00:09,160 --> 04:00:12,680
AND BE INTEGRATED INTO WHOLE 

4998
04:00:12,680 --> 04:00:15,600
HEALTH CLINICS THAT DO EXIST.

4999
04:00:15,600 --> 04:00:16,920
SO QUESTION IS IS THERE A 

5000
04:00:16,920 --> 04:00:20,560
DISCUSSION TO IMPLEMENT A 

5001
04:00:20,560 --> 04:00:30,920
POSITION OF THIS SORT?

5002
04:00:34,000 --> 04:00:35,040
WHAT ARE THE SOLUTIONS?

5003
04:00:35,040 --> 04:00:38,160
HOW DO WE MOVE FORWARD?

5004
04:00:38,160 --> 04:00:40,560
>> DID YOU SAY IS THERE A 

5005
04:00:40,560 --> 04:00:44,360
MOVEMENT TO IMPLEMENT WHOLE 

5006
04:00:44,360 --> 04:00:46,320
HEALTH CLINICS FOR CHRONIC PAIN 

5007
04:00:46,320 --> 04:00:47,600
OR PHYSICIANS?

5008
04:00:47,600 --> 04:00:50,880
>> ACTUALLY THE SUGGESTION
WAS 

5009
04:00:50,880 --> 04:00:53,080
MAYBE ONE SOLUTION IS A 

5010
04:00:53,080 --> 04:00:57,560
SPECIALIST WHOLE PERSON HEALTH 

5011
04:00:57,560 --> 04:00:58,840
SPECIALIST IN PLACE OF A 

5012
04:00:58,840 --> 04:01:00,560
STEPPING STONE IN BUILDING THE 

5013
04:01:00,560 --> 04:01:02,880
WHOLE PERSON CLINIC.

5014
04:01:02,880 --> 04:01:13,160
>> THAT'S CORRECT.

5015
04:01:30,280 --> 04:01:37,120
>> SOMEONE WHO CAN
INTEGRATE THE

5016
04:01:37,120 --> 04:01:41,160
WHOLE PERSON HEALTH AND IS THERE

5017
04:01:41,160 --> 04:01:44,360
A HOSPITALIST, IF YOU WILL, AT 

5018
04:01:44,360 --> 04:01:46,440
LEAST A MAJOR FACILITIES A 

5019
04:01:46,440 --> 04:01:50,640
MEDICAL EXPERT TO HELP THE 

5020
04:01:50,640 --> 04:01:56,560
COMPLEX PATIENTS REFERRED TO 

5021
04:01:56,560 --> 04:02:03,680
THEM SO THEY CAN THEN FACILITATE

5022
04:02:03,680 --> 04:02:06,720
THE WHOLE PERSON CONCEPT.

5023
04:02:06,720 --> 04:02:08,960
>> THAT'S THE MODEL AT 

5024
04:02:08,960 --> 04:02:09,320
VANDERBILT.

5025
04:02:09,320 --> 04:02:19,880
THERE'S A MEDICAL TEAM PROVIDER 

5026
04:02:26,240 --> 04:02:36,360
[NO AUDIO]

5027
04:02:54,560 --> 04:02:57,080
-- WE HAVE EVERYBODY UNDER ONE 

5028
04:02:57,080 --> 04:02:58,800
ROOF IT MAKE THAT HAPPEN.

5029
04:02:58,800 --> 04:03:01,800
>> LIKE A QUARTERBACK AND
HOW 

5030
04:03:01,800 --> 04:03:03,640
THERE'LL BE QUARTERBACKS PLACED,

5031
04:03:03,640 --> 04:03:07,280
AT LEAST AT MAJOR MEDICAL 

5032
04:03:07,280 --> 04:03:09,440
FACILITIES BEFORE THE COST IS 

5033
04:03:09,440 --> 04:03:12,520
SUBSTANTIATED IN ORDER TO 

5034
04:03:12,520 --> 04:03:13,080
IMPLEMENT THE PHENOMENAL 

5035
04:03:13,080 --> 04:03:18,120
APPROACH DISCUSSED HERE THE LAST

5036
04:03:18,120 --> 04:03:18,720
COUPLE DAYS.

5037
04:03:18,720 --> 04:03:27,080
>> WHAT CAN BE DONE TO GET
THIS 

5038
04:03:27,080 --> 04:03:27,560
IN THE PRIVATE SECTOR?

5039
04:03:27,560 --> 04:03:35,640
THIS WAS A QUESTION OPPOSED IN 

5040
04:03:35,640 --> 04:03:37,720
2011 AND IT'S AN IMPORTANT 

5041
04:03:37,720 --> 04:03:39,040
QUESTION AND SOMETHING THAT 

5042
04:03:39,040 --> 04:03:40,920
KEEPS RESONATING THROUGH HIRE.

5043
04:03:40,920 --> 04:03:51,080
-- HERE.

5044
04:03:53,440 --> 04:03:56,040
ALSO A SPECIALTY RECRUITMENT 

5045
04:03:56,040 --> 04:03:57,680
PROVIDER AND FUNCTIONAL 

5046
04:03:57,680 --> 04:03:57,960
MEDICINE.

5047
04:03:57,960 --> 04:04:03,720
I DON'T KNOW HOW MANY PEOPLE ARE

5048
04:04:03,720 --> 04:04:05,320
FAMILIAR WITH THIS TYPE OF 

5049
04:04:05,320 --> 04:04:05,600
PRACTICE.

5050
04:04:05,600 --> 04:04:07,880
>> LIKE TO JOIN IN IN THE 

5051
04:04:07,880 --> 04:04:12,440
CONVERSATION AND GIVE AN EXAMPLE

5052
04:04:12,440 --> 04:04:12,840
FROM THE MILITARY.

5053
04:04:12,840 --> 04:04:17,800
WHOLE BLESSED TO ACTUALLY WORK 

5054
04:04:17,800 --> 04:04:20,480
WITH AN ARMY MEDICAL CENTER AND 

5055
04:04:20,480 --> 04:04:26,160
IN ARMY AND ACTIVE DUTY THERE'S 

5056
04:04:26,160 --> 04:04:27,840
THE INTERPROFESSIONAL TEAM 

5057
04:04:27,840 --> 04:04:30,960
MANAGEMENT CLINICS AND WHAT THEY

5058
04:04:30,960 --> 04:04:36,560
HAVE DONE IS THERE YOU DO GET 

5059
04:04:36,560 --> 04:04:39,080
THAT INTERDISCIPLINARY TEAM 

5060
04:04:39,080 --> 04:04:43,840
APPROACH BUT THEN WHAT IS 

5061
04:04:43,840 --> 04:04:44,840
GERMANE TO THIS CONVERSATION IS 

5062
04:04:44,840 --> 04:04:48,280
THAT WHAT THEY HAVE DONE IN 

5063
04:04:48,280 --> 04:04:50,880
COMMUNITY CLINICS IS PAIN 

5064
04:04:50,880 --> 04:04:51,320
CHAMPIONS.

5065
04:04:51,320 --> 04:04:56,040
THESE PAIN CHAMPIONS ARE PRIMARY

5066
04:04:56,040 --> 04:04:58,080
CARE PROVIDERS THAT HAVE 

5067
04:04:58,080 --> 04:04:59,120
SPECIALIZED TRAINING IN PAIN 

5068
04:04:59,120 --> 04:04:59,600
MANAGEMENT.

5069
04:04:59,600 --> 04:05:02,720
I THINK THAT RESONATES WITH ME 

5070
04:05:02,720 --> 04:05:04,360
WITH WHAT WE'RE TALKING ABOUT 

5071
04:05:04,360 --> 04:05:09,920
HERE AND WE'VE DONE THAT A 

5072
04:05:09,920 --> 04:05:13,840
LITTLE BIT MORE IN RURAL HEALTH 

5073
04:05:13,840 --> 04:05:17,000
CLINICS SO IF YOU HAVE THAT 

5074
04:05:17,000 --> 04:05:18,840
CHRONIC PAIN PATIENT COMING 

5075
04:05:18,840 --> 04:05:20,280
THERE'S THAT EXPERIENCE BUT WITH

5076
04:05:20,280 --> 04:05:24,400
BACK UP THEY CAN CALL SOME OF 

5077
04:05:24,400 --> 04:05:25,800
THESE INTERPROFESSIONAL 

5078
04:05:25,800 --> 04:05:28,040
PROVIDERS TO JOIN VIA TELEHEALTH

5079
04:05:28,040 --> 04:05:32,880
TO PROVIDE THAT EXTRA LAYER AND 

5080
04:05:32,880 --> 04:05:37,480
THAT MIGHT BE SO THERE IS A 

5081
04:05:37,480 --> 04:05:38,880
NUMBER OF INTERPROFESSIONAL 

5082
04:05:38,880 --> 04:05:40,560
CLINICS OUT THERE BUT THERE'S 

5083
04:05:40,560 --> 04:05:42,880
ALSO IN AREAS WHERE PERHAPS YOU 

5084
04:05:42,880 --> 04:05:46,760
CAN'T GET THAT GROUP TOGETHER, 

5085
04:05:46,760 --> 04:05:48,640
THE PAIN SPECIALIST TRAINED 

5086
04:05:48,640 --> 04:05:54,640
PROVIDER THAT CAN START AND HAVE

5087
04:05:54,640 --> 04:05:56,160
THAT BACKGROUND OR EXTRA LAYER 

5088
04:05:56,160 --> 04:05:59,440
OF SUPPORT TO CALL ON VIA 

5089
04:05:59,440 --> 04:06:00,520
TELEHEALTH THAT WILL HELP WITH 

5090
04:06:00,520 --> 04:06:04,160
SOME OF THE COMPLEX PATIENTS.

5091
04:06:04,160 --> 04:06:07,600
JUST SOME IDEAS OF MODELS IN 

5092
04:06:07,600 --> 04:06:08,520
OPERATION AS IT WERE FOR CHRONIC

5093
04:06:08,520 --> 04:06:16,360
PAIN MANAGEMENT.

5094
04:06:16,360 --> 04:06:17,680
>> THIS IS WALLY.

5095
04:06:17,680 --> 04:06:19,200
I WANT TO AGREE WITH THAT AND 

5096
04:06:19,200 --> 04:06:22,200
THE PROBLEM WE HAVE IS THAT OF 

5097
04:06:22,200 --> 04:06:23,520
NOMENCLATURE.

5098
04:06:23,520 --> 04:06:26,240
ANESTHESIOLOGISTS LISTENING IN 

5099
04:06:26,240 --> 04:06:28,080
WILL KNOW THAT THEY ARE OFTEN 

5100
04:06:28,080 --> 04:06:30,720
REFERRED TO AS PAIN MANAGEMENT 

5101
04:06:30,720 --> 04:06:31,240
SPECIALISTS.

5102
04:06:31,240 --> 04:06:32,880
AND PATIENTS ARE OFTEN REFERRED 

5103
04:06:32,880 --> 04:06:40,480
TO THEM EXPECTING WHAT THIS 

5104
04:06:40,480 --> 04:06:41,560
SPECIALTY TRAINED PHYSICIAN CAN 

5105
04:06:41,560 --> 04:06:41,840
OFFER.

5106
04:06:41,840 --> 04:06:44,920
IN FACT, WHAT THEY DO OFFER AS 

5107
04:06:44,920 --> 04:06:50,440
AN ANESTHESIOLOGIST IS 

5108
04:06:50,440 --> 04:06:51,440
INJECTIONS OR SOME NARROW RANGE 

5109
04:06:51,440 --> 04:06:55,080
OF SERVICES THAT IS NOT 

5110
04:06:55,080 --> 04:06:56,880
BEHAVIORAL AND THE PATIENT AND 

5111
04:06:56,880 --> 04:07:04,760
THE PAIN MANAGEMENT SPECIALISTS 

5112
04:07:04,760 --> 04:07:07,680
HAVE ONE OR TWO IN COMMON.

5113
04:07:07,680 --> 04:07:18,040
>> THAT'S A STANDARD.

5114
04:08:16,840 --> 04:08:21,680
>> I FEEL BETTER HEARING
THE 

5115
04:08:21,680 --> 04:08:24,560
PAIN IS BEING DISCUSSED BY CARE 

5116
04:08:24,560 --> 04:08:25,800
PEOPLE AND SHARE THIS WITH MY 

5117
04:08:25,800 --> 04:08:29,840
COMMUNITY WHERE PAIN IS 

5118
04:08:29,840 --> 04:08:32,760
PREVALENT AND OFTEN POORLY 

5119
04:08:32,760 --> 04:08:33,000
MANAGED.

5120
04:08:33,000 --> 04:08:36,560
SO DOUBLY GRATEFUL FOR THE 

5121
04:08:36,560 --> 04:08:38,240
OPPORTUNITY TO PRESENT AND 

5122
04:08:38,240 --> 04:08:39,280
RECEIVE USEFUL INFORMATION I CAN

5123
04:08:39,280 --> 04:08:49,680
SHARE WITH MY FRIENDS.