>>WELCOME
THIS IS THE FIRST IN-PERSON PAIN
CONSORTIUM SINCE THE BEGINNING
OF THE COVID-19 PANDEMIC AND IS
DELIGHTFUL TO SEE SOME OF YOU
BRAVE SOULS OUT HERE.
WITHOUT FURTHER ADO I WILL
INTRODUCE DR. D'SOUZA WHO IS
DIRECTOR AT NATIONAL INSTITUTE
OF DENTAL AND CRANIOFACIAL
RESEARCH SHE IS PASSIONATE ABOUT
ADVANCING FUNDAMENTAL KNOWLEDGE
OF DENTAL CRANIOFACIAL AND ORAL
DISEASE THAT IMPROVE OVERALL
HEALTH FOR ALL INDIVIDUALS IN
COMMUNITIES ACROSS THE LIFESPAN
AND PRIOR TO JOINING NIH AS
INSTITUTE DIRECTOR SHE SERVED AT
UNIVERSITY OF UTAH AS ASSISTANT
VICE PRESIDENT FOR ACADEMIC
AFFAIRS AND EDUCATION FOR HEALTH
SCIENCES AND IS PAST PRESIDENT
OF AMERICAN ASSOCIATION FOR
DENTAL RESEARCH AND
INTERNATIONAL ASSOCIATION FOR
DENTAL RESEARCH AND AUTHORED
OVER 150 PUBLICATIONS AND BOOK
CHAPTERS IN AREAS OF
CRANIOFACIAL DEVELOPMENT,
GENETICS, TOOTH DEVELOPMENT AND
REGENERATIVE DENTAL MEDICINE AND
AMONG MANY AWARD INZ DOCTRINATED
INTO ACADEMY OF SCIENCES.
SHE IS NIH HELPING TO END
ADDICTION OR HEAL EXECUTIVE
COMMITTEE MEMBER AS WELL AS
MEMBER OF PAIN CONSORTIUM AND IS
DEEPLY COMMITTED TO ADVANCING
RESEARCH ON PAIN AND PAIN
MANAGEMENT AS HER INSTITUTE'S
MISSION. PLEASE WELCOME DR.
D'SO
D'SOUZA.
>>THANK YOU AND FOR
REPRESENTING WORK IN PAIN
CONSORTIUM THAT TRANSITIONED
INTO A NEW ERA OF SUCCESS AND
HAPPY TO BE HAD HERE AND TO SEE
FACES AND WELCOME TO THE VIRTUAL
AUDIENCE AS WELL. IN THE NEXT
FEW MINUTES, I WOULD LIKE TO --
OOPS. LET ME SEE IF I CAN DO
THIS. TO FIRST ACKNOWLEDGE THE
EXECUTIVE COMMITTEE MEMBERS FOR
PAIN CONSORTIUM WITH SPECIAL
SHOUTOUT TO LINDA PORTER OFFICE
OF PAIN POLICY IN COLLABORATION
WITH THE EXECUTIVE COMMITTEE OF
THE CONSORTIUM.
I SEE DR. [INDISCERNIBLE] HERE
IN THE AUDIENCE AND WALTER AND
SHANNON. THIS EXECUTIVE
COMMITTEE WORKS REALLY HARD TO
KEEP RESEARCH RELEVANT AND
MOVING FORWARD. IT IS A
PLEASURE FOR ME TO BE INVOLVED.
I SHOULDN'T BE TELLING THIS
AUDIENCE THIS. YOU KNOW THAT
PAIN REMAINS A PUBLIC HEALTH
CRISIS AND INDIVIDUAL BURDEN AND
SURGEON GENERAL RECENTLY
DECLARING THAT LONELINESS IS
ACTUALLY AN EPIDEMIC IN THE US
THAT IS VERY MUCH CONNECTED TO
PAIN AND HOW WE AS A SOCIETY
DIAGNOSE AND TREAT AND COPE WITH
PAIN.
YOU CAN SEE FROM DATA THAT IS A
SIGNIFICANT NUMBER OF
INDIVIDUALS THAT SUFFER FROM
CHRONIC PAIN AND REPORT SEVERE
PAIN DAILY AND BET IF WE TOOK A
POLL IN THE AUDIENCE ALL OF US
WOULD RAISE OUR HANDS.
TWL IS -- BEHAVIORAL AND SOCIAL
DETERMINANTS OF PAIN AND
MANAGEMENT AND NOW AND TO WORK
OF HEAL AND PAIN CONSORTIUM, WE
REALIZE IMPORTANCE OF
SOCIOECONOMIC BURDENS AND
UNDERSTANDING DISPARIT
TREATMENTS AND PRESCRIPTION
MODALITIES BY PHYSICIANS AND HOW
UNDERSERVED COMMUNITIES
PARTICULARLY SUFFER BECAUSE OF
THESE DISPARITIES.
THAT HAS BECOME A VERY MUCH
FOCUS OF THE INITIATIVES WE HAVE
ON CAMPUS THAT YOU CAN SEE IN
FACT ARE BROAD BASED AND PAIN
CONSORTIUM IS IMBEDDED IN A
MULTI-DISCIPLINARY CONSORTIA OF
COLLABORATIONS AND INITIATIVES
ON OUR CAMPUS.
I WANT TO ACTUALLY FOCUS A
LITTLE BIT ON HEAL. THIS IS A
TRANSFORMATIVE PROGRAM ON --
INITIATED SEVERAL YEARS AGO ON A
MANDATE AND CONNECTING THESE TWO
ECOSYSTEMS HAS BEEN REALLY
MAGICAL FOR HEAL AND REBECCA HAS
DONE AN AMAZING JOB DEVELOPING
THIS TO WHERE IT IS LAUNCHING
NOW INTO MANY EXCITING NEW AREAS
WITH GREAT OUTCOMES AND IF YOU
LOOK AT HEALS PROGRESS IN THE
AREA OPIOID PRESCRIPTIONS HAVE
DROPPED AND DISPENSARYIES
REACHED LOWEST POINT IN HISTORY
AND WORK TO BE DONE BECAUSE OF
VARIOUS NEW DRUGS FLOATING
AROUND ON THE STREET AND
FENTANYL CONTAMINATION REMAINS A
HUGE PROBLEM. YOU CAN SEE THERE
IS LOTS OF WORK TO BE DONE AND
TREATING PAIN REMAINS A
CHALLENGE.
WHAT HEAL HAS BROUGHT TO FOCUS
IS NEED FOR COMMUNITY
ENGAGEMENT. YOU SEE THAT THEME
ACTUALLY COMING THROUGH IN MANY
OF NIH'S NEW INITIATIVES THAT
EMERGED IN THE LAST FEW YEARS
AND NEED TO ENGAGE AND HAVE
COMMUNITY-LED ENGAGEMENT IS
DIFFERENT FROM COMMUNITY
ENGAGEMENT ITSELF; RIGHT?
COMMUNITY-LED PROJECTS WILL I
THINK BRING PATIENT'S CONCERNS
TO THE VERY FORE THAT IS AN
IMPORTANT DIRECTION THAT HEAL
TOOK.
THERE IS ALSO THE FACT THAT
SEEDING PROGRAMS REQUIRES
FURTHER LEVERAGING THROUGH
INDUSTRY PARTNERSHIPS TO MAKE
THERAPY AND DRUGS THAT ARE
AFFORDABLE AND EFFECTIVE TO THIS
IMPORTANT AREA FOR OUR HEALTH
CONCERNS.
IF WE DIDN'T TAKE CARE OF THE
FUTURE GENERATION, WE WOULDN'T
DO THE RIGHT THING; RIGHT?
EACH OF US THAT HAS FUNDING FROM
NIH AND IS WORKING IN THIS AREA
HAS THAT RESPONSIBILITY OF
TRAINING FUTURE GENERATION OF
PAIN AND NEUROSCIENTISTS SO WE
IN FACT ENSURE THAT ROBUST AND
SUSTAINABLE ASPECTS OF THE
PROGRAM CONTINUE WELL INTO THE
FUTURE AND SEVERAL SUPPLEMENTS
SUPPORT DIVERSITY TO CREATE
BROADEST COMMUNITIES THAT ARE
ABLE TO ADDRESS EVERY ONE OF
THOSE MULTIPLE DETERMINANTS OF
PAIN IN OUR SOCIETY.
YOU CAN SEE HERE THAT HEAL HAS
SUCCEEDED IN SUPPORTING 30
INDIVIDUALS FROM
UNDER-REPRESENTED GROUPS.
EXCITING IS THE FACT THAT HEAL
IS PIONEERING AN ECOSYSTEM OF
DATA SCIENCE ECOSYSTEM TO
DEVELOP AI ALGORITHMS AND
MACHINE-LEARNING TOOLS TO
IDENTIFY AND TREAT MODALITIES
THAT WORK AND THOSE THAT DON'T
AND LOOKING AT ZIP CODE ANALE
SIS THROUGH DISTRIBUTION
POPULATIONS EFFECTED MOST BY
CHRONIC PAIN.
I WANT TO SPEND A FEW MOMENTS TO
TALK ABOUT PAIN RESEARCH AT
NIDCR. REASON I'M DOING THAT IS
TO INVITE YOU TO JOIN OUR
COMMUNITY OF RESEARCHERS.
WE ARE -- YOU KNOW, AS COMPARED
TO MEDICINE WE ARE A SMALLER
PROFESSION AND DEAL WITH BIG
PROBLEMS THAT ARE VERY CENTRAL
TO YOUR INTEREST AREAS.
WHY WERE WE CREATED ALMOST 75
YEARS AGO?
ABOUT A MONTH SHORT. PRESIDENT
HARRY TROOUMAN SCRATCHED HIS
HEAD REALLY CONCERNED THAT HE
WAS NOT ABLE TO ENLIST 25% OF
YOUNG MALE POPULATION TO THE
WAR.
AND THEY COULDN'T GET TO THE
BATTLEFIELD.
MOUTHS WERE RAVAGED WITH DECAY
AND THEY ALSO EXPERIENCED PAIN
AND HE WAS VERY CONCERNED AND
WANTED AN INSTITUTE AND PRESENCE
ON THE NATIONAL LEVEL TO
RESEARCH THAT. NIDCR NOW 75
YEARS LATER IS STILL DEALING
WITH DENTAL AND ORAL FACIAL --
TO ADVANCE SCIENCE THROUGH OUR
PROGRAMS AND STRATEGIC PLAN HAS
PAIN INTERTWINED INTO EACH OF
OUR GOALS AND FIRST IS TO MAKE
SURE WE HAVE MEAT ON THE BONES
AND PROVIDING EVIDENCE THAT ORAL
HEALTH IS CRITICAL TO OVERALL
HEALTH AND WELLBEING AND TO BE
ABLE TO IN STRATEGIC PRIORITY
NO. 2 TO ADVANCE PERSONALIZED OR
INDIVIDUALIZED APPROACHES IS
SOMETHING THAT ALL OF YOU ARE
CONCERNED WITH.
EACH ONE OF US HAVE UNIQUE
BIOCHEMICAL PROFILES TO
TRANSLATE AND IMPLEMENT REMAINS
CHALLENGE TO ADVANCE
STRATEGICALLY IN THE AREA
CREATING BROAD WORKFORCE IN THE
FUTURE CONNECTING WITH
STAKEHOLDER GROUPS SUCH AS THIS.
SO, OUR PORTFOLIO IS BROAD AND
DIVERSE AND YOU SEE DENTAL AND
ORO FACIAL PAIN REMAINS RIGHT AT
THE CENTER AND SEEING THAT
CONDITIONS THAT EFFECT DENTAL
ORAL AND CRANIO -- ARE DIFFICULT
TO PREDICT AND TO TREAT AND
DON'T HAVE TIME TO DESCRIBE
SYSTEMS BUT THEY ARE UNIQUE AND
NOT PRESENT IN MAMMALIAN ORGAN
SYSTEMS DENTAL OR FACIAL PAIN
WHETHER A TOOTHACHE OR TRY
NEUROLOGIST AND CANCER REMAIN
CHALLENGING AND BREADTH OF
INVESTMENT COVERS SPECTRUMS OF
ORGANS AND TISSUES WE ARE
RESPONSIBLE FOR.
WHETHER IT IS IN FACT ORAL
FACIAL PAIN OR DISORDERS LOOKING
AT MINERALIZED TISSUES WE ARE
RESPONSIBLE WITH THAT SURROUND
TEETH MAKING UP CRANIOFACIAL
SKULL LOOKING AT TISSUE ENGINEER
REGENERATIVE APPROACHES BEHAVIOR
AND SOCIAL DETERMINANTS OF
HEALTH THAT DRIVE ORAL HEALTH
CONDITIONS AND MAKING SURE WE
ACCESS POPULATIONS THAT FIND IT
DIFFICULT TO ACCESS ORAL HEALTH
CARE IS CRITICAL THAT IS ALL
ENCOMPASSING OF THE PAIN ARENA
THAT WE ARE COMMITTED TO.
OF COURSE, MAKING SURE THAT WE
CAN TAKE WHAT WE DO OR KNOW AND
TRANSLATE IT TO WHAT WE DO
THROUGH CLINICAL RESEARCH.
THESE ARE INVESTMENTS.
I DON'T KNOW HOW MUCH YOUR --
HOW -- WHERE YOU ARE OF THE
ACTUAL DATA THAT SHOWS THAT
DENTAL PAIN IS NORMALLY ACTUALLY
THE -- RANKS AMONGST HIGHEST
REASONS OR MOST COMMON REASON
FOR VISITING AN ER AND EMERGENCY
ROOM AND TYPICALLY EMERGENCY
ROOM PHYSICIAN WILL PRESCRIBE
PAIN KILLERS OR PAIN MANAGEMENT
OPIOID SOMETIMES AND YOU GET THE
PATIENT INTO A VICIOUS CYCLE OF
BECOMING ACTUALLY ADDICTED OR
COMMITTED TO SUBSTANCE USE
DISORDER.
YOU SEE DENTAL PAIN RANKS THERE
PRETTY HIGH OR HIGHEST.
IT IS ALSO IN THE LAST FEW YEARS
FORTUNATELY WE HAVE SEEN A
DECLINE THANK YOU TO EFFORTS OF
DR. SUMMERMAN AND ADA, THE
PREVIOUS DIRECTOR WE WERE ABLE
TO GET TO COMMUNICATE TO ORAL
HEALTH PROFESSIONAL COMMUNITY
ABOUT PRESCRIBING OPENOIDS IN
HIGHLY RESTRICTIVE AND
RESTRAINED MANNER AND THERE IS
LOTS OF REDUCTION BUT LOTS OF
WORK TO BE DONE THERE AND HARD
TO DISSECT ISSUE OF PAIN AWAY
FROM MENTAL HEALTH CONDITIONS
AND WE ARE WORKING HARD NOW TO
MAKE SURE THAT THE MAGIC THAT
COULD BE CREATED AT THAT
INTERFACE IS EMBRACED REALLY BY
ORAL HEALTH PROFESSIONALS.
SUBSTANCE USE, MENTAL HEALTH AND
ORAL HEALTH ARE CONNECTED THAT
IS TYPICAL FOR A DENTIST TO BE
IDENTIFYING CHRONIC DRUG USAGE.
YOU HAVE EFFECTS IN ORAL CAVITY
THAT ARE EASILY VISIBLE.
TRY MOUTH AND HIGH LEVEL OF
DECAY, ET CETERA. CAN ORAL
HEALTH PROFESSIONALS DO THINGS
ALONG AND WITH HEALTH
PROFESSIONALS AND POINTING TO
STATISTICS FOR NEED TO ENGAGE IN
INTERSECTION OF A FEW EXAMPLES
OF RESEARCH AND A FEW AMONGST
MANY THAT HAVE MOVED THE FIELD
FORWARD.
AS I MENTIONED HAD THEY HAD
CANCERS THAT ARE THREATENING AND
LATE DETECTION AND RATHER
RADICAL TREATMENT MEASURES THAT
IS TYPICALLY FOR CANCER THAT IS
BEYOND EARLY STAGE OF DYSPLASIA
YOU REMAIN HALF THE JAW AND
TONGUE AND ISSUES INVOLVED IN
REGENERATING TISSUES ARE
DIFFICULT TO MANAGE BOTH FOR THE
PHYSICIAN AND DEFINITELY FOR
PATIENT INVOLVED AND IN THE
STUDIES WE WERE ABLE TO SHOW THE
[INDISCERNIBLE] WERE ABLE TO
DEMONSTRATE TNF ALPHA AND ROLE
IN NOCICEPTION WHEN CANCER IS
PRESENT AND THE NATIONAL CENTER
FOR COMPLEMENTARY AND
INTEGRATIVE HEALTH AND NATIONAL
INSTITUTES FOR -- AND OF COURSE
NINDS TO GO TO LEADERSHIP AND WE
HAVE CURRENTLY FUNDING SPECIAL
INITIATIVE CALLED REJOIN THAT
WOULD BE FOCUSED ON REALLY THE
INNOVATION AND UNDERSTANDING
INNOVATION OF SYSTEMS THAT ARE
PRESENT IN THE KNEE AND TEMPORAL
MEN DIBULAR JOINT AND ARE PIS
THAT ARE FUNDED THROUGHOUT THE
COUNTRY AND IS IMPORTANT IN
UNDERSTANDING NEUROGENICS OF
PAIN REALLY GIVES A BETTER
UNDERSTANDING OF PANELO GENESIS
AND LAST YEAR PART OF SIGNATURE
INITIATIVES 70 FIFTH ANNIVERSARY
NIDCR LAUNCHED A COLLABORATIVE
CALLED IMPACT TO DRAW IN
INDIVIDUALS FROM VARIOUS FIELDS
TO HANDLE LOOKING AT TEMPORAL
MAN DIBULAR DISFUNCTION THIS IS
LAGGING BEHIND OTHER JOINTS AND
IS TRULY DEBILITATING AND
FERVENT PATIENT ADVOCATE FEELS
STRONGLY THIS IS AN AREA IF WE
UNDERSTOOD AND COULD DRAW FROM
OTHER AREAS OF PAIN MANAGEMENT
WOULD BENEFIT A LARGE
POPULATION.
THANK YOU, TERRY, FOR YOUR WORK.
THIS INITIATIVE, MELISSA WHO WAS
VERY INVOLVED IN PLANNING THIS,
IS NOW IN THE EARLY PHASE AND WE
HAVE A PLANNING GRANT THAT HAS
BEEN AWARDED TO SOON ENTER
IMPLEMENTATION FAIZE IN ABOUT A
YEAR THAT HAS DRAWN
COLLABORATIONS OF INSTITUTES
THAT CAN COME TO THE TABLE.
YOU CAN SEE IT IS VERY COMPLEX
AND IS AN ENVIRONMENTAL AND HAS
BIOPSYCHOSOCIAL ELEMENT AND
COMORBIDITIES THAT EXIST AND IS
A JOINT THAT WE USE MOST
COMMONLY.
AS YOU KNOW, IT IS ONE THAT
REACTS TO STRESS AND TO
DIFFERENT FACTORS, REALLY. YOU
CAN SEE OVERALL MULTIDIMENSIONAL
APPROACH IS WHAT IS NEEDED OR
HOLISTIC APPROACH THAT HEL AN
WOULD SAY TO MANAGE THIS
CONDITION AND BRINGING FORTH
THROUGH MODERN TECHNOLOGIES AND
DATA SCIENCE TOOLS AN ECOSYSTEM
WITH COMMON DATA ELEMENTS THAT
COULD BE SHARED AND PATIENT
REPOSITORIES AND BIOSAMPLING
THAT IS ALL REGISTERED AND WANT
TO LET YOU KNOW WELCOMING YOU
INTO THE COMMUNITY WOULD BE
REALLY CRITICAL FOR ITS FUTURE
SUCCESS.
DO KEEP AN EYE OUT FOR THAT
ANNOUNCEMENT THAT SHOULD COME
OUT ABOUT A YEAR FROM NOW.
ONE ADVANCE MADE IN THE AREA IS
WHEN YOU ACTUALLY TARGET
TREATMENT IN PATIENTS WITH UP
AND DOWN EPISODES OF PAIN
RELATED TO TMD DOES IMPROVE
OVERALL PERCEPTION TO CLINICAL
PAIN MANAGEMENT THAT IS WORK
THAT WAS RECENTLY PUBLISHED IN
SCIENTIFIC REPORTS.
WE HAVE ALSO LEARNED NOSI
CREPTOR NEURIOS COULD --
THAT IS THREATENING TO OUR
SOCIETY -- STIMULATED AREAS AND
SENSORY DISCRIMINATIVE AND
MOTIVATIONAL EFFECTIVE PAIN
PROCESSING THAT OCCURS AT HIGHER
FREQUENCY IN THOSE THAT SUFFER
FROM TMD.
FINALLY, WE HAVE AWARDS THAT
HEAL HAS THROUGH HEAL WHERE WE
ARE LOOKING AS YOU CAN SEE AS
SECONDARY ANALYSIS AND LOOKING
AT DATA TO CONNECT CHRONIC ORAL
FACIAL PAIN WITH PLACEBO EFFECTS
LOOKING AT LONG-TERM EFFECTS OF
OPIOID THERAPY AND DEPRESSION
AND SUICIDE RISKS AND PATIENTS
WITH HEAD AND NECK CANSER THAT
IS A VERY RELEVANT AREA FOR OUR
INSTITUTE -- LOOKING AT NEONATAL
OPIOID WITHDRAWAL SYNDROME WAS
REPORTED -- DATA WAS REPORTED
FROM A GROUP OF INVESTIGATORS,
ACTUALLY, AT THE LAST HEAL
3EETING LAST FALL.
YOU SEE BROAD-BASED NATURE
REACHING OUT TO THE COMMUNITY
INCLUDING THOSE WHO ARE
INCARCERATED AND IDENTIFYING
THROUGH NEW PAIN THERAPEUTICS
AND TECHNOLOGIES IS DIRECTION
THAT HEAL IS GOING.
THERE ARE LOTS OF NOCIS TO
CONSIDER LOOKING AT BROAD
DISCIPLINARY APPROACH IN PAIN
MANAGEMENT AND LIST THAT
INCLUDES INITIATIVE THAT ARE
TARGETING INDIVIDUALS AND GRUMS
THAT ARE UNDER-REPRESENTED IF
THIS THIS ARENA.
I WANT TO SAY THIS WILL BE A
SPECIAL MEETING AND HOPE THOSE
PRESENT PHYSICALLY WILL CONNECT
WITH EACH OTHER AND LEARN AND
NETWORK TO MOVE THE FIELD
FORWARD TOGETHER AND INVITE YOU
AND EMBRACE YOU IN COMING INTO
THE COMMUNITY THAT NIDCR IS
COMMITTED TO ADVANCING THAT IS
THE COMMUNITY OF PAIN
PHYSICIANS, CLINICIANS, DENTISTS
AS WELL AS ALL RESEARCH THAT
GOES WITH IT.
70 FIFTH YEAR IS A CELEBRATION
OF THAT LEGACY AND HISTORY AND
WE HAVE SEVERAL EVENTS PLANNED
ON CAMPUS AND OFF CAMPUS TO
ALLOW US TO REMEMBER
CONTRIBUTIONS FROM THE PAST AS
PIONEERS IN THE FIELD THAT BOTH
HAVE PASSED AWAY SADLY AND
RECOGNIZING THEIR LEGACY
BRINGING US TO THE PRESENT AND
PLANNING FOR NEXT 25 YEARS WHERE
HOPE IS EVERY CHILD AND ADULT
AND EVERY AGING INDIVIDUAL HAS
THE RIGHT TO LIVE A PAIN FREE
LIFE THAT IS VISION WE WOULD
HAVE FOR THE NEXT 25 YEARS AND
WANT TO END HERE. ONE SECOND.
I HAVE TO PULL THIS UP IN A
MINUTE.
SO, I HAVE -- GIVE ME A MINUTE.
WHERE ARE YOU DR. HASSEN?
THERE YOU ARE. WELCOME TO NIH I
HAPPEN TO BE MARITAL WOLVERINE
AND YOU BECOME EXTRA SPECIAL AND
ASSOCIATE PROFESSOR AND DIRECTOR
OF PAIN AND OPIOID RESEARCH AT
UNIVERSITY OF MICHIGAN THAT IS A
RELEVANT TOPIC YOU ARE SO
PASSIONATE ABOUT TODAY. AS
CLINICAL PSYCHOLOGY AND
PRINCIPLE INVESTIGATOR AT
CHRONIC PAIN AND FATIGUE
RESEARCH CENTER SHE EXPLORES
NOVEL INTERVENTIONS FOR
RESILIENCE AND SHE IS A MULTIPLE
PI ALONG WITH DR. DANIEL PLOW
UNIVERSITY OF MICHIGAN'S
[INDISCERNIBLE] IT IS A RESEARCH
CENTER AND SITE PI FOR NIMAS
BACKPACK FOR BEST CLINICAL TRIAL
AND DR. HASSETT RECENTLY
COMPLETED RANDOMIZED CLINICAL
TRIAL EXPLORING POTENTIAL
EXPANDING FOCUS ON RESILIENCE IN
CBT FOR CHRONIC PAIN AND IS PAST
PRESIDENT OF ASSOCIATION OF
RHEUMATOLOGY PROFESSIONALS AND
ASSOCIATED EDITOR OF CARE AND
RESEARCH AND PUBLISHED OVER 100
PEER REVIEW ARTICLES AND HAS
LOTS TO SHARE WITH US, I'M SURE.
NOW IS THE AUTHOR OF CHRONIC
PAIN RESEARCH AND WELCOME. WE
LOOK FORWARD TO HEARING FROM
YOU.
THANK YOU.
>>GOOD MORNING. THANK YOU SO
MUCH FOR LETTING ME COME TALK TO
YOU AND TALK TO YOU A LITTLE
ABOUT HOW PATIENTS WITH CHRONIC
PAIN AND PARTICIPANTS IN THE
STUDY MAY HAVE REMARKABLE POWERS
WE HAVE ONLY BEGUN TO TAP INTO.
THESE ARE MY DISCLOSURES.
I WOULD LIKE TO THAFK NIH FOR
HAVING A PAIN AND RESILIENCE
CONFERENCE.
I NEVER THOUGHT THIS WOULD
HAPPEN BACK WHEN I WAS FIRST
INTERE
INTERESTED.
WHEN I WAS FIRST INTERESTED IN
RESILIENCE, I THOUGHT THERE IS
NOT GOING TO BE A PLACE FOR ME
AT THE NIH. I WILL NEVER GET AN
R01. THEN ALL OF A SUDDEN THE
WORD RESILIENCE STARTED TO POP
UP IN PROGRAM ANNOUNCEMENTS AND
I THOUGHT, YES. DANCE OF JOY!
I WILL BE IN THE RIGHT PLACE.
WE DIDN'T OR AT LEAST MOST OF US
DOESN'T START STUDYING
RESILIENCE I'M A GOOD PSYCHOLOGY
AND LIKE LIKE TO LOOK AT
DEPRESSION AND ANXIETY AND MANY
STARTED WITH RISK AND RISK
FACTORS FOR CHRONIC PAIN.
AS A GOOD PSYCHOLOGIST IN
TRAINING FOR MY DISSERTATION
BASED ON MY CLINICAL WORK AND
ALL MY TRAINING I KNEW I FIGURED
OUT FIBROMYALGIA DUE TO PAIN
CATASTROPHIZING AND DID MY
DISSERTATION ON THAT. IT WAS
IMPORTANT BUT SURE DIDN'T TELL
THE WHOLE STORY.
LOOKING AT OUR DATA WE SAW AN
INCREDIBLE MIX OF BAG OF
INDIVIDUALS EMOTIONAL AND
EFFECTIVE AND BEHAVIORAL STYLES
AND PEOPLE THRIVING DESPITE
CHRONIC PAIN. THAT MESSED UP MY
RESEARCH FOR A WHILE.
I WENT BACK AND THOUGHT, YOU
KNOW WHAT? I WILL DOUBLE DOWN
ON PSYCH CO-MORE IDTY AND
NATIONAL INSTITUTE AT MENTAL
HEALTH WAS KIND ENOUGH TO GIVE
ME A K08 AND STUDIED WITH
COLLEAGUE AND MENTOR LEN
SOOEGLE. WE STUDIED CHRONIC
LYME DISEASE LIKE INFECTIOUS
TRIGGERED MAIALGIA BUT LET'S
UNDERSTAND WHAT IS GOING ON
THERE I PUBLISHED MY PAPERS AND
FOUND SAME THING GRIFRJ SITTING
ON TOP OF MOUNT CRUMB PET
LOOKING DOWN ON WHOVILLE GOING
YOU HAVE INCREDIBLE PAIN AND
HAVE LO S AND LOST FRIENDSHIPS
RELATIONSHIPS AND YOUR JOB AND
YET YOU MOTOR ON. WHAT IS THAT?
WE WENT BACK TO LITERATURE AND
STARTED TO THINK WHAT DO WE CALL
THIS? WHAT IS THIS THING?
PAPER BY BARBARA FREDERICK THIS
IS HER THEORY I WILL TALK ABOUT
A LITTLE BIT AND SET PREDICATE
FOR HOW POSITIVE EMOTIONS MIGHT
HAVE A ROLE AND VERY
CONSERVATIVE AMERICAN
PSYCHOLOGIST PUBLISHED ENTIRE
ADDITION DEDICATED TO POSITIVE
PSYCHOLOGY IN FIELD OF PAIN AND
RESILIENCE WERE PEERS.
[INDISCERNIBLE] FROM ARIZONA
STATE UNIVERSITY LED THE WAY
TRAINING MANY PEOPLE DOING THIS
WORK TODAY.
COLLEAGUES TOO FROM ACROSS THE
POND WERE CONTRIBUTING ALSO TO
THIS NOTION OF PAIN AND
RESILIENCE.
AND SO I WENT BACK TO MY K DATA
P.
I KNEW I TOSSED IN POSITIVE AND
NEGATIVE AFFECT SCALE CAN WE
CATEGORIZE PEOPLE BY EFFECTIVE
BALANCE AND WE ARE A BUNDLE OF
BALANCE OF THESE.
SO, WE WENT BACK AND THOUGHT,
OKAY. IF SOMEBODY HAS HIGH
NEGATIVE AFFECT AND LOW POSITIVE
AFFECT THAT IS WHAT WE SEE IN
DEPRESSION AND WOULD BE A
DEPRESSIVE STYLE. WE HAVE
PEOPLE WITH HIGH POSITIVE AFFECT
AND LOW NEGATIVE AFFECT. THAT
IS HEALTHY AND WHAT WE HOPE FOR
AND WHAT BARBARA FREDERICKSON
WAS WRITING ABOUT IN HER THEORY
AND WE SAW UNUSUAL PEOPLE WHO
HAD LOW POSITIVE AFFECT AND LOW
NEGATIVE AFFECT. THEY ARE
MELLOW AND MAYBE ANHEDONIC AND
WASN'T CLEAR AND CALLED THEM
LOWS AND FOLKS A LOT LIKE MY
HISPANIC FAMILY ARE VERY FIERY
AND LOTS OF AFFECT POSITIVE AND
NEGATIVE AFFECT AND CALLED THEM
REACTIVES FOR LACK OF A BETTER
TERM AND IT PANNED OUT
DEPRESSIVE STATE WAS COMMON IN
FIBROMYALGIA AND DEPRESSIVE
STYLE DEPICTED THINGS BAD. NO
GROUNDBREAKING HERE. WE KNOW
DEPRESSION IS BAD BUT WE STARTED
TO SEE SUBTLE DIFFERENCES LOW
STYLE POSITIVE AFFECTS AND LOW
STY WITH HIGH AFFECT IN CONTEXT
OF HIGH NEGATIVE AFFECT AND
FUTURE ME WORKED WITH MY BUDDY
KIM AND DOVE INTO AFFECT BALANCE
STYLE.
WE FOUND THAT ACTUALLY THIS
REACTIVE STYLE OR ADDITIONAL
POSITIVE AFFECT SEEMS TO BUFFER
AND PEOPLE WITH REACTIVE STYLE
DO BETTEDER THAN DEPRESSIVE
STYLE. WE SAW THAT EVEN IN
HEALTHY SAMPLES THIS PLAYED OUT
AND THAT REACTIVE STYLE AND
HAVING POSITIVE AFFECT TO BUFFER
NEGATIVE AFFECT WAS REALLY
IMPORTANT.
OKAY. THAT WAS FUTURE ME.
NOW, BACK TO MY CRISIS.
I WAS DOING CONSULTING FOR A
LARGE PHARMACEUTICAL COMPANY
WORKING WITH GLOBAL OUTCOMES
TEAM WHO CALLED ME UP ONE DAY.
HEY, COULD YOU GET OVER HERE?
WE NEED YOU TO SEE THIS. THIS
IS AMAZING AND I EXAM PERKED
OVER THERE. THEY SAID WE
CONDUCTED A LARGE CLINICAL TRIAL
IN BIOLOGICS AND WE DID
RECORDINGS OF ALL SUBSET OF
PARTICIPANTS BEFORE AND AFTER
THE DRUG TRIAL.
THESE ARE BEFORES. THEY SHOWED
VIDEOS THAT ARE PRETTY UNIFORMLY
SAD AND PEOPLE HAVING A VERY
DIFFICULT TIME TALKING ABOUT
WHAT IS IT IS LIKE AND HOW
RHEUMATOID ARTHRITIS IMPACTED
THEIR LIVE AND WHAT THEY CARE
ABOUT IN LIFE IS SOMETHING THEY
NO LONGER CAN ASPIRE TO DO OR GO
TO.
THEY SHOWED ME A WHOLE SET OF
VIDEOS THAT WERE TAKEN AFTER
DRUG TRIALS THAT IS A VERY
SUCCESSFUL TRIAL AND SHOWED ME
ANOTHER GROUP OF PEOPLE AND
WATCHED THESE PEOPLE AND OH,
THIS IS AN ENTIRELY DIFFERENT.
I'M A PSYCHOLOGIST AND HAD
TRAINING AND RECOGNIZE WHAT THAT
IS. THAT IS HAPPINESS. IN BACK
OF MY MIND I'M THINKING I HAVE
NO IDEA HOW TO STUDY HAPPINESS.
SO, BACK TO THE CRISIS. I'M
DRIVING BACK TO MY OFFICE
THINKING, YOU KNOW WHAT?
I NEED TO TALK TO SOMEBODY WHO
UNDERSTANDS THIS. THIS BECAME
AN OPPORTUNITY.
ACTUALLY, IT BECAME KIND OF
EMBLEMATIC OF MY ENTIRE CAREER.
KIND OF DUMB LUCK TOO.
I REACHED OUT TO THE MAN WHO WAS
A FORMER PRESIDENT OF AMERICAN
PSYCHOLOGICAL ASSOCIATION AND
FATHER OF POSITIVE PSYCHOLOGY
AND GIANT IN THE FIELD AND WROTE
HIM A LITTLE E-MAIL. HEY DR.
SELLIGMAN. HE WROTE BACK. WE
-- I TOLD HIM ABOUT OUR
CONUNDRUM AND HAVE NO IDEA HOW
TO STUDY THIS COULD YOU PLEASE
TALK TO US? WEEK LATER HE IS
SITTING ACROSS FROM US AND
PHARMACEUTICAL COMPANY
COLLEAGUES AT STARBUCKS HE IS
EATING EGG SALAD SANDWICH I
REMEMBER THESE THINGS AND HE
BEGINS TO TELL US ABOUT
PHILOSOPHY AND SAYS THAT WE
PSYCHOLOGISTS DO A BEAUTIFUL JOB
OF ALL THAT GOES WRONG WITH
HUMAN BEINGS AND WE STRIVE TO
MAKE THIS STUFF GO AWAY AND TRY
TO GET PEOPLE BACK TO ZERO.
PROBLEM IS TOO FEW PEOPLE THINK
ABOUT ALL OF THE AFFECTS AND
PROCESSES THAT ARE NORTH OF
ZERO.
THESE ARE THE THINGS THAT HELP
US BUILD RESILIENCE.
THEY ARE PROTECTIVE AGAINST ALL
BAD THINGS.
SO, RESILIENCE, THAT WHICH DOES
NOT KILL ME WILL MAKE ME
STRONGER.
PRETTY SIMPLE; RIGHT?
OR NOT.
SO, THERE ARE LOTS OF COMPETING
THEORIES ABOUT RESILIENCE.
THESE ARE REALLY PASSIONATELY
HELD. THIS IS AN ARTISTIC
DEPICTION OF LAST INTERNATIONAL
POSITIVE PSYCHOLOGY MEETING
WHERE RESILIENCE WAS DEBATED
HOTLY AND WE DON'T REALLY KNOW
BUT KNOW THERE ARE SOME SHARED
PRINCIPLES WE CAN HANG OUR HATS
ON AND FIRST OF ALL FOR
RESILIENCE TO MEAN ANYTHING, WE
DID ADVERSITY AND LOOK AT
ABILITY TO BOUNCE BACK.
WE ALSO THINK THAT RESILIENCE IS
A TRAIT.
IT IS ALSO A DYNAMIC AND
ADAPTIVE CAPACITY AND SOMETHING
THAT COULD BE A STATE.
AS SUCH, IT COULD BE A MALIABLE
FACTOR AND SOMETHING WE CAN
TRAIN AND TEACH AND HELP TO
IMPROVE.
SO, WHEN WE THINK ABOUT HUMANS,
THEY ARE NOT REALLY RESILIENT OR
NOT RESILIENT. THAT IS NOT
WHERE WE REALLY ARE. THERE IS
LOW RESILIENCE AND MODERATE
RESILIENCE AND HOPEFULLY HAVE
MORE HIGH RESILIENCE AND IS
ANOTHER STATE THAT IS KNOWN AS
THRIVING.
THIS IS WHERE PEOPLE DO EVEN
BETTER THAN EXPECTED AFTER A
SETBACK.
THEIR LIFE MIGHT BE RICHER THAN
BEFORE AND THEY HAVE LEARNED
SOMETHING INCREDIBLE ABOUT
THEMSELVES AND THEY FIND LIFE
MORE REWARDING BECAUSE OF WHAT
THEY HAVE BEEN THROUGH.
SO, PEOPLE IN THIS THRIVING
CATEGORY JUST EMBRACE THESE
PROCESSES AND POSITIVE
PROCESSES.
SO, THAT TAKES US TO RESILIENCE
AND PAIN. RESILIENCE IS SIMPLE;
RIGHT?
WE ADD IN ONE OF THE MOST
COMPLEX THINGS WE HAVE HAD TO
STUDY, PAIN.
WHAT DO WE HAVE?
RIGHT?
PAIN IS WEIRD. WE CAN AGREE IT
IS JUST THAT SIMPLE.
IT IT IS FASCINATING BECAUSE IT
IS A COMBINATION OF SENSORY
EFFECTIVE COGNITIVE AND
INTENTIONAL PROCESSES AND MANY
PROCESSES ARE PROCESSED IN THE
BRAIN BY SIMILAR STRUCTURES.
EXACT SAME STRUCTURES OR
STRUCTURES THAT ARE
INTERCONNECTED.
AS SUCH, WE END UP WITH A
STRANGE NATURE OF PAIN WE TRY TO
GET OUR HANDS AROUND DEVELOPING
APPROACHES TO SUPPORTING OUR
PATIENT.
ONE THOUGHT IS TISSUE DAMAGE AND
INFLAMMATION, OPTIONAL; RIGHT?
WE SEE WITH NOSI PLASTIC PAIN
PAIN COULD BE MADE WORSE BY THE
PAIN OR COMPLETELY GENERATED BY
THE BRAIN.
WE HAVE A BOAT LOAD OF ARTICLES,
REVIEWS THAT TELL US THAT
MALADAPTIVE THOUGHTS PAIN
CATASTROPHIZING FEAR OF VOICE
AND PESSIMISM MAKE LIFE WORSE
AND ADAPTIVE THOUGHTS COULD MAKE
PAIN BETTER NEGATIVE INTENSE
EMOTION MAKES PAIN WORSE AND
INTENSE POSITIVE EMOTION MAKES
PAIN BETTER. ATTENTION AND
DISTRACTION IS REALLY POWERFUL
AND THIS REPRESENTS A STUDY BY
FRYE AND OUR STUDY LOOKING AT
EARLY STAGE LABOR GIVING WOMEN
VIRTUAL REALITY GOGGLES FOR
EVERY CONTRACTION TO SEE HOW IT
WOULD GO AND WONDERED IF THEY
WOULD DO IT AND THEY LOVED THEM
AND IF THEY WOULD GET NAUSEOUS
AND THEY DIDN'T AND CONTRACTIONS
THEY ASKED FOR GOGGLES THIS IS A
FASCINATING NEW FRONTIER FOR
PAIN AND BRENNAN AND OTHERS ARE
DOING REMARKABLE WORK IN THIS
AREA. SOCIAL ISOLATION AND DR.
D'SOUZA TALKED ABOUT POWER OF
LONELINESS AND
INTERCONNECTEDNESS AND SURGEON
GENERAL PUT THIS TO FOREFRONT.
SOCIAL ISOLATION AND REJECTION
MAKE PAIN WORSE SOCIAL
CONNECTION AND SUPPORT AND
DANCING TOGETHER IN SIN KRON ANY
TO GANG HAM STYLE MAKES PAIN
BETTER IT IS A STUDY PAIN IS
DYNAMIC AND MULTIDIMENSIONAL AND
APPROACH TO UNDERSTANDING AND
IMPROVING RESILIENCE NEEDS TO BE
DYNAMIC AND MULTIDIMENSIONAL
TOO.
I WILL TALK ABOUT TWO MODELS.
THERE IS MANY MORE.
BRIEFLY, YOU WILL HEAR FROM
EMILY BARKLEY IN A LITTLE BIT
AND COLLEAGUES PUT TOGETHER WHAT
I REALLY MODEL I REALLY LIKE
ABOUT PAIN RESILIENCE.
WHAT THEY SAY IS A COMBINATION
OF PSYCHOLOGICAL, SOCIAL, AND
BIOLOGICAL AND HEALTH LIFESTYLE
FACTORS COULD COMBINE
SYNERGISTICALLY TO HAVE
MULTIDIMENSIONAL PAIN RESILIENCE
THAT INVOLVES OVER THE LIFE
CYCLE AND ENVIRONMENTAL
SOCIOCULTURAL ENVIRONMENT
FACTORS AND HEALTHY PAIN
ADAPTATION AND IMPROVED QUALITY
OF LIFE AND INCREASED FUNCTION
AND REDUCED PAIN.
I HAVE A RESILIENT KIN DRID
SPIRIT IN MY GROUP. HE
PUBLISHED A LOVELY EFFECTIVE
MODEL OF PAIN ADAPTATION
RESILIENCE RESOURCES COMBINED
WITH MECHANISMS TO INFLUENCE
COPING RESPONSES WHILE
VULNERABILITY TRAITS AND
MECHANISMS ALSO INFLUENCE COPING
RESOURCES AND WHAT WE GET ARE
RESILIENCE OUTCOMES AND DEGREE
TO WHICH SOMEBODY CAN RECOVER
AND DEGREE TO WHICH THEY SUSTAIN
DOING VALUABLE LIFE ACTIVITIES
AND DEGREE TO WHICH THEY MIGHT
THRIVE OR GROW FROM PAIN AND IS
A LITTLE GENERIC MODEL AND LESS
ABOUT PAIN ITSELF AND MORE ABOUT
ADAPTATION.
AND THEN I HAD JUST A DELIGHTFUL
EXPERIENCE WORKING WITH
COLLEAGUE PATRICK AND PUTTING
TOGETHER A KIND OF OVERVIEW
ABOUT THE ROLE OF RESILIENCE IN
CLINICAL PAIN AND FOCUSED ON
POSITIVE ACTIVITY INTERVENTIONS
WE WILL TALK ABOUT IN A BIT AND
ARE GRATITUDE AND ACTS OF
KINDNESS AND UNDERSTANDING
CHARACTER STRENGTHS WE LIKE THEM
THEY ARE ENGAGING AND SCALEABLE
AND WORK AT ENHANCING RESILIENCE
THROUGH UPREGULATION OF POSITIVE
EMOTION.
WE CONSIDERED I WILL LET
EVERYBODY ELSE PROBABLY TOO
RESILIENCE WITH TRAIT RESOURCES
AND STATE MECHANISMS AND
QUESTIONS WE END IT BY END OF
THE PAPER WERE SHOULD RESILIENCE
INTERVENTIONS TARGET RESILIENCE
TRAITS IN EFFORT TO
FUNDAMENTALLY CHANGE PERSON'S
APPROACH AND LIFE TO CHRONIC
FOCUS ON MECHANISMS MEDIATING
PERSONALITY STYLE AND CHRONIC
PAIN ADAPTATION?
WE DON'T KNOW.
WHY BOTHER WITH RESILIENCE? WE
DO GOOD WITH RISK FACTORS WE
KNOW ABOUT THAT. WHY RESILIENCE
THAT STRONGLY PREDICTS PAIN
OUTCOMES INCLUDING WHETHER OR
NOT SOMEBODY HAS PAIN AND WILL
PREDICT WHETHER SOMEONE'S PAIN
IS FOCAL ORE WIDESPREAD AND
DISABILITY PAIN INTERFERENCE
POOR SLEEP AND PSYCHIATRIC
SYMPTOMS AND PSYCHOLOGICAL
ADAPTATION AND THEY ARE
IMPORTANT AND RESILIENCE
MATTERS. I SHOW YOU THE SLIDE
AND WANT TO SHOW YOU HIGHLAND
CATTLE I AM OBSESSED WITH LOVELY
10-YEAR COHORT STUDY LOOKING AT
6,000 INDIVIDUALS AND DETERMINE
THAT MOST RESILIENT PEOPLE AND
PEOPLE WITH HIGH PAIN AND LOW
DISABILITY WERE 25% LESS LIKELY
TO DIE IN 10 YEARS.
COMPARED TO VULNERABLE PEOPLE
THAT WERE DEFINED AS HAVING LOW
LEVELS OF PAIN AND HIGH
DISABILITY.
THEY WERE 45% MORE LIKELY TO
DIE.
THIS IS AN IMPORTANT FACTOR.
I AM A GOLFER AND WHEN I'M NOT
THINKING ABOUT HOW TO KEEP MY
BALL OUT OF THE TREES I THINK
THAT THERE IS A LOT ABOUT WHAT
IS GOING ON PSYCHOLOGICALLY AND
SOCIALLY AND HOW WE TRANSLATE
LEARNING WAYS TO HELP PATIENTS
BECOME MORE RESILIENT AND
PROVIDE THIS CONTEXT TALKING
ABOUT BASIC SCIENTISTS BEFORE WE
JUMPED ON THE BAND AND WOW WE
COME AT THIS FROM SUCH DIFFERENT
PLACES. I'M SO INTERESTED IN
PHENOTYPE AND FACTORS PREDICTING
PAIN OUTCOMES AND PUTTING
TREATMENTS BOOSTING EXISTING
THERAPIES AND USING STANDALONE
TREATMENTS AND WHAT THEORIES DO
WE RELY ON THAT ARE ALL OUT
THERE IN THE OPEN AND AS SUCH I
GROUPED NEXT SECTION OF MY TALK
AS JOY, OPTIMISM AND LOVE AND
TALKING ABOUT EACH OF THE
TOPICS, YOU WILL TALK ABOUT ONE
OF THE THREE THEORIES I THINK
ARE IMPORTANT FOR US TO
CONSIDER.
LET'S BEGIN WITH JOY.
JOY REFERS TO HEALTHY AND
POSITIVE EMOTIONS.
RIGHT?
WE TALKED ABOUT NEGATIVE
EMOTIONS THAT EXIST OUT THERE.
AND THIS IS IMPORTANT, AS I SAID
BEFORE, BECAUSE NEGATIVE
EMOTIONS ARE ASSOCIATED WITH
EVERYTHING WE DON'T WANT TO HAVE
IN CHRONIC PAIN.
LUCKILY, WE ARE MADE OF JUST
MORE NEGATIVE EMOTIONS AND WE
HAVE POSITIVE AFFECT AND GRATE
AFFECTIVE STATES AFFECTIVE LIKE
JOY AND WHITE AFFECT LIKE CALM,
DETERMINATION AND EMPATHY THAT
ARE IMPORTANT IT TOO. THERE IS
A REALLY RICH SET OF DATE THAW
TELLS US THAT POSITIVE AFFECTIVE
STATES REALLY MATTER IN CHRONIC
PAIN OUTCOMES AS WELL.
FIRST THEORY I WILL MENTION IS
THAT ELUDED TO BEFORE, BROUGHT
IN BUILD THEORY BY BARBARA
FREDERICKSON MY PERSONAL HERO
PUTTING FORWARD THAT POSITIVE
EMOTIONS BUFFER EFFECTS OF
NEGATIVE EMOTIONS LIKE SEEING IN
AFFECT BALANCE STYLE WORK AND DO
THIS BROADENING THOUGHT IN
BEHAVIORAL REPERTOIRES AND MAKE
THEM OPEN UP AND LOOK WIDELY AT
THE WORLD AND THINKING IN OPEN
AND NONJUDGMENTAL WAYS AND
POSITIVE EMOTIONS THINKING ABOUT
BEING AT A PARTY SEEING A GROUP
OF PEOPLE SMILING LOOKING CRANKY
WHERE DO YOU GO?
POSITIVE EMOTIONS DRAW PEOPLE IN
LIKE BEES TO FLOWERS POSITIVE
EMOTIONS BUILD CRITICAL
RESOURCES WE NEED AND POSITIVE
EMOTIONS DRIVE OFTEN GOOD
SELF-CARE WHEN WE ARE HAPPY WE
ARE MORE LIKELY TO EXERCISE AND
SLEEP WELL AND EAT BETTER AND WE
FOLLOW PRESCRIPTIONS BETTER WHEN
IN A GOOD SPACE.
BUT, THE BUGABOO IN CHRONIC PAIN
IS THAT NEGATIVE AFFECT TENDS TO
BE HIGH. MAYBE MORE TROUBLING
POSITIVE AFFECT TENDS TO BE VERY
LOW AND IN BOTTOM EXAMPLE OF
CHRONIC PELVIC PAIN WE SEE A
6-POINT ELEVATION COMPARED TO
HEALTHY INDIVIDUALS AND NEGATIVE
AFFECT AND 10 POINT DECREASE IN
AMOUNT OF POSITIVE AFFECT
AVAILABLE THIS IS NOT GOOD FOR
US TO THINK ABOUT COULD IT BE
PEOPLE WITH CHRONIC PAIN DON'T
DO THINGS THEY LOVE TO DO
VALUABLE LIFE ACTIVITIES SPENT
WITH PEOPLE THEY LOVE AND WHEN
THEY DON'T WE START TO LOSE
RELATIONSHIPS AND JOY IN LIFE
GETS LOST AND SOME PATIENTS AND
PARTICIPANTS DON'T HAVE THE
ABILITY TO SEEK HAPPINESS AND
POSITIVE RE-ENFORCERS.
THERE IS A WHOLE FIELD THIS HAS
LOOKING AT POTENTIAL REWARD
DISRUPTION IN THE BRAIN AND DATA
IS ALL OVER AND DOES SEEM TO
SETTLE ON THERE IS CHANGES IN
NEUROCIRCUITRY AND DEFICIENCY TO
PROCESS POSITIVE STIMULI AND
ANHEADONIA AND RELUCTANCE TO GO
OUT THERE AND SEEK REWARD AND
KATIE WAS SPENDING TIME CHATTING
WITH ME BEFORE THIS TALK. I
WANTED TO SHARE THIS STUDY WITH
HER SHE RECENTLY DID THAT IS A
REPLICATION LOOKING AT NEURAL
PROCESSES IN REWARD INFLUENCE
NETWORK IN PEOPLE WITH FOOIB ROW
MYALGIA AND THEY FOUND CLEAR
DIFFERENCES IN PREFRONTAL CORTEX
IN RESPONSE TO ANTICIPATION AND
CONVERSELY RESPONSE TO THIS
PREFRONTAL CORTEX IS ENHANCED
DOING OUTCOMES AND ARE CLEAR
DIFFERENCES AND AREA CONTINUES
TO DEVELOP AND CLINICALLY WE
THINK WE HAVE SEEN THIS. WE
HAVE A LITTLE POSITIVE DAILY
REFLECTION ACTIVITY GIVING
PATIENTS TO TRY AND TELL THEM
HEY HERE IS A PIINGY BANK AND
END OF EACH DAY REFLECT ON
THINGS THAT HAPPEN EACH DAY AND
PICK THINGS AND SAVOR IT AND JOT
IT DOWN ON PIECE OF PAPER
TOSSING INTO PIGGY BANK. LARGE
GROUPS DO THIS AND THEY HAVE
BENEFIT AND PEOPLE UNDERGOING
NEWLY DIAGNOSED BREAST CANCER DO
THIS BEFORE SURGERY AND HAVE
IMPRESSIVE RESPONSE AND CHRONIC
PAIN DATA IS FLAT AND TO CHAGRIN
LET'S GO BACK AND COLLECT SLIPS
AND DUMPED THEM OUT AND LOOKED
AT THEM. WE WERE SO SURPRISED
BY WHAT WE SAW.
THERE WAS A NUMBER OF PATIENTS
OR PARTICIPANTS THAT REALLY HAD
A HARD TIME COMING UP WITH ONE
POSITIVE THING THAT HAPPENED
THAT DAY AND ANYTHING. THESE
ARE EXAMPLES THAT STRUCK US LIKE
I MADE IT THROUGH THE DAY.
IT WAS BEST THING THAT
HAPPENED. THIRD DAY IN BED, I'M
SAD. BEST THING THAT HAPPENED.
TODAY IS BROTHER'S 61ST BIRTHDAY
NOTHING TO BE HAPPY ABOUT AND
PASSED AWAY 65 YEARS AGO. THAT
WAS REFLECTED AND WAY THIS MIGHT
PLAY OUT AND 100 PATIENTS GAVE
ASSESSMENT OF CHARACTER
STRENGTHS AND HEY PICK 6 OR 7
THAT SEEM TO FIT YOU. WE
COALATED THEM AND SAW THAT
ACCORDING TO OUR ANALYSIS THAT
OUR PATIENTS AND PARTICIPATE
YAVPTS ARE HIGH IN HONESTY
KINDNESS HUMOR AND LEVEL OF
ACTIVITY AND LEARNING. I LOVE
PEOPLE LIKE THAT. THAT IS
AMAZING AND WHAT STRUCK US IS
ZEST AND NO THE WHAT HEALTHY
POPULATIONS LOOK LIKE AND ZEST
IS HIGHER LOOKING LIKE REWARD
PROCESSING DEFICIT AND GOOD NEWS
IS EARLY STUDIES ARE SHOWING
THIS IS MAYBE REVERSIBLE AND
STUDY AT CHARLIE TAYLOR'S LAB
AND [INDISCERNIBLE] ALONG WITH
POSITIVE ACTIVITY INTERVENTION
AND SONIA LEIBER MERE SKI USED
POSITIVE ACTIVITY INTERVENTION
AND SAW STRENGTHENING OF BRAIN
CONNECTIVITY IN REWARD
PROCESSING AND ATTENTION
EMOTIONAL REGULATION AFTER
PEOPLE DID THE INTERVENTION FOR
A WHILE. THAT GIVES US A LITTLE
BIT OF HOPE.
AND OPTIMISM. NEXT SECTION WILL
TALK ABOUT OPTIMISM THAT IS A
STAND-IN FOR HAVING MORE
POSITIVE THOUGHTS AND ABILITY TO
COPE WELL.
IN A STUDY WE CONDUCTED WITH
MARTY SELIGMAN AND COLLEAGUE DAN
CLAW AND FELLOW SPORTS BUDDY
DIRECTOR OF CHRONIC PAIN AND
FATIGUE RESEARCH CENTER AND
LORIE ANA V AT RESEARCH
LABORATORY WE LOOKED AT DATA
FROM 2,000US ARMY SOLDIERS
BEFORE AND AFTER DEPLOYMENT AND
MANY HAD MULTIPLE DEPLOYMENTS.
WE DID THIS BECAUSE CHRONIC PAIN
IS A HUGE PROBLEM IN THE ARMED
SERVICES AND WONDERED IF FACTORS
WERE PROTECTIVE FOR DEVELOPMENT
OF NEW CHRONIC PAIN POST
DEVELOPMENT AND WE SAW ABOUT 37%
OF RETURNING SOLDIERS INDEED HAD
PAIN IN NEW CHRONIC PAIN AND NEW
BODY AREA IN THE END AND WENT
BACK LOOKING AT POSITIVE
FACTORS.
WHAT STRUCK US WAS POWER OF
OPTIMISM.
SO, COMPARED TO HIGH OPTIMISM
SOLDIERS, THOSE WITH LOW
OPTIMISM HAD 35% GREATER ODDS OF
REPORTING NEW PAIN THAT WAS
CONTROLLING FOR COMBAT AND
MILITARY FACTORS LIKE MULTIPLE
DEPLOYMENTS AND THINGS THAT
HAPPEN DEMOGRAPHICALLY LIKE
DIVORCE AND COMBAT FACTORS
WHETHER ONE IS EXPOSED TO IUD OR
SOMEBODY KILLED IN ACTION OR
INJURED THEMSELVES THAT IS A
PRETTY EXCITING FACT AND MATTER
OF FACT SYSTEMATIC REVIEWS TELL
US THAT OPTIMISM MATTERS IN PAIN
AND STUDY AND REVIEW OF 69
STUDIES, 79% OF STUDIES FOUND
OPTIMISM IS PROTECTIVE IN PAIN
AND WHAT IS COOL IS BETTER STUDY
WAS EXPERIMENTAL STUDY OR
STUDIES OF HIGHER QUALITY EFFECT
WAS MORE PRONOUNCED.
SO, IN EXPLORING RELATIONSHIPS
BETWEEN GRATITUDE AND THAT IS
ANOTHER KEY COGNITIVE FACTOR IN
PAIN, WE SEE A PAPER THAT IS BY
MELISSA MCCOOL AND EMILY BARTLY
AND WILL TOUCH ON THIS LIGHTLY
AND FOUND THAT GRATITUDE IS
NEGATIVELY ASSOCIATED WITH
PERCEIVED STRESS AND SLEEP
DISTURBANCE AND SOCIAL SUPPORT
AND ANALYSIS WAS INTERESTING
BECAUSE IT TOLD US THAT
PERCEIVED STRESS AND SLEEP
DISTURBANCE MIGHT BE FACTOR OR
PATHWAY BETWEEN GRATITUDE AND
WELLBEING.
AND THEN ROB EDWARDS IS HERE AND
WILL TALK TO YOU AS WELL AND
TEAM AND ACTION HAVE DONE A NICE
JOB SUMMARIZING KEY COGNITIVE
PROCESSES TO EXPLORE INCLUDING
ACTIVE COPING POSITIVE
SELF-STATEMENTS EFFICACY
MINDFULNESS CHANGE RING PATIENTS
MODEL OF PAGE AND GREATER
FLEXIBILITY ARE ALL FIELDS THAT
NEED STUDY.
THIS BRINGS FORWARD
PSYCHOLOGICAL FLEXIBILITY MODEL
THAT IS SECOND OF THE MODELS
THAT IS CORE ACCEPTANCE AND
COMMITMENT THERAPY. THEY HOLD
NEGATIVE EMOTIONS ARE NORMAL AND
DO MAKE BEHAVIOR CHANGE REALLY
DIFFICULT THAT REQUIRES
PSYCHOLOGICAL FLEXIBILITY TO
BETTER DO BUSINESS WITH NEGATIVE
THOUGHTS AND EMOTIONS AND SOME
PROCESSES IN BLUE ARE WHAT ARE
LEANED ON ACCEPTANCE OF NEGATIVE
EMOTION AND DIFFUSION ABILITY
HAVE DISTANCE FROM EMOTION AND
UNDERSTAND THOUGHTS AND EMOTIONS
ARE NOT US.
THEY ARE JUST PROCESSES.
IT FOCUSES ON VALUES AND
GETTING PEOPLE MOVING TOWARDS
VALUE AND COMMITTED ACTION
TOWARDS DOING THINGS THAT
ENHANCE THEIR VALUES.
AND THEN MY THIRD FACTOR IS
LOVE.
LOVE STANDS IN FOR RELATEDNESS
AND HEALTHY RELATIONSHIPS WE
NEED IN OUR LIVES TO BE
RESILIENT.
WE WERE NOT EXPECTING THIS FOR
YOU.
THIS IS A POP QUIZ AND STUDY BY
JULIA LOOKED AT FACTORS
PROTECTIVE AGAINST MORTALITY AND
CAME UP WITH LOTS OF THINGS THAT
WOULD PROBABLY BE ON OUR
GUESSING LIST AND IF EXPOSE THE
TO CLEAN AIR YOU ARE LESS LIKELY
TO DIE AND TREATMENT FOR
HYPERTENSION LESS LIKELY TO DIE
AND DRINKING ALCOHOL MUCH BIGGER
EFFECT AND IF YOU SMOKE MORE
LIKELY YOU ARE TO NOT LIVE AND
STUDY THAT OUTSTRIPPED SMOKING
AND DO YOU HAVE A GUESS?
WHAT ARE WE TALKING ABOUT?
OUR SOCIAL RELATIONSHIPS THAT IS
SOCIAL INTEGRATION AND SOCIAL
SUPPORT OF FEELING CONNECT WAS
MORE POWERFUL IN PRESERVING LIFE
THAN EVEN SMOKING AND LESS
DRINKING.
SO, I HAVE BEEN TALKING ABOUT
RESILIENCE MOSTLY AND WANT TO
TALK ABOUT LONELINESS THAT
HASN'T BEEN WELL STUDIED IN
CHRONIC PAIN AND ANOTHER
EXCITING AREA AND MENTEE
VICTORIA POWELL PALLIATIVE CARE
PHYSICIAN IS REALLY INTERESTED
IN ROLE OF LONELINESS AND
EXISTENTIAL CRISIS TOWARDS END
OF LIFE THAT IS ALSO INTERESTED
IN PAIN AND LOOKED AT STUDY IN
UNIVERSITY OF MICHIGAN HEALTH
AND RETIREMENT STUDY AND
IDENTIFIED ABOUT 6,000 PEOPLE
AND LOOKED AT TWO TIME POINTS
FINDING THAT LONELINESS GREATLY
INCREASED ODDS OF PEOPLE
SUBSEQUENTLY REPORTING PAIN AND
INCREASED ALSO ODDS OF REPORTING
FATIGUE AND DEPRESSION IN LATER
YEARS.
WHAT WAS REALLY AMAZING VERY
POWERFUL PREDICTOR OF PEOPLE
THAT DEVELOPED ALL THREE. WE
SEE SYMPTOMS CLUSTERED TOGETHER.
SO, MORE THAN ANYTHING SOCIAL
RELATIONSHIPS ARE IMPORTANT TO
MENTAL PHYSICAL HEALTH AND
TYPICALLY TRAVEL THROUGH MANY
PATHWAYS, BEHAVIORAL,
PSYCHOSOCIAL AND PHYSIOLOGICAL
AND ARE COSTS THOUGH.
SO, IT IS NOT JUST HAVING
RELATIONSHIPS BUT HAVING GOOD
HEALTHY RELATIONSHIPS BECAUSE
NEGATIVE RELATIONSHIPS LIKE
ABUSIVE RELATIONSHIPS COST US IF
IN OUR HEALTH AND STRONG
RELATIONSHIPS WE NEED TO
CULTIVATE AND EFFECTS FROM
SOCIAL RELATIONSHIPS ARE
CUMULATIVE OVER TIME AND BENEFIT
FROM LIFELONG AND ONGOING
RELATIONSHIPS AND AREAS TO
EXPLORE ALSO OPEN FOR
EXPLORATION AND LOVING KINDNESS
MEDITATION AND PAIN, HOW IS THIS
NOT BETTER STUDIED THAT IS
POWERFUL AND FORGIVENESS AND
SELF-COMPASSION AND MEETING IN
PURPOSE AND VOLUNTEERISM.
THIS BRINGS THIRD THEORY OF
SELF-DETERMINATION THIS IS A
GREAT THEORY. WE ARE GROWTH
ORIENTED BEINGS AND ARE SOCIAL
AND WANT TO CONNECT NEEDS
THROUGH AUTONOMY WE WANT TO BE
ABLE TO DO INTERESTING AND
ENGAGING THINGS AND WANT TO HAVE
SENSE OF COMPETENCE AND WANT TO
FEEL COMPETENT AND CONNECTED AND
WE ARE MOTIVATED BY INTRINSIC
THINGS AND INTRINSIC THINGS TO
MOVE TOWARDS IMPORTANT KEY
GROWTH AREAS.
HOW DO WE HAVE INTERVENTION THAT
IS INTRINSICALLY MOTIVATING
HELPING INCREASE PSYCHOLOGICAL
FLEXIBILITY AND BOOST POSITIVE
EMOTION AND RESILIENCE FEELING
INTERVENTIONS AND ARE MANY OF
THESE AND MANY QUESTIONS AND
FIRST OF ALL WHAT SHOULD WE
CONSIDER RESILIENCE BUILDING
INTERVENTION?
THERE IS MANY. ARE THEY
EFFECTIVE FOR PEOPLE WITH
CHRONIC PAIN? FOR WHAT OUTCOMES
WE RR STARTING TO LEARN AND FOR
WHOM DO THEY WORK BEST AND HOW
AND WHAT ARE MECHANISMS
UNDERLYING RESILIENCE BUILDING
INTERVENTIONS AND TAILORING
INTERVENTIONS TO BETTER MEET
NEEDS OF UNIQUE POPULATIONS AND
UNIQUE INDIVIDUALS AND WHAT ARE
MOST EFFECTIVE WAYS TO DELIVER
INTERVENTIONS WHEN WE HAVE THEM?
SHOULD WE CONSIDER CBT
RESILIENCE BUILDING
INTERVENTION? YEAH. WHY NOT;
RIGHT?
FOCUSING ON BOUNCING BACK AFTER
SOMETHING HAPPENING AND HELPS
PEOPLE DEVELOP SKILLS AND HAS A
-- IT HAS A PLEASANT ACTIVITY
SCHEDULING ELEMENT; RIGHT?
SOMETHING THAT TARGETS POSITIVE
EMOTION.
ANOTHER EXCUSE TO HAVE A SLIDE.
CBT HAD BABIES AND SECOND
GENERATION FORMS OF CBT AND
SECOND WAVE INCLUDES MINDFULNESS
THERAPIES AND MINDFULNESS BASED
COGNITIVE THERAPY AND COMMITMENT
THERAPY AND POSITIVE
INTERVENTIONS FROM REALM OF
POSITIVE PSYCHOLOGY.
SO, I WILL FOCUS ON THESE.
WE ARE -- OUR TIME IS LIMITED
AND WHERE I'M DOING WORK NOW.
POSITIVE ACTIVITY AND
INTERVENTIONS ARE AS THEY SOUND.
THEY HAVE TWO THINGS THEY DO,
AMPLIFY POSITIVE EMOTION AND
BEHAVIORAL ACTIVATE AND ARE FUN
AND PEOPLE LIKE TO DO THEM AND
COGNITIVE BEHAVIORAL THERAPY AND
PAIN IS SCHEDULING AND PEOPLE DO
THINGS THAT BRING PLEASURE AND
BRING PAIN AND HOW WE ARE WIRED
AND DO THEY WORK FOR PEOPLE WITH
CHRONIC PAIN?
NUMBER OF METAANALYSIS AND
RECENT ONE THAT COMPARED
POSITIVE ACTIVITY INTERVENTIONS
TO CONTROLS AND FOUND THAT IN
CHRONIC PAIN THERE IS LESS PAIN
INTENSITY AND FEWER DEPRESSIVE
SYMPTOMS AND LESS PAIN
CATASTROPHIZING AND FEWER
EMOTIONS AND NEG INCREASED
EMOTIONS AND NEEDED IN STUDIES
WITH FOLLOW UPS THESE PERSISTED
GRATITUDE AND ACTS OF KINDNESS
AND THIS IS A STUDY BY LESLIE
WHO THIS IS A BEST POSITIVE
PSYCHOLOGY STUDY WE HAVE TO
DATE. THEY DID A 6 WEEK
INTERVENTION OF POSITIVE
ACTIVITY INTERVENTION BASED ON
PILOT DATA SHOWING GREAT EFFECT
AND CONTROLLED PROGRAM THAT IS
NEUTRAL STRUCTURED ACTIVITIES
AND THEY ARE FINDINGS THAT DID
NOT SUPPORT USE OF INTERVENTIONS
IN OLDER VETERAN WITH KNEE
OSTEOARTHRITIS POPULATION AND WE
HAVE TO THINK ABOUT POPULATIONS
TOO AND DON'T KNOW IF FOLKS
WOULD BENEFIT FROM SDOOUM BAH
CLASS; RIGHT?
THINKING ABOUT THAT GOING
FORWARD I WILL TELL YOU IN LAST
15 OR 16 MINUTES I HAVE HERE
ABOUT SEVERAL STUDIES UNDERWAY
WITH FEWER RESULTS AND MAYBE
COULD TALK ABOUT NEXT YEAR AND
HERE WE HAVE COMPLETING
RANDOMIZE KOD N TROLL TRIAL OF
COGNITIVE BEHAVIORAL THERAPY
VERSUS -- AUGMENTED WITH
POSITIVE ACTIVITY INTERVENTIONS
TO INCREASE ENGAGING EMOTIONS
AND ACTIVITY AND WE TRIED TO
PICK ONE OF TOUGHEST POPULATIONS
IN CLINIC DELIVERING
INTERVENTION ONLINE AND NOVEL
TELEHEALTH COACHING STRATEGY.
THEY WERE BRILLIANT GREAT JOB
AND PATIENTS LOVED THEM I THINK
THEY FELT GRATIFIED IN PROVIDING
CARE THAT IS STRUCTURE OF THE
STUDY AND AS I SAID WE ARE
ANALYZING DATA AND THERE IS A
CAVEAT.
THIS STUDY TOOK PLACE DURING
COVID-19 PANDEMIC AND HAD TO
RETOOL EVERYTHING WE DID AND
DELIVERED THIS REMOTELY BEFORE
AND DIDN'T KNOW WHAT WE WOULD
HAVE HERE AND PUT IN COVID
IMPACT QUESTIONNAIRE EARLY ON
AND WILL SEE WHAT HAPPENS. WE
WILL HAVE A WHOLE SERIES OF
STUDIES THAT COULD BE
INTERESTING TO INTERPRET DOWN
THE LINE AND ANOTHER QUESTION
WHO DO THEY WORK BEST AND HOW DO
THEY WORK?
THIS IS PROBABLY REALLY FOR US
BEST EXEMPLIFIED BY SOMETHING IT
THEY CAME TO US WITH HEAL
INITIATIVE AND THANK YOU, HEAL.
THIS SAY GAME CHANGER NOT JUST
PAIN AND OPIOID BUT RESILIENCE
AND OFFSHOOTS AND ARE PART OF
THE BACK PAIN CONSORTIUM.
KNOWN AS BACKPACK AND ARE ONE OF
THREE MECHANISTIC RESEARCH
CENTERS UNIVERSITY OF MICHIGAN
AND DAN CLAW IS MPI WITH THIS
AND 7 TEXT SITES ACROSS COUNTRY
AND TWO TRIALS UNDERGOING AND
DATA ACQUISITION CENTER
UNIVERSITY OF NORTH CAROLINA
THAT KEEPS US MOSTLY IN LINE.
OUR STUDY IS SOMETHING WE CALL
INLTVENTIONAL RESPONSE
PHENOTYPING STUDY THAT MEANS YOU
GIVE PEOPLE INTERVENTIONS THAT
HAVE BEEN SHOWN TO BE EFFECTIVE
AND SEE WHO RESPONDS TO WHAT
INTERVENTION AND HOW DO WE
PREDICT THIS?
WE ARE INTERESTED IN HOW THEY
WORK ALSO.
WE ARE LOOKING FIRST AT CAN
QUESTIONNAIRES AND FUNCTIONAL
TESTING TELL US WHO MIGHT
RESPOND BETTER TO ONE
INTERVENTION THAN ANOTHER AND
DOING A DEEPER DIVE OF SUBSET OF
PATIENTS DOING NEUROIMAGING
QUANTITATIVE SENSORY TESTING
COLLECTING PLASMA MEASURES DOING
AUTONOMIC TESTING TO SEE IF
MEASURES MIGHT TELL US MORE.
WE CAN BEGIN TO INFER MECHANISMS
OF ACTION LOOKING AT DEEPER
DATA.
SO, THIS IS OUR STUDY THAT IS
COMPLEX AND DO A 4-WEEK RUN-IN
OF A PAIN SELF-MANAGEMENT
PROGRAM KNOWN AS PAIN GUIDE AND
RANDOMIZED THEM TO PHYSICAL
THERAPY AND EXERCISE AND
MINDFULNESS BASED STRESS
REDUCTION DELIVERED IN GROUP
PT101 AND MINDFULNESS GROUP AND
ACKWU PRESSURE IS M HEALTH APP
PEOPLE TAKE HOME WITH THEM AND
COOL DEVICE APPLIES TO ACCU
PRESSURE AND MINDFULNESS
RESILIENCE WE SHOULD BE ABLE TO
LOOK AT RESILIENCE FACTORS THERE
AND DOESN'T PT BUILD RESILIENCE?
YES. DOESN'T ACCU PRESSURE
TEACH PEOPLE SELF-MANAGEMENT?
YES. THAT WILL BE INTERESTING.
WE ARE ALSO PART OF THE
COLLABORATIVE CLINICAL TRIAL
THAT IS KNOWN AS BEST OR
BIOMARKERS FOR EVALUATING SPINE
TREATMENTS THAT IS A USWIDE 14
MULTI-SITE TRIAL WHERE WE ARE
DOING THE SAME THING KIND OF AND
ARE ALSO DOING A COMPLEX SMART
DESIGN TRIAL LOOKING AT AFTER
RUN-IN PERIOD LOOKING AT
RANDOMIZATION TO EITHER ENHANCE
SELF-CARE ONLINE PAIN MANAGEMENT
PROGRAM PAIN GUIDE I WILL
MENTION AND TALK ABOUT IN A
SECOND AND ACCEPTANCE AND PAIN
THERAPY DEVELOPED ONLINE AND
EVIDENCE-BASED MANIPULATION
PHYSICAL THERAPY EXERCISE AND
DELL OXOTEEN AND ACT 2 YOU HAVE
TOTAL RESILIENCE AND EBEM THAT
IS PHYSICAL THERAPY TO BUILD
RESILIENCE AND PAIN MANAGEMENT
TEACHING RESILIENCE AND WE SEE
THAT AND THIS IS PAIN GUIDE
SHOUTOUT TO DAVE WILLIAMS
COLLEAGUE BRAIN CHILD AND OPEN
ACCESS AND CARE FOR PATIENTS AND
ALSO FOR CARE PROVIDERS THAT
WANT TO UNDERSTAND MORE ABOUT
THESE PROCESSES.
THERE IS A SELF-CARE SECTION
THAT DELIVERS COGNITIVE
BEHAVIORAL THERAPY FOR PAIN AND
OTHER TYPES OF INTERVENTIONS AND
IS A RESILIENCE SECTION AND WE
ARE CURRENT WILL I STUDYING BEST
VERSION OF PAIN GUIDE THAT ALSO
HAS TAILORING AND COMPARED TO
STATIC FORM AND MORE DATA IS ON
THAT DOWN THE ROAD.
THAT IS ME. I DID RESILIENCE
SECTION.
HOW CAN WE TAILOR INTERVENTIONS
TO MEET NEEDS OF UNIQUE PAIN
POPULATIONS AND UNIQUE
INDIVIDUALS?
WELL, THERE IS SO MUCH WORK THAT
NEEDS TO BE DONE IN DIVERSITY,
EQUITY, AND INCLUSION AND QUICK
SHOUTOUT TO FOLKS FROM
UNIVERSITY OF FLORIDA WHO DO
THIS BETTER THAN ANYTHING
SEVILLE AND JARED TANNER AND
BROW GOOD WHO IS SHAEKING HERE
AS WELL AND THEIR TOTAL TOLD US
WE HAVE TO THINK OF SOCIO
DEMOGRAPHIC FACTORS NOT JUST
SOMEBODY THAT IS WHITE OR
CAUCASIAN AND NEED TO THINK
ABOUT HAVING EQUAL
REPRESENTATION AMONG SEXES AND
EQUAL DEMOGRAPHICS AND LEADING
TO A STUDY I HAVE BEEN INVOLVED
IN FOR YEARS AND JUST LOVE THE
STUDY.
THIS IS LED BY MARY WHO IS A
PUBLIC HEALTH FACULTY MEMBER.
SHERIA ROBINSON LANE, OUR OTHER
COLLEAGUE IN NURSING WHO IS --
THIS IS THE PILOT STUDY THAT WE
CONDUCTED LOOKING AT TAILORING
INTERVENTIONS TO OLDER AFRICAN
AMERICAN ADULTS WITH CHRONIC
PAIN. IT IS DELIVERED BY
COMMUNITY HEALTH WORKERS THAT IS
ANOTHER NOVEL WAY TO GET
INTERVENTIONS OUT AND
INTERVENTION CONSISTS OF
EDUCATION AND TEACHING PEOPLE
ABOUT STAYING ACTIVE AND IS
WALKING STEP PROGRAM THAT IS
INVOLVED AND DOING WHAT YOU LOVE
AND HELPING PEOPLE TO GET BACK
TO VALUE LIFE ACTIVITIES AND
MUSIC IS MEDICINE AND SOMETHING
THAT CAME THROUGH PILOT STUDIES
THAT THIS IS REALLY IMPORTANT TO
THIS OLDER AFRICAN AMERICAN
GROUP AND WE HAVE THEM PICK TWO
OF FOUR POSITIVE ACTIVITY
INTERVENTIONS FROM LIFE
HIGHLIGHTS AND KINDNESS TO
KEEPING A GRATITUDE JAR AND
SAVORING AND IN THE PILOT STUDY
THERE WERE REALLY STRONG EFFECTS
AND 86% OF THE INTERVENTION
GROUP REPORTED THAT FUNCTIONING
WAS BETTER OR MUCH BETTER AND
COMPARED TO 25% OF THE CONTROL
AND PAIN AND 67% OF GROUP WAS
REPORTED BETTER OR MUCH BETTER
COMPARED TO 21% OF CONTROL GROUP
AND WERE EFFECTS FOR MEDICATION.
I WILL GO BACK. YAY!
WE HAVE R0 ONE THAT IS FUNDED
AND WE ARE STARTING THAT BASED
ON THESE PILOT DATA THAT WILL BE
AROUND IN ABOUT THREE YEARS AND
ALL RIGHT. WHAT ARE MOST
EFFECTIVE WAYS TO DELIVER
INTERVENTIONS?
THIS IS MY COLLEAGUE.
THIS IS SUN CHOI WHO IS
PEDIATRIC ONKOLGS DOING BONE
MARROW TRANCE PLANT WORK AND
WORKED TOGETHER TO DEVELOP
POSITIVE CARE INTERVENTIONS AND
ALLOWS PEOPLE TO CONNECT THROUGH
CHAT ROOMS AND MONITOR
ACTIVITIES AND DEVELOPED IT FOR
A SPECIFIC GROUP AND FOR
CAREGIVERS AND SINCE USED IN
CAREGIVER AND PATIENT DIIADS
DURING COVID-19 PANDEMIC GAVE TO
HEALTH CARE WORKERS IT USE AND
BENEFITED IMMENSELY FROM IT AND
COLLEAGUE STUDENTS ISOLATING
2,000 OF THEM AND OUR ACT
PATIENTS.
AND THEN OUR NEXT ROUTE IS
CHRONIC PAIN POST BMT OR HCT
TREATMENT THAT IS SKYROCKETING
IN 40% AND WE WILL LOOK DOWN
THAT PANEL AND CAN WE HELP
PATIENTS AS WELL?
BRIEFLY, I WILL TALK ABOUT MY
CARE PATH THAT IS SOMETHING THAT
WE ARE PASSIONATE ABOUT AND IS
PERIOPERATIVE AND
PREHABILITATION AND IS SOMETHING
WE DEVELOPED WITH JEN WHO IS A
HAND SURGEON AND COLLEAGUE CHAD
BRUMET AN ANESTHESIOLOGIST AND
WE HOPE IT WILL HELP PATIENTS TO
BETTER PREPARE FOR THEIR
SURGERIES THAT IS DELIVERED ON
MI DATA HEALTH PLATFORM AND ARE
ABLE TO CONSENT PATIENTS.
THEY GET A SERIES OF VIDEOS
DELIVERED TO THEM THAT ARE
EDUCATIONAL VIDEOS TALKING ABOUT
HOW TO PREPARE FOR SURGERY AND
HOW TO THINK ABOUT SURGERY THAT
IS PAINFUL THAT IS NORMAL AND
USE OPIOIDS SPARINGLY AND
DISPOSE OF THEM AND PAIN
MANAGEMENT AND WHAT YOU CAN DO
YOURSELF AND SKILLS YOU CAN
DEVELOP BEFOREHAND AND WORKING
WITH DAVE WILLIAMS AT VANDERBILT
UN STRIRS AND WE DEVELOPED A
SERIES OF VIDEOS THAT DELIVER
BREATHING AND PACING ACTIVITIES
AS WELL POSITIVELY AND
ANALGEEZIC ORIENTED GUIDED
IMAGERIES AND IN OUR BRIEF
ANALYSIS OF OUR PILOT DATA HERE,
WE FOUND THAT MATCHED FOR AGE
AND SEX PEOPLE UNDERGOING MY
CARE PATH HAD MUCH BETTER
OUTCOMES AS FAR AS USE FOR
OPIOIDS AND END OF TWO WEEKS
AFTER SURGERY 75% OF PATIENTS
TAKING OPIOIDS BUT 7% OF
PATIENTS IN LONG CARE PATH AND
LAST STUDY I WILL TALK ABOUT IS
SOMETHING THAT MAKES US BUMP OUT
OF OUR SILOS THAT IS A PROJECT
THAT IS BROUGHT ABOUT BY GEORGE
WHO IS CHAIR OF OUR DEPARTMENT
AND WORKING AT [INDISCERNIBLE]
WHICH IS RCTRSA IS EFFORT TO
BRING TOGETHER MEDICINE AND ART.
I HAVE BEEN WORKING WITH MY
LOVELY COLLEAGUES. IT THIS IS
HANA. THIS IS STEPHANIE. THEY
WORKED WITH ME TO THINK ABOUT
HOW WE CAN TRANSLATE POSITIVE
ACTIVITY INTERVENTIONS INTO A
DESIGN-ORIENTED TOOLKIT TO HELP
PEOPLE EXPLORE PROCESSES AND
AFTER MANY, MANY ITERATIONS IS A
BEAUTIFUL TOOLKIT THEY CAME UP
WITH AND FIRST ON RIGHT IS ONE
WHERE PATIENTS PUT TOGETHER A
RESILIENCE COLLAGE FEELING MOST
AND LEAST RESILIENCE AND OTHER
ACTIVITIES ARE LIKE PIINGY BANK
THEY ARE DOING DAILY POSITIVE
REFLECTIONS TAKING PHOTOS
SENDING THEM INTO US AND WE ARE
IN MIDDLE OF THE STUDY AND
ENROLLED PARTICIPANTS AND GARDEN
ORIENTING THEM TO PROJECT GIVING
TOOLKITS AND IN MIDDLE OF THREE
WEEKS WE KNOW THEY ARE DOING IT.
ALL HAVE SENT PICTURES AND SEND
US PICTURES DAILY ABOUT WHAT
THEY ARE DOING AND MEET WITH
THEM IN A WEEK AND A HALF AND
THIS WORKSHOP WORKING WITH
DESIGN TEAM AND PSYCHOLOGY TEAM
TALKING ABOUT WHAT EXPERIENCE
MEANT AND PUTTING IT FORWARD
MAKING PEOPLE RESILIENT TO REACH
GOALS AND TAKES US TO GOING
FORWARD FOR US.
HOW DO WE MOVE FORWARD?
WE MOVE FORWARD AS A GROUP AND
EXPAND COLLABORATIONS ACROSS
UNIVERSITIES AND ACROSS
COUNTRIES AND ACROSS
DISCIPLINES.
WE THINK ABOUT HOW WE CAN DO
THIS BETTER.
THESE ARE RESILIENCE AND YOU
WILL MEET A COUPLE OF THE FOLKS
IN A LITTLE BIT.
TOGETHER, WE LEAN INTO DIVERSITY
AND INTO EQUITY AND INCLUSION IN
OUR RESEARCH AND THINK ABOUT HOW
WE MAKE RESEARCH AS RICH AND
GENERALIZABLE AS POSSIBLE.
WE INCLUDE PATIENT VOICE.
PARTNERING WITH PEOPLE WITH
LIVED EXPERIENCE IS PROBABLY ONE
OF THE MOST IMPORTANT THINGS WE
CAN DO.
THEY KNOW WHAT IS IMPORTANT TO
THEM. THEY KNOW THINGS THAT WE
CAN ONLY GUESS AT. WHY NOT
BRING THEM ON BOARD AND HELP US
CREATE BETTER MORE EFFECTIVE
RESEARCH STUDIES TO TARGET AND
BOOST ENGAGEMENT AND PERSISTENCE
WE FOCUS ON SYMPTOM REDUCTION
AND BEHAVIORAL ACTIVATION IS
GREAT AND GETTING PEOPLE TO
CONNECT WITH THOSE THEY LOVE AND
VITALITY AND ZEST AND HAVING
MEANING AND PEOPLE THRIVING AND
HAVING LIFE THAT IS REWARDING
AND PURPOSEFUL ARE GREAT
TREATMENT TARGETS. WE CAN DO A
BETTER JOB GETTING THE WORD OUT.
WE TALK TO OURSELVES A LOT AND
HAVE TO TALK TO OTHERS.
VIBRANT GROUP ON TWITTER AND
INSTAGRAM TALKING ABOUT SCIENCE
AND PAIN SCIENCE AND SOME ARE IN
THE CHAT AND HAVE TO DO A BETTER
JOB GETTING THINGS OUT THERE
USING MEDIA AND SOCIAL MEDIA AND
TALKING ABOUT WHERE WE GO NEXT
WITH SCIENCE.
THIS IS MY PANDEMIC PROJECT AND
PROJECT TO TRY TO GET RESEARCH
OUT INTO PATIENTS HANDS TO
PEOPLE'S LIVED EXPERIENCES THAT
IS A SUMMARY OF NEUROSCIENCE AS
WE UNDERSTAND IT AND
NEUROSCIENCE AND RESEARCH BEHIND
PROCESSES SUCH AS GRATITUDE AND
FRIENDSHIPS AND RELATIONSHIPS
AND LOVE AND LONELINESS AND HOW
TO USE EVIDENCE-BASED ACTIVITIES
TO BUILD A FLOURISHING PLAN.
SO, MOVING FORWARD, WE WANT TO
BE MINDFUL HOW WE TALK ABOUT
RESILIENCE TO PATIENTS AND LOVED
ONES AND NEVER WANT TO INFER IF
THEY ARE ONLY MORE RESILIENT
THEY WOULDN'T HAVE CHRONIC PAIN.
THAT IS NOT THE MESSAGE OR
POINT AND NOT WHAT WE ARE DOING.
WE HAVE TO BE CAREFUL WE DON'T
COME ACROSS THAT WAY.
AND RESPECT THE FACT THAT WE ARE
ALL STRIVING TO BE MORE
RESILIENT.
OUR COUNTRIES AND INSTITUTIONS
AND OUR FRIENDSHIPS AND OUR
FAMILIES.
RESILIENCE IS NOT A YES OR NO
BUT FLOWING PROCESS ON A
CONTINUUM THAT WE CONTINUE TO
BUILD.
LASTLY, I WANT A SHOUTOUT TO
PEOPLE MAKING MOST OF THE
STUDIES HAPPEN AND IS STUDY TEAM
AT BACK AND PAIN CENTER. YOU
GUYS TOTALLY ROCK AND THANKING
THE UNIVERSITY OF MICHIGAN AND
NIH FOR THEIR KIND SUPPORT OF MY
RESEARCH AND MY SALARY. THANK
Y
YOU.
I MIGHT HAVE TIME FOR -- DO I?
YES. WE DO HAVE TIME.
ANY QUESTIONS?
OKAY. PLEASE DO MOVE TO THE
MICROPHONE.
THANK YOU. OH, NO. WHY DON'T
YOU ASK AND I WILL REPEAT IT FOR
FRIENDS AT HOME.
HERE COMES THE AV GUY.
>>I THINK IT IS ONLINE NOW.
OKAY. EXCELLENT TALK. I
ENJOYED IT. YOU ELUDED TO LOTS
OF IMPORTANT THINGS WE ARE
DAEGING WITH NOW IN TERMS OF THE
IMPACT OF THE PANDEMIC AND FOR
MANY PEOPLE AND MUCH OF OUR
SOCIAL LIFE IS SPENT IN OUR
PROFESSIONAL ROLE AND MUCH OF
OUR PROFESSIONAL LIFE IS STILL
VERY VIRTUAL WITH ZOOM MEETINGS
AND SO FORTH AND WHAT MOST
RECOGNIZE IS THE GREAT REDUCTION
AND SOCIAL RE-ENFORCERS AND SO
FORTH COMPARED TO IN REAL LIFE
EXPERIENCES.
ARE WE STUDYING NOT ONLY THE
NEGATIVE IMPACT MAYBE THAT JUST
A KIND OF CHRONIC DIEIAD OF ZOOM
INTERACTIONS BUT ALSO LOOKING AT
MORE POSITIVELY THERE IS GREAT
OPPORTUNITIES FOR USING, YOU
KNOW, EMERGING VIRTUAL
TECHNOLOGY TO DO THE SORT OF
INTERVENTIONS THAT YOU HAVE BEEN
TALKING ABOUT AND REALLY
UNDERSTANDING HOW TO ENHANCE THE
VARIABLES THAT LEAD TO MORE
FEELINGS OF SOCIAL CONNECTEDNESS
AND LESS PRISONERS DIIAD OF
GROUND MEAT AND NOT GOING TO THE
REST ROOM AND THINGS LIKE THAT.
>>GREAT QUESTION. I ASSUME
PEOPLE ARE WE CONDUCT ONE OF THE
MOST GRAND EXPERIMENTS IN OUR
LIFETIME AND HAD A THING THAT
CAME IN AND FROM SOCIAL
SCIENTISTS AND PSYCHSOLOGIST
STANDPOINT AND SERVING
LONELINESS FOR AT RISK
POPULATIONS AND FOR US WE SAW IN
STUDENTS THAT IS ACROSS THE
COUNTRY AND IS INCREDIBLE
ELEVATION IN ANXIETY AND
DEPRESSION AND SEE IN HEALTHCARE
WORKERS ON FRONTLINES FEELING
ALSO ISOLATED AND ALIENATED AND
STUDIED IN EVERY WHICH WAY AND
IS SOMETHING THAT ALSO HAS
PROVIDED AN OPPORTUNITY THAT HAS
MADE US RETHINK REALLY HOW WE DO
THINGS AND MAYBE WE ARE SPENDING
LESS TIME COMMUTING TO WORK AND
WITH FAMILIES IN PRIMARY SOCIAL
RELATIONSHIPS IS A GOOD THING
AND MAYBE GETTING INTERVENTIONS
OUT TO MORE PEOPLE AND FIGURED
OUT HOW TO DELIVER SOME OF THESE
THINGS LIKE TELEHEALTH IS
ANOTHER WAY TO GET THERE AND
AGREE NO SUBSTITUTE FOR BEING
TOGETHER AND SEEING EACH OTHER
AND GET TEARY EYED WHEN THINKING
ABOUT THIS HOW MEANINGFUL IT IS
TO HUG COLLEAGUES WITH LITERALLY
SOMETIMES THREE YEARS NO THE
SEEING THEM AND HOW GLORIOUS IT
IS AND GOING INTO WORK AND IT IS
BIG AND 10 PRINCIPLE
INVESTIGATORS IN ARMY OF PEOPLE
THAT SUPPORT US AND WALKING IN
HAVING VIBRANCY AND ABILITY TO
WALK INTO OFFICE NEXT TO YOU
TALKING TO NEUROSCIENTIST AND
SOMEBODY WITH INFLAMMATORY
FACTORS AND SYNERGY BEING
TOGETHER THAT DOESN'T EXIST IN
ZOOM AND ZOOM FATIGUE. OH, MY
GOSH. WHO IS SO DONE WITH ZOOM?
FOR THE RECORD, A SHOW OF HANDS.
YEAH. YOU KNOW, IT IS A
BLESSING AND A CURSE. YEAH. I
THINK IT WILL BE FASCINATING TO
SEE. WE WILL TALK ABOUT THIS
PROBABLY FOR NEXT DECADE. IT
WILL BE DECADE RESPONSES THAT WE
WILL BE INTERESTED IN.
THANK YOU.
DISSERTATIONS; RIGHT?
YEAH.
>>WE CAN'T.
HERE COMES AV GUY AGAIN.
DUN, DUN, DUN.
IT IS SO BAD.
>>OKAY.
THANK YOU. HI. I REALLY
ENJOYED YOUR TALK AND JUST THE
OTHER DAY MY DAD ASKED ME FOR
ADVICE I HAD BEEN CHRONIC PAIN
AND LOWER BACK PAIN AND CURIOUS
ABOUT ONE THING YOU MENTIONED IS
THAT OPTIMISM TENDS TO BE
PROTECTED FOR CHRONIC PAIN AND
KNOW THAT AMERICANS COULD BE A
PRETTY OPTIMISTIC BUNCH.
WAS THIS SOMETHING YOU SAW
ACROSS MULTIPLE COUNTRIES AND
MULTIPLE DIFFERENT CULTURE
GROUPS?
>>COOL QUESTION.
YOU KNOW, IN THE INTEREST OF
TIME WE CAN DO A WHOLE TALK ON
OPTIMISM AND IS BAD OPTIMISM TOO
AND MAKES PEOPLE DO THINGS THEY
SHOULDN'T BE DOING. WE ARE
OPTIMISTIC AND DIFFERENT GROUPS
ARE AND SOLDIERS WERE
RIDICULOUSLY OPTIMISTIC AND
ESPECIALLY OFFICERS AND PEOPLE
THAT ARE SALES AND YOU HAVE TO
BE TO DO THAT.
>>YEAH.
>>GREAT QUESTION. THERE IS
DIFFERENCES THAT IS OPTIMISM IS
A KIND OF BIG TOPIC.
>>OKAY.
>> YEAH. GENERALLY, SUPER
HELPFUL THAT IS KIND OF THE
OPPOSITE OF PAIN CATASTROPHIZING
THAT IS KIND OF BAD ACROSS THE
BOARD.
>>THANK YOU.
>>YOU MIGHT NEED TO GO OVER
THERE.
OKAY. GIVE IT A TRY. HE SAID
GIVE IT A TRY.
MAYBE YOU COULD ASK YOUR
QUESTION. WE CAN COME BACK,
MAM.
OKAY.
>>THANK YOU. GREAT TALK.
>>THANK YOU.
>>I -- I WAS VERY INTRIGUED BY
THAT RELATIONSHIP THAT YOU
TALKED ABOUT BETWEEN GRATITUDE
AND WELLBEING THROUGH STRESS --
PERCEIVED STRESS AND SLEEP.
CAN YOU THINK ABOUT -- I WONDER
WHAT YOUR THOUGHTS ARE ABOUT A
POSSIBLE MECHANISM HERE.
>>YEAH.
>>SLEEP IS SUCH A HUGE PIECE
THAT IS NOT REALLY PART OF THESE
TYPES OF STUDIES AND WONDERING
WHERE AND HOW THAT COULD BE
BROUGHT IN MORE AND DO YOU HAVE
THOUGHTS ABOUT THAT?
>>I LOVE YOU ARE TALKING ABOUT
SLEEP AND PAT TRICK IS DOG
REMARKABLE WORK LOOKING AT HOW
SLEEP IS RIGHT AND POSITIVE
EFFECT DOESN'T SEEM TO FUNCTION
PROPERLY AND SEEMS TO BE A LYNCH
PIN AND WE DO CONSIDER SLEEP
JUST ABOUT EVERY STUDY DIDN'T
TALK ABOUT IT A LOT AND KNOW IT
IS CRITICAL AND CHRONIC PAIN
PATIENTS SLEEPING AND NOT
SLEEPING WELL BEFORE AND IF WE
CAN DO ONE THING NOT SLEEPING
WELL AND EVERYTHING SEEMS TO
CHANGE AND PEOPLE WILL TALK MORE
ABOUT THIS AND WHAT THEIR
THOUGHTS ARE ABOUT AND RATHER
MECHANISMS THAT ARE LIKELY
NEURAL AND HAVE TO DO.
>>NEURAL AND TWO WAYS.
>>RIGHT.
>>YEAH. GOES BOTH WAYS.
>>THANK YOU.
>>[INDISCERNIBLE].
>>STILL DOESN'T WORK?
HE WILL GET YOU THE OTHER MIC.
>>YEAH. I LIKE WHAT YOU TALKED
ABOUT. I THINK THERE IS
PROBABLY TWO THINGS THAT SEEM TO
ME TO BE THRESHOLDS FOR THE
ABILITY TO PROFIT FROM YOUR
OPTIMISM OR, YOU KNOW, HAVE
POSITIVE PSYCHOLOGY AND AN
EFFECT. THOSE TWO ARE PAIN
INTENSITY AND ACCEPTANCE.
IF YOUR PAIN IS TOO HIGH, I LIVE
WITH PAIN AND KNOW THAT. I ALSO
LEAD SUPPORT GROUPS FOR PEOPLE
WITH PAIN AND FEEL MEDICAL
MANAGEMENT OF PAIN IS INCREDIBLY
IMPORTANT AS A THRESHOLD TO
PROFIT FROM SOME OTHER THINGS
AND OTHER IS ACCEPTANCE AND
ACCEPTING THAT THIS IS IT AND
THERE IS NO CURE FOR CHRONIC
PAIN AND THEREFORE IT DOESN'T
MEAN, YOU KNOW, GIVING UP OR
ANYTHING.
IT MEANS YOU HAVE TO BUILD A NEW
LIFE AND YOU NEED TO ACCEPT
THIS.
IT IS HARD, I THINK, FOR PEOPLE
TO DO POSITIVE STUFF WITHOUT THE
EARLY STUFF AND I'M WONDERING IF
-- WHAT YOU THINK OF PAIN
INTENSITY AND ACCEPTANCE BEING
PREREQUISITES?
>>I LIKE THAT AND THINK IT
MAKES A LOT OF SENSE AND THINK
THAT PAIN ACCEPTANCE MIGHT BE
THE KIND OF LYNCH PIN THINKING
THIS IS WHERE I AM AT AND WHAT I
GOT AND NOW WHAT?
FEELS THAT KIND OF OPENS THE
DOOR AND WONDER IF PEOPLE WHO
ARE OPTIMISTIC BY TRAIT MIGHT BE
MORE ABLE TO COME TO THAT.
THERE IS A KIND OF -- FEELS LIKE
THERE IS A REALLY INTERESTING
POTENTIAL CAUSATIVE PATHWAY THAT
IS ON THE MARK.
>>PAIN INTENSITY IS
INTERESTING.
WE TALKED ABOUT THE
[INDISCERNIBLE] STUDY AND SHOWED
PEOPLE HAVE LOW PAIN INTENSITY
AND LOW DISABLE THE AND SOME HAD
HIGH PAIN INTENSITY AND MINIMAL
DISABILITY AND MIGHT BE AN
INDIVIDUAL PROCESS AND DO THINK
THAT ALMOST EVERYTHING IS EASIER
AND BETTER WHEN NOT TOTALLY
OVERWHELMED BY PAIN.
>>YES.
>>RIGHT?
THAT IS A NONSTARTER SO THAT I
THINK THAT WHEN YOU HAVE PAIN --
PERHAPS THERE IS OTHER WAYS TO
MANAGE PAIN AND QUESTIONS WE
DON'T KNOW AND TRY TO DO IN
SMART DESIGN TRIALS GIVING
SOMEBODY DRUG FIRST AND GIVE
PAIN BETTER CAN WE GET THEM TO
DO ACCEPTANCE AND COMMITMENT
THERAPY DOES THAT WORK BETTER OR
ACCEPTANCE AND COMMITMENT
THERAPY AND DRUG WORKS BETTER
THEY FEEL BETTER ABOUT THEIR
CASE AND WE DON'T KNOW THAT AND
TRY TO ANSWER QUESTIONS AND
THINK IT IS REALLY ON THE MARK.
>>OKAY. YEAH. I THINK IT IS
IMPORTANT AND THAT MEDICATION IS
A PIECE OF IT. BECAUSE I FEEL
LIKE PEOPLE WITH VERY SEVERE
PAIN NEED A LEVEL OF SOME TYPE
OF MEDICATION BEFORE THEY CAN
FUNCTION.
WHEN PAIN IS SO INTENSE EVERYONE
KNOWS THAT EXPERIENCE OF PAIN
BEING SO INTENSE YOU CAN'T
ABSOLUTELY THINK OF ANYTHING
ELSE.
>>I THINK YOU ARE RIGHT AND
TALKED MOSTLY ABOUT POSITIVE
PAIN INTERVENTION ACTIVITIES AND
THEY PROBABLY SHOULDN'T BE
DELIVERED ALONE THAT IS ALL YOU
DO. I'M VERY MUCH FOR
MULTIDISCIPLINARY AND
MULTICOMPONENT TREATMENT AND WE
KNOW WORKS AND GET PEOPLE
STABILIZED PERHAPS
PHARMACOLOGICALLY AND GET THEM
MOVING AND TO SLEEP AND
DEPRESSED WITH THAT OR ANXIOUS
WE HELP WITH THAT AND ADDRESSING
WHOLE HUMAN AND HAS BEEN OUR
PROBLEM AND HIT THEM EVERYTHING
WITH MEDICATION AND NOT DOING
MUCH ELSE.
IT FEELS LIKE WE REALLY NEED TO
ATTACK ALL DOMAINS THAT ALSO
BEING PEOPLES RELATIONSHIPS AND
THEIR --
>>AGREE.
>>AND SENSE OF LIFE AND THAT
THEY SEE A WAY FORWARD AND
PEOPLE ARE LIKELY TO TAKE CARE
OF THEMSELVES WHEN THEY FEEL
THEY HAVE SOME PLACE THEY CAN GO
THAT WILL BE WORTH WHILE.
>>I AGREE.
>>THANK YOU AND FOR YOUR
COMMENTS.
>>[APPLAUSE].
I'M KAREN KALE AND PROGRAM DIRECTOR
AT NATIONAL INSTITUTE OF NURSING
RESEARCH AND HONORED THIS
MORNING TO BE HERE TO MODERATE A
PANEL ON PAIN DISPARITIES ACROSS
DIVERSE POPULATIONS AND WILL
INTRODUCE OUR PANELISTS TO YOU
FIRST. THEY WILL EACH GIVE
THEIR PRESENTATIONS.
WE HAVE TIME FOR QUESTIONS AND
ANSWERS AFTERWARDS.
IF YOU HAVE QUESTIONS DURING A
PRESENTATION, WRITE IT DOWN AND
MAKE YOURSELF A NOTE.
WE WILL HAVE TIME AGAIN AT THE
END.
FIRST, I WANT TO INTRODUCE TO
YOU DR. ROBERT EDWARDS WHO WILL
GIVE US AN OVERVIEW ON
BIOPSYCHOSOCIAL CONTRIBUTORS TO
PAIN DISPARITIES AND IDENTIFYING
OPPORTUNITIES TO FACILITATE
REDISTILLANCE. DR. EDWARDS IS
AN ASSOCIATE PROFESSOR AND
LICIENCED CLINICAL PSYCHOLOGIST
IN THE PAIN MANAGEMENT CENTER IN
THE DEPARTMENT OF ANESTHESIOLOGY
AT BRING HAM AND WOMEN'S
HOSPI
HOSPITAL.
AFTER COMPLETING POST DOCTORAL
FELLOWSHIP HE JOIN THE FACULTY
THERE AND MOVED TO BRIGHAM --
ACUTE AND CHRONIC PAIN FUNDED BY
NIH PCORI NATIONAL SCIENCE
FOUNDATION AND OTHER
ORGANIZATIONS AND HE STUDIES
INDIVIDUAL DIFFERENCES IN PAIN
RESPONSES AND NEUROBIOLOGICAL
MECHANISMS BY WHICH PSYCHOSOCIAL
PROCESSES SHAPE INDIVIDUAL
DIFFERENCES AND SECOND SPEAKER
IS DR. [INDISCERNIBLE] TALKING
ABOUT THREATS TO SOCIAL SAFETY
AND WHETHER OR NOT THEY PROMOTE
PAIN DISPARITIES AND DR. GOODIN
IS A PROFESSOR IN DEPARTMENT OF
ANESTHESIOLOGY AT WASHINGTON
UNIVERSITY SCHOOL OF MEDICINE IN
ST. LOUIS WHO IS A WIDELY
RECOGNIZE THE EXPERT IN
TRANSLATIONAL PAIN SCIENCE WITH
BROAD EXPERTISE RANGING FROM
CLINICAL PSYCHOLOGY TO SOCIAL
NEUROSCIENCE AND NOTABLE RECORD
OF BUILDING AND LEADING
TRANSDISCIPLINARY RESEARCH
TEAMS. DR. GOONIN SERVES IN
LARGE FUNDED STUDIES ACROSS
MULTIPLE N ICHLT HIH INSTITUTES
NATIONAL INSTITUTE OF NURSING
RESEARCH.
HIS SCIENTIFIC RESEARCH IS
RELATED TO DISPARITIES AND
EXPERIENCE OF PAIN BASED ON
MANAGEMENT AND MINORITY STATUS
AND REPUTATION BRINGING TOGETHER
INVESTIGATORS FROM DISCIPLINES
AND AREAS TO ADDRESS SCIENTIFIC
PROBLEMS MENTORING NEXT
GENERATION OF PAIN SCIENTISTS
AND WILL HAVE DR. CHRISTINE
RITCHIE SPEAKING ON PAIN
DISPARITIES DR. RITCHIE -- AND
DIRECTOR OF RESEARCH FOR
DIVISION OF PALLIATIVE CARE AND
MEDICINE AT MASSACHUSETTS
GENERAL HOSPITAL AND PALLIATIVE
-- WHO CONDUCTS RESEARCH FOCUSED
ON OPTIMIZING QUALITY OF LIFE
FOR THOSE WITH SERIOUS CHRONIC
ILLNESSES AND DR. RITCHIE
DIRECTS CENTER FOR AGING AND
SERIOUS ILLNESS RESEARCH IN MGH
[INDISCERNIBLE] INSTITUTE AND
LEADS SEVERAL NIH FUNDED STUDIES
TO UNDERSTAND LIVED EXPERIENCE
OF PAIN IN OLDER ADULTS TESTING
STRATEGIES IMPROVING FUNCTIONAL
LIFE QUALITY OUTCOMES IN ADULTS
WITH CHRONIC PAIN. DR. EDWARDS?
>>THANK YOU FOR HAVING US AT
THIS WONDERFUL CONSORTIUM AND
NICE TO SEE SO MANY MADE IT
THROUGH SECURITY THIS MORNING.
CONGRATULATIONS. I'M SURE THERE
IS A NUMBER ONLINE AS WELL AND
I'M EXCITED TO TAKE THE
OPPORTUNITY TO TALK TO EVERYONE
TODAY ABOUT BIOPSYCHOSOCIAL
CONTRIBUTIONS TO PAIN RESILIENCE
AND FACTORS AND INTERVENTIONS
THAT MIGHT HELP TO AMELIORATE
HEALTH DISPARITIES AND SUSPECT
EVERYONE HERE IS FAMILIAR WITH
BIOPSYCHOSOCIAL MODEL OF PAIN
WITH POSITIES THAT DOZENS AND
HUNDREDS OF FACTORS SHAPE
PEOPLE'S PAIN EXPERIENCES AND IF
WE WANT WE CAN BROADLY DEFINE
FACTORS INTO RISK FACTORS THAT
TEND TO SHAPE ADVERSE OUTCOMES
OF PAIN TRAUMA DISTRESS
CATASTROPHIZING AND SOCIAL
SUPPORT ACCEPTANCE TALKING
NICELY ABOUT LOTS OF FACTORS
THAT IS IMPORTANT TO KEEP IN
MIND THAT LITERALLY ALL OF THE
BIOPSYCHOSOCIAL FACTORS ARE
STRONGLY SHAPED BY RACE AND
ETHNICITY AND WE HAVE KNOWN
ABOUT THIS FOR A LONG TIME.
STUDY OF THIS IN THE FIELD OF
PAIN HAS REALLY TAKEN OFF IN THE
LAST 20 YEARS OR SO SINCE 2003
WHEN KARMEN GREEN AND OTHERS
PUBLISHED REVIEW PAPER ON
UNEQUAL BURDEN OF PAIN
DOCUMENTING FACT THAT RELATIVE
TO WHITE AMERICANS AFRICAN
AMERICANS REPORTED GREATER
SEVERITY OF ACUTE POST-OP
ITERATIVE PAIN AND MORE AND MORE
DISABLING CANCER PAIN AND WORSE
EXPERIENCE OF CHRONIC
NONMALIGNANT PAIN AND
ESSENTIALLY EVERY PAGE OUTCOME
YOU CAN THINK OF WAS MEASURED AS
BEING WORSE IN AFRICAN AMERICAN
RELATIVE TO WHITE PATIENTS IF IN
THE US AND SINCE THAT TIME WE
HAD A NUMBER OF OTHER STUDIES
AND REVIEWS IN MODELS THAT
FOLLOWED UP ON THESE SORTS OF
FINDINGS AND IN 2003 WAS
INSTITUTE OF MEDICINE REPORT
THAT REALRY EMPHASIZED ROLE OF
HEALTH CARE SYSTEM IN CREATING
PERPETUATING AND MAINTAINING
THESE SORTS OF DISPARITIES THAT
RECOMMENDED WAY BACK IN 2003 WE
SHOULD IMPLEMENT A MULTILEVEL
STRATEGY AND INCLUDE THINGS LIKE
CROSS-CULTURAL CURRICULA
INTEGRATED INTO MEDICAL
EDUCATION CURRICULUM AND
FINDINGS SINCE THEN ARE A REAL
GLASS HALF FULL AND GLASS HALF
EMPTY SORT OF DEAL DEPENDING ON
YOUR PERSPECTIVE AND HAVE DONE A
REASONABLE JOB IMPROVING THINGS
LIKE INCLUSION OF DISPARITIES
CURRICULUM IN MEDICAL RESIDENCY
PROGRAMS AND IMPROVED IT SO MUCH
GOING FROM 17 PROGRAMS IN 2012
TO 40% CLOSE TO A DECADE LATER
AND MORE THAN DOUBLING BUT IS
LESS THAN HALF AND IS A COMMON
THEME I SUSPECT ACROSS THE
CONSORTIUM. WE MADE PROGRESS
BUT HAVE A WAYS TO GO. BEFORE I
GO FURTHER, I WANT TO EMPHASIZE
THESE DISPARITIES RACE AND
ETHNICS IN PAIN ARE NOT UNIQUELY
AMERICAN PHENOMENON WE SEE THEM
AROUND THE WORLD AND ARE STUDIES
FOR EXAMPLE IN HONG KONG THAT
MAINLAND CHINESE STUDENTS SHOW
GREATER PAIN SENSITIVITY
RELATIVE TO HONG KONG STUDENTS
WHEN DOING LABORATORY PAIN
TESTING OF PAIN SENSITIVITY AND
DOING THESE SORTS OF STUDIES
ENGLAND YOU FIND INDIVIDUALS OF
A SOUTH-ASIAN BACKGROUND HAVE
HIGHER PAIN RATINGS AND ARE MORE
SENSITIVE TO PAIN THAN WHITE
BRITISH PARTICIPANTS IN THESE
STUDIES AND WHEN YOU DO THE SAME
TESTING IN INDIA, THERE IS IF NO
DIFFERENCE BETWEEN INDIAN
STUDENTS AND EUROPEAN AMERICAN
STUDENTS OR YOU MIGHT GET
FINDINGS WHERE INDIAN STUDENTS
SHOW GREATER TOLERANCE FOR PAIN
AND LESS SENSITIVITY TO PAIN AND
IS A GLOBAL PHENOMENON. WE ARE
TALKING ABOUT NOT INNATE
BIOLOGICAL DIFFERENCES BUT SOME
EFFECTS OF LIVING AS RACIAL AND
ETHNIC MINORITY WITH MINORITIZED
STATUS IN PARTICULAR COMMUNITY
FOR ANY LENGTH OF TIME AND SEE
THIS IN THE US AND AROUND THE
WORLD WE HAVE A NUMBER OF VERY
WELL DONE REVIEWS PUBLISHED AND
SAM WHO HAS A TERRIFIC POSTER ON
PAIN RELATED STIGMA PUBLISHED
REVIEW OF EXPERIENCE OF PEOPLE
FROM ETHNIC MINORITY BACKGROUNDS
LIVING WITH CHRONIC PAIN IN THE
USA AND REFERENCE THE PATHWAYS
FROM BIOLOGICAL TO SOCIAL
DETERMINANTS OF HEALTH TO
PSYCHOLOGICAL THAT CONTRIBUTE
PROBABLY TO THESE DISPARITIES
LAND TOUCH ON A FEW BRIEFLY AND
MANY AT THE PROVIDER LEVEL WILL
SEE 2016 STUDY FROM TONY HOFFMAN
THAT IS A SURVEY OF MEDICAL
STUDENTS RESIDENTS AND OTHERS
EVALUATING DEGREE TO WHICH
PEOPLE ENDORSE FALSE BELIEFS
ABOUT BIOLOGICAL DIFFERENCES
BETWEEN BLACKS AND WHITES AND
WHAT YOU CAN SEE FROM DATA THERE
AND THAT MEDICAL STUDENTS AND
RESIDENTS TO A DISTURBING DEGREE
ARE PERCENTAGES YOU SEE IN A
HIGHLIGHTED ROW ENDORSE BELIEFS
THAT BLACK SKIN IS THICKER THAN
WHITES AND MORE TROUBLINGLY WHEN
YOU FOLLOW UP WITH HYPOTHETICAL
TREATMENT SCENARIOS BLACK
PAISHIENTS ARE LESS LIKELY TO
GET PROPER TREATMENT IN CONTEXT
OF HIGHER LEVELS IN PROVIDERS'S
FALSE BELIEFS AND VIGNETTE OF
HYPOTHETICAL STUDIES AND SEE
SAME THINGS LOOKING AT ACTUAL
PROVISION OF CHRONIC PAIN
TREATMENT HERE IN THE US AND
THINGS LIKE RATES OF OPIOID
PRESCRIPTIONS ARE LOWER FOR
HISPANIC AND LEET TEENO SAMPLES
RELATIVE TO WHITE BLACK OR
AFRICAN AMERICAN SAMPLES
RELATIVE TO WHITE AND THINGS
LIKE SPINE SURGERY FOR CHRONIC
PAIN OCCUR AT SUBSTANTIALLY
LOWER RATES HALF THE RATES
SYSTEMATIC METAANALYSIS IN BLACK
AMERICANS RELATIVE TO WHITE
AMERICANS AND SOME MAY HAVE SEEN
RECENT STUDIES AND REPORTS ON
BIAS INHERENT IN RACE-BASED
ALGORITHMS USING THROUGHOUT
MEDICINE AND REPORTS ARE NOT SO
MUCH FROM PAIN AND IN MANAGEMENT
OF THINGS LIKE KIDNEY DISEASE
AND PULL MONDAYOLOGY AND APPEARS
TO BE RACIAL AND ETHNIC BIAS
CREEPING INTO ALGORITHMS THAT
RESULTED IN SUBOPTIMAL CARE FOR
INDIVIDUALS FROM ETHNIC MINE
ORITY BACKGROUNDS AND NEED TO
EMPHASIZE THAT LOTS OF THE RACE
AND ETHNIC DIFFERENCES SEEM TO
PERSIST ACROSS MORE OR LESS ANY
SETTING THAT WE STUDY THEM AND
ARE WORKING ON FASCINATING DATA
FROM FOOTBALL PLAYER'S AND LARGE
NUMBER OF PLAYERS IN NFL AND ARE
NOW RETIRED AND FASCINATING
SAMPLE TO STUDY RACIAL AND
ETHNIC DIFFERENCES FOR VARIETY
OF REASONS AND IS A LARGE SAMPLE
ABOUT 4,000 RESPONDENTS HERE.
YOU MIGHT BE ABLE TO SEE FROM
YELLOW HIGHLIGHTED ROWS THAT
BLACK RELATIVE TO WHITE FORMER
PLAYERS REPORT A GREATER
INTENSITY OF PAIN AND GREATER
PAIN INTERFERENCE IF IN THE
SAMPLE OF RETIRED FOOTBALL
PLAYERS AND MEASURE RISK AND
RESILIENCE FACTORS DEPRESSION
AND ANXIETY AND SOCIAL SUPPORT
AND SEE IN PINK HIGHLIGHTED ROWS
THAT ESSENTIALLY ALL FACTORS ARE
IN A WAY THAT THEY SHOW BLACK
FORMER PLAYERS REPORT LESS
SCORES AND LESS SOCIAL SUPPORT
RELATIVE TO WHITE FORMER PLAYERS
EVEN IN SAMPLE THAT IS LET'S SAY
CONSIDERABLY ADVANTAGED RELATIVE
TO OVERALL US POPULATION.
WHAT WE CONTROL FOR ALL OF THE
RISK FACTORS AND RESILIENCE
FACTORS AND SOCIAL DETERMINANTS
OF HEALTH FACTORS IN THE SAMPLE
WE FIND RACE DIFFERENCES PERSIST
AND AFRICAN AMERICAN FORMER
PLAYERS CONTINUE TO REPORT
HIGHER PAIN INTENSITY AND MORE
PAIN INTERFERENCE THAT IS
RELATIVE TO WHITE FORMER
PLAYERS.
SO, PRESUMABLY IF WE MEASURED
EVERY POTENTIALLY IMPORTANT
FACTOR THAT IS CONTRIBUTING TO
RACE AND ETHNIC DIFFERENCES THAT
WOULD BE IMPOSSIBLE TO DO AND IF
WE DID IT, WE WOULD BE ABLE TO
FULLY EXPLAIN ALL
BIOPSYCHOSOCIAL VARIABLES THAT
CONTRIBUTE TO THESE EFFECTS.
ONE VARIABLE WE NEED TO MEASURE
WOULD SURELY BE PAIN-RELATED CAT
ASS TROE FIEZING NEGATIVE
COGNITIVE EMOTIONAL RESPONSES TO
PAIN THAT AFTON TALKED ABOUT
EARLIER AND MEASURE
CATASTROPHIZING WITH INDIVIDUAL
SELF-REPORT ON PAIN
CATASTROPHIZING SCALE AND THEY
RESPOND TO ITEMS EXAMPLES YOU
SEE HERE THAT MEASURE THINGS
LIKE DEGREE TO WHICH THEY FEE
M
-- FEEL HELPLESS AND TYPICAL FOR
THIS TALK IS A DOZEN STUDIES
THAT SUGGEST CATASTROPHIZING TO
SOME DEGREE MEDIATING
DIFFERENCES IN PAIN-RELATED
OUTCOMES ELLEN TERRY HAS DONE
WORK WITH THIS AND PATIENTS WITH
ARTHRITIS AND MEDIATION MODELS
ARE THERE AND RACE GROUP
DIFFERENCES IN PAIN INTENSITY
AND PHYSICAL FUNCTION FOR OA
PATIENTS THAT DIFFER IN
CATASTROPHIZING AND MEDIATIONAL
EFFECT THERE IS SUCH THAT ETHNIC
GROUP DIFFERENCE IN
CATASTROPHIZING STATISTICALLY
EXPLAINS OR CONTRIBUTES TO GROUP
DIFFERENCES IN PAIN AND PHYSICAL
FUNCTION SAM'S SHOWS SOMETHING
SIMILAR WITH EXPERIMENTAL
TESTING AND DOING STUDIES
SPECIFICALLY IN GROUPS OF
AFRICAN AMERICAN PARTICIPANTS
AND GROUP DIFFERENCE PART OF
THIS YOU FIND CATASTROPHIZING IS
CONTRIBUTOR TO PAIN OUTCOMES IN
GROUP CATASTROPHIZING MEDIATED
ASSOCIATION BETWEEN EARLIER LIFE
ADVERSITY AND DISCRIMINATION IN
PAIN-RELATED OUTCOMES ENTIRELY
AFRICAN AMERICAN SAMPLE AND
CATASTROPHIZING IS PRESUMABLY
IMPORTANT FACTOR MEASURING AS
PSYCHOSOCIAL VARIABLE VIA
PARTICIPANT SELF-TLOORT IS A
CONVENIENCE-BASED MEASUREMENT
ARTIFACT AND REASONABLE QUESTION
FOR CATASTROPHIZING AND
PSYCHOSOCIAL CONTRIBUTORS TO
THESE DISPARITIES, CAN WE
EVALUATE WHAT IS GOING ON IN THE
NERVOUS SYSTEM AND FIND
BIOMARKERS ASSOCIATED WITH
IMPORTANT FACTORS AND GREAT DEAL
OF EVIDENCE IT IS IMPORTANT TO
STUDY EVALUATE AND USE
BIOMARKERS IN TRIALS SEEMING TO
ENHANCE SUCCESS OF THERAPEUTICS
AS THEY PROGRESS THROUGH THE
VARIOUS PHASES OF CLINICAL
TRIALS AND OUR GROUP HAS BEEN
WORKING FOR LAST FIVE OR SIX
YEARS OR SO AND ON IDENTIFYING
CENTRAL NERVOUS SYSTEMS
MECHANISMS OF CATASTROPHIZING
USING MRI AND CENTRAL
NEUROIMAGING TECHNIQUES AND WE
ARE MEASURING THINGS LIKE
FUNCTIONAL CONNECTIVITY BETWEEN
DIFFERENT NEURAL SYSTEMS AND WE
HAVE SYSTEMS OR BRAIN NETWORKS
ANDSOME ATTOMOTOR NET WORK THAT
IS LARGELY RESPONSIBLE FOR
PERKRENGS OF VARIOUS SENSATIONS
AND ORGANIZING MOVEMENT-BASED
RESPONSES TO SENSATIONS AND
SALIENCE NETWORK RESPONSIBLE FOR
DETECTING THREAT AND DEFAULT
NETWORK THAW HAVE HEARD ABOUT
THAT I WILL TALK ABOUT IS
RESPONSIBLE FOR THINGS LIKE
SELF-REFLECTION OR
SELF-CONCEPTION.
NORMALLY, ALL THESE NETWORKS ARE
QUITE SEPARATE FROM ONE ANOTHER
AND SERVE SEPARATE FUNCTIONS AND
DO THEIR OWN THING LAND SEE IN
CONTEXT OF CHRONIC PAIN THAT
NETWORKS TO SOME DEGREE CAN
BECOME ENMESHED OR MALADAPTIVELY
INTERRELATED THAT I WILL WIND UP
FOCUSING ON DEFAULT MODE NETWORK
AND YOU SEE VISUAL
REPRESENTATIONS HERE TASK
DEFAULT NETWORK THAT IS
DEACTIVATED WHEN DOING ACTIVE
TASKS LIKE SOLVING A MATH
PROBLEM OR PLAYING TENNIS OR
WHATEVER IT MIGHT BE IS
ACTIVATED ENGAGING IN
SELF-COGNITION AND
AUTOBIOGRAPHICAL MEMORIES
SITTING IN AUDIENCE NOW
DAYDREAMING ABOUT FUTURE AND
WHAT LIFE WOULD BE LIKE DOWN THE
ROAD IS DEFAULT NETWORK AT WORK.
ONE THING WE HAVE BEEN
INTERESTED IN IS FIGURING OUT
TASKS WE CAN DESIGN THAT CAN BE
DEPLOYED IN THE SCANNER THAT
EVALUATE SOME OF THE NEURAL
UNDERPINNINGS OF CATASTROPHIZING
COGNITIONS.
WHAT WE DO IS BRING PEOPLE INTO
THE SCANNER AND EXPOSE THEM TO
DIFFERENT KINDS OF STATEMENTS
AND CATASTROPHIZING STATEMENTS
AND I HAVE BECOME AFRAID THAT
PAIN WILL GET WORSE AND
ANXIOUSLY WANT PAIN TO GO AWAY
OR NEUTRAL STATEMENTS MATCHED ON
VARIETY OF SENTENCE STRUCTURE
VARIABLES AND PEOPLE REFLECT ON
AND ENGAGE WITH STATEMENTS USING
FUNCTIONAL MRI TO DETERMINE WHAT
BRAIN CORRELATES OF ENGAGING IN
CATASTROPHIZING ARE.
AND WHAT YOU CAN PROBABLY SEE
HERE IS THAT IN THE SCANNER WHEN
PEOPLE ARE CATASTROPHIZING
RELATIVE TO ENGAGING WITH
NEUTRAL STATEMENTS, HEARTRATE
GOES UP AND THEY HAVE
ACTIVATIONS IN NUMBER OF AREAS,
MOST OF WHICH CORRESPOND TO
DEFAULT MODE NETWORK AREAS AND
ONE PRIMARY ONE I WILL TALK MORE
ABOUT IS PCC OR POSTERIOR
SINGULARATE CORTEX KEY HUB OR
NODE IN DEFAULT NETWORK AND WE
FIND GOING ON TO DO FURTHER
STUDIES IN PATIENTS WITH CHRONIC
PAIN ARE FINDINGS OF SIZABLE
SAMPLE OF PATIENTS WITH
FIBROMYALGIA AND WHAT HAPPENS
WHEN PEOPLE CATASTROPHIZE IS IT
SEEMS TO ACTIVATE DEFAULT MODE
NETWORK REGIONS THAT THEN
RESULTS IN FUNCTIONAL
INTERCONNECTIVITY BETWEEN
DEFAULT MODE NETWORK AND
NETWORKS LIKE IN THIS CASE
SALIENCE NETWORK AND DEGREE TO
WHICH THAT HAPPENS AND DEGREE TO
WHICH DEFAULT MODE NETWORK
CONNECTS WITH SALIENCE NETWORK
THAT IS HIGHLY PREDICTIVE OF ALL
SORTS OF THINGS LIKE PAIN
SENSITIVITY AND DOING
EXPERIMENTAL PAIN TESTING AND IN
THIS CASE, DEGREE OF WIDESPREAD
PAIN THAT FIBROMYALGIA PATIENTS
EXPERIENCE AND YOU CAN SEE IN
THE SCATTER PLOT FOR
FIBROMYALGIA PATIENTS HIGHER
LEVEL OF PAIN CATASTROPHIZING
GREATER LEVEL OF CONNECTIVITY
BETWEEN NETWORKS THAT
CONNECTIVITY MEDIATES
ASSOCIATION BETWEEN PAIN
CATASTROPHIZING AND HOW
WIDESPREAD THEIR PAIN IS.
THIS IS ESPECIALLY RELEVANT HERE
AND I WILL BRING US BACK TO RACE
AND DIFFERENT ETHNIC DIFFERENCES
AND ARE NOW FASCINATING STUDIES
THAT ALSO USE SIMILAR BRAIN
IMAGING METHODS THAT SUGGEST
THAT DEFAULT MODE NETWORK
REGIONS SEEM TO PLAY A ROLE IN
SHAPING RACIAL AND ETHNIC
RESPONSES TO PAIN AS WELL AND
STUDY FROM ELIZABETH ANDTORY'S
LAB ON NEUROSOCIOCULTURAL
MEDIATORS IN ETHNIC DIFFERENCES
OF PAIN AND BRING PEOPLE INTO
THE LAB AND STANDARDIZED PAIN
STIMULI AND SEE FROM FIGURES
THERE THAT AFRICAN AMERICAN
PARTICIPANTS ARE MORE PAIN
SENSITIVE AND HAVE HIGHER
RATINGS OF PAIN STIMULI AND
THOSE RATINGS ARE INFLUENCED BY
PEOPLE'S REPORTING OF
DISCRIMINATION AND STICKING
PEOPLE IN THE SCANNER, THERE ARE
CERTAIN BRAIN REGIONS THAT
AFRICAN AMERICAN PARTICIPANTS
SEEM RESPONSIVE TO PAIN HEAT
STIMULI THAN COUNTERPARTS THAT
ARE GENERALLY IN DEFAULT AREAS
IN MEDIAL PREFRONTAL CORTEX THAT
INTERCONNECT WITH POSTERIOR
CORTEX THAT IS DEFAULT HUB I
SHOWED IN CATASTROPHIZING
ACTIVATION SLIDES THAT IS A SORT
OF NEUROBIOLOGICAL UNDERPINNING
OF PAIN RELATED CATASTROPHIZING
THAT SEEMS TO CONTRIBUTE TO
PHENOMENON OF PAIN AND
RACIAL/ETHNIC DIFFERENCES IN
PAIN EXPERIENCE AND WANT TO
EMPHASIZE THAT EVEN THOUGH WE
TEND TO PUT DIFFERENT
INFLUENTIAL FACTORS INTO VARIOUS
BUCKETS WHETHER SOCIOLOGICAL AND
PSYCHOLOGICAL AND BEHAVIORAL AND
NEUROLOGICAL AND ALL OF THESE
THINGS ARE STRONGLY INNER
RELATED AND QUESTION IS AT WHAT
LEVEL ARE WE MEASURING THIS
PARTICULAR FACTOR?
MEASURE CATASTROPHIZING WE
MEASURE WITH SELF-REPORT THAT IS
A BEHAVIORAL PROCESS AND
NEUROBIOLOGICAL PROCESS THAT
SEEMS TO BE TRUE FOR ALL THESE
INFLUENTIAL FACTORS THAT WE ARE
MEASURING.
OKAY. SO, NOW IN THE LAST SIX
OR 7 MINUTES OR SO, I GET TO GET
TO ENCOURAGING PART OF THIS TALK
THAT IS ALWAYS A NICE THING AND
TALK ABOUT SOME INTERVENTIONS
AND OPPORTUNITIES FOR USING
RESILIENCE-RELATED FACTORS AND
INTERVENTIONS TO REDUCE SORTS OF
PAIN RELATED DISPARITIES.
AFTON NICELY MENTIONED COGNITIVE
BEHAVIORAL THERAPY THAT IS
STRONGLY EMPIRICALLY SUPPORTED
INTERVENTION FOR ALL SORTS OF
CHRONIC PAIN CONDITIONS.
AND COGNITIVE BEHAVIORAL THERAPY
WE CAN THINK OF AS SOMETHING
THAT BOLSTERS RESILIENCE FACTORS
REDUCING RISK FACTORS AND KNOW
THAT CBT HAS STRONG IMPACTS IN
REDUCING PAIN-RELATED
CATASTROPHIZING. AT SAME TIME
IT ALSO SEEMS TO AMPLIFY
RESILIENCE RELATED FACTORS IN A
NUMBER OF SAMPLES AND WE
RECENTLY COMPLETED FUNCTIONAL
NEUROIMAGING STUDY THAT WE
WANTED TO LOOK AT SOME BRAIN
CORRELATES BY WHICH CBT SEEMS TO
INFLUENCE CATASTROPHIZING AND
PAIN RELATED OUTCOMES IN
PATIENTS WITH FIBROMYALGIA THAT
IS A SAMPLE OF 100 PATIENTS WITH
FIBROMYALGIA AND COGNITIVE --
CONTROL INTERVENTION THAT IS
MATCHED FOR THERAPIST AND LENGTH
OF SESSION AND THAT SORT OF
THING.
AND WHAT YOU CAN SEE FROM THOSE
CHANGED SCORES THERE IS THAT
COMPARED TO EDUCATION CONTROL
CONDITION, CBT HAS A NICE IMPACT
ON REDUCING PAIN INTERFERENCE
PAIN SEVERITY FIBROMYALGIA
IMPACT SCORES AND
CATASTROPHIZING AND RUNNING
MEDIATION MODEL WE SEE BENEFITS
OF CBT ARE DIRECTLY DUE TO
REDUCTION IN CATASTROPHIZING
THAT IT SEEMS TO ENGENDER AND
REDUCTION IN PCS SCORES SEEMS TO
EXPLAIN HOW IT IS THAT CBT HELPS
PATIENTS TO REDUCE PAIN
INTERFERENCE AND BURDEN OF
FIBROMYALGIA SYMPTOMS LOOKING AT
IMAGING DATA ALONG WITH IT CBT
RELATIVE TO EDUCATIONAL CONTROL
CONDITION SEEMS TO HAVE
BENEFICIAL EFFECTS IN REDUCING
CONNECTIVITY BETWEEN DEFAULT
MODE STRUCTURES POSTERIOR
SINGULARATE CORTEX AND OTHER
NETWORKS THIS IS ELEMENT OFSOME
ATTOMOTOR NETWORK AND SALIENCE
NETWORK AS WELL AND CBT SEEMS TO
BE REDUCING RISK FACTORS
BUILDING RESILIENCE FACTORS AND
ALL THAT IS PARTLY AT LEAST
HAVING THIS ADAPTIVE EFFECT ON
BRAIN FUNCTION IN PARTICIPANTS
THAT UNDERGO THIS TREATMENT AND
PRESUMABLY TREATMENTS WHETHER
MINDFULNESS MEDITATION OR
ACCEPTANCE IN COMMITMENT THERAPY
OR SIMILAR EMPIRICALLY SUPPORTED
NONPHARMACOLOGIC INTERVENTION
AND FOR THE VERY LAST PART OF
THE TALK I WANT TO TURN TO WHAT
I CONSIDER SOME REALLY
ENCOURAGING EVIDENCE THAT
BUILDING RESILIENCE FACTORS MAY
HELP TO REDUCE DISPARITIES IN
PART BECAUSE RESILIENCE FACTORS
MAY HAVE STRONGEST PROTECTIVE
EFFECTS IN PATIENTS FROM
MINORITY GROUPS.
AND PROBABLY AFTON AND I ARE
COMPETING TO SEE WHO PUT UP
EMILY'S PICTURE MORE TIMES AND
SEE ROGER'S AS WELL AND ARE
DOING SOME LEADING WORK IN THESE
AREAS AND DATA FROM UPLOAD STUDY
FROM PARTICIPANTS WITH PAINFUL
OSTEOARTHRITIS.
YOU SEE FROM FIGURES THERE AND
INTERACTIONS THAT IN
NON-HISPANIC BLACK PARTICIPANTS
WITH OA, HIGHER LEVELS OF
RESILIENCE FACTORS OPTIMISM AND
POSITIVE AFFECT, THEY ARE MORE
ASSOCIATED WITH BETTER PAIN
OUTCOMES THAN IS TRUE FOR
NON-HISPANIC WHITE PARTICIPANTS
AND IN OTHER WORDS, IN THE
SAMPLE OF BLACK NON-HISPANIC
BLACK INDIVIDUALS AND HAVING
MORE OPTIMISM AND HAVING A
GREATER DEGREE OF POSITIVE
WELL-BEING IS MORE ASSOCIATED
WITH REDUCTIONS IN PAIN THAN YOU
SEE FOR WHITE PARTICIPANTS THAT
SEEMS TO SUGGEST RESILIENCE
INTERVEJSS CBT OR OTHER
TREATMENTS MIGHT BE PARTICULARLY
BENEFICIAL IN THAT THEY COULD
HAVE MOST OPTIMIZED EFFECTS IN
SOME MAJORITY AND MORE
DISADVANTAGED GROUPS STRONGLY
POSITIONED TO BENEFIT FROM THESE
INTERVENT
INTERVENTIONS.
WE GET NICE EVIDENCE FROM
NONPAIN LITERATURE FROM MENTAL
HEALTH LITERATURE AND RECENT
REVIEW COGNITIVE BEHAVIORAL
THERAPY FOR -- AND GET NICE
EVIDENCE THERE ARE VERY GOOD
EFFECT SIZES FOR THESE SORTS OF
TREATMENTS IN MINORITY PATIENTS
AND EFFECT SIZE COULD BE
BOLSTERED IMPLEMENTING CULTURAL
ADAPTATIONS TO SOME EXISTING
TREATMENTS THAT IS REALLY
ENCOURAGING IN THAT IF WE CAN
SCALE AND MAKE AVAILABLE AND
INCREASE ACCESS TO THESE SORTS
OF TREATMENTS THAT WE KNOW WORK
AND WE THINK MAY WORK BEST FOR
THE MOST DISADVANTAGED
MINORITIZED PATIENTS, THAT MIGHT
BE A NICE CONTRIBUTOR TO
REDUCING DISPARITIES AND PAIN
THAT IS PERVASIVE AND SEEMINGLY
PERSISTENT.
THERE IS REALLY EXCITING
EVIDENCE THAT IS RECENTLY
PUBLISHED BY GROUP AT UNIVERSITY
OF PITTSBURGH AND BENEFITS OF
REMOTE CBT ARE ACTUALLY STRONGER
IN AFRICAN AMERICAN PARTICIPATE
YANTSS THAN IN WHITE PARTICIPATE
YANTSS REMOTE COMPUTER-BASED CBT
PROGRAM COMPARED TO A CONTROL
CONDITION AND WERE VERY SMALL
NONSIGNIFICANT BENEFITS OBSERVED
IN THE WHITE PARTICIPANTS BUT
REALLY NICE EFFECT SIZES THAT
ARE OBSERVED IN THE AFRICAN
AMERICAN PARTICIPANTS ON THE
ORDER OF .47 AND .54 DEVALUED
STANDARD OF EFFECT SIZE MODERATE
TO LARGE EFFECTS AND QUITE
STRONG AND FASCINATING THEY ARE
MUCH STRONGER IN AFRICAN
AMERICAN THAN IN WHITE
APARTMENTANTS UNCLEAR WHETHER IT
IS EFFECT OF TREATMENT BEING
REMOTE OR FEATURES OF
INTERVENTION IS A CERTAIN AREA
THAT IS DESERVING OF QUITE A BIT
MORE STUDY AND TO WRAP UP I'M
HOPEFUL THAT LOTS OF THIS WORK
ON IDENTIFYING RISK AND
RESILIENCE FACTORS CAN HELP US
TO REALLY PERSONALIZE PAIN
MANAGEMENT BASED ON AN
INDIVIDUAL'S PHENOTYPE OR
PROFILE. WE CAN TARGET RISK
FACTORS NEEDING REDUCTION AND
RESILIENCE FACTORS THAT NEED
MOST BENEFIT FROM BOLSTERING
WITH VARIETY OF TREATMENTS AND
THINK I HAVE SO MANY CONCLUSIONS
I HAVE SEVERAL CONCLUSION
SLIDES.
THIS IS THE FIRST OF ONE OF
THEM. I WILL READ SORT OF
OVERBASED CONCLUSIONS NOW THAT
ARE PERSISTENT RACE AND ETHNIC
DISPARITIES AND PAIN AND PEOPLE
DOG TERRIFIC WORK TO UNDERSTAND
SOURCES OF DISPARITIES AND BEST
WE CAN TELL THERE IS NOT INNATE
BIOLOGICAL DIFFERENCES BETWEEN
RACIAL AND ETHNIC GROUPS AND
PROBABLY CASE THAT LARGE
MULTIMODAL SET OF FACTORS
CONTRIBUTES TO OBSERVED EFFECTS
IN THE US AND AROUND THE WORLD.
AND IT IS HOPEFULLY, I THINK,
REASONABLE FOR US TO TARGET A
PERSONALIZED OR PRECISION PAIN
MEDICINE APPROACH THAT WE
CAREFULLY PHENOTYPE INDIVIDUALS
AND TARGET INTERDISCIPLINARY
MULTIMODAL TREATMENTS ACCORDING
TO WHAT WILL FIT BEST WITH
PHENOTYPIC PROFILE.
WE DO AT THIS POINT KNOW QUITE A
BIT ABOUT WHAT SORTS OF THINGS
MIGHT BE HELPFUL FOR
IMPLEMENTING PROGRAMS TO REDUCE
SOME DISPARITIES THAT WHAT IS TO
BE DONE IS INTERESTINGLY A TITLE
OF REVOLUTIONARY PAMPHLET THAT
LENNON PUBLISHED AROUND THE TIME
OF THE RUSSIAN REVOLUTION AND
DON'T MEAN FOR IT TO BE QUITE SO
REVOLUTIONARY AND SOME
STRATEGIES ARE HOPEFULLY QUITE
OBVIOUS AND THINGS WE CAN
IMPLEMENT AS QUICKLY AND WIDELY
AS POSSIBLE.
DEM ARIO OVERSTREET IN THE NICE
REVIEW THAT RECENTLY PUBLISHED
HAS A SECTIONING THAT WE ENGAGE
IN INDIVIDUATION EVALUATING
PEOPLE ON PERSONAL
CHARACTERISTICS RATHER THAN
CHARACTERISTICS OF GROUP TO
WHICH THEY BELONG AT PROVIDER
LEVEL WE KNOW THAT ALL OF US
HAVE BIASES BOTH RECOGNIZED AND
UNRECOGNIZED AND MORE WE CAN DO
TO IDENTIFY THEM AND ENGAGE IN
PERSPECTIVE TAKING APPROACHES TO
MANAGING PATIENTS BETTER OFF WE
WILL BE.
STRUCTURALLY IT CAN BE GREAT IF
WE CAN MAKE RAPID PROGRESS IN
INCREASING ACCESS TO AND
UTILIZATION TO EFFECTIVE
TREATMENTS FROM INDIVIDUALS FROM
MINORITY BACKGROUNDS THAT YOU
CAN SEE SOME EDUCATIONAL AND
INSTITUTIONAL SUGGESTIONS THERE
AND PERSPECTIVE LIKE MIND FROM
PAIN PSYCHOLOGIST STUDYING
NONPHARMACOLOGIC TREATMENTS WE
HAVE EVIDENCE SUGGESTING THAT
NOT ONLY IS CBT HELPFUL AND
EFFECTIVE FOR SORTS OF PAIN
CONDITIONS BUT HAVE DISPARITY
REDUCING EFFECTS AS WELL AS
ADDITIONAL BENEFIT.
IT WOULD BE NICE IF WE COULD
ENHANCE EFFECTIVENESS OF
TREATMENTS FOR RACIAL AND ETHNIC
MINORITY SAMPLES WORKING TOWARDS
CULTURAL ADAPTATION OF EXISTING
TREATMENTS AND THEN THERE ARE
PEOPLE THAT I'M SURE ARE WORKING
ON DEVELOPING OR ADAPTING
TREATMENTS TO MORE EFFECTIVELY
AND RAPIDLY ENHANCE SORTS OF
RESILIENCE FACTORS WE KNOW ARE
SO IMPORTANT FOR SHAPING THESE
OUTCOMES AND FINAL SLIDE AND
THANKS VERY MUCH TO ALL
COLLEAGUES IN BOSTON AND ACROSS
THE COUNTRY THAT DO ALL THIS
WORK AND ALLOW ME TO STAND UP
HERE AND TAKE CREDIT FOR IT AND
UNCHARACTERISTICICALLY FINISHED
TWO MINUTES EARLY AND IN YELLOW
NOT RED THAPD IS GREAT LAND ASK
SAM TO MAKE NOTE ABOUT THAT.
THIS IS WONDERFUL. I WILL TELL
PEOPLE ABOUT THAT FOR YEARS AND
THANK YOU VERY MUCH FOR YOUR
ATTENTION.
>>[APPLAUSE].
>>>>OKAY. ALL RIGHT. I WILL
GET SITUATED HERE, FOLKS.
GOOD MORNING. I'M BUREL GOODIN
AND THINK A LOT OF YOU NOT ALL
OF YOU KNOW FOR THE LAST 10
YEARS I WAS AT UNIVERSITY OF
ALABAMA BIRMINGHAM AND ELOCATED
TO UNIVERSITY IN ST. LOUIS AND
HAVE TO FLY BACK TO BIRMINGHAM
WHEN DONE HERE MOVERS ARE COMING
TOMORROW TO PACK UP MY STUFF AND
HAUL TO ST. LOUIS AND EVENTFUL
WEEK ALREADY TO SAY THE LEAST
AND POLICED WITH GREAT
INFORMATION INCLUDED IN AFTON'S
PLENARY AND THIS TALK WILL
COMPLEMENT THAT VERY NICELY. I
WILL APPROACH IT WITH A LITTLE
BIT OF A DIFFERENT SPIN IN
TALKING ABOUT THREATS TO SOCIAL
SAFETY, SOCIAL RELATIONSHIPS.
EXCUSE ME. AND THE SOCIAL
ASPECT OF BIOPSYCHOSOCIAL PAIN
MODEL TALKING ABOUT HOW THEY MAY
OR MAY NOT PROMOTE PAIN
DISPARITIES AND MAKING AN
ARGUMENT TO HOW THEY DO JUST
THAT.
I DIDN'T INCLUDE THE OBLIGATORY
FINANCIAL DISCLOSURE SLIDE. I
DON'T HAVE ANY FINANCIAL
CONFLICTS OF INTEREST. I'M
ALWAYS OPEN TO HAVING SOME AND
IF THERE IS ANY POSSIBILITIES
THERE, LET ME KNOW. I WILL
DISCLOSE THEM EVERY DAY OF THE
WEEK AND WE WILL MOVE ON. THAT
BEING SAID, PAIN DISPARITIES
FROM THE TIME I WAS IN GRADUATE
SCHOOL THROUGH POST DOC, PAIN
DISPARITIES HAS BEEN REALLY THE
BREAD AND BUTTER OF MY RESEARCH
AND SORT OF UNDERSTANDING HOW
THEY MANIFEST GOT ROLLING
INITIALLY WITH THAT WITH
RACIALIZED MINORITIES AND LOTS
OF BLACK AND WHITE AND HISPANIC
DIFFERENCES AND MOVING FORWARD
TO THE CURRENT DAY.
MOST ANY SORT OF DISPARATE GROUP
WHETHER A FUNCTION OF RACE AND
ETHNIC STATUS AND SEX AND GENDER
MINORITY STATUS OR JUST AS A
FUNCTION OF HEALTH STATUSES THAT
ARE OTHERWISE MARGINALIZED AND
UNDERSERVED AND UNDERATTENDED
HAS BECOME PART OF THE RESEARCH
PROGRAM AND THESE ARE FOLKS THAT
NEED OUR HELP THE MOST AND FOLKS
THAT I CARE MOST ABOUT AND ARE
ONES I WANT TO ADVOCATE FOR WHEN
I HAVE FORTUNATELY ENOUGH
ADVANTAGE TO STAND ON A PLATFORM
LIKE THIS AND SPEAK TO ALL OF
YOU TODAY.
ONE THING SORT OF THAT IS
CHARGING TO PAIN DISPARITIES AND
GREATER PAIN COMMUNITY IS IT IS
TIME TO MOVE ON SIMPLY BETWEEN
DESCRIBING PAIN OUTCOMES AND
DISPARATE GROUPS NOT TO SAY IT
IS NOT IMPORTANT BUT CAN'T BE
END ALL BE ALL OF PAIN
DISPARITIES AND RESEARCH AND
HAVE TO UNDERSTAND BETTER HOW
DISPARITIES MANIFEST SO WHEN
THEY ARE CHARACTERIZED WE CAN
UNDERSTAND BETTER HOW BEST TO
INTERVENE AND MITIGATE
DISPARITIES WHETHER AT
INDIVIDUAL LEVEL OR PERHAPS MORE
PRUDE YENLTLY AND IMPORTANTLY AT
SYSTEMATIC LEVEL AND SYSTEMS
LEVEL IS WHERE YOU START TO SEE
DISPARITIES REALLY TRICKLE DOWN
TO THE INDIVIDUAL.
SO, THIS IS WHERE I CAN START TO
TIE THINGS BACK TO AFTON WHERE
WE HAVE REALLY BEEN THINKING
ABOUT PAIN DISPARITIES THAT IS
IN PEOPLE'S SORT OF LIVED
EXPERIENCES OUT IN THEIR
PERSONAL ENVIRONMENTS AND SOCIAL
INTERACTIONS THAT THEY HAVE AND
OUR APPROACH HAS REALLY BEEN
STEEPED IN SOCIAL SAFETY THEORY
THAT IS A THEORY DEVELOPED BY A
NEW COLLEAGUE OF MINE OUT OF
UCLA NAMED GEORGE SLAVICH IN
THIS SERIES OF REVIEWS AND THESE
THEORETICAL PAPERS HE PUT OUT
HERE IN THE LAST 2 TO 3 YEARS
AND GEORGE IS VERY ELOQUENTLY
TALKED ABOUT HOW POSITIVE SOCIAL
EXPERIENCES AND ENCOUNTER IS A
POSITIVE SOCIAL ENVIRONMENT CAN
PROMOTE HEALTH AND WELLBEING AND
VERY MUCH IT CAN TO ALL OF THE
RESILIENCY PROMOTING WAYS THAT
AFTON SO NICELY ELUDED TO AND
ALTERNATIVELY WHEN FOLKS SOCIAL
SAFETY IS THREATENED, WHETHER
THAT IS BY TOXIC ENVIRONMENTS OR
PROBLEMATIC RELATIONSHIPS OR
LACK OF RELATIONSHIPS, IE,
LONELINESS S IS WHEN THINGS CAN
START TO BE A PROBLEM FOR HEALTH
AND AS IT RELATES TO PAIN AND
SOCIAL THREATS THEORETICALLY
BODY WILL RESPOND WITH
HEIGHTENED PAIN SENSITIVITY AND
SOMETHING IS WRONG YOU HAVE TO
ATTEND TO THIS AND AVOID
PHYSICAL DANGERS FIGHT OR FLIGHT
YOU HAVE TO GET OUT OF HERE AND
LONG TERM COSTS THINGS RELATED
TO POOR MENTAL HEALTH OUTCOMES
ANXIETY DEPRESSION AND CHRONIC
PAIN AND INFLAMMATORY MEDIATORS
THERE CAN KICK OFF A CASCADE OF
NEGATIVE HEALTH OUTCOMES AND
THINKING ABOUT THREATS TO SOCIAL
SAFETY AND WANT TO PROVIDE
NOMENCLATURE HERE BEFORE WE GET
INTO NEW DATA GENERATED IN MY
LAB AND IDEA OF STIGMA THAT IS A
SET OF BELIEFS THAT ARE
PERTAINING TO SORT OF NEGATIVE
BELIEFS, ATTITUDES ASSUMPTIONS
ABOUT A GROUP OR PEOPLE AND THIS
IS THE SORT OF IN-GROUP AND
OUT-GROUP AND WE ARE THE
IN-GROUP AND THAT IS OUT-GROUP
AND THAT STIGMATIZATION THAT IS
BEHAVIOR THAT COULD BE PERP
RATED AGAINST INDIVIDUALS ACTING
IN WAY DISCREDITING VALIDATING
SOMEONE BASED ON CHARACTERISTICS
DEEMED LESS OF THE NORM.
THAT MIGHT BE PEOPLE AS
DEMOGRAPHIC CHARACTERISTICS
COULD BE RELATED TO RACE AND
ETHNICITY OR RELATED TO SEX AND
GENDER IDENTITIES.
IT COULD ALSO BE RELATED TO
THINGS LIKE CHRONIC PAIN
PARTICULARLY IN CONTEXT OF LOTS
OF CHRONIC PAIN THAT IS SORT OF
MEDICALLY AMBIGUOUS AND NOT
QUITE CLEAR WHAT CAUSE IS AND
MIGHT START TO SEE
STIGMATIZATION POPPING UP FROM
HEALTH CARE PROVIDERS AND FAMILY
FRIENDS WITH THOUGHT OF MAKING
THIS UP AND GETTING OUT OF YOUR
FAMILY DUTIES AND DOING CHORES
AND BACKGROUND FLAIR TODAY AND
EMPLOYER YOU WANT LIGHT DUTY
WORK AND STIGMATIZATION AND A
LITTLE MORE OVERTLY THAT AND
OVERLAPPING DISCRIMINATION THAT
YOU FLAT-OUT DIFFERENTIALLY
TREAT PEOPLE OR GROUPS OF PEOPLE
BASED UPON STIGMA PREJUDICES AND
THEIR IDENTITIES AND
INTERSECTIONALITY THAT IS A
FRAMEWORK SUCH THAT PEOPLE BRING
A LOT OF DIFFERENT IDENTITIES
AND CONDITIONS TO THEIR LIVED
ENVIRONMENTS AND EXPERIENCES
THAT INTERCONNECT AND THUS THEY
MAY ACTUALLY EXPERIENCE
DIFFERENT SORTS OF
DISCRIMINATION AND STIGMA AS
FUVENLGS OF RACE, CLASS, GENDER
HEALTH CONDITIONS IN ANY GIVEN
WEEK THAT PEOPLE EXPERIENCE
DISCRIMINATION AND BECAUSE
MONDAY A PERSON IS BLACK AND
TUESDAY THEY ARE PART OF THE
LGBTQ XHUNLTY AND WEDNESDAY AT
DOCTOR'S APPOINTMENT CHRONIC
PAIN NOT BEING FULLY BELIEVED
AND INTERSECTIONALITY IS TIP OF
THE SPEAR OF PEOPLE'S LIVED
LIVEDIENCES THAT IS DIFFICULT TO
STUDY AND ANLLIZE HOW YOU SORT
OF MODEL FIVE DIFFERENT
INTERACTIONS BASED UPON A
PERSON'S IDENTITIES.
THAT DOESN'T MEAN IT IS NOT
WORTH DOING AND WE ARE TRYING TO
DO THAT VERY THING.
EXCUSE ME. JUST TO ROUND THIS
OUT A LITTLE MORE. THIS IDEA OF
SOCIAL THREAT AND PAIN WAS
INITIALLY SORT OF DONE IN MY
OPINION VERY WELL BY NAOMIISE
ENBERGER BACK WHEN SHE WAS
SHOWING TO BEOS TRA CRIED OR
OTHERWISE SOCIALLY DISKEBLTHED
CAN PROMOTE PAIN AND PAIN
SENSITIVITY AND SHARED NEURAL
NETWORKS AND LOTS OF WHAT ROB
WAS SCRIBING THINGS RELATED TO
LIMBIC SYSTEM AMYGDALA THINGS
LIKE THAT RELATING TO PHYSICAL
AND SOCIAL PAIN AND DISTINCTION
OF PHYSICAL AND SOCIAL PAIN IS A
BIT ARBITRARY. BRAIN ONLY
REALLY KNOWS PAIN IN WHAT HURTS.
BUT IN THE LINE OF HUMAN
EVOLUTION, THE BRAIN STRUCTURE'S
UNDERLYING PAIN INITIALLY
EVOLVED AND MADE SENSE. YOU
SPRAINED YOUR ANKLE THAT MAKES
YOU MORE VULNERABLE TO CYBER
TOOTH TIGER ATTACK THAT WILL
HURT AND BE MINDFUL OF THAT AND
BEING COMMUNAL AND FARM TOGETHER
AND LIVE TOGETHER THAT PROTECTS
US GREATER AND THREATS TO BEING
AN OUTCAST, RIGHT, ARE ALSO
POTENTIALLY THREATENING IN SAME
WAY THAT CYBER TOOTH TIGER WILL
ATTACK YOU IS AND BRAIN
STRUCTURE AND NEURAL BIOLOGY IS
UNDERLYING SOCIAL CONNECTEDNESS
THAT PIGGYBACKED ON TOP OF BRAIN
STRUCTURES THAT PROMOTE PAIN
SUCH THAT SOCIAL THREAT CAN BE
ALSO PHYSICALLY THREATENING IN
FORM OF PROMOTING PAIN AND VERY
INTERESTING STUFF AND KAIR OES
HAS DONE STUFF SHOWING HOW
SOCIAL THREAT INCREASES PAIN
REPORTS AND AGGRESSION AND OVERT
AND OUTWARD EXPRESSION OF PAIN
IS REDUCED AND STUDENT IN MY LAB
JOANNA HOBSON THAT I WILL SPEAK
MORE ABOUT IN A MOMENT WAS
APPLYING IDEA OF SOCIAL STRESS
AND CONTENTS OF RACISM AND
NEURAL BIOLOGY THEY ARE IN AND
RACISM AS SOCIAL THREAT HAVING
IMPLICATIONS OF PAIN DISPARITIES
PARTICULARLY AMONG RACIALIZED
MINORITIES THAT IS AN
INTERESTING CONCEPT THERE THAT I
ENCOURAGE YOU TO CHECK OUT HER
WORK.
WHAT WE HAVE DONE OVER THE LAST
FIVE OR SIX YEARS IS START TO
REALLY THINK WHAT POPULATION
REALLY KIND OF REPRESENTS
INTERSECTIONALITY AND WHERE WE
CAN REALLY START TO UNPACK A LOT
OF WHAT IS GOING ON HERE IN
TERMS OF SOCIAL THREATS AND PAIN
AND WHERE WE LAPPEDED THAT WAS
IN OUR HIV POSITIVE COMMUNITY
THAT HIV IN ITSELF IS
NOTORIOUSLY STIGMATIZE THE
HEALTH CONDITION IN A LONG TIME
AND LAST COUPLE YEARS IN
LABORATORY AND PERHAPS OTHERS
HAVE KNOWN FOR LONGER PEOPLE
WITH HIV DUE TO REALLY NICE
ADVANCEMENTS IN RETRO ANTIVIRAL
THERAPY ARE LIVING LONGER LIVING
LONGER DOESN'T NECESSARILY MEAN
LIVING HEALTHIER WITH HIGHER
QUALITY OF LIFE AND LOTS OF
INDIVIDUALS ARE EXPERIENCING
CHRONIC PAIN AND FROM
INTERSECTIONAL STANDPOINT TWO
THINGS THAT ARE POTENTIALLY
STIGMATIZING AND NOT UNCOMMON IN
BIRMING HAM ALABAMA LOTS OF WORK
WAS DONE TO SHOW YOU FOLKS BLACK
OR HISPANIC OR PART OF LGBTQ
COMMUNITY AND LAYERS POTENTIALLY
OF STIGMATIZATION AND FOR THIS
GROUP STIGMA AND NOT FEELING
COMFORTABLE GOING AND SEEING
HEALTH CARE PROVIDERS AND THINGS
OF THAT NATURE EQUATE TO
PROBLEMATIC ADHERENCE AND CARE
AND PROVIDER RELATIONSHIPS THAT
COULD BE ACTUALLY LIFE
THREATENING FOR THIS GROUP OF
INDIVIDUALS AND THIS IS A CASE
EXAMPLE.
RIGHT?
SO, I WON'T GO THROUGH
EVERYTHING. WHAT YOU CAN SEE
UNDER CLINICAL IS THIS PERSON
HAS PAIN AND THEY ARE HIV
POSITIVE AND IS A TRANSGENDER
INDIVIDUAL AND SEX ASSIGNED AT
BIRTH IS MALE AND GENDER
IDENTITY IS WOMAN AND DIDN'T
FINISH HIGH SCHOOL AND DISABLED
VERY LOW SOCIOECONOMIC
STANDPOINT AND MULTIPLE POINTS
OF DISCRIMINATION AND SOCIAL
THREAT HERE FOR THIS INDIVIDUAL
THAT IS REALLY REPRESENTATIVE OF
SAMPLES WE ARE CURRENTLY
STUDYING.
BACK TO JOANNA HOBSON AND I SAY
NOT TOO LONG AGO 3 OR 4 YEARS
AGO HLBI FUNDED US TO LOOK AT
SLEEP AND PAIN IN PEOPLE WITH
HIV AND PART OF HER DISSERTATION
AND GRADUATE WORK JOANNA HOBSON
WANTED TO KNOW TO WHAT EXTENT
EXPERIENCES OF STIGMA CHRONIC
PAIN TO MOOD SLEEP AND PAIN AND
CREATED AN INTERSECTIONAL STIGMA
COMPOSITE OF HIV AND CHRONIC
PAIN AND ALBEIT CRUDE AND
DEPENDING ON HOW YOU FEEL ABOUT
MEDIAN SPLITS AND PAIN STIGMA
YOU WERE CONSIDERED TO BE HIGH
AND BELOW MEDIAN ON BOTH
CONSIDERED TO BE LOW AND LOW
MEDIAN ON ONE OR ANOTHER YOU ARE
MODERATE AND POINT BEING IN
STAIRCASED EFFECT THOSE
INDIVIDUALS REPORTING HIGH
LEVELS OF INTERSECTIONAL HIV AND
CHRONIC PAIN STIGMA REPORTED
MOST DEPRESSIVE SYMPTOMS TOP
LEFT AND [INDISCERNIBLE] IS
MIDDLE AND GREATEST PAIN
SEVERITY ON TOP RIGHT AND WITH
SOME INTERESTING SEQUENTIAL
MEDIATION MODELING REPRESENTED
BY RED ARROWS THOUGHT AS
PUNITIVE PATHWAY IS THAT GREATER
STIGMA WILL HAVE DELETERIOUS
EFFECT ON MOOD AND IN TURN WILL
BE PROBLEMATIC FOR YOU TO SLEEP
AND SUBSEQUENT TO THAT YOUR PAIN
WILL BE MORE PROBLEMATIC AND
INTENSE AND NOT WELL CONTROLLED
FOR YOU AND IMPORTANTLY IF YOU
LOOK ALL THE WAY AT BOTTOM YOU
CAN SEE WHEN PAPER WAS PUBLISHED
BY JOANNA WE HAVE 82 INDIVIDUALS
PREDOMINANTLY BLACK AFRICAN
AMERICAN BY OWN SELF-REPORTED
IDENTITY THAT ARE MOSTLY
CISGENDER MEN AND WHOPPING 90%
OF THEM LIVING BELOW POVERTY
LINE AND MULTIPLE POINTS OF
VULNERABILITY HERE. IF YOU
DON'T KNOW JOANNA, YOU WILL.
SHE IS A BIT OF A FORCE AND
DOESN'T MIND INTRODUCING HERSELF
TO FOLKS.
STAY TUNED.
OKAY. JOANNA IS REALLY
ADDRESSING THAT STIGMA PIECE AND
PERHAPS HOW IT COULD BE
INTERVENED TO BETTER IMPROVE
SLEEPING PAIN AND FUNDED BY
NHLBI TO FOCUS ON SLEEPING PAIN
AND WANT TO PRESENT SOME OF THAT
TO YOU. WHAT WE HAVE ON X
ASYMPTOTE IF YOU WILL INSOMNIA
REASON BEING IS VALIDATED WHEN
HIGHEST SCORE 15 OR GREATER
SUGGESTS CLINICALLY RELEVANT
INSOMNIA AND YOU SEE IN HIV
POSITIVE INDIVIDUALS THAT THOSE
THAT ARE ENDORSING CLINICALLY
RELEVANT INSOMNIA HAVE GREATER
SEVERITY OF PAIN ON LEFT AND
PHYSICAL FUNCTIONING IS
SIGNIFICANTLY REDUCED AND
LIKEWISE EXPOSING THEM TO
QUANTITATIVE TESTING PAIN
THRESHOLD AND PAIN MODULATION
PROTOCOL AND INSOMNIA SEVERITY
INDEX AND POOR EFFICIENCY OF CPM
THAT IS SUGGESTIVE OF GREATER
PAIN SENSITIVITY.
ALL RIGHT.
AND THEN ONCE THEY COMPLETE ALL
THAT EXPERIMENTAL PAIN
SENSITIVITY TESTING QST AS AN
ACUTE STRESSOR WE TOOK BLOOD.
YOU CAN SEE THAT THERE ARE A
COUPLE INFLAMMATORY CYTOKINES
INTERLEUKIN 6 ON LEFT AND
[INDISCERNIBLE] ON RIGHT AND
INDIVIDUALS THAT ARE INSOMNIA
GROUP HAVE MORE REBUST AND
PRONOUNCED REACTION TO CYTOKINES
THAT ARE ELEVATED TO STAY OVER
TIME AND TIME IS ABOUT 45
MINUTES POST QFCT OFFSET AND
NONGROUPS HAD REACTION AND
RETURN TO BASELINE WITH
INFLAMMATORY CASCADE STAYED
ELEVATED FOR THAT GROUP WITH
INSOMNIA. WHAT DO YOU DO;
RIGHT?
COGNITIVE BEHAVIORAL THERAPY FOR
INSOMNIA IS A GOLD STANDARD HERE
THAT IS VERY INTENSIVE THAT
COULD BE FROM 6 TO 8 TO 10
TREATMENTS AND PEOPLE HAVE TO
COME IN WEEKLY AND CAN TELL YOU
HIV POSITIVE GROUP CAN'T COMMIT
TO THAT LEVEL OF TREATMENT.
YOU KNOW, OFTEN TIMES THERE IS
CHAOS AND COGNITIVE LOAD ON
THEIR LIVES.
I DON'T MEAN CHAOS LIKE
PEJORATIVELY AND THINGS THAT
MIGHT OTHERWISE BE MINOR
INCONVENIENCES TO US MIGHT
HAPPEN TO REALLY THROW OFF
ENTIRE WEEK FOR THESE FOLKS THAT
IS HOW CAN WE ACTUALLY INTERVENE
AND DO SO IN A MORE TIME
EFFICIENT AND SIMPLE SORT OF
MANNER AND ENTER BRIEF
BEHAVIORAL THERAPY FOR INSOMNIA
THAT IS SLEEP RESTRICTION AND
PARADOXICALLY SLEEP LESS TO
SLEEP BETTER AND CONSOLIDATE
THEIR SLEEP AND WHEN THEY ARE
NOT WAKING UP THROUGHOUT THE
NIGHT YOU ELONGATE THAT AND THEY
GET A LONGER SLEEP OPPORTUNITY
AND STIMULUS CONTROL THAT IS
USING BED AS IT IS INTENDED FOR
SLEEP AND DEVICES AND THINGS OF
THAT NATURE AND BEHAVIORAL
COMPONENT AND ROLLING OUT IN
FOUR SESSIONS DONE OVER THE
TELEPHONE. TELEPHONE IS MUCH
BETTER AND PREPOST IN TERMS
HAVING THEM COME IN WAS LINKED
TO CLINICAL VISITS IS EASIER TO
DO THAT. THEY ARE COMING IN AND
HAVE TRANSPORTATION ARRANGED AND
POINT BEING IS IF YOU LOOK ABOVE
AND KNOW I HAVE TO SPEED UP
HERE.
THIS IS LIMITED AND IS 10 PEOPLE
THAT ARE RANDOMIZED TO BBTI AND
OTHER 10 ARE RANDOMIZED TO
MINDFULNESS THAT TREATS
EVERYTHING AND WANT TO HAVE IT
BE ACTIVE CONTROL TO SEE HOW IT
COMPARED AND IMPORTANTLY IF YOU
LOOK AT BOTTOM LEFT HERE, ONE --
WITH FOUR SESSIONS OF BBTI FROM
PRETO POST INTERVENTION AND BLUE
LINE YOU SEE INDIVIDUALS ISI
SCORES WERE ROUGHLY 18 AND
REDUCED DOWN TO 11 THAT IS A
SIGNIFICANT REDUCTION AND ONE
MONTH LATER THEY STAYED REDUCED
WITH MINDFULNESS INTERVENTION
SLEEP DIDN'T REALLY IMPROVE AT
ALL. BBTI LOOKS LIKE WHEN
DELIVERED TELL FONICALLY COULD
BE USEFUL FOR IMPROVING THEIR
SLEEP AND IN BBTI CONVENTION OR
INTERVENTION, EXCUSE ME. YOU
CAN SEE PAIN INTENSITY DECREASED
BY ABOUT A POINT AND IMPORTANTLY
WHEN YOU CREATED CHANGE SCORES
IN TERMS WHAT SLEEP IMPROVEMENT
WAS RELATIVE TO PAIN IMPROVEMENT
YOU SEE NICE CORRELATING
EMERGING THERE ABOUT TLIE AND
BETTER SLEEP IMPROVEMENT YOU GET
MORE LIKELY PAIN IS TO
CONCOMBINNATETIVELY IMPROVE AND
ONE THING WE NOTICED TOO WE ARE
HAVING TRANSGENDERED INDIVIDUALS
POP UP WITHOUT TRYING TO RECRUIT
THEM AND ALL OF A SUDDEN WE WERE
TAPPING INTO POCKETS AND WITH
SNOWBALL RECRUITMENT WE WERE
HAVING TRANSGENDER WOMEN AND SEX
ASSIGNED AT BIRTH AND MALE
IDENTITY WOMAN COMING IN AND WE
WERE LIKE CAN WE START TO SPIN
WHEELS AND STUDY THIS AND IN
THIS PILOT STUD PUBLISHED A
COUPLE YEARS AGO TRANS WOMEN AND
FIVE HAPPEN TO BE ON ESTTROE
DIAL HORMONE THERAPY AND ALL
BLACK AFRICAN AMERICAN ALL
LIVING BELOW THE POVERTY LINE
AND THERE IS A LOT GOING ON
HERE. I WANT TO SHOW YOU IN THE
TOP LEFT THAT TRANSGENDER WOMEN
HAVE LOWEST HEAT PAIN THRESHOLDS
AS TOP LEFT OF THE TOP LEFT.
BOTTOM LEFT HAVE HIGHEST LEVELS
OF CATASTROPHIZING AND HIGHEST
DEPRESSION IN THE TOP RIGHT THAT
IS SIGNIFICANTLY GREATER THAN
THE CIS MEN.
OKAY?
WITH QST, WHAT YOU BASICALLY SEE
HERE IS THAT THE PURPLE IS THE
TRANSGENDER WOMEN AND RED IS CIS
GENDER WOMEN WHO ARE TRACKING
EACH OTHER BEING MORTEM PORE
ALLEY SUMMATIVE OR PAIN
SENSITIVE THAN CIS GENDER MEN
AND TEMPORAL SUMMATION IS CHANGE
SCORES SEEING TRANSGENDER WOMEN
ARE SIGNIFICANTLY TEMPORALLY
SUMMATIVE NOT SURE IF THAT IS
HOW WE DESCRIBE IT STICK WITH ME
THERE THAN CIS GENDER MEN AND WE
ARE SEEING HERE A FUNCTION OF
IDENTITY AND TRANSJEND ERR WOMEN
ARE ACTUALLY RESPONDING TO QST
SIMILAR TO CIS GENDER WOMEN.
ALMOST THERE. DRAWING ATTENTION
TO PANEL C, THIS IS HEAT
TEMPORAL SUMMATION ON X ASS EM
TOTE AND DISCRIMINATION SCORES
ON Y ASYMPTOTE AND MOST SORT OF
STRONGEST CORRELATION CO
EFFICIENT OF DETERMINATION YOU
GET ME THERE. TRANSGENDER WOMEN
WERE INDICATING GREATER
DISCRIMINATION AND SUMMATION OF
HEAT PAIN AND PARLAYED THIS INTO
I WANT TO PAY HOMAGE HERE YOU
WILL LIKE THIS PARLAYED THIS TO
R01 RECENTLY FUNDED BY NINR
STUDYING PAIN SENSITIVITY AND
IMMUNE FUNCTION IN TRANSGENDER
AND CIS GENDER MEN AND WOMEN AND
WITHIN TRANSINDIVIDUALS AS
FUNCTION OF HORMONE THERAPY TO
EARLY STAGE INVESTIGATORS OUT
THERE I THINK WE SUBMITTED IT
SIX TIMES BEFORE WE GOT BEST
SCORE OF 35 THAT IS NOT FUNDABLE
AND WHEN APPLYING TO RFA, AS
LONG AS 35 IS BETTER THAN
EVERYBODY ELSE'S 40S AND 45S AND
STILL MONEY LEFT OVER YOU GET
FUNDED.
KEEP GOING AND GET IT IN THERE.
ALL RIGHT.
YEAH. LAST BUT NOT LEAST, YOU
CAN'T JUST WALK INTO A
VULNERABLE COMMUNITY LIKE THIS
AND EXPECT FOR THEM TO BE LIKE
YOU SEEM SAFE. WE WILL WORK
WITH YOU AND YOU HAVE TO START
TO BUILD STREET KRED. I KNOW I
NEED TO STOP. POINT BEING WE
ARE ACTUALLY INTERFACING WITH
BIRMINGHAM'S AID OUTREACH AND
GENDER FOCUSED ADVOCACY GROUP
PAYING THEM CASH TO BUILD
DURABLE CONSULTANCY PROVIDING
SENSITIVITY TRAINING FOR US AND
HELPING US OUT AND WE ARE ALSO
WORKING WITH THEM TO SORT OF
GAIN A BETTER SORT OF
CREDIBILITY IN THE COMMUNITY AND
IS A LAB THAT MAKES IT ALL
POSSIBLE. THANK YOU. I'M
SORRY.
I USED YOUR TWO MINUTES.
THANK YOU.
>>THANK YOU BUREL.
>>YOU'RE WELCOME. WE WILL
CHANGE A LITTLE OUR FOCUS
TALKING ABOUT CHRONIC PAIN
DISPARITIES IN OLDER ADULTS AND
TALKING ABOUT THIRD DIVIDENDS
NOT FAMILIAR TO YOU AND
HOPEFULLY WILL HELP YOU THINK
ABOUT AGISM THAT WE WILL TALK
ABOUT AFTER THAT AND TALK ABOUT
WHAT WE ARE LEARNING WITH
RESPECT TO CHRONIC PAIN AND
OLDER ADULTS AND IF YOU HAD BEEN
BORN OVER 100 YEARS AGO, YOU
WOULD NOT ACTUALLY EXPECT TO
LIVE MUCH PAST 65.
PROBABLY ACTUALLY NOT MUCH PAST
50.
AND SO OVER THE PAST 100 YEARS,
AS A SPECIES, WE HAVE ACTUALLY
GAINED FRANKLY ANOTHER 1/3 OF
OUR LIFE AND THE THIRD DIVIDEND
THAT IS AMAZING AND IS A GREAT
ACCOMPLISHMENT. WE HAVE NOT
ACTUALLY ADAPTED TO THIS SPECIES
TO THIS ADDITIONAL DIVIDEND WE
HAVE. AS A RESULT, IT IS
LEADING TO A LOT OF AGISM.
SO, WHAT IS AGISM?
IT IS ESSENTIALLY NOT UNLIKE
WHAT WE HAVE ACTUALLY HEARD FROM
BUREL AND ROB. IT IS A SET OF
STEREOTYPES AND PREJUDICES THAT
ACTUALLY IN THIS INSTANCE ARE
FOCUSED ON PEOPLE'S AGE.
THERE ARE MANY DIFFERENT
VARIATIONS THAT ARE IN OTHER
KINDS OF ISMS AND STRUCTURAL
INTERPERSONAL INSTITUTIONAL AND
INDIVIDUAL.
I THINK WHAT IS PARTICULARLY
INTERESTING ABOUT AGISM,
HOWEVER, IS HOW MUCH IS
SELF-FOCUSED AND IN OTHER WORDS
IS LOTS OF SELF-AGISM THAT SEEMS
TO BE CONTRIBUTING TO LOTS OF
THESE SORT OF FACTORS AND
NEGATIVE OUTCOMES WE SEE
ASSOCIATED WITH AGISM IN
ADDITION TO OTHER THINGS.
IF YOU LOOK HERE, I WANT YOU TO
PARTICULARLY NOTICE THE FAR LEFT
COLUMN THAT IS ESSENTIALLY THE
NUMBER OF PEOPLE WHO AS A RESULT
OF AGISM ARE DENIED ACCESS TO
HEALTH SERVICES AND TREATMENTS
THAT IS PARTICULARLY RELEVANT
WHEN TALKING ABOUT CHRONIC PAIN
AND CHRONIC PAIN IN OLDER
ADULTS.
CHRONIC PAIN IS A COMMON
PHENOMENON OF OLDER ADULTS THAT
GROWS AS WE GET OLDER AND NOT
ONLY DOES IT GROW AS WE GET
OLDER BUT GROWS IN IMPACT ON OUR
WELLBEING.
WHEN WE THINK ABOUT
BIOPSYCHOSOCIAL MODEL OF PAIN
THAT YOU ALREADY HAVE HEARD OF
FROM ROB THERE IS IF NEW FACTORS
PLAYING INCREASING ROLE WHEN WE
GET OLDER IN THAT STARTING TO
COLLECT THINGS AND START TO
COLLECT THINGS AT VARIOUS FORMS
OF CHRONIC CONDITIONS THAT WE
MAY BE COLLECTING VARIOUS WAYS
OF PSYCH LODGE CALLING COPING
THAT WE MAY BE EXPERIENCING
DIFFERENT KINDS OF ERODING
SOCIAL SUPPORT.
AND WE MAY BE EXPERIENCING
AGEISM IN ADDITION TO A NUMBER
OF OTHER FACTORS YOU SEE ON THE
SLIDE THERE.
THE SAD PART IS WE HAVE ACTUALLY
VERY, VERY LITTLE DATA ON
CHRONIC PAIN AND OLDER ADULTS
AND MOST LARGE PAIN STUDIES THAT
ARE NATIONALLY REPRESENTATIVE IN
THE GENERAL POPULATION THAT
THERE IS VERY LITTLE ATTENTION
TO OLDER ADULTS AND WE WERE
FORTUNATE TO BE FUNDED BY
NATIONAL INSTITUTE ON AGING TO
DO NATIONALLY REPRESENTATIVE
STUDY OF CHRONIC PAIN IN OLDER
ADULTS.
ESSENTIALLY, WHAT THE STUDY IS,
IS IT USES PARTNERSHIP WITH
NATIONAL OUTCOMES RESEARCH
CENTER AT UNIVERSITY OF CHICAGO
AND A PANEL TO UNDERSTAND
CHRONIC PAIN PREVALENCE AND LOOK
ALSO AT SOME CHARACTERISTICS OF
CHRONIC PAIN IN OLDER ADULTS AND
LONGITUDINALLY OVER TIME HOW
THAT EFFECTS COGNITIVE FUNCTION
AND PHYSICAL FUNCTION AND
QUALITY OF LIFE.
AND WHAT WE FOUND SO FAR IN THAT
WE HAVE JUST COMPLETED THE
BASELINE ASSESSMENTS FOR THE --
THIS PARTICULAR STUDY IS THAT
THERE ARE NOT UNLIKE OTHER
NATIONAL STUDIES LARGE
PROPORTION OF OLDER ADULTS
EXPERIENCING CHRONIC PAIN AND
DON'T SEE THINGS INCREASED THAT
YOU SEE IN OTHER STUDIES I
SHOWED YOU YOU SEE AS WE GET
OLDER IN 85 YEAR GROUP FASTEST
GROWING AGE GROUP IN OUR COUNTRY
CLOSE TO 4/10 OF INDIVIDUALS ARE
EXPERIENCING CHRONIC PAIN AND
WHEN WE THINK ABOUT ETHNICITY
AND RACE, WE SEE THAT THERE IS
ACTUALLY A LOT OF VARIABILITY IN
PEOPLE'S EXPERIENCE OF CHRONIC
PAIN AND BASED ON WHAT WE HEARD
ABOUT FROM ROB THIS SHOULD COME
AS NO SURPRISE TO US THAT
PEOPLES EXPERIENCE OF CHRONIC
PAIN IS A FUNCTION OF IT THEIR
BACKGROUNDS.
WHAT WE ALSO SEE IS THAT CHRONIC
PAIN IS MUCH MORE LIKELY IF WE
ARE COMING FROM LESS -- A LESS
WELL RESOURCED SETTING THAT IS
IN ADDITION TO THAT, THAT AGISM
AND DISCRIMINATION DO INFORM
CHRONIC PAIN. THESE ARE
ACTUALLY SCALES YOU SEE ON THE Y
ACCESS THAT IF YOU EXPERIENCE
HIGHER LEVELS OF AGISM OR OF
DISCRIMINATION YOU ARE MUCH MORE
LIKELY TO EXPERIENCE CHRONIC
PAIN.
AND SPECIFICALLY THINKING ABOUT
AGISM, WE SAW THAT ABOUT 31% OF
PEOPLE WITH CHRONIC PAIN AND
CLINICIANS THAT ARE ASSOCIATED
WITH ANY AILMENT IT THEY WERE
EXPERIENCING AS FUNCTION OF AGE
AND ESSENTIALLY THEIR PAIN WAS
WRITTEN OFF.
THIS WAS TWO FOLD HIGHER AND
HIGHER RATE THAN PEOPLE THAT ARE
ACTUALLY NOT EXPERIENCING
CHRONIC PAIN.
WHAT WE ALSO SEE IS THAT PEOPLE
WHO ARE EXPERIENCING AGISM AND
DISCRIMINATION EXPERIENCE HIGHER
LEVELS OF PAIN-RELATED DIFFICULT
AND LOWER SELF-EFFICACY FOR PAIN
MANAGEMENT AND HIGHER PAIN
INTENSITY.
WE ARE ALSO SEEING THAT THIS --
IN GENERAL AS I MENTIONED
EARLIER IN OLDER ADULTS THAT
THEY ARE MORE LIKELY TO
EXPERIENCE PROBLEMS WITH ACCESS
TO CHRONIC PAIN MANAGEMENT
PROGRAMS AND WOULD SAY
PSYCHOLOGICALLY SUPPORTED AND
INFORMED PROGRAMS AND EVEN THEN
MANY PEOPLE DON'T GO OVER 1/3 OF
PEOPLE WITH CHRONIC PAIN AND
DON'T KNOW WHERE TO GO FOR
PROFESSIONAL CARE AND ABOUT A
21% HAVE PROBLEMS WITH
TRANSPORTATION OR TRAVELING TO
APPOINTMENTS AND 1/3 ARE NOT
ABLE TO AFFORD FINANCIAL COSTS
INVOLVED AND MIGHT BE AWARE THAT
MANY CHRONIC PAIN PROGRAMS WON'T
TAKE MEDICARE AS FORM INSURANCE
PAYMENT AND ARE CONCERNS ABOUT
TREATMENTS AVAILABLE AND RESULT
OF HALF DON'T SEEK ACCESS FOR
PAIN SUPPORT RESULT OF OTHER
SENSE THAT THERE IS NOT ANYTHING
THAT OTHERS COULD DO FOR THEM
AND CHRONIC PAIN AND SERIOUS
ILLNESS PREVENTS PARTICULARLY
UNIQUE CLINICAL CHALLENGES
BECAUSE WE HAVE LACK OF CLARITY
WHEN SOMEONE IS EXPERIENCING A
GUIDELINES THEY ARE OR ARE NOT
FOLLOWING AND MANY WITH CHRONIC
PAIN THAT EXPERIENCE SERIOUS
ILLNESS THAT HAS PAIN THAT
ACTUALLY PRECEDES THEIR SERIOUS
ILLNESS AND THAT MULTI-SITE PAIN
FACTOR IS IGNORED AND GENERALLY
SPEAKING INTEGRATIVE BEHAVIORAL
PAIN MANAGEMENT IS OFRNL NOT
TAILORED TO PEOPLE WITH SERIOUS
CHRONIC ILLNESS AND OLDER ADULTS
CONSTITUTE PATIENTS WITH CANCER
THAT IS ONE OF THE SERIOUS
ILLNESSES AND FOR THAT REASON WE
ARE PARTICULARLY INTERESTED IN
LOOKING AT HOW OPIOID THERAPY IS
USED IN PEOPLE WITH ADVANCED
CANCER TRYING TO SEE WHETHER OR
NOT THERE ARE NET BENEFITS OR
HARMS IN WAY THAT OPIOIDS ARE
USED IN THIS POPULATION AND IS A
STUDY THAT IS ONGOING FUNDED BY
NATIONAL INSTITUTE FOR NURSING
RESEARCH THAT IS REALLY TRYING
TO UNDERSTAND THIS RELATIONSHIP
BETWEEN OPIOID THERAPY AND
RELATED BENEFITS AND RISK
FACTORS FOR OPIOID RELATED HARMS
AND WHAT PEOPLE ARE THINKING
CLINICIANS AND PEOPLE LIVING
WITH SERIOUS ILLNESS ABOUT THIS
OPIOID RELATED DECISION MAKING
THAT IS IT EVEN A CONVERSATION
OF SHARED DECISION MAKING?
WHAT INTERVENTIONS MIGHT THEN
INFORM OPIOID RELATED DECISION
MAKING IN THE FUTURE?
WE ARE ALSO ENGAGED IN A NUMBER
OF CLINICAL TRIALS TO TRY TO
UNDERSTAND HOW TO BETTER SUPPORT
PEOPLE OR OLDER ADULTS LIVING
WITH CHRONIC PAIN AND STUDY THAT
NPI DID CALLED ACTIVE BRAIN
STUDY AND IN THIS STUDY WE ARE
TRYING TO AVOID CHRONIC PAIN
DISABILITY SPIRAL WE SEE IN
OLDER ADULTS AND BECAUSE OF
NARRATIVE OF PAIN THEY DECREASE
PHYSICAL ACTIVITY LEADING TO
EXACERBATION OF THE PAIN AND
HELPING TO BREAK THAT DISABILITY
SPIRAL THROUGH MIND BODY
ACTIVITY PROGRAM AND PROGRAM IS
THROUGH NUMBER OF NIH STAGE
MODELS AND CURRENTLY AT MODEL 2
DOING VIRTUAL EFFICACY CLINICAL
TRIAL OF OLDER ADULTS LIVING
WITH CHRONIC PAIN TO SEE HOW
INTERVENTION INFLUENCES OUTCOMES
AND AS I MENTIONED PEOPLE
EXPERIENCE PROFOUND DISPARITIES
TO ACCESS TO CHRONIC PAIN
MANAGEMENT THAT WE WERE
PARTICULARLY INSPIRED BY
OPPORTUNITY TO WORK WITH
COMMUNITY HEALTH CENTER
PREDOMINANTLY SUPPORTING
DISADVANTAGED POPULATIONS AS
POPULATIONS THAT HAVE LIMIT
ENGLISH LANGUAGE PROFICIENCY AND
MIGHT BE SPANISH SPEAKING AND
COME FROM LOWER SOCIOECONOMIC
BACKGROUNDS AND IN THIS STUDY WE
ARE ESSENTIALLY INCORPORATING
EVIDENCE-BASED MIND BODY
ACTIVITY PROGRAM IN THIS
COMMUNITY HEALTH CENTER THROUGH
A GROUP VISIT PROGRAM AND WITH
TRAINING NONBEHAVIORAL HEALTH
INTERVENTIONISTS WITH THE GOAL
THAT MIGHT PROVIDE INCREASED
SUSTAINABILITY.
GET ACTIVE SKILLS ARE ONES YOU
HEARD ALREADY THROUGHOUT THE
MORNING AND ARE THINGS RELATING
TO MINDFULNESS DEEP BREATHING
BODY SCAN MINDFULNESS OF PAIN
AND ACCEPTANCE AND CHALLENGING
NEGATIVE THOUGHTS WITH ALSO
WALKING GOALS THAT ARE BASED
PACING AND WALKING ACTIVITY
MONITORING AND ATTENTION TO
DISABILITY SPIRAL.
FINDINGS TO DATE IS ENGAGING
STUDY TO BEGIN WITH AND MANY
BARRIERS TO OVERCOME AND WE NOW
ACTUALLY STARTED WITH THE
INTERVENTION SEEING TREMENDOUS
ENTHUSIASM BY STUDY PARTICIPANTS
FOR THIS KIND OF CHRONIC PAIN
MANAGEMENT THAT MANY OF THEM OR
ALL OF THEM HAVE NOT EXPERIENCED
AT ALL BEFORE. WE ARE SEEING
LOTS OF INTEREST FOR OUR
SPANISH-SPEAKING PATIENTS AND WE
ARE ENGAGING IN SPANISH-SPEAKING
PILOT AND GOAL IS ULTIMATELY TO
FIGURE OUT HOW TO USE
INTERPRETERS OR OTHER TOOLS TO
SUPPORT THE 50 OTHER LANGUAGES
THAT ARE SPOKEN IN THE CLINIC
WHO ARE CURRENTLY NOT
NECESSARILY ABLE TO ACCESS THIS
KIND OF SUPPORT.
SO, TAKEAWAYS, FIRST OF ALL,
OLDER ADULTS WITH -- PAIN LEADS
TO DISPROPORTIONATE DECLINES
COGNITION AND QUALITY OF LIFE
AND TRYING TO UNDERSTAND
MECHANISMS THROUGH THIS
LONGITUDINAL STUDY WE ARE
ENGAGING IN NOW AND THINK THAT
AGISM AND DISCRIMINATION
EXACERBATE CHRONIC PAIN AND SEE
FROM BASELINE CROSS-SECTIONAL
DATA THERE IS AT LEAST AN
ASSOCIATION AND WE BELIEVE YOU
HEAR FROM ALL PANELISTS WILL
TAKE A PERSONALIZED APPROACH
TAKING INTO ACCOUNT THESE
MARKERS ASSOCIATED WITH NEGATIVE
OUTCOMES ASSOCIATED WITH PAIN
AND THANKING VARIOUS SUPPORTIVE
AGENCIES THAT SUPPORTED OUR WORK
ALONG WITH AMAZING COLLEAGUES
AND COLLABORATORS.
THANK YOU.
>>THANK YOU VERY MUCH FOR YOUR
PRESENTATIONS.
WE HAVE TIME FOR QUESTIONS IF
PEOPLE HAVE QUESTIONS.
I HAVE ONE I WOULD LIKE TO START
OUT WITH THAT IS AMR.ICABLE FOR
ALL OF YOU. ALL OF YOU TALKED
ABOUT THE IMPORTANCE OF REALLY
FINDING OUT THE INDIVIDUAL'S
CHARACTERISTICS NOT GROUP THEY
ARE IN OR OTHER THINGS AND I
CAME FROM PALLIATIVE CARE
BACKGROUND AND LOOKING AT WHAT
THE INDIVIDUAL'S BELIEFS AND
PREFERENCES AND VALUES ARE.
HOW DO YOU INCORPORATE THAT
CLINICALLY?
>>I'M HAPPY TO START.
ALSO, COMING FROM -- ALSO COMING
FROM A PALLIATIVE CARE
BACKGROUND WE REALLY THINK ABOUT
THE DIFFERENT FORMS OF
BIOLOGICAL AND PSYCHOLOGICAL AND
SOCIAL AND SPIRITUAL SUFFERING
AND OTHER LIVED EXPERIENCES THAT
PEOPLE HAVE THAT THEY BRING TO
THEIR ILLNESS OR LIVED JOURNEY
WITH CHRONIC PAIN.
I THINK THE STARTING POINT IS AN
ASSESSMENT TOOL THAT ADDRESSES
ACTUALLY ALL OF THOSE AND TELL
YOU BY AND LARGE THAT IS NOT
WHAT HAPPENS IN HEALTH CARE AND
BY AND LARGE WHAT HAPPENS IN
HEALTH CARE IS IF WE ARE LUCKY,
PEOPLE ASK ABOUT PAIN PERIOD.
THEY MAY ASK USING A VISUAL
ANALOG SCALE IF WE ARE LUCKY
THEY MIGHT ASK ABOUT IMPACT ON
FUNCTION THAT IS AS FAR AS IT
GOES AND OPPORTUNITY TO REALLY
DIG DEEPER INTO UNDERSTANDING
WHAT IS GOING ON SO THAT YOU CAN
PROVIDE PERSONALIZED CARE IS
SOMETHING THAT I THINK THAT WE
CAN REALLY PUSH FORWARD ON.
>>THAT WAS MUCH MORE ARTICULATE
THAN I DON'T KNOW.
I FEEL LIKE THERE IS A CHASM
RIGHT NOW BETWEEN WHAT WE ARE
SAYING ON THE STAGE TODAY IN
SPONLS TO RESEARCH WE DO AND
RELATIVE TO HOW IT TRANSLATES TO
CLINICAL CARE THAT THE FIGHT IS
WORTH FIGHTING AND FIGURING
THINGS OUT AND HONEST TO
GOODNESS S ANSWER NOW IS I DON'T
-- I DON'T KNOW. I DON'T KNOW
EXACTLY HOW WE WILL DO THAT.
IT IS SUPER IMPORTANT, BUT THERE
WAS SO MANY THINGS THAT ARE JUST
PRESENTED TODAY THAT ARE SUPER
IMPORTANT TO ADDRESS AND HOW DO
YOU GET ALL THAT INTO A 5-MINUTE
INTERVIEW?
I -- YOU KNOW, THAT IS A BIT
RHETORICAL AND DON'T EXPECT
ANYBODY TO ANSWER THAT. I LEGIT
AM SITTING UP HERE SAYING I
DON'T KNOW. AGAIN, IT IS WORTH
CONSIDERING AND CONTINUING TO
CONSIDER HOW TO MAKE PROGRESS ON
THAT FRONT.
IT IS TOUGH. IT IS PEELING AWAY
THE ONION. WE ARE JUST BARELY
SCRATCHING AWAY AT THE SURFACE.
SORRY.
>>NO WORRIES.
SO, THAT IS A -- I CAN'T TELL IF
THIS IS ON.
>>YES.
>>IT IS ON, OKAY. THE SOUND OF
MY OWN VOICE.
SO, THERE IS PROBABLY TWO
QUESTIONS IN THERE. ONE IS WHAT
ARE WE DOING NOW?
THE OTHER MAYBE MORE EXCITING
QUESTION IS WHAT SHOULD WE BE
DOING IF IN THE FUTURE?
AND I'M NOT EXACTLY THE RIGHT
PERSON TO COMMENT ON WHAT WE ARE
DOING NOW.
I CAN TELL YOU BASED ON MY OWN
EXPERIENCE WORKING AT A TERTIARY
CARE PAIN MANAGEMENT FACILITY IN
BOSTON WE ARE -- I DON'T KNOW.
5 TO 10% OF THE WAY DOWN THE
ROAD TOWARDS PERSONALIZED PAIN
MEDICINE THAT IS BETTER THAN 0.
RIGHT NOW, WE DO THINGS LIKE
WITH INITIAL ASSESSMENT WE WILL
EVALUATE, FOR EXAMPLE, PEOPLES
PREFERENCES FOR PHARMACOLOGIC
VERSUS NONPHARMACOLOGIC CARE
THAT CERTAINLY GETS INCORPORATED
IF INTO TREATMENT THAT IS
RECOMMENDED AND MIGHT EVALUATE
HOW NEUROPATHIC THEIR PAIN IS
AND INFLUENCE MEDICATIONS THAT
ARE RECOMMENDED AND EVALUATE HOW
SYSTEMATICALLY HOW DISTRESSED
THEY ARE OR SEEM IN AN INITIALLE
INTERVIEW AND MIGHT INFLUENCE
WHETHER THEY ARE REFERRED TO A
PAIN PSYCHOLOGIST AND WE
PROBABLY DON'T DO MUCH MORE THAN
THAT NOW AND THERE IS A WORLD
HOPEFULLY NOT TOO, TOO FAR IN
THE FUTURE TO DO FAIRLY
STANDARDIZED PHENOTYPING
ASSESSMENT TAKING INTO ACCOUNT
ALL INFLUENTIAL CHARACTERISTICS
OF THE PERSON INCLUDING THEIR
CULTURAL BACKGROUND AND
PREFERENCES FOR CERTAIN KINDS OF
TREATMENT IN ADDITION TO ALL
FACTORS WE ALL TALKED ABOUT
INFLUENCING COURSE OF PASH YENLT
IN TREATMENT AND SLEEP AND
CATASTROPHIZING PAIN SENSITIVITY
OR WHATEVER IT MIGHT BE AND
STANDARDIZING ASSESSMENT
OFFERING PEOPLE LET'S CALL IT
INFORMATION-BASED MENU AND
SAYING BASED ON FACTORS AND
EXCITING WORK THAT IS BEING DONE
BEST GUESS ABOUT TREATMENTS MOST
HELPFUL FOR YOU ARE A, B, C, AND
D AND WHAT DO YOU THINK ABOUT
THAT AND WHAT ARE YOUR TREATMENT
PREFERENCES AND WHAT WOULD YOU
LIKE TO START WITH AND THINK
ABOUT MAYBE COMBINING THOSE
THINGS AND WE HAVE A WAYS TO GO
THERE TO GET THERE, I THINK.
ALTHOUGH, WE ARE TAKING BABY
STEPS DOWN THE ROAD THAT IS AT
LEAST A LITTLE ENCOURAGING.
>>THANK YOU. PLEASE.
>>HI. OH, IT IS ON. THANK
YOU. WONDERFUL TALKS.
IT HAS BEEN VERY ENJOYABLE.
ONE QUESTION THAT I HAD IS
ACTUALLY KIND OF THE OPPOSITE OF
THE FIRST QUESTION THAT IS MORE
ABOUT HOW -- WHEN TALKING ABOUT
PAIN AND EQUITY AND EVERYONE ALL
THREE OF YOU IN TALKS AND
ADDRESSED TALKING ABOUT ISMS
THAT ARE OBVIOUSLY SOCIAL AND
STRUCTURAL AND MUCH MORE THAN
INNER PERSONAL AND INDIVIDUAL
LEVEL AND MY QUESTION IS KIND OF
MORE ABSTRACT IN SENSE WHY DO WE
-- WHY AND SHOULD WE CONTINUE TO
FOCUS ON THIS INDIVIDUAL LEVEL?
WHAT RECOMMENDATIONS WOULD YOU
HAVE FOR KIND OF EXPANDING AND
ZOOMING OUT IN WAYS THAT WE
THINK ABOUT PAIN PREVENTION ON A
MORE SOCIAL AND STRUCTURAL
LEVEL.
>>SO, YOU KNOW, I THINK THERE
IS SO -- FIRST OF ALL, THANK YOU
FOR THE QUESTION.
I THINK IT IS A REALLY IMPORTANT
QUESTION.
AS A SOCIETY, WE TEND TO OFTEN
BE VERY REACTIVE IN THE WAY THAT
WE THINK ABOUT MANAGING PROBLEMS
OPPOSED TO PROACTIVE AND IDEA OF
ENGAGING ACTUALLY IN PREVENTIVE
EFFORTS AROUND CHRONIC PAIN IS
TO ME VERY EXCITING.
REALLY, THAT WOULD START, YOU
KNOW, IN PRESCHOOL.
BUT, ANYWAY, IF THAT IS NOT
GOING TO HAPPEN RIGHT AWAY, I
THINK THAT THE FIRST THING WE
CAN DO IS START THINKING ABOUT
WHAT DOES A PREVENTIVE CARE
APPROACH LOOK LIKE FOR PAIN AND
NAVIGATING PAIN AND PAIN
QUANTIFICATION AND WHAT ARE WAYS
TO POTENTIALLY REDUCE PAIN
QUANTIFICATION?
IN ADDITION TO THAT, FOR OUR
CLINICAL COMMUNITY, HOW DO WE
ACTUALLY REDUCE STIGMA
ASSOCIATED WITH CHRONIC PAIN AND
INCREASE EFFICACY AMONG
CLINICIANS AROUND MANAGEMENT OF
CHRONIC PAIN?
>>ALONG THAT LAST POINT I WILL
SAY TAKING A PAGE FROM RESEARCH
IN -- STIGMA RESEARCH THAT COULD
BE DONE SAID INDICATION AND LOTS
OF TIMES WHEN PEOPLE ARE
STIGMATIZING OTHERS IT IS NOT
COMING REALLY FROM MALICIOUS
PLACE BUT COMING FROM PLACE OF I
DIDN'T REALLY KNOW THAT.
MORE EDUCATION AND IMPORTANTLY
THERE HAS BEEN LOTS OF NATIONAL
TALK AROUND PAIN EDUCATION OR
LACK THEREOF IN MEDICAL
CURRICULAR OR WHAT HAVE YOU AND
THINK THAT EDUCATION AND
EDUCATION WILL BE AN IMPORTANT
PIECE THERE AND JUST SORT OF
BRINGING PEOPLE'S SUBCONSCIOUS
TO CONSCIOUS AND HELPING
INDIVIDUALS REALIZE PARTICULARLY
IN CHRONIC PAIN SPACE THAT LOTS
OF TIMES SITTING AND LISTENING
IS TREATMENT AND MEDICINE AND
VALIDATING A PERSON'S
EXPERIENCES IN A WAY THAT IS NOT
STIGMA PROMOTING AND THINK THAT
EDUCATION IS STILL, AGAIN, NOT
END ALL, BE ALL BUT DON'T THINK
YOU COULD GET AS FAR AS YOU
POSSIBLY COULD WITHOUT AN EYE
TOWARDS GOOD EDUCATIONAL EFFORTS
IN THIS SPACE.
>>FANTASTIC ANSWERS AND IS A
REALLY, REALLY GOOD QUESTION
THAT HAS TO BE A LITTLE
INTIMIDATING FOR SOMEONE ASKING
NEXT QUESTION AND WILL ADD ON A
LITTLE BIT AND LIKE WORK I DO
NOW THAT FOCUSES ON
INDIVIDUALIZED PRECISION
MEDICINE AND EDUCATION AND
CAREER AND TOLD ME SET IT UP
MAKING BIG DIFFERENCE FOR
BIGGEST NUMBER OF PEOPLE AND GET
TRAINING IN COMMUNICATIONS,
MEDIA AND ADVERTISING AND THINK
I WOULD BE TERRIBLE AT THAT NOW
BUT THINK I COULD GET TRAINED
AND WORK ON INCORPORATING PAIN
NEUROSCIENCE EDUCATION CONCEPTS
INTO VARIOUS CURRICULA EARLY AND
I MEAN HIGH SCHOOL AND MIDDLE
SCHOOL TO THINK ABOUT HOW TO
CHANGE CHRONIC HEAD PAIN AS A
SOCIETY IN GENERAL AND COULD
INCORPORATE THINGS WE KNOW
ALREADY ABOUT TREECHLTS OR
APPROACHES THAT ARE MOVEMENT
BASED THERAPIES DOING MORE OF IF
DON'T HAVE CHRONIC PAIN
MONITORING IMPROVING SLEEP AS
BEST AS WE CAN AND ALL THAT
STUFF IS POSSIBLE TO MAKE A BIG
DIFFERENCE INCORPORATING
CONCEPTS MAKING EDUCATION AND
ADVERTISING PAIN RELATED
CONCEPTS STARTING AT EARLY LEVEL
NOT JUST EDUCATING PSYCHOLOGISTS
PAIN TERTIARY PAIN MEASURES.
YEAH.
>>HI. GREAT TALK AND MY
QUESTION REVOLVES AROUND EACH OF
YOUR PROJECTS AND HAVE ANY OF
YOU ACTUALLY LOOKED AT
CORRELATIONS OR CONNECTIONS
BETWEEN CULTURES YOU ARE LOOKING
AT AND NUTRITION THEY ARE
CONSUME SNG.
LOTS OF CULTURES AND ESPECIALLY
PEOPLE LOOKING AT SLIDE OVER AND
LOOKING AT PEOPLE AT SPANISH
SPEAKING COUNTRIES SOUTH-ASIANS
DR. [INDISCERNIBLE] WAS TALKING
ABOUT THIS AND LOTS OF PEOPLE
CONSUME VERY SPICY FOOD, FOR
EXAMPLE ACTIVATING TRYP1
RECEPTORS AND HOW IT IMPACTS
LATER ON IN LIFE HOW THEY ARE
PERHAPS PERCEIVING PAIN OR
RESILIENCE IS CHANGING AND
SECOND QUESTION TO THAT IS ALSO
IN SOUTH AMERICA PEOPLE
CONSUMING COCOA LEAF FOR
THOUSANDS OF YEARS TO ALLEVIATE
PAIN FROM HIGH ALTITUDE BUT ALSO
TO GIVE THEM ENERGY THAT
CORRELATES BACK TO THEIR
NUTRITION AND CULTURE AND I
GUESS WHAT IS CONSIDERED NORMAL
FOR THEM TO BE CONSUMING AND HOW
THAT IMPACTS ALSO LONGITUDINAL
ACTIVITY OF THEIR LIFE AND
HISPANICS LIVE A LONG LIFE
COMPARED TO OTHER ETHNICITIES
AND IF YOU CAN PUT IT TOGETHER
FOR ME THAT WOULD BE GREAT.
>>THAT IS ALSO A WONDERFUL
QUESTION.
I'M NOT SURE WE WILL WIND UP
SUCCEEDING IN PUTTING IT ALL
TOGETHER BUT WILL TAKE BEST SHOT
AT IT. POINT IS A REALLY GOOD
ONE IN THAT A LOT OF NOVEL AND
EFFECTIVE PAIN TREATMENTS HAVE
BEEN LOTS THAT WE LIKE AND IN
RECENT DECADES LOTS COME FROM
VARIOUS BOTANICAL COMPOUNDS AND
THINGS POTENTIALLY IDENTIFIED
ORIGINALLY AS BEING USED BY
INDIGENOUS CULTURES OR FOLKS
LIVING IN SMALL COMMUNITIES AND
IN OTHER PARTS OF THE TWHOORLD
IS PROBABLY A REALLY RICH SOURCE
OF POTENTIALLY EFFECTIVE FUTURE
PAIN TREATMENTS IN REGARDS TO
FIRST PART OF YOUR QUESTION, WE
PROBABLY KNOW WAY LESS THAN WE
WOULD LIKE TO ABOUT THINGS LIKE
HOW EARLY LIFE DIETARY CHOICES
AND DEGREE OF CAPSATION ONE
CONSUMES FOR EXAMPLE HAS IMPACT
ON LATER PERCEPTION OF PAIN AND
MAYBE VERY BEST SHOT I HAVE AT
PUTTING ALL THINGS TOGETHER IS
TO HIGHLIGHT FACT THAT WHAT YOU
ASKED ABOUT IS A CRITICALLY
UNDERSTUDIED AREA THAT IS OF
CRUCIAL IMPORTANCE AND WE DON'T
KNOW NEARLY AS MUCH AS WE SHOULD
THAT PRESUMABLY WOULD BE A
WONDERFUL AREA TO WORK IN OR
FUND NOVEL STUDIES IN. THANK
YOU FOR BRINGING IT TO OUR
ATTENT
ATTENTION.
>>OKAY.
YEAH. COPY EVERYTHING THAT ROB
SAID THAT IS AN IMPORTANT
QUESTION AND TOPIC.
SO, I SPEAK VERY FORTUNATELY
HERE ANOTHER STUDY WE FUNDED BY
NATIONAL INSTITUTE OF NURSING
RESEARCH REFERRING TO AS DIRECT
PAIN COLLEAGUE AT UAB ARE
ACTUALLY EVALUATING DIFFERENT
DIETS PARTICULARLY LOW CARB
DIETS HIGH PROTEIN DIETS THAT
ARE ANTIINFLAMMATORY PROPERTIES
ON NEOOSTEOARTHRITIS PAIN
LOOKING AT RACE DIFFERENCES IN
TERMS OF RESPONSES AND
PSYCHOSOCIAL VARIABLES TO
EXPLAIN POTENTIAL INTERACTIONS
THERE AND RELATED TO THAT DOING
WORK NOW IN CHILDREN THAT HAVE
FUNCTIONAL AB-NO. DOM NAL PAIN
DISORDERS NO LONGER TERMINOLOGY
BUT THAT OF GUT BRAIN
INTERACTION LOOKING AT DIET AND
DIETARY CHOICES HOW IT EFFECTS
MICROBIOME TO EFFECT ABDOMINAL
PAIN IN ABSENCE OF OTHER MEDICAL
REASONS FOR THAT PAIN.
I THINK YOU ARE RIGHT THERE IS
SPACE TO GROW AND UNDERSTAND
THERE AND THINKING ABOUT DIET
NOT AS A VERB I'M ON A DIET BUT
DIET AS A NOUN WHAT CHOICES I
MAKE IN WHAT FOODS I PUT IN BODY
AND PROMOTE PHYSICAL AND MENTAL
HEALTH AND DISPARITY SLANT WHO
IS GETTING ACCESS TO FOODS AND
WHO IS NOT AND IDEA OF FOOD
DESERTS AND THINGS IS VERY ALIVE
AND WELL IN AMERICA. I WILL
STOP WITH THAT.
>>THAT IS AWESOME AND EXCITED
ABOUT THAT. IT IS IMPORTANT TO
BE LOOKING AT SOME OF THESE
DIETARY APPROACHES THAT YOU KNOW
THERE ARE NOW A NUMBER OF
STUDIES, FOR EXAMPLE LOOKING AT
ROLE OF DIET AND
NEURODEGENERATIVE DISEASE AND
SHOWING IMPORTANT RELATIONSHIP
AND WHY WOULDN'T THERE BE A
RELATIONSHIP HERE?
THERE PROBABLY HAS TO BE AND
ONLY THING I WOULD ADD IS
THINKING ABOUT ROLE OF
INTERMITTENT FASTING AND HOW
THAT MAY ALSO PLAY A ROLE IN
CHRONIC PAIN EXPERIENCE THAT WE
HAVE, AGAIN, VERY LITTLE DATA
ON.
LOTS OF ROOM FOR NEW DISCOVERY.
>>OKAY. SO, ONE OF THE
PRESENTATIONS TALKED ABOUT
UNEQUAL BURDEN OF PAIN IN
AFRICAN AMERICANS AND MOST
DIFFERENCES OF UNEQUAL BURDEN OF
PAIN IS IN SOCIAL AND
PSYCHOLOGICAL FACTORS RATHER
THAN BIOLOGICAL.
I WONDER IF THERE ARE EPIGENETIC
FACTORS OR CONTRIBUTIONS PLAYING
INTO UNEQUAL BURDEN OF PAIN IN
AFRICAN AMERICANS AND WONDERING
IF STUDIES REFERENCED ARE IN
JUST BLACK PEOPLE THAT ARE
DESKENLDIENTS OF SLAVES OR JUST
BLACK PEOPLE ACROSS AMERICA?
>>A MORE SENIOR INDIVIDUAL.
>> THANK YOU. HOW KIND OF YOU.
FANTASTIC QUESTION THAT I WILL
LET BOOURO TAKE A CRACK AT
EPIGENETICS PART OF YOUR
QUESTION THAT IS A REALLY
EXCITING AREA OF WORK I DON'T
KNOW A LOT ABOUT AND PROBABLY
CAN'T DRAG COLLEAGUES SAM MITES
UP HERE TO ANSWER THAT PART OF
IT FOR ME.
SHE IS WORKING WITH FOLKS AT UAB
AMONG OTHERS TAKING LEAD IN
LOOKING AT POTENTIAL EPIGENETIC
FACTORS IN CONTRIBUTION TO
RACIAL AND ETHNIC DIFFERENCES IN
PAIN.
IT IS A REASONABLE AND FAIR
CONCLUSION TO MAKE FROM
LITERATURE THAT THERE IS A WHOLE
LOT OF FACTORS TO CONTRIBUTE TO
DISPARITIES WE SEE NOW AND VERY
FEW OR MAYBE NONE OF THOSE
FACTORS INVOLVE THINGS LIKE
INNATE BIOLOGICAL DIFFERENCES
AND EPIGENETICS WOULD PRESUMABLY
BE IN A DIFFERENT CATEGORY AND
CERTAINLY THERE ARE EPIGENETIC
CHANGES THAT HAPPEN AS A RESULT
OF STRESSFUL EXPERIENCES WITH
DISCRIMINATION FOR EXAMPLE AND
DON'T HAVE MUCH DOUBT THERE IS
POTENTIAL SHAL CONTRIBUTION
PATHWAY OR SELF THERE AND
CONCEPTUALLY IS IN SEPARATE
CATEGORY INNATE STARTING AT BOTH
BIOLOGICAL DIFFERENCES I SUSPECT
WE ALL THINK ARE NOW NOT A
SUBSTANTIVE CONTRIBUTOR TO GROUP
DIFFERENCE AND ETHNIC
DISPARITIES WE SEE AND QUESTION
ABOUT CATEGORIZATION IS A GOOD
ONE AND STUDIES AS FAR AS I CAN
TELL DIFFER SOME IN MEASUREMENT
OF RACIAL AND ETHNIC CATEGORIES
AND IN GENERAL WE TEND TO
CONCEPTUALIZE THESE CATEGORIES
AS SELF-REPORT ALLOWING PEOPLE
TO PUT THEMSELVES INTO CATEGORY
THAT BEST FITS AND I BET PEOPLE
IN AUDIENCES KNOW BETTER THAN I
DO AND THERE IS REALLY EXCITING
DATA ON DEGREE TO WHICH US
SOCIETY IS BECOMING MORE AND
MORE MULTIRACIAL EVERY YEAR AND
ANTICIPATE A TIME IN THE NOT TOO
DISTANT FUTURE WHERE CURRENT
CATEGORIES COULD BE SOMEWHAT
HELPFUL AND EXISTING LITERATURE
IS MOSTLY BASED ON AND TIME
WHERE THEY SEEM WILDLY
INADEQUATE TO CAPTURE INDIVIDUAL
PEOPLES CONCEPTIONS OF RACIAL
AND ETHNIC BACKGROUNDS AND MIGHT
BE GETTING TO THAT TIME FAIRLY
QUICKLY.
>>.
>>WHAT HE SAID.
NO. SO EDWIN PROBABLY DOING
SOME FOREMOST WORK ON THIS TOPIC
RIGHT NOW AS IT RELATES TO
EPIGENETICS BEING BIOLOGICAL
MANIFESTATION OF RACE AS A
SOCIAL CONSTRUCT IN AMERICA AND
ALL STRESSFUL EXPERIENCES THAT
COULD BE EXPERIENCED THEREIN
BECAUSE OF THAT I THINK YOU
COULD LOOK AT LITERATURE OVER
LAST 10 YEARS AND PRETTY
RENOWNED GENETICISTS SAYING RACE
IS NOT GOOD PROXY FOR GENETIC
VARIABILITY ACROSS HUMANS
LENDING CREDENCE TO FACT THAT
RACE IS A SOCIAL CONSTRUCT AND
DISCRIMINATION AND ZIG
MATIZIZATION MANIFEST IN SKIN
COLOR AND HAIR TEXTURE AND
CULTURAL DIFFERENCES THAT AGAIN
GENERALIZED INTO YOU ARE THAT
PERSON VERSUS THAT PERSON AND
INTERESTINGLY ENOUGH, IF YOU
LOOK AT LOTS OF -- RELATED TO
PAIN YOU CAN LOOK AT ADULT
LITERATURE SEEING BLACK AND
WHITE INDIVIDUALS SHOW PAIN
SENSITIVITY; RIGHT?
WHY IS THAT?
MIGHT BE REFLECTION OF SOCIAL
THREAT HARKENING BACK TO THE
TALK I GAVE OVER THE YEARS AND
OFTEN TIMES LOOKING AT SAME
TYPES OF STUDIES NOT MANY OF
THEM AND CHILDREN YOU DON'T SEE
THOSE DIFFERENCES AND OVER YEARS
CUMULATIVE EXPOSURE TO SOCIAL
ASPECTS BEING RACIAL ALLEY
MINORITIZED BASED ON WHATEVER
IDENTITY YOU HAVE THERE YOU WILL
START TO SEE EPIGENETIC
TRANSFORMATIONS THAT IS REALLY
WHEN I GREW UP IS IT NATURE OR
NURTURE AND NATURE VIA NURTURE
AND IN THIS INSTANCE IF NOT
NURTURE IT IS A THREAT AND
NATURE VIA THREAT WILL MANIFEST
EPIGENETIC CHANGE RS TO
RESILIENCE HEALTH AND BIOMARKERS
THERE ALLOSTATIC LOAD AND TELLO
MERACE ACTIVITY AND WILL HEAR A
LITTLE ABOUT THAT.
WHEN PEOPLE STUDY BIOLOGICAL
ASPECTS OF BIOPSYCHOSOCIAL MODEL
IN CONTEXT OF PAIN DISPARITY NOT
FUNCTION OF INNATE BIOLOGICAL
DIFFERENCES CONSEQUENCES OF
DISPARATE SOCIAL ENCOUNTERS
PEOPLE HAVE OVER THE YEARS AND
BECAUSE OF THAT ARE MORE
INFLAMED OR EP GENETICALLY ARE
MORE VULNERABLE OR SOMETHING
LIKE THAT. MAKE SENSE?
OKAY. ANYTHING ELSE TO SAY TO
THAT? NO? NAILED IT?
VERY GOOD.
>>WE ARE GETTING NEAR END OF
OUR TIME. I WANT TO GIVE EACH
OF YOU THE OPPORTUNITY TO LEAVE
OUR AUDIENCE BOTH HERE AND
ONLINE WITH A FINAL THOUGHT
ABOUT THE ISSUES OF DISPARITIES
AND RESILIENCE AND PAIN.
CHRISTINE, WOULD YOU START?
>>SURE.
>>LET'S GO.
>>THIS IS AN AREA THAT NEEDS A
LOT MORE STUDY.
THIS, I THINK, GIVES ME HOPE
THAT WHATEVER WE ARE LEARNING AS
A RESULT OF SORT OF WHAT
CHARACTERISTICS SEEM TO BE
IMPACTFUL FOR PEOPLE
EXPERIENCING CHRONIC PAIN AND
OPPORTUNITY TO THINK ABOUT HOW
REGARDLESS WHERE SOMEONE IS ON
THEIR AGE CONTINUUM, THEY CAN
BENEFIT FROM SOME INTERVENTIONS
AND FINDINGS THAT WE ARE
LEARNING EVERY DAY THROUGH THIS
SHARED WORK AND I'M EXCITED,
ACTUALLY, WAY MORE THAN I WAS AS
A CLINICIAN 10 TO 15 YEARS AGO
ABOUT WHAT WE CAN DO SUPPORTING
PEOPLE WITH CHRONIC PAIN ACROSS
THE ENTIRE AGE SPECTRUM.
>>IN A VERY HYPERPOLARIZED
UNITED STATES IN 2023, MEDIA IS
RIFE WITH ISSUES RELATED TO RACE
AND IMMIGRATION STATUS AND LGBTQ
AFFILIATION AND ADAMANT PEOPLE
ON BOTH SIDES OF EVERY ARGUMENT
AND WANT TO SAY MENTIONING THAT
BECAUSE DISPARITIES ARE BORN
THEREIN AND AT END OF THE DAY WE
ARE PEOPLE AND HAVE TO TAKE CARE
OF EACH OTHER AND DOESN'T MEAN
WE ALWAYS HAVE TO AGREE WITH
WHAT YOU SAY OR I SAY AND IF I
AGREE WITH EVERYTHING YOU SAY,
WE SHOULD TAKE INVENTORY WHAT IS
GOING ON HOOER AND POINT BEING
IS WE ARE PEOPLE WHO NEED TO
TAKE CARE OF EACH OTHER AND MORE
INTEREST IN HELPING OUT BROTHERS
AND SISTERS I THINK THE WORLD
WOULD BE IN A MUCH BETTER PLACE
AND HOPEFULLY WE CAN GET THERE
AND AT END OF THE DAY LET'S TAKE
CARE OF EACH OTHER.
>>THAT IS REALLY WELL-SAID. I
WILL KEEP IT
UNCHARACTERISTICALLY SHORT.
DISPARITIES AND PAIN HAVE BEEN
WIDESPREAD AND PERVASIVE FOR AS
LONG AS WE HAVE BEEN MEASURING
THEM AND MADE A LITTLE PROGRESS
IN REDUCING THEM AND ONLY A
LITTLE NOT ENOUGH AND NOT NEARLY
FAST ENOUGH. WE MIGHT HAVE AN
OPPORTUNITY NOW TO FOCUS ON
DEVELOPING AND REFINING AND
ADAPTING RESILIENCE BUILDING
INTERVENTIONS THAT WILL BE A
CHANGE FROM WAY WE HAVE DONE
THINGS IN THE PAST FOCUSING
ENTIRELY ON RISK AND THAT NOVEL
FOCUS ON RESILIENCE BUILDING
INTERVENTIONS IN ADDITION TO
HELPING ALL OUR PATIENTS MAY
ACTIVELY HELP TO REDUCE
DISPARITIES HAVING MOST
BENEFICIAL EFFECTS IN MOST
DISADVANTAGED SAMPLES OF PEOPLE
THAT NEED IT MOST AND IS A
REALLY EXCITING TIME TO WORK IN
THIS AREA.
>>THANK YOU ALL SO MUCH AND
THANK YOU FOR YOUR QUESTIONS.
WE REALLY APPRECIATE THEM.
I THINK THAT WE NOW BREAK FOR
LUNCH; CORRECT?
SO, FOR THOSE OF YOU WHO ARE NOT
HERE, PLEASE ENJOY YOUR LUNCH.
FOR THOSE HERE, WE ARE NOW GOING
TO BE ON BREAK. WE WILL SEE YOU
BACK!
>>AUDIENCE: [APPLAUSE].
>>>>THANK YOU VERY MUCH TO THE
AUDIENCE AND KAREN. YOU
IMPRESSIVELY KEPT US ON TIME.
SCHEDULE SAYS LUNCH IS AT 12:10
AND IT IS CURRENTLY 12:10.
>>STRONG WORK!
>>[LUNCH BREAK].
>>SO, MOST PREVALENT THEME IS
REPORTING SUPPORT FROM OTHERS
AND SOMETIMES IS MORE PUSHING
SUPPORT AND MOTIVATIONAL PIECE
THEY GET FROM FAMILY AND FRIENDS
AND OTHER TIMES IS SUPPORTING
IDENTIFIED UNDERSTANDING THAT IS
UNDERSTANDING WHAT THEY ARE
GOING THROUGH AND HOW HARD IT IS
TO DO IT AND OTHER TIMES IT IS
ACTUALLY HAVING SOMEONE DO
ACTIVITY WITH THEM AND FRIEND OR
FAMILY MEMBER TO ENGAGE IN
ACTIVITY AND MADE THEM
[INDISCERNIBLE].
PARTICIPANTS TALK ABOUT ALSO
VALUE IN ACTIVITY AND
UNDERSTANDING WHY THEY DO IT AND
THAT IT IS IMPORTANT AND
IDENTIFYING WITH THAT PIECE.
PERHAPS THAT IS AWESOME AND
HELPS WITH MOTIVATION ASPECT.
UNDERSTANDING ALSO DOING THESE
ACTIVITIES IS NOT ONLY PART OF
THE TREATMENT AND DOG THEM TO
GET BETTER AND HAVING THAT
ENGAGEMENT AND IS VALUES PIECE
THAT SHOWS THROUGH AND TALK
ABOUT ACKNOWLEDGING SMALL WINS
AND GOALS ASSOCIATED WITH THESE
THINGS AND CHRONIC PAIN COULD BE
A LONG JOURNEY RECOGNIZING SMALL
GOALS ALONG THE WAY HELP
RECOGNIZING THINGS THAT MAYBE
THEY COULDN'T DO BEFOREHAND BUT
COULD NOW AND RECOGNIZING BEING
AWARE AT TIMES THAT PAIN IS NOT
AS SEVERE AS IT ONCE WAS AND
ALSO KNOWING IT CAN STILL BE
[INDISCERNIBLE] DOING SOME OF
THESE THINGS SECOND TO THAT IS
ASSOCIATED LONG TERM BEING AND
KEEPING GOING IN LONG-TERM
MOMENT AND GOING FORWARD AND
BETTER UNDERSTANDING WHERE THEY
ARE GOING AND WHAT THEY ARE DOG
AND GOOD O- OUTCOME AND NO ONE
HELPFUL AND BENEFICIAL FOR THEIR
HEALTH AND PAIN AND MOOD AND ALL
THAT STUFF.
PARTICIPANTS ALSO DISCUSS
UNDERSTANDING A CONNECTION
BETWEEN PHYSICAL ACTIVITY AND
MOOD AND PAIN. MORE THAN JUST
DOING ACTIVITY BECAUSE THAT IS
HOW THAT IS IN A MORE STRICT
MANNER AND BETTER UNDERSTANDING
HOW IT PLAYS INTO THE BROADER
OPTION AND HOW IT EFFECTS MOOD
AND EFFECTS MENTALITY AND EVEN
IF THEY DON'T WANT TO DO IT,
UNDERSTANDING HOW THAT IS WITH
THEIR MOOD AND DOING SOME OF
THESE THINGS ANYWAYS AND
ATTITUDE AND SAYING HOW IT
EFFECTS THEIR ASPECT AND
ATTITUDE AND SOMETHING THEY DEAL
WITH EVERY DAY AND ALL THESE
THEMES CAN BE DRAWN UPON I THINK
TO BE HELPFUL FOR FUTURE
INTERVENTIONS THAT ARE IN
ADDITION TO SOME MORE
ACCEPTANCE-BASED COMMUNITY
THERAPIES AND PIECES COMING MORE
COMMON AND INTERVENTIONS AND
ALSO THINKING ABOUT HOW THESE
THIJS APPLY TO ENGAGEMENT
SPECIFICALLY.
THANK YOU.
>>I'M SARA BROWN AND POST
DOCTORAL SCHOLAR AT UNIVERSITY
OF PITTSBURGH AND RESEARCH
EXAMINES OVERLAP BETWEEN SOCIAL
AND PHYSICAL PAIN INFLUENCES
SUICIDE RIFSHG AND PAIN OVERLAPS
THEORY SUGGESTING SOCIAL AND
PHYSICAL PAIN SHARE NEURAL
STRUCTURES HAVE COMMON
MECHANISMS INDUCE REDUCTION AND
OTHERS AND ARE INFLUENCED BY
OTHER FACTORS.
WHERE SEVERE INSULTS ARE CHRONIC
SOCIAL EXCLUSION LEADS TO
ALTERATION IN SYSTEM MALADAPTIVE
RESPONSE INCREASED RISK SUICIDE
IDEATION AND ENGAGE IN BEHAVIORS
AND TESTING PROPOSED MODEL
STUDYING ONE FOUND PARTIAL
SUPPORT FOR MODEL AND ACUTE
EXCLUSION BE RESULT IN GREATER
DEATH AND PAIN SENLSTIVETY AND
GREATER INTENTIONAL BUYASES
TOWARDS SOCIAL EXCLUSION AND
RESPONSES WOULD BUFFER AGAINST
SUICIDE RISK AND STUDY 2 I
EXAMINED REPEATED REJECTION IS
ASSOCIATED WITH MALADAPTIVE
COGNITIVE AND AFFECTIVE
HYPERSENSITIVITY INCREASING RISK
SUICIDE IDEATION AND FOUND
REJECTION SENSITIVITY THAT IS
POSITIED DUE TO REPEATED
EXPOSURE TO REJECTION IS
ASSOCIATED WITH SUICIDE IDEATION
THROUGH GREATER FEELINGS OF
BELONGING AND PERCEIVED BURDEN
AND STUDY 3 IN ONGOING STUDY IN
F32 ST
>>ADDITIONALLY, WHILE SICKLE
CELL PATIENTS ARE KNOWN TO HAVE
HIGHER SENSITIVES NOT JUST
STIMULI DATA SHOWS PATIENTS HAVE
REDUCED SENSITIVITY ARE
PARTICULARLY FOR COLD AND
PRESSURE PAIN AND HIGHER
SENSITIZATION AND CONTROL IN
POST CT PATIENTS MAY INDICATE
POTENTIAL MECHANISM FOR PAIN
PERSISTING APTITUDES OF CLARITY
AND FUTURE DIRECTIONS INCLUDE
LONGITUDINAL DURATION OF SICKLE
CELL PATIENTS FOR CURATIVE
THERAPY TO BETTER UNDERSTAND
DISPOSITIONS OF THIS PAIN.
>>BEHAVIORS AND SENSORY
EXPERIENCES ARE CLOSELY LINKED
AND BEHAVIOR ASSOCIATED WITH
SENSORY EXPERIENCES ENGAGING
WITH SENSORY EXPERIENCES IS
BEHAVIOR AND MAKING REASONABLY
-- ANIMALS MUST BE ABLE TO DO
COSTS AND BENEFITS THAT
EXPERIENCE REPRESENT.
COMPUTING AND COMPARING
SUBJECTIVE VALUES FOR EACH
SENSORY EXPERIENCE AND THEORY
GOES ON TO STATE NEURAL
MECHANISMS UNDERLYING VALUES
SHOULD BE DOMAIN GENERAL TO
COMPARISONS ACROSS DIFFERENT
STIMULI AND NOTABLY CLAIMS OF
MOTIVATIONAL EXPERIENCES SUCH AS
PLEASANTNESS AND UNPLEASANTNESS
ARISE FROM VALUATIONS AND
EFFECTIVE MOTIVATION OF ASPECTS
OF SENSATION EMERGE AND IF TRUE
THEORY MAY HAVE MAJOR
IMPLICATIONS FOR UNDERSTANDING
AND TREATMENT OF CHRONIC
OVERLAPPING CONDITIONS THAT ARE
AMPLIFIED BY MANY EXPERIENCES OF
STIMULI AND PAIN AND PHYSICAL
EFFORT AND THEORY REMAINS
LARGELY TESTED AND STUDY WE
TESTED THEORY BEHAVIORALLY
ASSESSING CORRELATION OBJECTIVE
HEAT PAIN AND OBJECTIVE
EVALUATION OF PHYSICAL EFFORT
AND THIS PREDICTS THEY BE
CLOSELY CORRELATED HEAT PAIN 13
HEALTHY VOLUNTEERS -- EACH
ADMINISTERED 18 NOXIOUS HEAT
IMPULSES RATED EFFECTIVE
MOTIVATIONAL UNMREZANTNESS AND
DISCRIMINATIVE INTENSITY
COMPONENTS OF ANALOG SCALES
RATINGS TO CREATE SINGLE
INTENSITY VARIABLE AND SINGLE
UNPLEASANTNESS VARIABLE AND
EFFORT VOLUNTEERS UNDERWENT
EFFORT EXPENDITURE AWARDS TASK
REPEATEDLY CHOSE PERFORMING EASY
TASK FOR SMALL FIXED CASH REWARD
AND HARD TASK FREE OF LARGE
VARIABLE CASH REWARD AND
SUBJECTIVE VALUE EFFORT THAT IS
LOW TO SAY EFFORT IS CHEAP
CHOOSE TO DO HARD TASKS FOR
THOSE WHOSE EFFORT IS COSTLY AND
ESTIMATED EQUATION MODELS
AVERAGE -- PREDICTED PROBABILITY
THAT VOLUNTEERS CHOOSE HARD TASK
FOR GIVEN TRIAL AND REWARD
CONSISTENT WITH PREDICTIONS PAIN
UNMREZANTNESS IN GREEN AND PAIN
INTENSITY IN ORANGE DID NOT AND
IN SUMMARY GREATER EXTENT TO
WHICH PEOPLE FOUND HEAT PAIN TO
BE UNPLEASANT MORE THEY NEED
TODAY PA I TO PER FORM
PHYSICALLY EFFORTFUL TASK AND
SUPPORT FOR EXISTENCE OF
AFOREMENTIONED SYSTEM AND THIS
BY NO MEANS REPRESENTS
DEFINITIVE PROOF AND BELIEVE
THAT INVESTIGATION IS WARRANTED.
>>I'M SAMANTHA AND PAIN
PSYCHOLOGY AT HOSPITAL AND
ASSISTANT PROFESSOR AT HARVARD
MEDICAL SCHOOL AND WILL TELL YOU
TODAY ABOUT A PROJECT WE FOUND
TREATING NEGATIVE AFFECT AND
CHRONIC PAIN REDUCES HEALTH
RELATED STIGMA IN PATIENTS WITH
CHRONIC LOW BACK PAIN EXPERIENCE
HIGH LEVELS OF NEGATIVE AFFECT
AND THOSE THAT DO REPORT GREATER
PAIN AND WORSE TREATMENT
OUTCOMES AND ARE AT RISK FOR
OPIOID MISUSE AND THEY ARE MORE
LIKELY TO EXPERIENCE STIGMA AT
INTERSECTION OF PAIN AND MENTAL
HEALTH AND OPIOID YOUTH. WE
CAPITALIZED ON RANDOMIZED
CLINICAL TRIAL TO EXAMINE
TREATMENT RELATED CHANGES OVER
TIME IN INTERSECTIONAL HEALTH
RELATED STIGMA IN PATIENTS WITH
CHRONIC LOW BACK PAIN AND HIGH
NEGATIVE AFFECT AND STUDY HAS
GOAL OF 250 PARTICIPANTS
RECRUITMENT AND DATA COLLECTION
IS ONGOING AND GIVING PEAK AT
RESULTS FOR [INDISCERNIBLE]
SAMPLE IS WHITE AND NON-HISPANIC
AND 25% ARE OPIOID MEDICATION
PRESCRIBED AND PATIENTS
COMPLETED 16 WEEKS OF
ANTIDEPRESSANT OPTIMIZATION AND
REHABILITATION OR E FAR OR
COMBINATION OF TWOT AND THOSE IN
ANTIDEPRESSANT GROUP RECEIVED
[INDISCERNIBLE] FOR EXAMPLE THIS
INCLUDES INCREASED DOSE
AUGMENTATION WITH ADDITIONAL
MEDICATION OR COMPLETE CHANGE IN
REJIMMEN AND PARTICIPANTS
INTERACTED WITH PAIN
PSYCHIATRIST EVERY 2 TO 4 WEEKS
AND IN EFAR GROUP RECEIVED 845
MINUTE PHYSICAL AND OCCUPATIONAL
THERAPY SESSION THAT INCLUDED
GREAT EXPOSURE EXERCISE PAIN
EDUCATION MOTIVATIONAL
INTERVIEWING AND USE OF
SMARTPHONE APP AND D- --
PARTICIPANTS CONTINUED STIGMA AT
BASELINE 8 TO 6 WEEKS AT START
OF TREATMENT AND USING VALIDATED
MEASURE OF STIGMA AND
INTERNALIZED STIGMA AND
SELF-STIGMA AND PERCEIVING
PUBLIC STIGMA SCALE MENTAL
HEALTH STIGMA AND SCALE STIGMA
RELATED OPIOID USE THAT IS USED
FOR OPIOID ABUSE ADJUSTING
LANGUAGE TO RECEIVE PRESCRIPTION
OF ADVERSE TERMINOLOGY AND ALSO
PARTICIPANTS TAKING OPIOIDS
PERCEIVE HARM SCALE TO THIS
MEASURE PARTICULARLY THOSE USING
THE MEDICATION. WE CONDUCTED
MIXED MODEL ANOVA TO LOOK AT
MAIN EFFECTS OF TIME COMPARING
ALL THREE TEMPLATES.
AND THEN WE ALSO EXAMINE
INTERACTION OF TIME AND
TREATMENT TO SEE IF THERE ARE
DIFFERENCES IN CHANGE IN STIGMA
ACROSS THREE TREATMENT GROUPS.
WE FOUND THAT CHRONIC PAIN AND
MENTAL HEALTH RELATED STIGMA
IMPROVED OVER TIME AND THERE
WERE NO INTERACTIONS WITH
TREATMENT GROUPS.
THAT IS STIGMA DECREASES
SIMILARLY ACROSS ALL THREE
TREATMENT GROUPS.
FOR OPIOID RELATED STIGMA WE SAW
IMPROVEMENT IN AWARENESS OF
OPIOID RELATED STIGMA ONLY FOR
THOSE PRESCRIBED OPIOID
MEDICATION OTHERWISE WERE NO
CHANGES.
BECAUSE THERE WAS NO GROUP
DIFFERENCES OR INTERACTIONS
BETWEEN GROUPS AND TIME, WE
COMBINED DATA FROM ALL THREE
TREATMENT GROUPS IN GRAPHS THAT
ARE PRESENTED HERE TO MAKE DATA
A BIT MORE CLEAR. STICKING
TOGETHER, RESULTS SUGGEST THAT
PARTICIPATION IN THIS RESEARCH
STUDY RESULT IN IMPROVEMENTS IN
PAIN AND HEALTH-ELATED STIGMA
AND TREATMENT SPECIFIC EFFECT
LIKE WE MIGHT HYPOTHESIZE WE
INSTEAD ARE LIKELY SEEING EFFECT
OF NONSPECIFIC FACTORS
INTERACTING WITH STUDY STAFF AND
PROVIDER WHERE'S NORMALIZATION
OF PAIN AND MENTAL HEALTH AND
ALSO IN LOOKING AND IN FUTURE
WOULD BE IMPORTANT TO EXAMINE
HOW TYPES OF STIGMA INTERACT TO
PROTECT PAIN EXPERIENCE AND
TREATMENT OUTCOMES AND IMPORTANT
TO EXPLORE FINDINGS IN
MARGINALIZED GROUPS TO EXAMINE
EFFECTS OF OTHER TYPES OF
STIGMA.
THANK YOU.
>>HELLO. THE GOAL OF MY WORK
IS TO UNDERSTAND HOW MOTOR
CORTEX STIMULATION INDUCES
[INDISCERNIBLE] WORKS USING
ANIMAL MODELS AND MICE
SPECIFICALLY TO IMPROVE
PROTOCOLS THAT ARE THEN USED IN
HUMANS.
SO, FIRST I WANTED TO UNDERSTAND
WHERE IN THE MOUSE MOTOR CORTEX
TO STIMULATE INDUCING PAIN IN
PART OF THE FACE AND LOOKED FOR
WHERE THERE IS INCREASE IN
NEURAL ACTIVITY USING A CENSOR I
CAN IMAGE INDIVIDUAL NEURONS
ACTIVITY AND HOPEFULLY YOU CAN
SEE IN THE RESOLUTION INDIVIDUAL
NEURONS RUN ACROSS THE DORSAL
SURFACE OF MOUSE MOTOR CORTEX
AND MOST NEURONS IN MOTOR CORTEX
WERE ACTIVE IN SALINE AND
SPECIFICALLY IN REGION OF MOTOR
CORTEX AND M2 REGION WE SAW LOTS
MORE ACTIVITY AND WHERE I HAVE
MY STIMULATION AND I USED
TRIGEMINAL NEUROPATHIC PAIN
MODEL THEN I USED FILAMENT
THROUGHOUT TO DETERMINE OR INFER
PAIN STATE OF THE INDIVIDUAL AND
EACH TREATMENT IS FIVE MINUTES
LONG AND MEASURED THRESHOLD AND
TREATMENT AND DEVELOPED COIL
WITH IMPORTANT FEATURE WHERE
MAGNETTIVE FIELD IS MAGNITUDE TO
HUMANS AND NARROW AND IN MOUSE
AND COULD INDUCE MOVEMENT AND
AFTER THE INJURY STATE OR MICE
IN CHRONIC INJURY STATE AND
INNOCUOUS BEHAVIORS AND TOUCH
AND TEMPORARILY REDUCED IN MICE
RECEIVING 75 OR 50% TMS
TREATMENT FOR ONE WEEK BEFORE IT
STARTED TO CREEP BACK UP AND YOU
SEE INDIVIDUAL MICE EFFICACY
SCORES AND SEE BEFORE AND AFTER
OF EACH STIMULATION IN EACH
MOUSE PER TREATMENT TYPE AND IN
MICE WITH OPIOID RECEPTOR
KNOCKOUTS THEY CHANGED
SUGGESTING THAT THE RECEPTOR IS
REQUIRES AND LOOK AT AREAS
INVOLVING ENDOGENOUS OPIOID
SIGNALING IMPORTANT FOR PAIN AND
SETTLED ON PAIN CONTROL CIRCUITS
LOOKING AT ROSTER MEDULLA AREA
TO PREVENT PAIN AND STARTED TO
LOOK AT MODULATING TONE AND 5
MINUTES INTO RBM BEFORE THE
TREATMENT NALOXONE INTO THIS
BLOCKED EFFECTS AND
NOREPINEPHRINE ENHANCED AND
TAKING THESE AREAS NEUROPICHLEL
PROBES AND PHYSIOLOGICAL PROBES
IDENTIFYING IN OFF CELLS HAVE
FIBROID DECREASE DURING PAIN
STIMULUS AND COMPARED FIRING OF
NEURON ACROSS RETENTION OF TMS
AND READ OUT COMPARED TO HUMAN
POPULATION AND THANK YOU FOR MY
FUNDING. THANKS VERY MUCH.
>>HI. WE ARE INTERESTED IN
UNDERSTANDING CHRONIC PAIN
MECHANISMS SPECIFICALLY EARLY
LIFE IMMUNE ACTIVATION PRENATAL
EXPOSURE CAUSES LONG-LASTING
CHANGES FROM IMMUNE FUNCTION AND
NEGATIVELY IMPACT CHRONIC PAIN.
ALTHOUGH PAIN RESILIENCE HAS
BEEN THOUGHT TO BE REGULATED BY
NUMBER OF PSYCHOLOGICAL FACTORS
WE APPRECIATE THAT NEUROIMMUNE
AND NEUROENDOCRINE FUNCTION CAN
PLAY A VERY IMPORTANT ROLE IN
PAIN RESILIENCE AND PROCESS OF
PAIN RECOVERY THAT IS VERY
IMPORTANT TO RECOGNIZE THAT
THERE COULD BE CLINICAL
PUBLICATION FOR RISK OF
NEUROIMMUNE FUNCTION AND POOR
NEURORECOVERY EXPOSED TO ALCOHOL
THROUGHOUT PREGNANCY AND WHEN
OFFSPRING ARE BORN WE WAIT UNTIL
THEY ARE ADULTS AND EXPOSE THEM
TO MINOR CHRONIC CONSTRUCTION
INJURY OF SCIATIC NERVE THAT IS
MINOR ENOUGH THAT MINIMIZED
INJURY DOESN'T REALLY CAUSE ANY
ALODEANIA IN NON-PA CONTROLLED
ANIMALS AND NOW SEE THERE IS
INCREASED SENSITIVITY TO LIGHT
TOUCH ONLY IN PRENATAL ALCOHOL
EXPOSED ANIMALS SO THEY DEVELOP
ALODEANIA FOR TWO WEEKS BEFORE
THEY SPONTANEOUSLY RESULT AND
WHAT IS MORE INTERESTING IS THAT
IF WE TREAT THIS MICE WITH MOR
TEEN AND STANDARD PAIN
THERAPEUTICS WE SEE ALODEANIA IS
SIGNIFICANTLY PROLONGED FOR A
COUPLE MORE WEEKS IN THIS PA
ADULT MICE AND IN OUR LAB WE ARE
VERY INTERESTED IN UNDERSTANDING
WHY MORPHING TREATMENT WOULD
FURTHER PROLONG ALODEANIA UNDER
PA CONDITIONS AND WE SUSPECT
THERE IS POSSIBLY INCREASED TLR4
SIGNALING IN PRESENCE OF
MORPHINE ON PE-PRIMED GLIAL
IMMUNE CELLS AND BELIEVE THERE
IS SIGNIFICANTLY UNIQUE PATTERN
OF NONCODING CIRCULAR RNA
EXPRESSION IN SPINAL CORD IN
ALODEANIC MICE COMPARED TO
NONALODEANIC MICE AND
INTERESTINGLY THESE ARE ENRICHED
WITH GENES TO [INDISCERNIBLE]
ACTIVATION AND WE BELIEVE THAT
EARLY LIFE CIRCULAR MODULATION
COULD ACTUALLY DRIVE TLR4
SIGNALING PATHWAYS SUCH THAT
MORPHINE TREATMENT FURTHER
PROLONGS ALODEANIA IN PLE MICE
AND BELIEVED THAT CIRCLE COULD
BE NOVEL THERAPEUTICS TO
REGULATE NEUROIMMUNE DISFUNCTION
AND IMPROVED RECOVERY FROM
CHRONIC PAIN AND HAPPY TO TALK
ABOUT THAT AT E-MAILS OR AT MY
POSTER.
>>SEVERE FORM OF PAIN
IMAGINABLE AND GENERATIONS
TISSUE AND NERVE DAMAGE AND
INDUCES INFLAMMATION RESULTING
IN REMARKABLY HIGH LEVELS OF
MECHANICAL AND NEUROLOGICAL AND
INFLAMMATORY PAIN AND HERE WE
ARE USING MODEL TRAUMATIC BURN
INJURY WE DEVELOPED BASED ON
MODEL CHARACTERIZED HERE BY DR.
FALLER AT ALL YOU CAN SEE A
SMALL BURN ON THE HIENTD PAW
RESULTING IN FULL THICKNESS
INJURY EXTENDING THROUGH TO
EPIDETERMINUS AND INTO
DETERMINIS AND PREGRESSION OF
DEVELOPMENT OF ALODEANIA AND
HYPERGEEZIA IS CHARACTERIZED IN
MODEL AND MALE RATS HERE AND
EXPANDING CHARACTERIZATION TO
INCLUDE FEMALES YOU CAN SEE HERE
AND RELEVANT TO BURN PAIN AND IN
RECENT STUDIES SHOW 32% OF WOMEN
COMPARED TO 5% OF MEN HAVE
SEVERE CHRONIC PAIN ONE YEAR
AFTER INJURY AND INTERESTING TO
SEE HOW SEVERITY AND DURATION OF
PAIN DIFFER BETWEEN SEXES WITHIN
THIS MODEL.
NOW, IN EFFORT TO PRODUCE BETTER
MODELS IS NOT ONLY IMPORTANT TO
CHARACTERIZE TRADITIONAL
ASSESSMENTS AND ARE INTERESTED
IN CHANGES OF NONEVOKED SCIENCES
OF PAIN AND BEGINNING WITH GAIT
ASSESSMENT AND BLUE BOXES GAIT
OF RAT WITH BURN ON --
THIS IS EVIDENT IN TIME SPENT
WITH EACH PAW TOUCHING ON
SURFACE AND DISTRIBUTION OF
FORCE BETWEEN EACH PAW AND STEP
CYCLE AND ANALYZING GAIT CAN
IDENTIFY VERY SENSITIVE MEASURES
OF PANE THAT ARE PRELIMINARY
DATA AND SEE IN THE CHANGE OF
IRREGULARITY OF STEP SEQUENCE ON
FAR LEFT IS EARLY INDICATOR OF
PAIN SHOWING UP WITHIN 24 HOURS
THAT IS BEFORE ANY EVOKED
RESPONSES THAT ARE MECHANICAL
AND ALODINIA AND THERMAL
HYPERALGEEZIA HAD SHOWN UP AND
IN MIDDLE SEE SWING SPEED SHOWS
UP EARLY AND ENDS UP LASTING
ABOUT AS LONG AS EVOKED MEASURES
AND ON RIGHT-HAND SIDE THE AREA
OF THE POD USED WHILE WALKING IS
A SENSITIVE INDICATOR OF PAIN
THAT STARTS EARLY AND ACTUALLY
EXTENDS PAST THE TIME THAT
EVOKED MEASURES WILL BE
INDICATIVE OF PAIN.
SO, THIS IS THE FIRST IN SEVERAL
MEASURES WE USE TO HOPE TO
EMPLOY TO GAIN A BETTER
UNDERSTANDING OF THE EXPERIENCE
OF BURN PAIN IN MALES AND
FEMALES.
THANK YOU FOR YOUR TIME.
>>ALMOST EVERYONE WILL
EXPERIENCE PAIN AT SOME POINT
DURING THEIR LIVES AND MANY OF
US PAIN WE EXPERIENCE IS SHORT
LIVED AROUND 1 IN 5 PEOPLE IN
UNITED STATES REPORT LIVING WITH
CHRONIC PAIN. PAIN AND ALCOHOL
USE OFTEN CO-OCCUR WITH ROUGHLY
HALF OF INDIVIDUALS WITH ALCOHOL
USE DISORDER THAT IS REPORTING
CHRONIC PAIN AND 1/4 OF
INDIVIDUALS WITH CHRONIC PAIN
REPORT SELF-MEDICATING WITH
ALCOHOL AND ADDITIONALLY
INCREASED PAIN FREQUENCY IS
ASSOCIATED WITH DIAGNOSIS OF
ALCOHOL USE DISORDER AND
FINDINGS HIGHLIGHT STRONG
RELATIONSHIP BETWEEN ALCOHOL
MISUSE AND PAIN AND SUGGEST THAT
RELATIONSHIP BETWEEN PAIN AND
ALCOHOL MISUSE MIGHT BE
BIDIRECTIONAL WITH ALCOHOL
CONSUMPTION OCCURRING WITH
RESPONSE TO PAIN AND INCREASED
PAIN SENSITIVITY RESULTING IN
CHRONIC HEALTH USE AND
WITHDRAWAL.
PREFRONTAL CORTEX IS KEY NOTE
FOR INTEGRATING PAIN ELATED
INFORMATION EXERTING TOP-DOWN
CONTROL OVER PAIN RELATED
SIGNALING NEURONS -- TO
PERIOUTPUT DUCTIAL -- INPUT TO
PRELIM BIK CORTEX FOR BASAL
LATERAL AMYG DOULA NEURONS --
ACTIVATING FAST SPIKING
INTERNEURONS MY RESEARCH USED
PRECLINICAL RAT MODELS TO STUDY
EFFECTS OF INTERMITTENT ALCOHOL
EXPOSURE ON ADOLESCENCE ACTIVITY
ON ADULTHOOD AND EXPOSURE IN
ALCOHOL AND ADOLESCENCE IN
CONJUNCTION WITH PAIN IN
ADULTHOOD -- BASAL LATERAL AND
AMYGDALA NEURONS AND
FACILITATING STUDY OF CHANGES IN
CIRCKITTRY IT IS EXPRESSIONED IN
BASAL NEUROAMYGDALA.
BEGINNING IN ADOLESCENCE AND
CONTINUING INTO ADULTHOOD.
SURPRISINGLY, INCREASED ALODINIA
IN RESPONSE TO CARO GENIN
INFLAMMATORY PAW CHALLENGE WAS
NOT POE 10 SHEEATED BY
ADOLESCENT ALCOHOL EXPOSURE AND
ENHANCED RATIO OF POLYSYNAPTIC
OPTOGENETICALLY ABOUT EXCITATORY
TO INHIBITORY NEUROTRANSMISSION
TO PRELIM BIK NEURONS WHILE
DECREASING RATIO AT PRELIM BIK
ALBUMIN OF FAST-SPIKING
INTERNEURONS AND CHANGES COULD
INDICATE ADOLESCENT PROJECTING
TO PERIAQUAD DUCTAL
[INDISCERNIBLE] AND INCREASE TO
INCREASED -- OBSERVED FOLLOWING
ADOLESCENT ALCOHOL EXPOSURE.
>>OSTEOARTHRITIS IS DEFINED AS
JOINT DISEASE EFFECTING MILLIONS
OF PEOPLE WORLDWIDE AND KNOW
THAT IT DOESN'T ONLY EFFECT
JOINT BUT HAS MULTI-FACTORIAL
NATURE THAT EFFECTS ENTIRE BODY
AND WHEN IMPACTS -- CMC JOINT
CAN LEAD TO PAIN AND DISABILITY
AND RESEARCH FOR SMALL AND
MOBILE JOINT OF THE HAND IS
LACKING.
IN THIS STUDY, WE EXPLORE HOW
INDIVIDUALS AT DIFFERENT RATE OF
GRAPHIC STAGES COMPARE
PSYCHOLOGICALLY AND DURING
EXPERIMENTAL PAIN AND
HYPOTHESIZE THAT INDIVIDUALS
WILL EXPERIENCE LOSS OF
SENSATION AND COMPARISON TO
INDIVIDUALS WITH STAGE HOA AND
BRIEFLY COLLECTED DATA FROM 31
MALE PARTICIPANTS BETWEEN AGES
OF 40 AND 90 YEARS OLD AND STUDY
INCLUDED WOMEN DUE TO HIGH
PREVALENCE OF CMCOA AND POST
MENOPAUSAL WOMEN AND CONTAIN
GRAPHIC IMAGES PORE PARTICIPANTS
AND CLASSIFIED TO SEE SEVERITY
BASED ON CLASSIFICATION.
>>PARTICIPANT: ANTS ASK TO
COMPLETE PSYCHOLOGICAL
ASSESSMENT QUESTIONNAIRES AND
QUANTITATIVE SENSORY TESTING OR
QST AND QST WE USE THERMAL AND
MECHANICAL STIMULI AT 7
DIFFERENT BODY SITES.
WHEN LOOKING AT SOME
PSYCHOLOGICAL ASSESSMENT RESULTS
WE FOUND THAT INDIVIDUALS WITH
END STAGE HOA REPORTED HIGHER
PAIN IN FUNCTIONAL DISABILITY IN
COMPARISON TO EARLY STAGE HOA
COMPARED TO INDIVIDUALS AND HAD
HIGHER SCORES FOR PAIN TO
[INDISCERNIBLE] QUESTIONNAIRE
IMPLYING THAT INDIVIDUALS WITH
EXPERIENCE MAY BE LIKELY OF
NEUROPATHIC ORIGIN AND QST THEY
WILL TRANSFORM USING EARLY STAGE
HOA AS A CONTROL AND RESULTS
SHOW PARTICIPANTS WITH END STAGE
HOA EXPERIENCE LOSS OF FUNCTION
SPECIFICALLY PERFORMING
PRELIMINARY COMPARISON USING
2-WAY SAMPLE T TEST DIFFERENCES
DURING DETECTION CALLED PAIN AND
HEAT PAIN THRESHOLDS AND LINEAR
MIXED MODELS WILL PERFORM ON
EXPERIMENTAL PAIN VARIABLES
CONTROLLING THE SUBJECT NATURE
OF ASSESSMENTS ACROSS MULTIPLE
BODY SITES AND SAW SEE SEVERITY
PROGRESSES INDIVIDUALS
EXPERIENCED HIGHER MECHANICAL
DETECTION AND LOWER COLD
DETECTION AND LOWER PAIN
THRESHOLDS AND FOUND SIGNIFICANT
INTERACTION BETWEEN AGE AND MOST
QST ASSESSMENTS AND THUS
DISTINGUISHING BETWEEN CHANGES
ATTRIBUTED TO AGING VERSUS THOSE
RELATED TO AN IS ALSO ESSENTIAL
AND IN CONCLUSION INTERVENTIONS
ADDRESSING PREFERENTIAL
SENSATION MIGHT BE BENEFICIAL
IMPROVING PAIN MOVEMENT IN
INDIVIDUALS WITH SMALL COA AND
SAMPLE SIZE SEEING PERIPHERAL --
THESE RESULTS HAVE IMPORTANT
IMPLICATIONS FOR DEVELOPMENT OF
MULTIMODAL APPROACHES TO
TREATING CMCA AND ADDRESSING
GAPS AND KNOWLEDGE WE IMPROVE
QUALITY OF CARE AND OUTCOMES FOR
INDIVIDUALS.
>>HELLO. I'M ELIZABETH AND
GRADUATE STUDENT IN LAB AT
COLUMBIA UNIVERSITY AND I WILL
DISCUSS OUR WORK ON NEW OPIOID
RECEPTORS ON SENSORY AND
AFFECTIVE COMPONENTS ON CHRONIC
NEUROPATHIC PAIN THAT IS A MAJOR
CAUSE OF DISABILITY THAT IS
CHARACTERIZED BY INCREASED
ALODINIA AND FIRST LINE
TREATMENT OPTIONS SUCH AS TRY
CYCLIC ANTIDEPRESSANTS WORK FOR
HALF PATIENTS OPIOID ANALGESICS
-- RAPID TOLERANCE AND ABUSE
POTENTIAL AND NOVEL TREATMENTS
IS NEEDED AND PREVIOUSLY THOUGHT
TO BE [INDISCERNIBLE] ITSELF IT
HAS SHOWN IT IS A FOOD RECEPTOR
AGNIFLT AND DESPITE THIS IT HAS
BEEN USED OVER 40 YEARS FOR
MAJOR DEPRESSANT DISORDER AND
SHOW ABUSE BEHAVIOR WE SEE IT
ALLEVIATES -- WITHOUT CAUSING
BROAD ANAL GEEZIA AND HOT PLATE
TEST AND CRITICALLY IT APPEARS
TO NORMALIZE AFFECTIVE SYMPTOMS
AS WELL AS INCLUDING DECREASING
NUMBERS OF MARBLES BURIED IN
MARBLE BURYING TASK AND INCREASE
IN OPEN TIME IN OPEN FIELD AND
HOW THEY ALLEVIATE NEUROPATHIC
PAIN SYMPTOMS ONE OPTION IS
THROUGH [INDISCERNIBLE] IN HEB
ENULA AND HAS INHIBITORY
PROJECTIONS MAJOR REWARD
PATHWAYS AND ALSO BECOMES
HYPERACTIVE UNDER CONDITIONS OF
CHRONIC PAIN AND NEW ECREPTORS
ARE INHIBITORY GPCRS AND BECOME
ACTIVE IN BRAIN AREAS IN -- TEEN
UP TEEN ON OTHER HAND MAY
NORMALIZE SHIFT ACTIVATING
REMAINING RECEPTORS AND
TRIGGERING MOR RECRUITMENT
LOOKING AT THE EXPRESSION IN
GROUPS SHOWS DECREASE IN
EXPRESSION IN SRI GROUP AND
DECREASE IN RED [INDISCERNIBLE]
TO HEAR AND REVERSED WITH
[INDISCERNIBLE] TREATMENT.
FUTURE WORK WILL EVALUATE
NECESSITY OF HAB ENULAR LORS AND
EFFECTS OF IT BY KNOCKING THEM
DOWN AND WE ARE ALSO IN PROCESS
OF PERFORMING SINGLE NUCLEUS RNA
SEQUENCING FROM TISSUE IN
COHORTS HERE CHANGING EXPRESSION
WITH BEHAVIORAL VALENCE AND
THANKING TEAMS FROM BOSTON
UNIVERSITY AND FUNDING SOURCES
AND THANK YOU FOR YOUR TIME.
>>I'M HAILEY AND POST DOC
FELLOW AT PAIN RESEARCH CENTER
AT NATIONAL CENTER FOR
COMPLEMENTARY INTEGRATIVE HEALTH
AND WILL PRESENT RESEARCH ON
ROLE OF [INDISCERNIBLE] 1 IN
HUMAN PAIN PERCEPTION AND
GENETIC MUTATIONS IN RELATED
TRANSCRIPTION FACTOR ONE AND
HUMANS RESULTING IN -- MYELOID
LEUKEMIA CHARACTERIZED BY
BLEEDING EASY BRUISING AND
INFECTIONS AND BRONX 1 IS A GENE
EXPRESSED IN TRIGEMINAL AND
DORSAL GANGLIA AND TRIP V1 IS
RESPONSIBLE FOR DETECTING
NOXIOUS HEAT AND WE HAVE SEEN IN
KNOCKOUT ANIMAL STUDIES IS IT IS
IMBLIKATED IN THERMAL AND
NEUROPATHIC PAIN BUT NOT
MECHANICAL PAIN AND MORE
SPECIFICALLY LOOKING AT GRAPHS
IN RED AND BLUE WE SEE THAT MICE
LACKING BRONX 1 DISPLAYED LESS
SENSITIVITY TO NOXIOUS HEAT IN
RED THEN WHEN PLACED ON HOT
PLATE AND TO COLD AS WELL AS IN
BLUE EXPOSED TO ACETONE TAP AND
PERKRENGS IS UNKNOWN AND DUE TO
FACT WE CAN'T HAVE KNOCKOUT
HUMAN 1 MODELS KNOCKING OUT THIS
GENE IN HUMANS IS LETHAL AND
PRESENCE OF ONGOING STUDY IS
PHENOTYPING PATIENTS WITH
HETEROZYGOUS MUTATIONS ILUSE
DATING ROLE IN HUMAN PAIN
PERCEPTION AND RESPONSE TO
NOXIOUS STIMULI INDEPENDENT TO
DAY-TO-DAY CLINICAL PAIN AND
MANIFESTATIONS COMING TO
DOWNSTREAM EFFECT OF MUTATION
AND METHODS KRURNLT STUDY
CONSISTS OF PATIENTS WITH -- AND
19 HEALTHY AGE MATCHED CONTROLS
PARTICIPANTS ADMINISTERED SERIES
OF QUESTIONNAIRES BEFOREHAND TO
ASSESS CLINICAL AND CURRENT PAIN
AND THREE QUANTITATIVE TESTING
PROCEDURES THRESHOLD MEASURED BY
APPLYING -- INCREASING AND
DECREASING -- GRADUALLY UNTIL
FIRST MOMENT OF COLD AND WARM
DETECTION COLD PAIN THRESHOLD
HEAT PAIN THRESHOLD AND HEAT
PAIN TOLERANCE WAS REACHED AND
PRESSURE PAIN THRESHOLD AND
TOLERANCE APPLIED BY INCREASING
INCREASED PRESSURE TO THUMB NAIL
AND GRADUALLY UNTIL FIRST MOMENT
OF PAIN WAS PERCEIVED
INTOLERABLE AND MEASURED
APPLYING 7 STIMULI TO WEIGHTS
AND PALM OF THE HAND UNTIL THE
FIRST MOMENT OF SHARPNESS WAS
PERCEIVED AND AFTER TEST RATED
INTENSITY OF PAIN AND INTENSITY
OF CESSATION THEY EXPERIENCED
ANALYZING DATA PARAMETRIC 2T
TESTS LOOKING FIRST AT TABLE AND
RESULTS WE SEE FROM
QUESTIONNAIRES THAT PATIENTS
WITH MUTATIONS REPORT MORE
CLINICALLY RELATED PAIN ON DAILY
AND REGULAR BASIS AND ALTHOUGH
VALUES ARE RELATIVELY LOW THEY
ARE SIGNIFICANTLY HIGHER THAN
CONTROLS REPORT AND ARE NOT
NEUROPATHIC IN NATURE.
LOOKING AT THE TWO GRAPHS BELOW
PRESSURE PAIN THRESHOLD
TOLERANCE WAS BETWEEN PATIENTS
AND CONTROLLS BOTTOM LEFT GRAPH
SHOWS DISPLAY SIGNIFICANTLY WARM
DETECTION THRESHOLD COMPARE
TODAY HEALTHY CONTROLS NO
DIFFERENCES WERE OBSERVED AND
HEAT PAIN THRESHOLD TOLL RANLS
BETWEEN PATIENTS AND CONTROLS
BOTTOM RIGHT GROUP SHOWS NO
DIFFERENCES FOUND AND COLD PAIN
THRESHOLD AND COLD PAIN
TOLERANCE AND SUMMARIZING
FINDINGS SO FAR PATIENTS WITH
MUTATIONS EXPERIENCE MORE CLIN
KALILY RELATED PAIN THAN HEALTHY
CONTROLS AND SEVERITY IS LOW AS
WE MENTIONED AND NOT NEUROPATHIC
IN NATURE CORROBORATING PREVIOUS
FINDINGS IN ANIMALS PAIN
THRESHOLD DIDN'T DEFER BETWEEN
GROUPS SURPRISINGLY THERMAL PAIN
THRESHOLD AND TOLERANCE WAS
COMPARABLE BETWEEN GROUPS
SUGGESTING HETEROZYGOUS
MUTATIONS DON'T INTERFERE WITH
DEVELOPMENT OF PATHWAYS
THEMSELVES AND NEVERTHELESS
COMPARED TO HEALTHY CONTROLS
PATIENTS WITH MUTATIONS REQUIRE
HIGHER TEMPERATURES FOR
DISCRIMINATION INDICATING THAT
HETEROZYGOUS MUTATIONS MIGHT
HAVE EFFECTS ON THERMORECEPTORS
SPECIFIC TO WARMTH.
IN ALL PRESENT FINDINGS SUGGEST
THAT HETEROZYGOUS MUTATIONS IN
GENE DON'T INTERFERE WITH
RESPONSES IN HUMANS AND INSTEAD
DECREASE DISCRIMINATION AN
EFFECT NOT YET REPORTED IN
ANIMAL LITERATURE AND THUS
FURTHER WORK IS REQUIRED TO
DETERMINE WHERE OPERATION OF
WARMTH DETECTION OCCURS.
>>ASSOCIATIONS WITH
EXPERIMENTAL AND ENL
ENVIRONMENTAL PAIN AND STRESS IN
SICKLE CELL DISEASE BIOLOGICAL
AND PSYCHOLOGICAL FACTORS -- AND
PAINFUL BLOOD DISORDER EFFECTING
OVER 100,000 AMERICANS AND
GENETICS PLAYS IMPORTANT AND NOT
FULLY UNDERSTOOD ROLE
VARIABILITY OF PAIN AND ONE
SINGLE NUCLEOTIDE POLYMORPHISM
-- THIS SAY CROSS-SECTIONAL
STUDY OF 186 ADULTS LIVING WITH
SICKLE CELL DISEASE AND MEAN AGE
36.6 YEARS AGE RANGE 19 YEARS TO
74 YEARS AND THESE WERE ALL
AFRICAN AMERICAN ADULTS 62%
FEMALE AND 73% WITH SS GENOTYPE
19% WITH SC GENOTYPE AND 8% WITH
OTHER PHENOTYPES.
CURRENT LEAST AND WORST CLINICAL
PAIN IN PAST 24 HOURS OBTAINING
AVERAGE PAIN INTENSITY SCORE AND
COMPLETED PERCEIVED STRESS
QUESTIONNAIRE TO MEASURE
ENVIRONMENTAL STRESS,
QUANTITATIVE SENSORY TESTING
WITH [INDISCERNIBLE] TSA2 AND
FILAMENTS THAT GATHER THERMAL
AND PRESSURE PAIN THRESHOLDS.
GENOTYPE FOR 10877969 WAS CODED
AS THE NUMBER OF SEEN ALLELES
AND WE USED ROBUST LINEAR
REGRESSION CONTINUE WITH IMPACT
OF FITTING BY HIGH INFLUENTIAL
POI
POINTS.
RESULTS SUGGESTING FOR THIS
MODEL SUGGESTING AGE -- NO
DIFFERENCES IN COLD OR HEAT
PRESSURE THRESHOLD OR PERCEIVED
STRESS QUESTIONNAIRE.
WE -- BETWEEN ADPR1A GENOTYPES.
THE A -- THE AVERAGE PAIN
INTENSITY WAS MARGINALLY
ASSOCIATED WITH THE GENOTYPE AS
WELL AS PERCEIVED STRESS.
AND MODEL OF API, AND THIS
10877969PSQ AND INTERACTION OF
THE GENOTYPE IN PSQ, WE DIDN'T
OBSERVE SIGNIFICANT INTERACTION
OF THE SNIP AND PERCEIVED STRESS
AND AMONG ADULTS WITH SICKLE
CELL DISEASE, CLINICAL PAIN WAS
ASSOCIATED WITH SNIP AND NOT
EXPERIMENTAL, THERMAL AND
PRESSURE PAIN THRESHOLDS AND
CONCLUDE IN THIS SAMPLE OF.
AVERAGE PAIN INTENSITY AND
STRESS AND REPORTED PREVIOUSLY
THAT INDIVIDUALS WITH SICKLE
CELL DISEASE AND CC GENOTYPE
SITED STRESS MUCH LESS THAN
OTHER TWO GENOTYPES AND FOUND
EVIDENCE OF CONTRIBUTIONS OF
SNIP CC GENOTYPE TO AVERAGE PAIN
INTENSITY MORE TO FURTHER
INVESTIGATION AND UNDERSTANDING
HOW THE SNIP AND/OR SURROUNDING
GENETICALLY LINKED REGIONS
INFLUENCE CLINICAL PAIN IN
SICKLE CELL DISEASE.
>>I'M KEN AND I WILL PRESENT
ABSTRACT TITLED [INDISCERNIBLE].
>>IT IS CHARACTERIZED BY
LESIONS IN AMD OUTSIDE OF THE
UTERUS AND INDUCTION OF CHRONIC
PAIN AND IS NOT CLEAR WHICH IN
FIELD FACTORS MECHANISMS ARE
DRIVING PAIN. WE KNOW FROM
LITERATURE [INDISCERNIBLE] HAVE
ELEVATED NUMBER OF MASS CELLS
AND MASS CELLS DON'T PLAY
IMPORTANT ROLE IN INFLAMMATION
AND [INDISCERNIBLE] IN MEN AND
IN ADDITION IS NOT IN
[INDISCERNIBLE] I WILL REFER TO
FOR NOW THAT IS KEY TO ASCENDING
AND DESCENDING SOMATIC PAIN
PATHWAYS AND IN THIS POSTER I
WILL USE NON-INVASIVE MOUSE
MODEL -- ASSOCIATED CHRONICLE
PAIN AND FILTRATION AND
ASSOCIATED WITH THIS OF PVN AND
MAIN TAKEAWAY FROM FIGURE WILL
ELICIT TACTILE DINNIA IN MICE
AND INDUCE ENDOMETRIOSIS AND IN
FIGURE 2 WE USE STAINING TO
VERIFY MASS OF VALIDATION IS
ONGOING IN [INDISCERNIBLE]
COLLECTED BY BIOSPECIMEN CORE AT
PET AND FIGURE 3A -- REVERSES
TACTILE DINNIA AND FIGURE 3B
DEMONSTRATED THAT MOUSE MODEL
ENDOMETRIOSIS CHEMICAL AND
HYPERACTIVITY TACTILE
INDEPENDENT MANNER IN MICE AND
USING THIS TO RECORD PBN OF MICE
WITH ENDOMETRIOSIS AND PANEL 5A
REPRESENTED RECORDING SHOWED PBN
ACTIVATE AFTER [INDISCERNIBLE]
REPRESENTED IN BLUE ARROWS AND
REGION IN [INDISCERNIBLE] AND
HOWEVER MICE WITH ENDOMETRIOSIS
AND CHEMICAL ASSIMILATION TO
THIS AKTIVATES PBN AND
ASSIMILATION APPLY TO MICE DOES
NOT ACTIVATE PVN AND IN THIS WE
SHOW [INDISCERNIBLE] SIGNIFICANT
COMPARED TO CONTROL AND STICKING
TOGETHER WE DEMONSTRATED MASS
CELLS IN BGF IN UTERUS PLAYS
IMPORTANT ROLE OF TACTILE DINNIA
AND PBN IS RELEVANT CENTRAL
MECHANISMS THAT HAVE
[INDISCERNIBLE] AND IN FUTURE
THEY WILL DECIPHER WHICH
INTERACT WITH MASS CELLS AND
ENDOMETRIOSIS AND IDENTIFY WHICH
CELL TYPES IN ENDOMETRIOSIS AND
FUNDED BY NIDK. THANK YOU.
>>I'M MATT FROM CLINICAL CENTER
AND HERE TO TALK TO YOU ABOUT
HOW PAIN BEGINS AND IS DATA FROM
A HUMAN PROTOCOL WE COLLECTED
TISSUE DURING [INDISCERNIBLE].
SO, THIS PROJECT BEGINS WITH A
MODEL THAT IS SOMEWHAT LIKE AN
ANIMAL MODEL WHERE AN INJURY IS
INDUCED TO FOLLOW THE EVENTS
OVER TIME AND EXCEPT IN THIS
CASE, THE MODEL INJURY IS
INDUCED FOR A CLINICAL PURPOSE
AND TISSUE IS COLLECTED AS
SURGICAL DISCARD THROUGHOUT THE
PROCEDURE AND WORKING WITH
SURGEONS OPENING THORACIC CAVITY
AND AFTER BRAIN INCISION WE
COLLECT THIS TIME POINT THAT IS
BEFORE THE TISSUE HAD TIME TO
RESPOND MOLECULARLY AND IS ZERO
CONTROL AND COLLECTED 1 HOUR 2
HOURS 4 HOURS OR 6 HOURS AND
THESE ARE IN LONG CASES AND IN
EACH SAMPLE UNDERSTANDING ALL
MOLECULAR CHANGES SUBDIVIDED TO
LOOK AT RNAS FOR RNA SEEK AND
IMBEDDING LOOKING AT SPATIAL
TECHNIQUES AND SPATIAL BIOLOGY.
H & E HISTOLOGY AND
[INDISCERNIBLE] AND LIPO DOME EX
IN LIPID MODELS FOR PAIN AND
RESOLVING WAY TO SURVEY THINGS
INVOLVED IN BEGINNING OF PAIN
AND ALSO IN TISSUE INJURY
RESPONSES SUBSEQUENTLY WOUND
HEALING THAT IS FIRST PLACE IN
WHICH SIGNALING CASCADES ARE
ACTIVATED AT SKIN RIGHT AFTER
INCISION AND LOTS OF THINGS WE
SEE ARE INFLAMMATORY SIGNALS
ALSO AND WAY THAT THESE THINGS
INTERACT AS THEY ARE COLLECTIVE
AT SAME TIME AND MANY SIGNAL AT
SAME MOLECULES.
SITE OF THIS INJURY AND SKIN IS
INITIATION FOR DOWNSTREAM EVENTS
AND THING TO REMEMBER ABOUT THIS
IS IT IS TRANSLATED AND IN HUMAN
AND RELEVANT AT LEAST TO PEOPLE
THAT ARE PARTICIPANTS IN THE
STUDY AND LOOKING AT DATA IS A
BROAD SURVEY OF RNA SEEK DATA
CAN'T GET TO ALL OF IT BECAUSE
OF THE TIME AND OVERALL TISSUE
WAS CONTINUALLY TRAUMATIZED OVER
COURSE OF THE SURGERY AND THINGS
CONTINUING TO INCREASE INCREASE
MORE STRONGLY OVER TIME AND
THINGS DECREASING CONTINUE TO
DECREASE MORE STRONGLY OVER TIME
AND IN GENERAL, WE CAN LOOK AT
THE SHAPES OF THE DISEASE
CHANGING OVERALL AND PRIORITIZE
STRONGLY INCREASING GENES
CYTOKINES IL-6 AND CCL2 TO
FOLLOW UP TO EXAMINE ROLE AND
INFLAMMATION PAIN AND WOUND
HEALING AND WE CAN DO THIS
BACKTRANSLATING TAKING MOST
IMPORTANT FINDINGS PUTTING THEM
BACK INTO MODELS OF PAIN AND
WOUND HEALING IN RATS AND
SUBCULTURE AND INDUCIVE WOUND
BACK IN THE RAT MANIPULATING
MOLECULAR CHANGES SEEING EFFECT
NOT ONLY ON PAIN BUT WOUND
HEALING INL FLAMATION OF THIS
ALL TOGETHER PUTTING IT BACK
TOGETHER AND BEYOND THIS MODEL
ONE THING WE NOW DO IS GO BACK
AND LOOK AT LONGER TIME POINTS
FROM IMPLANTED TO.
[INDISCERNIBLE] COULD BE QUITE
[INDISCERNIBLE] TO DO AND WE ARE
IN FOR IT. OVERALL THIS IS AN
INTERESTING STUDY THAT IS PART
OF CLINICIAN SCIENCE PARTNERSHIP
THAT WE ARE VERY EXCITE BD IT
AND WOULD LOVE TO TALK MORE
ABOUT IT.
>>MY WORK FOCUSES ON INFLUENCE
OF PARENTAL BELIEFS OF PAIN
MANAGEMENT AND OVERALL AIMS OF
STUDY WERE TWO FOLD TO DEVELOP A
MEASURE AND PAIN MANAGEMENT
SPECIFIC TO SURGICAL CONTEXT AND
EVALUATE EVALUATION OF
[INDISCERNIBLE] ANALGESICS AND
PSYCHOLOGICAL FACTORS AND
DECISION MAKING REGARDING
[INDISCERNIBLE] MEASURE BASED ON
REVIEW OF LITERATURE AND SEE A
GAP FOR THIS TYPE OF MEASURE
THAT HAS PSYCHOMETRIC PROPERTIES
THAT IS SHORT AND HAS GOOD
CLINICAL UTILITY AND WE ARE
INTERESTED IN EVALUATING WHETHER
OR NOT THIS COULD BE AN
IMPORTANT CONSTRUCT FOR
TAILORING AND PARENT EDUCATION
ON OPIOIDS AND INCLUDING
ULTIMATELY OUTCOMES FOR CHILDREN
THAT ARE FOLLOWING SURGERY.
WE EVALUATED THIS MEASURE IN THE
CONTEXT OF TWO STUDIES AND FIRST
BEING IN A SAMPLE APPEARANCE IN
CHILDREN AGES 5 THROUGH 17 AND
RESEARCH MA CH THAT IS PURELY
CROSS-SECTIONAL THAT WAS NOT WE
NEED TO HAVE CHILDREN UNDERGOING
SURGERY AT ALL AND THIS IS
PURELY HOW THEY PERFORM AND
EVALUATE OTHER CONSTRUCTS AND WE
SAW TWO SUBSCALES EMERGED FIRST
BEING POSITIVE PARENT OPIOID
BELIEFS AND SIGNIFICANTLY
CORRELATED WITH PARENT AND
CHILD'S OWN MEDICAL OPIOID
EXPOSURE IN THE PAST AND
CATASTROPHIZING ABOUT CHILD'S
PAIN AND DEPRESSIVE SYMPTOMS AND
GREATER LIKELIHOOD GIVING ACUTE
SCENARIO WE GAVE THEM AND SAW
PARENT OPIOID UNCERTAINTIES
UNLIKE THOSE THAT ARE HARD TO
DECIDE WHETHER OR NO THE TO GIVE
CHILD OPIOID FOLLOWING SURGERY
THAT IS SIGNIFICANTLY CORRELATED
WITH LOWER PARENT MEDICAL OPIOID
EXPOSURE IN THE PAST PARENT
CATASTROPHIZING ABOUT CHILD'S
PAIN AND GIVING OPIOID AND
[INDISCERNIBLE] PAIN SCENARIO
AND WANTED TO SEE HOW MEASURE
PERFORMED IN REAL WORLD DATA AND
CASE 23 STUDY ONGOING DATA
COLLECTION THAT IS SMALL
SUBSAMPLE OF PARTICIPANTS AT
THIS POINT THAT WE HAVE DAILY
DIARIES FOR 7 DAYS FOLLOWING
[INDISCERNIBLE] PROCEDURES AND
WHAT WE SAW HERE IS THAT THIS
SURGERY POSITIVE OPIOID SCALES
-- ADMINISTRATIONS FOLLOWING
TONSILLECTOMY AND PRESURGERY
OPIOID UNCERTAINTY SUBSCALE
CORRELATED ARE HIGHER LEVEL OF
PARENT STRESS AT TIME OF OPIOID
ADMINISTRATION AND THINK USING
MEASURE LIKE THIS PRESURGERY
GETS TO 6 ITEMS TELLING HOW
PARENTS THINK ABOUT OPIOIDS IS
USEFUL IN TAILORING INTERVENTION
TO HELP HAVE ADEQUATE PAIN
MANAGEMENT FOR CHILDREN
FOLLOWING SURGERY AND GOAL IS TO
PAIR THIS WITH PAIN DATA IN THE
FUTURE.
>>HELLO. -- THE LAB OF DR.
[INDISCERNIBLE].
OUR LAB IS INTERESTED IN CENTRAL
NERVOUS SYSTEM MECHANISMS WORK I
WILL PRESENT FOCUSES ON BRAIN
REGION IMPORTANT FOR PERCEPTION
OF PAIN INDUCING PLASTICITY AND
PBN IS IMPORTANT BRAIN REGION
FOR ASPECTS OF OFFENSIVE
BEHAVIORS -- PBN OUTPUT TO
CENTRAL AMYGDALA IS IN PAIN AND
MUCH STUDY LITTLE FOCUS WHAT IS
HAPPENING AT LEVEL OF PBN --
NEURONS FOLLOWING INJURY AND
USED CUFF MODEL OF NEUROPATHIC
INJURY INDUCING HYPERSENSITIVITY
THROUGH CONSTRUCTION OF SCIATIC
NERVE AND IN VIVO ARE NEURONS
FIRING SPONTANEOUSLY IN CUFF
GROUP COMPARED TO
[INDISCERNIBLE] THAT IS PAIN
FREE AND HOWEVER I HAVE
PRELIMINARY DATA SUGGESTING THAT
NEURONS PROJECTING TERMINALIS
AND ANOTHER LIMBIC SUBNUCLEUS
AND STICKING TOGETHER INDICATES
PBN HYPERACTIVITY OBSERVED IN
VIVO IS RESTRICTED TO CERTAIN
NEURONAL POPULATIONS AND
SPONTANEOUS FIRING FIRING
FREQUENCY AND PROPERTIES WE
OBSERVE NO DIFFERENCES BETWEEN
[INDISCERNIBLE] AND FOUND NO
CHANGES IN INTRINSIC PROPERTIES
IN THESE COMPARISONS AND FOUND
PBN NEURONS ARE VARIABLE IN
POLARIZING STEP CLASSIFYING THEM
ACCORDINGLY AND ANALYZE K THEM
BY GROUP AND COMPRISED MAJORITY
OF THE NEURONS AND FOUND THAT
REGULAR NEURONS BUT NOT LATE
FIRING NEURONS DECREASE
EXCITABILITY IN [INDISCERNIBLE]
THAT IS SURPRISING SO SURPRISING
IN FACT WE FURTHER EXAMINE
POPULATION AGAIN FINDING
DECREASED EVOKED EXCITABILITY
THAT WORKS AS PROOF OF CONCEPT
CERTAIN HYPERACTIVITY SHOWN IN
VIVO ARE TO STUDY
ELECTROPHYSIOLOGY AS THEY ARE
PRESERVED IN APROPRIATION AND
SUBSET OF NEURONS NOT SHOWN IN
VIVO IDENTIFYING WHO NEURONS ARE
DOWNSTREAM PROJECTIONS MARKERS
THEY EXPRESS ALLOW TO ENRICH IN
POPULATIONS -- DETERMINING
MECHANISMS UNDERLYING INJURY
INDUCED PLASTICITY AND THANKS
FOR YOUR ATTENTION.
>>HELLO, EVERYONE.
I'M FROM UNIVERSITY OF MICHIGAN
AND LAB IS INTERESTED IN
DESIGNING GENETIC AND CODING
CENSORS AND TOOLS FOR STUDYING
OPIOID SIGNALING.
FOR EXAMPLE, WE HAVE DESIGNED
GENETIC AND CODING CENSORS FOR
DETECTING OPIOIDS IN CELL
CULTURES AND IN [INDISCERNIBLE]
AND CALLED SPOTTING THAT WE
DISCOVERED THIS INHIBIT
[INDISCERNIBLE] FOR MATURATION
AND IN PRESENCE OF OPIOIDS WILL
BE REMOVED BECAUSE IT BINDS TO
ACTIVATED PEER RECEPTOR TIGHTER
AND [INDISCERNIBLE] CAN MATURE
AND THIS IS AN IRREVERSIBLE
CHEMICAL TRANSFORMATION AND
THEREFORE ONCE CENSOR DETECTS
OPIOIDS AND FOR ESSENCE WILL BE
STABLE AND TESTED THEM IN CELL
CULTURES AND IN PRESENCE OF
OPIOIDS SEE ENHANCED GOING FOR
RESIDENTS AND TEST SPOTTED
[INDISCERNIBLE] BY INJECTING
VIRUSES ENCODING SPOTTED INTO
MOSS BRAIN AND BASICS WHEN
CENSOR IS EXPRESSED WILL INJECT
MORPHINE OR SALINE INTO HOUSE
INJECTION. YOU SEE THAT THEY
HERE SHOW MUCH HIGHER GOING FOR
RESONANCE AND CENSORS BEING
EXPRESSED IN MORPHINE AND
[INDISCERNIBLE] MODELS AND UPON
IMPROVEMENT OF THESE CENSOR WE
HOPE IT WILL ENABLE UNBIASED
SDOOE TECHS OF OPIOID MOLECULES
AND PEPTIDES IN THE BRAIN IN THE
FUTURE AND SAME TIME WE ARE ALSO
TRYING TO DESIGN CHEMOGENETIC
TOOLS THAT COULD BE INTRODUCED
INTO SPECIFIC NEURON POPULATIONS
AND ACTIVATED OPIOID RECEPTOR
THERE AND READ OUT FUNCTION
OUTPUT IN PAYING MODULATION AND
DEPENDENCE AND SO ON.
WHAT WE DESIGN IS THESE CHEMICAL
DEPENDENT PROTEIN SWITCH THAT
COULD BE USED TO CAGE UNCUFFING
AND PRESENCE IN SHEER 1
UNCUFFING WILL BE UNKANLED TO
ACTIVATE MOR AND THEREFORE
TRIGGER DOWNSTREAM SIGNALING AND
TO CATEGORIZE THESE TOOLS SO WE
USE MP BIOCENSOR THAT CAN DETECT
THIS LEVEL AND GIVE OTHER LUMINE
ESSENCE AND FORCED TO INCREASE
SECOND P LEVEL AND UPON ADDITION
OF THIS WE SEE BOTH DECREASE OF
THE SECOND MP LEVEL AND
INDICATING THAT THE MORE INDEED
COULD BE ACTIVITY BY EITHER
OPIOIDS AND SHEER ONE UNCAGED
UNCUFFLING AND HOWEVER THE
CENSOR NOW IS NOT VERY GOOD WHEN
ADDING NALOXONE THAT IS INCREASE
THAT IS INDICATING THAT
UNCUFFLING IS NOT IN BASAL STATE
AND UPON FULL IMPROVEMENT WE
HOPE THAT THESE TOOLS CAN
EVENTUALLY BE USED.
>>COPY. CHECK, 2, CHECK 2.
>>PUTTING THESE UP FOR LIKES.
>>FROM OHIO STATE UNIVERSITY
DEPARTMENT OF MEDICINE AND
REHABILITATION -- ONE OF BIGGEST
PROBLEMS IN SURVIVORSHIP AND
CHEMOTHERAPY TO USE ESPECIALLY
BREAST CANCER SURVIVORS KILLS
TUMORS AND NERVES AND LEAVES
THEM WITH SOME BRAIN DAMAGE.
THEY HAVE PAIN. THEY HAVE
NEUROMOTOR DEFICITS.
INTO SURVIVORSHIP.
BECAUSE IT IS CIN.
MEDICATIONS HAVE BEEN FOUND TO
NOT REALLY WORK OR PRODUCE
ADDITIONAL SIDE-EFFECTS.
PHYSICAL ACTIVITY HAS BEEN
FOUNDED AND PROMISING AND
QUESTION WAS WHETHER WE COULD
IMPROVE ON PHYSICAL ACTIVITY
WITH PARTNER DANCE THAT COMBINED
RHYTHMIC AUDITORY STIMULATION
FROM MUSIC SCIENCE WITH PHYSICAL
ACTIVITY AS MEDICINE.
OUR RESULTS ARE PROMISING.
I SHOULD SAY WE LOOKED AT
ADAPTIVE TANGO CALLING IT
NEUROLOGICAL DANCE TRAINING NDT
TANGO AND AFTER FOUR WEEKS OF
NDT TANGO TRAINING IMPROVED
PATIENT REPORTED SYMPTOMS OF
NEUROPATHY AND NEUROMOTOR
VARIABILITY AND POSTURE CONTROL
AND TASK CONTROL.
SO, TIMED UP AND GO WITH A
COGNITIVE DUAL TASK AND ALL
THREE AREAS ARE BIG AREAS OF
DEFICITS FOR THIS POPULATION AND
IMPROVEMENTS WE SAW AT FOUR
WEEKS RETAINED AT 8 WEEKS AND
ALSO ONE MONTH FOLLOWING
INTERVENTION END AND FOLLOW UP
STUDY AND FIVE SURVIVORS THAT
WENT THROUGH PROGRAM LOOKING AT
EEG WHEN LISTENING TO MUSIC
FOUND DOING A CHALLENGING TASK
STOOD WITH EYES CLOSED FOR THREE
SECONDS DOING SILENCE VERSUS
LISTENING TO TANGO MUSIC
VARIABILITY AND POSTURE CONTROL
GOES DOWN AND STABILIZE AND
GAMMA BRAIN GOES DOWN AND
COGNITIVE [INDISCERNIBLE] GOES
DOWN AND LISTENING TO MUSIC
TRAINING TO MUSIC FOR 8 WEEKS
IMPROVED INSTANTANEOUSLY
NEUROMOTOR CONTROL AND COGNITIVE
LOAD.
WE ARE EXCITED TO KEEP STUDYING
TH
THIS.
>>IN THIS STUDY WE SOUGHT TO
IDENTIFY PROMOTIONAL RESILIENCE
FACTORS IN ENGAGEMENT AND
[INDISCERN
[INDISCERNIBLE].
>>THIS IS COMMON IN CERTAIN
ADOLESC
ADOLESCENCE.
[STANDING BY FOR REAL-TIME
CAPTIONING].
>>GOOD AFTERNOON. WE WILL
START THE AFTERNOON SESSION AND
I'M DAVE THOMAS AND SENIOR
ADVISOR AND OFFICE OF RESEARCH
AND WOMEN'S HEALTH AND ADVISOR
TO PAIN CONSORTIUM AND I'M VERY
HAPPY ABOUT HOW FAR THE PAIN
CONSORTIUM HAS COME OVER THE
YEARS AND TODAY THIS SESSION IS
THE -- I BETTER READ THIS.
IT IS THE MITCHELL MAX AWARDS
SESSION AND AWARD IS NAMED FOR
DR. MITCHELL MAX A NEUROLOGIST
AUTHORITY ON MECHANISMS AND
NEUROPATHIC PAIN AND GENETIC
BASIS OF PAIN AND DURING YEARS
AT NIH MITCHELL SERVED AS CHIEF
OF CLINICAL PAIN RESEARCH
SECTION AND DIRECTOR OF PAIN
RESEARCH CLINIC IN NATIONAL
INSTITUTE OF DENTAL AND CRANIAL
FACIAL RESEARCH THAT IS AN AWARD
THAT HONORS HIS LIFETIME
CONTRIBUTION TO RESEARCH AND I
WAS 25 AT NIH AND THEY HAD ONE
OF BEST PAIN RESEARCH GROUPS IN
THE WORLD AND PEOPLE WOULD COME
FROM AROUND THE WORLD AND
MITCHELL STOOD TALL IN THE
CONTEXT AND TO US YOUNGER FOLKS
ARE LUMINARY CLINICAL EXPERT IN
PAIN THAT YOU COULDN'T QUITE
FATHOM HOW MUCH HE KNEW ABOUT
PAIN AND CLINICAL WORK THAT IS
AROUND PAIN.
WE LEARNED SO MUCH FROM HIM OVER
THE YEARS AND HE IS VERY MUCH --
I'M VERY -- THIS IS SPECIAL FOR
ME TO INTRODUCE THIS. I -- I
KNEW HIM AND LIKED HIM AND
WORKED WITH HIM AND I MISS HIM.
NIH PAIN CONSORTIUM HAS BEEN
DOING THIS AWARD TO HIGHLIGHT
OUTSTANDING JUNIOR INVESTIGATORS
AND THEY HAVE BEEN DOING IT
SINCE 2009.
THERE IS THREE PEOPLE SELECTED
TO NEW INVEST GRA GATORS.
I HAVE TO STOP DOING THAT. I
WAS WATCHING ALL POSTERS GO BY.
THERE IS A REALLY A LOT OF GOOD
ONES.
SO, THIS IS EMPHASIZING PEOPLE
EARLY IN THEIR CAREERS THAT ARE
NIH FELLOWS OR CAREER
DEVELOPMENT AWARD HOLDERS OR
PEOPLE HOLDING FIRST INDEPENDENT
NIH GRANT AND PANEL OF PAIN
CONSORTIUM PEOPLE THAT REVIEWED
ALL OF THE POSTERS AND NARROWED
IT DOWN TO 3.
AND NOW THE THREE OF YOU WILL
PRESENT AND SOMEWHERE IN THIS
AUDIENCE AND AMONGST US ARE
PEOPLE THAT ARE GOING TO GATHER
TOGETHER AND JUDGE AND -- AND BY
THE END OF THE DAY, ONE OF YOU
WILL BE 2023 MITCHELL MAX AWARD
WINNERS AND CONGRATULATIONS TO
ALL OF YOU.
I WILL DO THE INTRODUCTIONS OF
ALL THREE PRESENTERS TO SAVE
TIME JUST REAL QUICKLY AND WE
WILL GET UP WITH WHEN IT IS YOUR
TURN AND FIRST PERSON IS MADELYN
WHO IS A PHD CANDIDATE IN
CLINICAL SCIENCE AT WASHINGTON
UNIVERSITY IN ST. LOUIS AND
MADELYN COMPLETED UNDERGRADUATE
STUDIES AT UNIVERSITY OF NORTH
CAROLINA CHAPEL HILL AND WILL DO
-- MADELYN'S RESEARCH FOCUSES ON
MOBILE HEALTH DATA TO IMPROVE
UNDERSTANDING PREDICTION AND
TREATMENT OF CO-OCCURRING
PSYCHOLOGICAL AND PHYSIOLOGICAL
PROBLEMS.
DR. TAICHI GOTO IS A RESEARCH
FELLOW WITH LABORATORY THAT IS
AT THE NATIONAL INSTITUTE OF
NURSING RESEARCH.
NIH, HE OBTAINED PHD FROM HEALTH
SCIENCE UNIVERSITY OF TOKYO IN
2018 AND COMPLETED TWO POST
DOCTORAL FELLOWSHIPS AT NIR AND
NURSING AND AT UNIVERSITY OF
MARYLAND SCHOOL OF NURSING
TRANSITIONED TO CURRENT POSITION
LAST YEAR AND RESEARCH INTERESTS
INCLUDE SYMPTOM SCIENCE FOR
DISEASE PREVENTION AND HEALTH
PROMOTION THAT IS ONE NIH
LEADING AREAS OF RESEARCH
INTEREST THAT HE HAS BEEN
WORKING ON UNDERLYING MECHANISMS
AND IDENTIFYING BIOMARKERS FOR
WOUND PAIN TO HELP DEVELOP
APPROPRIATE INTERVENTIONS FOR
ESPECIALLY VULNERABLE
POPULATIONS SUCH AS THOSE WITH
COGNITIVE IMPAIRMENT.
LASTLY, THERE IS DR. TYLER
NELSON A POST DOCTORAL ASSISTANT
RESEARCH SCIENTIST NEW YORK
UNIVERSITY PAIN RESEARCH CENTER
RECEIVING PHD IN NEUROBIOLOGY
PITTSBURGH SCHOOL OF MEDICINE
TRAINEE FOR PITTSBURGH --
NEUROPATHIC AND NEUROMUSCULAR
PAIN USING COMBINATION OF
MOLECULAR GENETIC
ELECTROPHYSIOLOGICAL AND
BEHAVIORAL APPROACHES AND
MADELYN YOU ARE FIRST. I TURN
THE PODIUM OVER YOU TO.
>>THANK YOU SO MUCH AND FOR THE
INVITATION TO BE HERE TODAY.
THIS HAS BEEN A GREAT MEETING.
I'M EXCITED TO SHARE WITH ALL OF
YOU WORK WE HAVE DONE TO IMPROVE
PREDICTION OF SPINE SURGERY
OUTCOMES USING DYNAMIC FEATURES
DUR DERIVED -- THIS AUDIENCE IS
KNOWLEDGEABLE ABOUT PREVALENCE
AND IMPACT OF CHRONIC BACKPAIN.
I WILL SKIP OVER THAT AND JUMP
TO THE ISSUE OF SPINE SURGERY
AND SEEN GREAT INCREASES IN RATE
OF SPINE SURGERY IN PAST COUPLE
DECADES THAT BENEFITS CERTAINLY
MANY PATIENTS THAT DON'T BENEFIT
FROM SPINE SURGERY AND 10 TO 40%
OF PASH YENTSS EXPERIENCE FAILED
BACK SURGERY SYNDROME NOT
INVENTIVE NAME SIGNALING BACK
SURGERY DIDN'T HAVE INTENDED
EFFECT AND INDIVIDUALS
EXPERIENCING ONGOING PAIN AND
IMPAIRMENT THAT CONTRIBUTES
SIGNIFICANTLY TO ONGOING OPIOID
EPIDEMIC 50% OF PATIENTS
ANALGESIC POISONING INCLUDING
ACKRIDENTAL -- LUMBAR FUSION
SURGERY AND GIVEN NEGATIVE
OUTCOMES IT IS IMPORTANT THAT WE
CAN IDENTIFY PATIENTS IF NOT
LIKELY TO BENEFIT FROM SIDE
SURGERIES TO PROVIDE THEM
ADJUNCTIVE OR ALTERNATIVE
PREVENTIONS AND OTHER STUDIES
APPROACH THIS PROBLEM IN
PREDICTIVE FRAMEWORK AND STUDIES
FOCUS ON STATIC RISK FACTORS
THAT ARE TYPICAL BASELINE
CHARACTERISTICS WE CONDUCT IN
STUDIES THINGS LIKE DEMOGRAPHICS
LIKE SYMPTOM SEVERITIES AND
PSYCHOSOCIAL -- APPROACH ONE
PREDICTION ACCURACY IS NOT VERY
GOOD AND PERFECT ET WHY I GOOD
ACCURACY TELLING PARNIENTS IF
THEY ARE LIKELY TO BENEFIT FROM
SURGERY AND DON'T GET ACTION
INSIGHTS FROM RISK FACTORS AND
SOME NOT MODIFIABLE AND OTHERS
HETEROGENIS AND COMMON AND
DEPRESSION EXPERIENCED BY AS
MUCH AS 40% OF PEOPLE WITH
CHRONIC BACKPAIN AND GOAL IN
STUDY GRAPHICS WON'T LOAD
APPROPRIATELY AND THIS ITEM
THERE GOAL IN STUDY IS TO ADD IN
MOBILE HEALTH MONITORING
INCLUDING EMA AND FIT BIT DATA
TO IMPROVE PREDICTION AS WELL AS
UNDERSTANDING WHY SOME
INDIVIDUALS ARE AT RISK FOR
NEGATIVE OUTCOMES AND WAY THAT
WE ARE DOING THIS WE CURRENTLY
HAVE 107 PATIENTS ENROLLED IN
THE STUDY COMPLETING BASELINE
SEMINARS CHARACTERISTICS
DEMOGRAPHICS VARIABLES WE
COLLECT FROM CHARTS AND PATIENTS
COMPLETE WEEKS OF MOBILE
MONITORING NOT HIRO GLYPHICS
SHOULD BE QUESTION ASKING ABOUT
PRESENT MOMENT PAIN SEVERITY AND
PATIENTS DO ASSESSMENT OR EMA
BRIEF SMARTPHONE BASED
ASSESSMENTS TO TALK ABOUT HOW
THEY ARE FEELING IN MOMENT
DURING COURSE OF DAY AND FITBIT
DURATION OF MOBILE MONITORING
AND GOING INTO DETAIL ABOUT DATA
WE ARE GETTING HERE PATIENTS
HAVE SPINE SURGERY AND
INTERESTED IN PREDICTING NOW ONE
MONTH OUTCOMES 46% OF SAMPLE HAD
CLINICALLY IMPORTANT IMPROVEMENT
IN PROMISED PAIN INTERFERENCE
DEFINED AS IMPROVEMENT IN
[INDISCERNIBLE] THREE WEEKS OF
MOBILE MONITORING WE HAVE FITBIT
FEATURES PATIENTS PROVIDED WITH
FITBIT INSPIRED TOO WEARING
DURING DURATION OF DAY AND NIGHT
AND WE LOOK AT THESE AS PATIENT
LEVEL FACTORS FOR EXAMPLE
PATIENTS AVERAGE DAILY STEP
COUNTS ARE DAY-TO-DAY
VARIABILITY IN STEP COUNT AND
BASIC EMA FEATURES NOT HIRO
GLYPHICS ASSESSING FOUR DOMAINS
OF PAIN INTENSITY AND MOMENTS OF
CATASTROPHIZING AND DEPRESSED
MOOD AND SAYING FOR EXAMPLE HOW
INTENSE BACK PAIN IS ON SCALE
FROM ONE-TO-ONE 00 AND
CALCULATING INDIVIDUAL LEVEL
DESCRIPTIVE STATISTICS MEANS
VARIABILITY MIN MA AND MA'AMIMA
AND DNA FEATURES INVOLVE COMPLEX
COMPUTATION EXTRACTING
INDIVIDUAL ESTIMATES FROM
MULTILEVEL DYNAMIC STRUCTURAL
EQUATION MODELS IF YOU DON'T
KNOW WHAT THAT IS, IT IS OKAY
WALKING THROUGH EXAMPLE --
MEASURE AT GIVEN TIME POINT WE
MIGHT BE FIRST INTERESTED IN
AUTO REGRESSIVE EFFECTS DEGREE
TO WHICH SYMPTOM PREDICTS ITSELF
OVER TIME AND FOR EXAMPLE PAIN
SEVERITY INCREASED NOW IT IS
STILL LIKELY TO INCREASE THREE
HOURS LATER LOOKING AT
CONTEMPORANEOUS EFFECTS SIMILAR
TO CORRELATIONS OR COVARIANCES
LOOKING AT RELATIONSHIPS AT SAME
MOMENT IN TIME AND FOR EXAMPLE
PAIN SEVERITY IS INCREASED NOW
CATASTROPHIZING TO BE INCREASED
IN SAME MOMENT AND HAVE
CROSS-LAGGED EFFECTS LOOKING AT
DYNAMIC RELATIONSHIPS BETWEEN
CONSTRUCTS OVER TIME AND FOR
EXAMPLE PAIN SEVERITY IS
INCREASED NOW CATASTROPHIZING TO
BE INCREASED IN NEXT ASSESSMENT
AND PATHWAYS EXTRACTING
INDIVIDUAL LEVEL ESTIMATE
TELLING US HOW MUCH PERSON TENDS
TO HAVE THIS RELATIONSHIP USING
THEM AS FEATURES IN DYNAMIC
MODELS USING SIMILAR PROCEDURE
TO COMBINE EMA AND FITBIT DATA
AND FITBIT DATA COLLECTED
CONTINUOUSLY AND PERSON LEVEL
AVERAGES WE LOOK AT IT IN
RELATION TO EMA AND FOR EXAMPLE
WE MIGHT BE INTERESTED IN
WHETHER INCREASED ACTIVITY IN
HOUR PRIOR TO EMA PREDICTS
SUBSEQUENT PAIN REPORTS LOOKING
AT THAT AGGREGATING EACH
PERSON'S STEP COUNT AND LOOK AT
THAT AS PREDICTOR OF EMA AND
OVERARCHING QUESTION IS WHETHER
PREOPERATIVE MOBILE HEALTH
MONITORING AND FEATURES DERIVING
FROM IT HAVE PREDICTION OF
SURGICAL OUTCOMES FOCUSING ON
ONE MONTH IMPROVEMENT PROMISED
PAIN INTERFERENCE DOING THIS
TAKING TRADITIONAL STATIC
FEATURES SIMILAR TO WHAT OTHER
STUDIES HAVE DONE BASELINE
CHARACTERISTICS FOLLOWED BY
LOGISTIC REGRESSION LEAVING OUT
CROSS-VALIDATION EXAMINING
PREDICTIVE PERFORMANCE OF BASIC
STATIC FEATURES IMPROVING
PROCESS INCLUDING MOBILE HEALTH
FEATURES BASELINE FEATURES FIT
BITT FEETERS BASIC AND DYNAMIC
EMA FEATURES AND COMBINED FITBIT
FEATURES SEEING IF IMPROVED
PREDICTIVE PERFORMANCE AND DATA
IMPROVED PREDICTION OF SURGICAL
OUTCOMES TRADITIONAL STATIC
FEATURES BY THEMSELVES HAVE AREA
UNDER CURVE OF .58 AND
PREDICTION IS NOT EXCELLENT IN
ADDITION TO WHAT WE HAVE SEEN IN
SOME STUDIES ADDING IN MOBILE
HEALTH FEATURES SEE BOOST OF
PREDICTIVE PERFORMANCE IN CURVE
OF .81 GETTING PREDICTION WITH
MOBILE HEALTH FEATURES
INTERESTED IN WHAT IS DRIVING
PREDICTION AND WHAT ARE FEATURES
THAT SEEM TO BE MOST IMPORTANT
IN THIS MODEL AND LOOK AT THAT
USING VALUES AND SEE STATIC
FEATURE POPS OUT AS IMPORTANT
FEATURE GREAT PREOPERATIVE --
THIS IS SOMETHING SEEN IN OTHER
STUDIES PERHAPS SUGGESTING THAT
INDIVIDUALS STARTING OUT WORSE
IN TERMS OF PAIN INTERFERENCE
HAVE ROOM FOR IMPROVEMENT AFTER
SURGERY AND SEE LOWER MOMENT OF
-- ASSOCIATED WITH HIGHER
LIKELIHOOD OF IMPROVEMENT AND
IMPACTING WHAT THAT IS IS SAME
THING AS PERSON LEVEL AVERAGE
FROM MOMENTARY EMA ASSESSMENTS
OF CATASTROPHIZING AND
HIGHLIGHTING THAT MOMENTARY
CATASTROPHIZING REPORTS ASKING
AND TAKING AVERAGE OF THAT AND
DOESN'T HAVE A HUGE CORRELATION
WITH SCORES ON PCS THAT DR.
EDWARDS TALKED ABOUT TODAY
SEEING THAT DISPOSITION AVERAGE
MOMENTARY CATASTROPHIZING SCORES
THAT IS ADDING TO PREDICTIVE
VALUE HERE AND EMA ASSESSMENT
CATASTROPHIZING AND DIFFICULT TO
THINK ABOUT TIMES IN PAIN AND
REPORT TYPICAL OR AVERAGE LEVEL
TO TENDENCY TO CATASTROPHIZE AND
TAKING MOMENTS FROM REPORTS THEY
MIGHT BE ACCURATE AND STRONGER
TENDENCY STEPS TO INCREASE PAIN
ASSOCIATED WITH HIGHER LEVEL OF
IMPROVEMENT.
MECHANICAL PAIN WE EXPECT THAT
ACTIVITY EXACERBATES PAIN AND
PROBLEM IN SPINE WALKING AROUND
A LOT LIKELY TO INCREASE PAIN
LEVELS SIGNIFICANT PORTION OF
PATIENTS THAT IS NO THE CASE AND
PATIENTS MIGHT BE LIKELY TO HAVE
ADVERSE OUTCOMES FROM SPINE
SURGERY AND ILLUSTRATING WHAT IT
LOOKS LIKE PAIN REPORTS IN GREEN
AND STEP COUNT IN BLACK AND
FIRST INDIVIDUAL WE SEE LINES
TRACKING WITH ONE ANOTHER STEP
INCREASE PAIN INCREASES STEPS
DECREASE PAIN DECREASES IN
CONTRAST TO A SECOND PERSON WITH
BIG SPIKES IN STEP COUNT AND HAS
NO IMPACT ON PAIN REPORTS THAT
IS NOT WHAT WE WOULD EXPECT IN
SOMEBODY EXPERIENCING MECHANICAL
PAIN AND WOULD EXPECT ACTIVITY
TO HAVE IMPACT ON PAIN AND
STUDIES EARLIER RESULTS OF
DEGENERATIVE -- HARD TO KNOW
WHETHER PROBLEMS WE SEE ON
IMAGES ARE CAUSE OF SOMEONE'S
PAIN. MANY PEOPLE WITH SIMILAR
DEGENERATIVE IMAGE FINDINGS
DON'T HAVE DEGENERATIVE PAIN AND
LOOKING AT IT RELATIONSHIP OF
ACTIVITY AND PAIN MIGHT BE ONE
WAY TO UNDERSTAND WHAT IS
CAUSING THE PAIN AND IF NOT
CAUSING ACTIVITY BIOPSYCHOSOCIAL
FACTORS WE ARE TALKING ABOUT
TODAY AND FUTURE DIRECTIONS FOR
THIS WORK IS FIRST STEP WE NEED
TO EXTERNALLY VALIDATE THIS IN
LARGER DIVERSE SAMPLES
INTERESTED IN EXAMINING
PREDICTORS IN RESPONSE TO OTHER
PREDICTIONS FOCUSING ON SPINE
SURGERY AND DYNAMIC
RELATIONSHIPS BETWEEN PAIN AND
CATASTROPHIZING ARE FOCUS OF
THINGS LIKE COGNITIVE BEHAVIORAL
THERAPY AND PREDICTORS OF
OUTCOMES THERE AND GROUP IS
INTERESTED IN DEVELOPING DATA
DRIVEN METHODS FOR TREATMENT
PERSONALIZATION AND HOPING
HAVING DEEPER PHENOTYPES AND
UNDERSTANDINGS OF MECHANISMS
PERPETUATING PAIN.
I THINK I WILL TAKE QUESTIONS.
>>THANK YOU.
>>WE HAVE TIME FOR A COUPLE OF
QUESTIONS IF ANYBODY HAS
ANYTH
ANYTHING.
>>I WILL ASK SOMETHING. THIS
IS REALLY GOOD. YOU START TODAY
ANSWER MY QUESTIONS BEFORE YOU
FINISHED AND HUGE PROBLEM YOU
LOOK AT SOMETHING PHYSICAL AND
PEOPLE SAY THAT IS WHERE PAIN IS
AND WHEN YOU DON'T SEE SOMETHING
PHYSICAL YOU DON'T BELIEVE THAT
PERSON IS IN PAIN AND TO BE ABLE
TO SORT IT OUT, I THINK IS
REALLY GOOD GETTING PEOPLE THE
RIGHT TREATMENT AND WONDERING
STATISTICALLY IF YOU THINK ABOUT
ADDING OTHER FACTORS IN HERE AND
MAYBE USING AI TO GET A BIG AND
COMPOSITE PICTURE SOME DAY.
>>WE HAVE PLANS FOR THAT AND
COLLABORATOR IS INTERESTED IN
THAT FOLKS FROM COMPUTER SCIENCE
WELL VERSED IN KIND OF
MULTICLASS PREDICTION MODEL
STUFF THAT IS ONE WAY THIS COULD
GO AND INCLUDING BIOMARKERS AND
OTHER TYPES OF CENSORS THAT
MIGHT BE USEFUL FOR
UNDERSTANDING THAT.
>>THANK R YOU. IF NO
QUESTIONS.
THERE IS ONE. THERE WE GO.
>>HI, MADELYN. VERY NICE TALK.
I WAS WONDERING IF YOU HAVE
CONSIDERED LOOKING AT THEIR
IMPLEMENTARY STATUS OR CURRENT
INFECTION RATE TO INCORPORATE IN
THE MODEL?
>>GREAT QUESTION. WE WOULD
LOVE TO AND IS DATA TO COBBLE
TOGETHER FUNDING FOR IT DIDN'T
HAVE MUCH FUNDING JACOB AND I
ARE PRETTY JUNIOR AND IN FUTURE
WE WOULD LOVE ABILITY TO COLLECT
THINGS LIKE BIOMARKERS AS WELL.
>>ALL RIGHT.
>>THANK YOU.
>>THANK YOU!
>>[APPLAUSE].
>>NEXT SPEAKER IS TAICHI GOTO.
GOOD JOB. THAT IS GOOD STUFF.
DID YOU GET NIH FUNDING FOR
THIS?
>>[INDISCERNIBLE].
>>>>GOOD AFTERNOON, EVERYONE.
THANK YOU FOR INVITING ME TO THE
GREAT OPPORTUNITY TO PRESENT
RECENT WORK HERE AND I'M VERY
EXCITED AND A LITTLE NERVOUS TO
BE HERE . LET'S GET STARTED.
THIS IS DISCLAIMER AND TOPIC IS
ABOUT NEGATIVE INFERENCE OF
GENETIC MUTATION FOR BRAIN
[INDISCERNIBLE] AND NEUROTROPIC
FACTOR ON NEUROPATHIC PAIN
SYMPTOM EXPERIENCED BY FEMALE
CANCER SURVIVORS.
SO, CANCER SURVIVORS CONTINUE
TO REPORT BEHAVIORAL AND
PHYSICAL TOXICITIES AND EVEN
YEARS AFTER COMPLETING THEIR
TREATMENT
SOME OF THE TOXICITIES INCLUDE
PSYCHONEUROLOGICAL SYMPTOMS
KNOWN TO BE MANIFESTED AS
SYMPTOM CLUSTER CONSISTING OF
PAIN FATIGUE ANXIETY AND
DEPRESSION AND SLEEP DISTURBANCE
AND SYSTEM CLUSTER CAN EFFECT
THE PATIENTS LIFE HOWEVER
UNDERLYING MECHANISM OF CLUSTERS
ARE STILL UNCLEAR AND WE HAVE
BEEN FOCUSING ON -- WHICH HAS
ROLES IN SURVIVAL AND
DIFFERENTIATION OF NEURONS IN
THE REGULATION OF SYNAPSIS.
SOME STUDIES REPORTED THE
ASSOCIATIONS BETWEEN BDNF AND
VARIOUS PSYCHONEUROLOGICAL
SYMPTOMS INCLUDING DEPRESSION
AND ANXIETY AND PAIN PERCEPTIONS
AND SINGLE NUCLEOTIDE
[INDISCERNIBLE] THAT IS GENETIC
MUTATION FOR BDNF THAT IS
SUBSTITUTION OF [INDISCERNIBLE]
EFFECTS THE SYMPTOM PHENOTYPES.
AND IN OUR GROUP, WE ARE ALSO
INVESTIGATING RELATIONSHIPS
BETWEEN BDNF PHENOTYPES AND
[INDISCERNIBLE] ESPECIALLY IN
CANCER SURVIVORS AND REPORTED
MALE ACTUALLY PROSTATE CANCER
PATIENTS WITH BDNF MUTATION
MIGHT HAVE PROACTIVE ADVANTAGE
AGAINST CANCER-RELATED FATIGUE
AND IN THIS STUDY WE WANT TO
EXPAND KNOWLEDGE TO OTHER COHORT
LIKE FEMALE CANCER SURVIVORS AND
OTHER CANCER TYPES IN OTHER
SYMPTOMS THAT ARE INCLUDING
NEUROPATHIC PAIN SYMPTOMS.
THEREFORE, OUR AIM IN STUDIES IS
TO EXAMINE ASSOCIATIONS BETWEEN
PATIENT SYMPTOM CLUSTER GROUP
AND BDNF POLYMORPHISM AND
EXPLORING RELATIONSHIPS BETWEEN
NEUROPATHIC PAIN AND BDNF
GENETIC MUTATION AND WE
RECRUITED FEMALE CANCER
SURVIVORS FINALLY ANALYZING 393
FEMALE CANCER SURVIVORS AND
COLLECTED THEIR SYMPTOM
PHENOTYPE SCORES USING PROMISE
FOR NEUROPATHIC PAIN FATIGUE AND
WE USED SF36 FOR PAIN SCORE AND
WE COLLECTED BUKO WEB SAMPLES TO
ISOLATE THEIR DNA AND THOSE WERE
USED TO DETERMINE BDNF
GENOTYPES.
SO, FIRST OF ALL, WE TRIED TO
IDENTIFY THE PATIENT CLUSTER
GROUPS THAT ARE BASED ON SYMPTOM
PHENOTYPES.
SO, THEY -- WE EMPLOY HIERARCHY
FOR [INDISCERNIBLE] METHOD AND
IDENTIFYING TWO CLUSTER GROUPS
THAT ARE SEVERE SYMPTOM AND LESS
SEVERE SYMPTOM GROUPS.
THIS CLUSTERING ANALYSIS WOULD
BE PRESENCE OF THE
PSYCHONEUROLOGICAL SYMPTOM
CLUSTER AND POD OF CANCER
SURVIVORS EXPERIENCED MORE
SEVERE SYMPTOM CLUSTER AND ALSO
PART OF CANCER SURVIVORS
EXPERIENCING SEVERE SYMPTOMS.
WE ALSO ANALYZE THE GENOTYPE
FREQUENCIES IN -- TO CLUSTER
GROUPS THREE TYPES OF GENOTYPES
AND THREE GENOTYPES LIKE WILD
TYPE AND [INDISCERNIBLE]
HETEROZYGOUS IN HOMOZYGOUS
GENOTYPE.
WE FOUND THE MORE SEVERE CLUSTER
GROUP THAT IS CLUSTER TO HAD
MORE NUMBER OF [INDISCERNIBLE]
GENOTYPE THAT IS MUTATED
GENOTYPE AND WE FURTHER
INVESTIGATE THE DETAILED
RELATIONSHIP BETWEEN BDNF
GENOTYPE IN EACH CLUSTER OR
SYMPTOM AND THOSE WITH GENOTYPE
HAD MORE SEVERE NEUROTIC PATH
IK /* /* -- NEUROPATHIC PAIN AND
-- CANCER STAGES AND RADIATION
THERAPY EXPERIENCES WERE
STATISTICALLY DIFFERENT ACROSS
GENOTYPES AND CONDUCTED SUBGROUP
ANALYSIS ALSO WE CONFORMED
CONSISTENT RESULT WITH MAIN
RESULT.
WHERE MED GENOTYPE HAD NEGATIVE
INFERENCE ON NEUROPATHIC PAIN
SCORE.
FINALLY, WE CONDUCTED REGRESSION
ANALYSIS THAT IS USING
REGRESSION MODEL AND FINAL MODEL
REVEALED THE NEGATIVE INFERENCE
OF BDNF GENOTYPE ON NEUROPATHIC
PAIN SCORE AND THEY HAD POSITIVE
9.3 COEFFICIENTS FOR NEUROPATHIC
PAIN SCORE.
BECAUSE THE HIGHER SCORE MEANS
THE WORST SYMPTOMS THAT IS WHY
BDNF HAD INFERENCE ON
NEUROPATHIC SYMPTOMS AND OTHER
VARIABLES THAT ARE ASSOCIATED
WITH NEUROPATHIC PAIN SCORE WERE
YEARS SINCE CANCER DIAGNOSIS AND
EDUCATION HISTORY AND THEY HAD
NEGATIVE COEFFICIENTS MEANING
THOSE WITH LONG TIME FROM CANCER
DIAGNOSIS AND THOSE WITH HIGHER
EDUCATION HISTORY LIKE GRADUATE
DEGREES EXPERIENCE A LESS SEVERE
NEUROPATHIC PAIN.
WHAT IS POTENTIAL MECHANISMS FOR
THIS RELATIONSHIP.
BASED ON PREVIOUS STUDIES BLOOD
BDNF LEVEL IS MOST LIKELY TO BE
KEY FACTAR FOR RELATIONSHIP AND
STUDIES CAUSE CO-OCCURRENCE OF
NEUROPATHIC PAIN AND THEY PRO
MO
PROMOTE IN FEMALE CANCER
SURVIVORS AND KNOWLEDGE THAT WE
BELIEVE THAT KNOWLEDGE PROMPTS
FURTHER INVESTIGATION FOR CLIENT
TRYING DETAILED MECHANISM LEVEL
AND MECHANISM OF THE
RELATIONSHIP THAT IS REQUIRING
TO DEVELOP A NEW MORE EFFECT
PREVENTIVE THERAPEUTIC
STRATEGIES FOR ALLEVIATING THEIR
SYMPTOMS IN CANCER SURVIVORS.
THAT IS FOR MY PRESENTATION
TODAY THAT IS CLUB RESEARCH
STUDY IN CLINICAL CENTER IN OHIO
STATE UNIVERSITY.
THANK YOU FOR YOUR KIND
ATTENTION.
>>QUESTIONS FROM THE AUDIENCE.
GET ON UP.
I HAVE A CROWD.
>>DOES YOUR REGRESSION MODEL
ALLOW YOU TO QUANTIFY IMPACT OF
THE BDNF MET PHENOTYPE.
>>ACTUALLY, THANK YOU VERY
MUCH. GOOD QUESTION. BECAUSE
WE USED MODEL THAT IS
NONPARAMETRIC MODEL AND WE
DIDN'T QUANTIFY IMPACT OF THE
MET GENOTYPE IN THIS MODEL.
>>HI. I HAVE A THREE-STEP
QUESTION AND FIRST YOU CHOOSE
THIS; RIGHT?
FIRST, YOU PROBABLY CHOOSE THIS
AND IT IS ALREADY KNOWN
FUNCTIONAL SNIP.
WHAT SNIP IS DOING.
THERE ARE OTHER FUNCTIONAL SNIP
IN BDNF AND DID YOU ANALYZE
THOSE TWO OR NO THE?
WHAT THEY -- WHAT THEY ARE DOING
AND ALSO I THINK THEY WOULD --
SO, WHAT ELSE IS KNOWN ABOUT
SNIP AND PAID PHENOTYPES.
>>THANK YOU FOR YOUR QUESTION.
THIS IS A SECONDARY ANALYSIS OF
SECOND LARGEST PARENT STUDY
FOCUSING ON RELATIONSHIP BETWEEN
BDNF PREMORPHISM AND
QUANTITATIVE [INDISCERNIBLE] IN
IMPAIRMENT IN CANCER SURVIVORS
AND WHY WE CHOOSE THIS AND WE
DON'T HAVE OTHER TYPE OF SNIP
FOR BDNF, ACTUALLY.
WHAT IS THIS QUESTION, AGAIN?
>>WHAT SNIP IS DOING.
>>THE SNIP?
>>YEAH.
>>SO.
>>IN TERMS OF FUNCTIONAL
CONSEQUENCE OF THIS MINOR
[INDISCERNIBLE].
>>YEAH. SO, DETAILED MECHANISM
IS STILL UNKNOWN OR
UNDERSTUDIED.
SOME STUDIES ALREADY REPORTED
RELATIONSHIP THAT IS BETWEEN
THIS SNIP AND COGNITIVE
IMPAIRMENT, LIKE I SAID.
IT IS ALSO LIKE AS INVOLVED
WHERE MAJOR DEPRESSION SYMPTOM
AND ANXIETY AND PAIN PERCEPTION.
>>OKAY. THANK YOU.
>>GREAT TALK. YOU COLLECTED A
LOT OF THE SAMPLES FOR BLOOD;
RIGHT?
>>SORRY?
>>THESE ARE BLOOD COLLECTIONS
SF HAD.
>>WHY HE.
>>DO YOU HAVE PLANS LOOKING AT
CEREBRAL SPINAL FLUID AND CNF
FOR CENTRAL MECHANISMS.
>>GOOD POINT.
>>WE DON'T HAVE SUCH PLAN.
>>THAT IS POINT THAT WE IF NEED
TO CONSIDER AT THAT POINT IN THE
FUTURE. THANK YOU.
>>>>OKAY. THANK YOU. WELL --
>>[APPLAUSE].
>>LAST SPEAKER OF THE SESSION
IS DR. TYLER NELSON.
>>HELLO, EVERYONE.
NEW YORK UNIVERSITY PAYING
RESEARCH CENTER GOING IN
COMPLETELY DIFFERENT DIRECTION
BASIC RESEARCH SCIENTIST AND UP
TO THIS POINT NO ONE MENTIONED
MOUSE THAT IS INCREDIBLE FOR A
PAIN CONFERENCE AND PRIMARILY
TALKING TODAY ABOUT UNCOVERING
SPINAL TREATMENTS ON TOPIC OF
NEUROPATHIC PAIN DESCRIBE
BURNING TINGLING PINS AND
NEEDLES AND SHOOTING PAIN THAT
IS HIGHLY PREVALENT EFFECTING 7
TO 10% OF GENERAL POPULATION AND
IT IS ANALGESIC DRUG WE
HAVOIDOIDS DON'T WORK AND QUICK
WILL I TO GIVE SINGLE BIOLOGY,
LEER WE GO, I WILL PRIMARILY
TALK ABOUT PERIPHERAL NEUROPATHY
FOLLOWING LESION DAMAGE TO NERVE
GAIN TO THIS NEURONS RESPONDING
TO THAT TOUCH AND DON'T BE THIS
IS FIRST SYNAPSE IN CENTRAL
NERVOUS SYSTEM AND INVASION OF
MICRO GLEEA AND STATE OF
NEUROINFLAMMATION AND LOSS OF
INHIBITION AND GAIN OF
EXCITATION -- AND THIS DRIVES
ALODINIA AND AS WELL AS KEY
SYMPTOMS SEEN IN NEUROPATHIC
PAIN PATIENTS LOOKING AT IT FROM
THERAPEUTIC PAIN PERSPECTIVE
NEURONS IS ONE APPROACH
TARGETING EXCITATORY NEURONS
THAT IS LATERAL APPROACH AND AS
OF 2020 WHEN PUBLISHED EVERY ONE
OF THESE REPRESENTS A DIFFERENT
EXCITATORY NEUROPOPULATION IN --
NAMES ARE NOT THAT IMPORTANT AND
THIS IS NEUROONE RECEPTOR
ANDSOME ATTO-STAN CONTINUE AND
NEUROPOPULATIONS IMPLEMENTS IN
MANIFESTATION OF ALODINIA AND
NONE REPRESENT REGULAR FARMO
THERAPEUTIC TARGETS CONVINCED TO
SHOW YOU ONE.
THIS IS NOT SOMETHING THAT I
FOUND ON MY OWN AND IS A WELL --
THERE IS 30 YEARS OF PRECLINICAL
RESEARCH IMPLICATING NPY LEVEL
OF SPINAL CORD AS ANALGESIC
RANGING FROM INFLAMMATORY TO
BONE INDUCED CANCER PAIN AND
MAIN REASON THIS IS THOUGHT TO
OCCUR IS RECEPTORS GI COUPLED
GPCR AND THINKING OF IT AS CANON
CAL -- YOU HAVE THIS GPCYR
COMBINED TO THAT CAN ACTIVATE
GATE AND RECTIFYING POTASSIUM
CHANNELS AND TO REDUCE
INTRACELLULAR CYCLIC AMP AND
DAMPEN CENTRAL LATENT
SENSETIESIZATION AND CHRONIC
PAIN AND SOME OWN DATA TO SORT
OF DEMONSTRATE WHY I THINK THIS
IS A NICE FARMICO THERAPEUTIC
TARGET IS ANIMALS MECHANICAL
DRAW THRESHOLD THAT IS ELEMENTS
THAT IS A MOUSE BEFORE INJURY
AND FOLLOWING SPARE INJURY
REDUCTION IN WITHDRAWAL
THRESHOLD AND DOSE DEPENDENTLY
INTRICK THEEJ CAL MANIPULATION
TO ATTENUATE HYPERSENSITIVITY
AND INDEED IS MPY1 SPECIFIC
EFFECT THAT IF WE COADMINISTER
503, 304Y1 SELECTIVE ANTAGONIST
WE CAN ABOLISH ANAL GEEZIA THAT
IS [INDISCERNIBLE] BY ANTAGONIST
AND COMPLEMENTARY APPROACH I
USED A CELL TYPE MANIPULATION
TECHNIQUE I HAVE USED NYP MOUSE
AND FINALLY COULD ADMINISTER
VIRUS THAT IS PREDEPENDENT AND
PUT INHIBITORY GPCR -- I DO THIS
ON ONE SIDE AND ECHLTHS FOR
IPSILATERAL AND WHAT THIS ALLOWS
IS I CAN TRANCE FEKT Y1
INTERNEURONS SHOWN IN RED.
A WELL-DOCUMENTED PAIN DRIVING
REGION AND I CAN NOW INHIBIT
NEURONS BY GIVING THIS LYINGAND
CLOZO PEEN AN OXIDE THAT IS ON
RECEPTOR EXPRESSED IN CELLS AND
WHEN I DO THIS AMAZINGLY IF YOU
INHIBIT NEURONS BEFORE AN INJURY
THERE IS NO CHANGE IN MECHANICAL
DRAW THRESHOLDS FOLLOWING INJURY
CONTROL GROUP YOU SEE ROBUST
MECHANICAL HYPERSENSITIVITY AND
RESPONDING TO THESE NEURONS
ATTENUATE HYPERINDUCED
HYPERSENSITIVITY AND THIS
APPROACH I WANTED TO SEE IF
ACTIVATION OF NEURONS IN NAÏVE
UNINJURED MOUSE SUFFICIENT TO
PRODUCE PAINLIKE BEHAVIOR AND
EXPERIMENTAL APPROACH AND GIVING
DESIGNER RECEPTOR THAT IS
EXCITATORY AND GIVING CNO I
ACTIVATE THESE INTERNEURONS AND
DID THIS AND 30 MINUTES LATER
INDIVIDUALODE BEHAVIOR AND VIDEO
IS WORTH 1,000 WORDS IF IT
PLAYS.
ONE SECOND.
IT IS PLAYING.
I WILL REPLAY IT. YOU MISSED
THE FIRST HALF. SORRY ABOUT
THAT.
SO, THIS IS MY CONTROL GROUP AND
YOU CAN SEE THE MOUSE THAT IS
WALKING AROUND AND NEURONS ARE
NOT ACTIVE. THIS IS A MOUSE
THAT IS EXPLORING AN OPEN FIELD
BOX. HOWEVER, IN THIS GROUP, IT
THIS IS THE EXCITATORY RECEPTOR
AND GIVING AGONIST I ACTIVATED
NEURONS AND SEEING ROBUST
ATTENTION S TO THE LEFT WILL EGG
THAT IS EXTREMELY HYPERTENSETIVE
THERE IS FLAPPING AND LICKING
AND LIFTING AND THEY DON'T WANT
TO PUT THIS DOWN AND NEURONS ON
ONE SIDE OF THE LUMBAR DORSAL
HORN. AND IF I QUANTIFY THIS,
IT IS ABUNDANTLY OBVIOUS THIS IS
A Y1 ACTIVATION CNO INDUCED
EFFECT AND I WOULD LIKE TO TALK
QUICKLY. THIS IS A MORE BROAD
AUDIENCE ABOUT WHERE WE ARE
TAKING THIS PROJECT AND HOPE I
CONVINCED YOU NEURONS SEEM TO BE
NECESSARY AND SUFFICIENT FOR
NEUROPATHIC PAIN BEHAVIOR AND
WITH THAT WE WOULD LIKE TO BRING
IT THIS TO A CLINICAL ENDPOINT
AND WE ARE UNFORTUNATELY FACING
PRECLINICAL TRANSLATION CRISIS
AND DRUGS FAIL COMING IF FROM
RODENT RESEARCH AND MICE ARE NOT
LITTLE PEOPLE AND FIRST THING TO
LOOK AT SPINAL NEURON POPULATION
AND THESE NEURONS EXPRESSED IN
HIGH-ORDER SPECIES AND WHAT IS
FLOUR ESSENCE IN C2
HYBRIDIZATION AND CONSERVATION
OF SPINAL CORD DORSAL NEURONS
ACROSS MOUSE PIG AND ADULT HUMAN
SPINAL CORD DONORS AND ORANGE IS
ADULT PIGMENT LIPOFUSION AND IS
ZOOMED IN IF CURIOUS WHY THAT
LOOKS DIFFERENT AND EXCITING
APPROACH WHERE WE ARE TAKING
THIS IS INTERNASAL
ADMINISTRATION OF MPY
NON-INVASIVE APPROACH TESTED IN
LAST THREE YEARS.
FOR FIRST TIME, I TESTED
INTRANASAL MPY POSSIBLE APPROACH
TO TREAT PAIN AND ABUNDANT
SURPRISE I FOUND ROBUST
ATTENUATION OF PERIPHERAL NERVE
INJURY INDUCED NEURAL PAIN AND
AROUND TIME I COLLECTED THIS
DATA AND LABORATORY EXPERT IN
FORCING MODEL OF NEUROPATHIC
PAIN AND HER AND I TOGETHER
ENTERED LAST YEAR VIRGINIA PAIN
RESEARCH CHALLENGE THAT IS
NON-INVASIVE APPROACH TO TRAIN
NEUROPATHIC PAIN AND WE WON AND
THIS IS DATA HOT OFF THE PRESS
AND WE MOVED MOUSE RESEARCH AND
TESTED FIRST LARGE ANIMAL MODEL
FINDING COMPLETE ATTENUATION OF
PERIPHERAL INJURY -- NPY IN PIG
MODEL OF PAIN. LASTLY, SIDE A
-- SHE UTILIZED CRYSTAL
STRUCTURES AND SCREEN HALF A
BILLION COMPOUNDS AND SMALL
MOLECULE TARGETS I SUBMITTED
RECENTLY IN STTR TO MOVE TO IN
VITRO AND IN VIVO TESTING INTO
PIG MODELS FIRST SMALL MOLECULE
OF MPY AGONIST AND WOULD LIKE TO
LEAVE YOU MPY1 EXPRESSING
NEURONS BECOME HYPEREXCITABLE IN
PAIN STATES AND PHARMACOLOGICAL
AND CELL TYPE INHIBITION OF THEM
LEADS TO NO PAIN AND I HAVE SO
MANY DIFFERENT PEOPLE TO THANK
AND SEVERAL NIH FUNDING SOURCES
I WOULD LIKE TO THANK CONSORTIUM
AND WITH THAT I WILL BE HAPPY TO
TAKE ANY QUESTIONS. THANK YOU.
>>HI. GREAT TALK.
>>THANK YOU.
>>I WANTED TO KNOW IF YOU HAVE
DONE ANY CHRONIC ADMINISTRATION
OF MPY SMALL PEPTIDE.
>>WE HAVE -- I HAVE SORT OF TWO
ANSWERS.
THERE IS A GROUP IN BEN OES
ARIES ABLE TO PUT KAJ ET TERS IN
AND DIDN'T THERE IS NOT
CONTINUOUS ADMINISTRATION BUT IS
REPEATED OVER TIME AND SIMILARLY
THERE IS REVIEWER REQUESTS FOR A
LOT OF PAPER THAT I PRESENTED
TODAY AND WENT TO 100 DAYS POST
NEURTIVE ENERGY TO ADMINISTER
COMPOUND AND DIDN'T SEEM TO LOSE
EFFICACY LIKE YOU DO WITH
OPIOIDS AND HOWEVER I HAVEN'T
TESTED LIKE IF THIS WAS IN
CHRONIC INFUSION STATE.
USING TECHNIQUE CALLED
CANNULATIONS TO TARGET TUBE TO
DIFFERENT BRAIN REGIONS INFUSING
AGONIST AT [INDISCERNIBLE]
PERIRAKIAL NUCLEUS AND GET SAME
EFFECTS WANTING TO ADD
FLUORESCENT TAG TO MOLECULE AND
SEE WHAT CELLS ARE UPTAKING THIS
AND MY HYPOTHESIS NOT REACHING
DORSAL HORN THAT IS IF IN ONE OF
THE THREE REGIONS SGR THAT
ANSWERED MY QUESTION THAT IS
BIODISTRIBUTION OF INTRANASAL
MPY. GOOD JOB.
>>HI. MPY DOES A LOT OF THINGS
AND ONE THING THAT YOU KNOW
THERE HAS BEEN INTEREST AND OFF
AND ON AND MPY RECEPTORS AND
ALCOHOL USE DISORDER AND BELIEVE
IT IS TIED TO SOME ASPECTS OF
ANXIETY AND NEGATIVE AFFECT AND
SO FORTH THAT WE KNOW IS ALSO
INTERSECTING WITH PAIN
CONDITION.
IS THERE INTEREST OR PLANS TO
LOOK AT THAT DIMENSION OF PAIN
AND NEGATIVE EFFECT OF ASPECT OF
PAIN AS IT RELATES TO MPY1
AGONIST?
>>100%.
>>IT DOES A LOT OF THINGS AND
ONE WORRY HAS ALWAYS BEEN MPY
VASO CONSTRIKTIVE PROPERTY THAT
INCREASES IN BLOOD PRESSURE AND
SURPRISED BY CLINICAL DATA
INTRANASALLY ADMINISTERING TO
THIS AND AMAZING CLINICAL TRIAL
THAT YOU READ AND MOST ADVERSE
EFFECTS THAT ARE REPORTED IN
PLACEBO NOT MPY GROUP THAT IS
WELL-TAKEN AND DOING THIS WORK
CONTINUOUS BLOOD PRESSURE CUFF
DIDN'T CHANGE BLOOD PRESSURE AND
THINKING IT IS MORE SAFE THAN I
WAS EXPECTING IN THAT REGARD AND
I WOULD LOVE TO SEE IT MOVING TO
HUMANS WITH PATIENT REPORT
OUTCOMES EXPECTING THEY WILL EAT
BETTER THAT IS A POTENT
HYPERFAITHIC COMPOUND AND WE
SHOULD FIX EATING AND SHOULD
RELIEVE ANXIETY DEPRESSION AND
SEEMS LIKE A WONDER DRUG. YOU
MIGHT GAIN WEIGHT.
YEAH. THAT IS WHY WE ARE VERY
EXCITED.
>>YEAH. A WONDER DRUG, HUH?
>>YEAH.
>>I GUESS IF IT IS ALREADY USED
CLINICALLY IN ALL THESE PLACES
HAVE THERE BEEN ANY REPORTS THAT
IT IS REDUCING PAIN LIKE.
>>IT NEVER HAS BEEN TESTED IN A
PAIN SETTING BEYOND PRECLINICAL.
TO OUR KNOWLEDGE I THINK IS THE
LARGEST MODEL IT HAS EVER BEEN.
>>RIGHT. ARE THERE ANY MOTOR
EFFECTS?
>>NO.
>>AT EXTREMELY HIGH DOSES, YES.
NOTHING LIKE PAIN RELIEVING DOES
AND DOING ACCELERATING ROTE OE
ROD WHEEL THAT IS FASTER AND
FASTER AND STILL PERFORMS
EQUALLY AS WELL TO PLACEBO
GROUP.
>>OKAY. THANK YOU, TYLER.
>>THANK YOU.
>>THAT PROMOTE RESILIENCE, GOAL
DIRECTED BEHAVIOR AND POSITIVE
HEALTH IN ADULTS. IN AREA OF
RESILIENCE AND PAIN HAS BEEN
SUPPORTED BY GRANTS FROM
NATIONAL INSTITUTES OF HEALTH
CALLED [INDISCERNIBLE]
EDEPENDENT CENTER AND
COLLABORATIVE NETWORK. I
WELCOME, INNA.
>>THANK YOU FOR THE KIND
INTRODUCTION.
AS DR. BELFER MENTIONED I'M AT
UNIVERSITY OF FLORIDA AND MUCH
RESEARCH FOCUSES ON
UNDERSTANDING WHAT RESILIENCE IS
AND TRYING TO DEVELOP
INTERVENTIONS CAPITALIZING ON
PATIENT STRENGTHS TO BOLSTER A
RESILIENT PROFILE AND FIRST WANT
TO START OFF BY SAYING THANK YOU
TO THE NIH PAIN CONSORTIUM AND
ORGANIZERS FOR ALLOWING ME TO
SPEAK TODAY.
THIS IS AN INCREDIBLY IMPORTANT
TOPIC AND ONE THAT IS VERY NEAR
AND DEAR TO MY HEART AND I'M
VERY EXCITED AND HONORED TO BE
HERE TODAY TO TALK TO YOU ABOUT
RESILIENCE FROM A SYSTEMS
PERSPECTIVE.
>>HM?
OKAY.
NOW THAT I HAVE FIGURED THAT
OUT, HERE ARE MY DISCLOSURES AND
MY OBJECTIVES TODAY ARE THREE
FOLD. FIRST OF ALL, I WANT TO
CHALLENGE EACH OF US TO THINK
ABOUT REALLY WHAT RESILIENCE IS
AND TAKE A HARD LOOK AT THE
DEFINITION. THERE IS
CONSIDERABLE CONCEPTUAL
AMBIGUITY ABOUT WHAT RESILIENCE
IS AND HOW WE MEASURE IT AND
SPECIFIC OUTCOMES THAT ENCOMPASS
RESILIENCE THAT ULTIMATELY
IMPACTS ITS CLINICAL RELEVANCE.
WHAT MAKES IT SO COMPLEX IS
RESILIENCE IS MULTI-FACETED
SPANNING ACROSS MULTIPLE SYSTEMS
OF FUNCTIONING AND WILL TALK
ABOUT SOURCES OF RESILIENCE AND
TALK ABOUT THEM LATER AND WHERE
WE GO FROM HERE AND HOW WE
DEVELOP INTERVENTIONS THAT COULD
BE IMPLEMENTED TO PROMOTE A MORE
RESILIENT PROFILE.
SO, RESILIENCE RESEARCH HAS A
VERY LONG AND SCIENTIFICALLY
RICH HISTORY DATING ALL THE WAY
BACK TO THE 1950S WHERE
DEVELOPMENT PSYCHOLOGISTS REALLY
STARTED TO NOTICE THAT THERE
WERE CHILDREN THAT HAD ENDURED
SIGNIFICANT LIFE ADVERSITIES
SUCH AS UNDERGOING WAR AND
POVERTY YET THEY SEEMED TO DO
WELL IN LIFE AND WERE THRIVING
AND HAD GOOD ACADEMIC
ACHIEVEMENT AND POSITIVE
OUTCOMES THAT STARTED TO SPUR AN
ENDLESS ARRAY OF RESEARCH
FOCUSING ON STRENGTHS BASED
MODELS THAT IS A DRIFT AWAY FROM
CURRENT -- EARLIEST STUDY ON
RESILIENCE WAS KAUAI
LONGITUDINAL STUDY STARTING IN
1950S AND FOLLOWED CHILDREN FOR
SEVERAL DECADES INTO ADULTHOOD.
THEY FOUND A SUBSET OF CHILDREN
THAT SEEMED TO HAVE POSITIVE
OUTCOMES AS ADULTS AND WHAT
DIFFERENTIATED CHILDREN FROM
THESE OTHER GROUPS OF
INDIVIDUALS IS THAT THEY WERE
HIGHLY SOCIABLE AND THEY HAD
HIGH INTELLIGENCE.
THEY ALSO FORMED GOOD AND
SUPPORTIVE RELATIONSHIPS OUTSIDE
OF THE FAMILY UNIT AND ANOTHER
KEY STUDY IN RESILIENCE RESEARCH
WAS DONE BY NORM WHO WAS A
PIONEER IN RESILIENCE RESEARCH
AND WAS INTERESTED IN STUDYING
PATIENTS WITH SCHIZOPHRENIA
FINDING HIGH-RISK POPULATIONS
WITH CHILDREN WHOSE PARENTS HAD
SCHIZOPHRENIA AND MAJORITY OF
THEM AND GOING THROUGH NEGATIVE
LIFE CIRCUMSTANCES, THEY ALSO
SEEMED TO BE DOING QUITE WELL IN
LIFE AND HAVING GOOD ACADEMIC
ACHIEVEMENT AND HAVING GOOD PEER
RELATIONSHIPS AND SO HE COINED
THESE INDIVIDUALS THE
INVULNERABLES AND WORK USHERED
IN NEW ERA OF RESEARCH TRYING TO
UNDERSTAND ATTRIBUTES AND
PROCESSES THAT UNDERLIE
RESILIENCE TO TARGETING
PROCESSES IN TERMS OF
THERAPEUTIC INTERVENTIONS AND
NOW PSYCHOLOGICAL RESEARCH HAS
REALLY STARTED TO LOOK AT
RESILIENCE FROM A DYNAMIC
SYSTEMS PERSPECTIVE.
AND SO WHAT IS RESILIENCE
EXACTLY?
WELL, IT IS COMMONLY DESCRIBED
AS ABILITY TO BEND AND NOT BREAK
OR BOUNCE BACK FROM ADVERSITY OR
SOME SORT OF GROWTH THAT HAS
OCCURRED BECAUSE OF AN ADVERSE
LIFE CIRCUMSTANCE.
NOW, WHILE DEFINITIONS ARE
INCREDIBLY USEFUL, THEY DON'T
REALLY REFLECT THE COMPLEXITY
THAT UNDERLIES RESILIENCE.
SO, ACCORDING TO THE AMERICAN
PSYCHOLOGICAL ASSOCIATION,
RESILIENCE IS THE PROCESS AND
OUTCOME OF SUCCESSFULLY ADAPTING
TO DIFFICULT OR CHALLENGING LIFE
CIRCUMSTANCES.
NOW, PAUSE ON THAT. SUCCESSFUL
ADAPTATION. WHAT EXACTLY DOES
THAT MEAN?
NOW, SOME LIKE GEORGE HAVE
REALLY CHAMPIONED THE IDEA THAT
RESILIENCE IS VERY DISTINCT FROM
RECOVERY AND IN FACT RESILIENCE
ENTAILS AN INDIVIDUAL'S ABILITY
TO MAINTAIN A STABLE AND HEALTHY
LEVEL OF PSYCHOLOGICAL
FUNCTIONING BEFORE AND AFTER
ADVERSITY.
OTHER DEFINITIONS AND ONE THAT
YOU MAY ALL BE VERY FAMILIAR
WITH IS THE THEORETICAL MODEL OF
PAIN RESILIENCE THAT IS
DEVELOPED BY DREW STURTHON AND
ALEX AND DR. HASSETT WHO SPOKE
ABOUT THIS MODEL A LITTLE
EARLIER. THEY CONCEPTUALIZE
RESILIENCE ON BASIS OF RESOURCES
AND MECHANISMS STRENGTHENING
PAIN RELATED COPE ING RESPONSES
A
AND.
EVEN THOUGH FIELDS OF SCIENCE
EMPLOY VERY DIFFERENT
DEFINITIONS FOR RESILIENCE,
THERE IS A GENERAL KIND OF
COMMON UNDERSTANDING THAT
RESILIENCE IS ASSOCIATED WITH
CHANGE OVER TIME AND THAT
ESSENTIALLY WANTS TO GET THE
SYSTEM BACK TO NORMAL OR MORE
PREFERRED LEVELS OF FUNCTIONING.
IT IS ALSO AGREED UPON THAT
RESILIENCE ONLY OCCURS IN
CONTEXT OF ADVERSITY AND YOU
NEED A STRESSOR TO HAVE A
RESILIENCE PROCESS OR RESILIENT
OUTCOME.
AND ALSO, IT IS AGREED UPON THAT
RESILIENCE SYSTEMS TYPICALLY
ENGAGE IN PROCESSES THAT ALLOW
THE SYSTEM OPPORTUNITIES FOR
PERSISTENCE RECOVERY AND
TRANSFORMATION AND WHAT
PROCESSES LOOK LIKE REALLY
DEPENDS ON TYPE AND DURATION OF
THE STRESSOR AND DEPENDS ON
RESOURCES AVAILABLE TO THE
SYSTEM AND ALSO THE OUTCOMES
THAT ARE BEING LOOKED AT.
4TH AND, YOU KNOW, FINALLY MOST
RESISTANT AND INTERACTIVE AND
CONNECTS ACROSS SYSTEMS AND
THINKING ABOUT RESILIENCE, THERE
IS A NUMBER OF RESOURCES AND
MECHANISMS ASSOCIATED WITH THAT
IS NOT CERTAINLY AN EXHAUSTIVE
LIST.
WHEN WE THINK ABOUT PAIN, WE
KNOW THAT VARIOUS COGNITIVE AND
EMOTIONAL FACTORS ARE ASSOCIATED
WITH PAIN EXPERIENCE AND
PERSONALITY CHARACTERISTICS THAT
ARE SOCIAL AND CULTURAL
ENVIRONMENT AND EVEN BIOLOGICAL
AND BEHAVIORAL FACTORS AS WELL.
THERE HAVE BEEN A NUMBER OF
CROSS-SECTIONAL STUDIES THAT
HAVE LOOKED AT ASSOCIATION OF
FACTORS IN THE CONTEXT OF PAIN.
OPTIMISM IS PROBABLY ONE OF THE
MOST HEAVILY STUDIED AND
PROTECTIVE FACTORS THAT WAS A
STUDY THAT WAS DONE AS PART OF
THE WOMEN'S HEALTH INITIATIVE
WHERE THEY FOUND THAT WOMEN WHO
WERE IN HIGHEST QUARTILE OF
OPTIMISM LIVE ON AVERAGE FOUR
YEARS LONGER THAN WOMEN IN
LOWEST QUARTILE AND HAD
EXCEPTIONAL LONGEVITY, MEANING
THAT THEY WERE LIVING OVER THE
AGE OF 90 YEARS.
THEY FOUND THAT THESE OUTCOMES
HAS EXISTED EVEN THOUGH THERE
WASN'T ANY DIFFERENCES ACROSS
RACE AND ETHNICITY.
SO, I WANT YOU TO THINK ABOUT
THAT FOR A MOMENT.
OPTIMISM CAN INCREASE LIFESPAN.
THAT IS PRETTY POWERFUL WHEN
YOU THINK ABOUT THE EFFECTS THAT
POSITIVE PSYCHOLOGICAL RESOURCES
COULD HAVE ON HEALTH.
SO, WE HAVE TAKEN A BROAD-BASED
APPROACH IN MY LABORATORY
STUDYING THESE FACTORS AND HOW
THEY LINK TO THE PAIN
EXPERIENCE.
WHAT YOU ARE SEEING HERE IS DATA
FROM OUR OLDER ADULT POPULATION
AND LOOKING AT PAIN OUTCOME
DIFFERENCES THAT IS ACROSS
LEVELS OF STRESS RESILIENCE.
IT WAS DONE BY LOOKING AT BRIEF
RESILIENCE SCALE. WHAT YOU SEE
HERE IS THAT PEOPLE WITH HIGHER
LEVELS OF STRESS RESILIENCE ARE
INDIVIDUALS REPORTING LOWER PAIN
INTENSITY AND DISABLE AND HAVE
LOWER LEVELS OF PAIN
INTERFERENCE AND ENGAGE IN LESS
PAIN BEHAVIORS AS COMPARED TO
PEOPLE WHO ARE HIGHER OR LOWER
IN STRESS RESILIENCE WE HAVE
BEEN LOOKING AT IT FROM CONTEXT
OF PAIN IMPACT THAT IS A VERY
IMPORTANT TOPIC AND IT IS IN
PAIN LITERATURE AND PEOPLE WITH
HIGHER LEVELS OF PAIN IMPACT ARE
PATIENTS WHO TEND TO BE
DEBILITATED BY PAIN AND USING
MORE HEALTH CARE RESOURCES
COMPARED TO INDIVIDUALS THAT ARE
LOWER IN PAIN IMPACT.
SO, THERE ARE A NUMBER OF WAYS
THAT YOU CAN EXAMINE PAIN IMPACT
AND RESOURCE CRITERIA THAT IS
MEASURES FROM PROMISE PAIN
MEASURES AND THIS IS SOME DATA
FROM A TRIAL WE CONDUCTED WITH
OLDER ADULTS WITH CHRONIC LOW
BACK PAIN AND YOU ARE SEEING
HERE JUST PAIN IMPACT THAT IS ON
THE Y AXIS HERE THAT KIND OF
VARIES IN LEVELS OF IMPACT FROM
HIGH TO LOW.
LOOKING AT THIS ACROSS A NUMBER
OF POSITIVE PSYCHOLOGICAL
RESOURCES SUCH AS RESILIENCE AND
PAIN ACCEPTANCE AND EVEN
GRATITUDE AND FIND THAT FOR
INDIVIDUALS WHO HAVE LOWER PAIN
IMPACT ARE INDIVIDUALS WHO IS
REPORTING A HIGHER DEGREE OF
POSITIVE AND PSYCHOLOGICAL
RESOURCES AND WHETHER RESOURCES
ARE PREDICTING PAIN IMPACT OR
VICE VERSA, WE DON'T REALLY
KNOW.
THERE SEEMS TO BE A RELATIONSHIP
BETWEEN HOW ONE FUNCTIONS WITH
THEIR PAIN AND OVERALL LEVEL OF
POSITIVE PSYCHOLOGICAL HEALTH.
SO, A QUESTION IS ARE THESE
FACTORS PRODICKTIVE WHO WILL DO
WELL AFTER SURGERY OR WHO ARE
THE INDIVIDUALS THAT ARE GOING
TO GO ON TO DEVELOP CHRONIC PAIN
AFTER SOME SORT OF ACUTE INJURY
HAS HAPPENED?
SHORT ANSWER TO THAT IS YES.
THERE HAS BEEN A VERY SMALL
HANDFUL OF STUDIES TRICKLING IN
STARTING TO LOOK AT SOME OF
THESE FACTORS THAT WAS A STUDY
CONDUCTED BY ROY CORE ON ADO
WHERE THEY WERE EXAMINING
PATIENTS UNDERGOING LAMBINECTOMY
AND FOLLOWED THEM FOR A PERIOD
OF 12 MONTHS AND THEY WERE
INTERESTED IN WHETHER THERE WERE
VARIOUS FACTORS THAT PREDICTED
PAIN OUTCOMES DURING EARLY
POST-OP ITERATIVE PERIOD AND
EARLY POST-OP ITERATIVE PERIOD
IS USUALLY 6 WEEKS AFTER SURGERY
AND IS A CRITICAL TIME PERIOD.
IT IS WHEN DOCTORS WANT TO START
TO DETERMINE WHETHER OR NOT
REFERRALS NEED TO BE MADE FOR
ADDITIONAL POST-OP ITERATIVE
CARE THAT THE PATIENT MAY NEED.
I WANT TO BRING YOUR ATTENTION
TO THE AREA THAT IS OUTLINED IN
RED AND THEY FOUND THAT
RESILIENCE AND SELF-EFFICACY AT
6 WEEKS POST SURGERY WERE
PREDICTED AT 12 OUTCOMES
PHYSICAL FUNCTION AND PAIN
INTERFERENCE AMONGST OTHER
OUTCOMES AND RESILIENCE SEEMED
TO HAVE A BIT OF AN EDGE OVER
SELF-EFFICACY IN TERMS OF
PREDICTIVE POWER.
AND SIMILARLY, OTHERS SUCH AS
THE STUDY HERE THAT WAS DONE AT
DUKE UNIVERSITY THAT FOUND THAT
HIGHER BASELINE RESILIENCE WAS
ASSOCIATED WITH BETTER POST-OP
ITERATIVE KNEE FUNCTION AND
GENERAL HEALTH THREE MONTHS
AFTER KNEE ARTHROMRAFTY AND LOTS
OF THE STUDIES IN SURGICAL SPACE
HAVE REALLY FOCUSED ON SURGICAL
AND MEDICAL FACTORS AND EVEN
PSYCHOLOGICAL RISK FACTORS IN
TERMS OF CONNECTORS AND IS NOT A
LARGE BODY OF EVIDENCE RIGHT NOW
FOR THIS.
IT IS SLOWLY GROWING.
WE ARE SEEING NICE SUPPORT FOR
SOME OF THE PREDICTORS.
I HAVE TOUCHED UPON MORE OF THE
PSYCHOLOGICAL ASPECT.
WE ALSO KNOW THAT RESILIENCE
INVOLVES VERY ACTIVE AND UNIQUE
BIOLOGICAL AND BEHAVIORAL AND
SOCIOCULTURAL PROCESSES THAT
IMPACT AGAINST STRESS AND PAIN
AND IS EVIDENCE FOR POTENTIAL
ROLE OF HEARTRATE VARIABILITY
THAT IS SEEN AS INDEX OF
RESILIENCE IN RELATION TO
EMOTION REGULATION CAPACITY
ESPECIALLY AND IS NICE EVIDENCE
FOR SOCIAL BUFFERING EFFECTS OF
THE HPA SYSTEM.
AND WE HAVE ACTUALLY RECENTLY
COLLECTED DATA THAT IS FINDING
THAT VARIOUS PROTECTIVE FACTORS
SUCH AS HOPE AND OPTIMISM.
THEY SEEM TO HAVE EFFECTS
ADVANTAGEOUS EFFECTS IN TERMS OF
CORTISOL AND REACTIVITY AND
RECOVERY AND COMPARING THEM TO
TRADITIONAL MEASURES OF RISK
SUCH AS PERCEIVED STRESS AND
CATASTROPHIZING AND WANT TO
POINT OUT THAT NO SINGLE
VARIABLE IS WHOLLY RESPONSIBLE
FOR THE COMPLEXITY OF PROCESSES
ASSOCIATED WITH RESILIENCE AND
OUTCOMES.
BUT, MUCH OF THE RESEARCH, AT
LEAST IN THE PAIN SPACES, THEY
ARE REALLY TRADITIONALLY FOCUSED
ON PSYCHOLOGICAL ASPECTS OF
RESILIENCE.
AND -- AND HAVE TYPICALLY KIND
OF MEASURED FACTORS IN
ISOLATION.
SO, I REALLY WOULD LIKE TO
EXPAND OUR KNOWLEDGE ON
RESILIENCE. WE REALLY NEED TO
CONSIDER IT FROM A WHOLE PERSON
PERSPECTIVE THAT SPANS ACROSS
MULTIPLE SYSTEMS.
SO, THIS IS ACTUALLY HAS BEEN
SOME INTEREST FOR NIH TRANS
RESILIENCE WORKING GROUP THAT
WAS ESTABLISHED TO COORDINATE
RESEARCH RESILIENCE AGENDA
ACROSS NIH SYSTEM AND THROUGH
WORK HAS BEEN APPRECIATION THAT
RESILIENCE IS IN FACT
MULTI-FACETED AND SPANS ACROSS
MULTIPLE SYSTEMS.
WHEN THE ORGANISM IS TAXED WITH
A SPECIFIC STRESSOR OR
ADVERSITY, THIS EFFECTS MULTIPLE
SYSTEMS INCLUDING ENVIRONMENTAL
AND COMMUNITY EXPOSURES AND
INDIVIDUAL PSYCHOLOGICAL AND
PHYSIOLOGICAL AND MOLECULAR
MAKEUP.
SO, WE HAVE ACTUALLY BEEN TRYING
TO TACKLE THIS A BIT THROUGH
SOME PHENOTYPING ANAL CEASE.
WE WANT TO IDENTIFY PROFILES OF
RESILIENCE THAT ARE BASED UPON
DIFFERENT DOMAINS.
SO, THIS HAS RESULTED IN A
SERIES OF STUDIES WHERE WE HAVE
EMPIRICALLY IDENTIFIED
COMPOSITES OF RESILIENCE THAT
ARE BASED UPON VARIOUS
PSYCHOLOGICAL AND HEALTH AND
SOCIAL RELATED FACTORS SUCH AS
WHAT YOU SEE HERE AT THE TOP OF
THE SLIDE.
THEN WHAT WE HAVE DONE IS USE
CLUSTERING TECHNIQUES TO
DETERMINE SUBGROUPINGS BASED
UPON PATTERNS OF FUNCTIONING AND
WE GENERALLY FOUND FOUR PATTERN
RS OF FUNCTIONING OR FOUR
PATTERNS OF SUBGROUPS THAT ARE
PRESENT AND TWO SUBGROUPS THAT
ARE DEFINED EITHER BY HIGHER
LEVELS OF RESILIENCE OR THOSE
WITH LOWER RESILIENT PHENOTYPE
AND FOUND ALSO TWO OTHER
SUBGROUPS PRESENT THAT VARY
ACCORDING TO THEIR LEVEL OF
PSYCHOSOCIAL AND HEALTH-RELATED
FUNCTIONING.
WITH THIS, WE WANTED TO TAKE
PROFILES AND DETERMINE WHETHER
AND HOW THEY TAP ON TO THE PAIN
EXPERIENCE.
SO, JUST TO KIND OF QUICKLY SUM
UP RESULTS, MORE PROTECTIVE
RESOURCES, THE BETTER AND WE
GENERALLY FIND THAT THOSE
INDIVIDUALS WHO HAVE A HIGHER
KIND OF RESILIENT PHENOTYPE ARE
INDIVIDUALS THAT ARE REPORTING
MORE OPTIMAL PSYCHOLOGICAL
HEALTH AND ARE ALSO REPORTING
MORE ADAPTIVE PHYSICAL
FUNCTIONING AND LESS DISABILITY
AND LESS COGNITIVE DISFUNCTION
AND HAVE LOWER LEVELS OF SLEEP
DISTURBANCE AND FATIGUE AND WHAT
IS INTERESTING ABOUT THIS IS WE
ARE SEEING DIVERGENCE ACROSS
OTHER SUBGROUPS IN PEOPLE WHO
HAVE HIGHER LEVELS OF PHYSICAL
FUNCTIONING AND ARE INDIVIDUALS
WITH LOWER LEVELS OF BMI AND
COMORBIDITIES AND TEND TO DO
BETTER IN TERMS OF PHYSICAL
FUNCTIONING AND HAVE LESS ADVISE
IBLTD AND FLIPSIDE INDIVIDUALS
HIGHER IN PSYCHOSOCIAL RESOURCES
ARE REPORTING THE LOWEST LEVEL
OR HIGHEST LEVELS OF STRESS
RESILIENCE.
WE HAVE ALSO LOOKED AT THIS IN
CONTEXT OF PAIN IMPACT.
SO, WHAT YOU SEE HERE IS THAT
INDIVIDUALS THAT ARE LOWER IN
RESILIENCE, THEY REPORT THE
HIGHEST DEGREE OF PAIN IMPACT.
SO, THESE STUDIES ARE
PRELIMINARY RIGHT NOW AND HAVE
AH FAIRLY SMALL SAMPLE SIZE.
WHAT THEY DO IS GIVE A KIND OF
VERY NICE ILLUSTRATION OF
INTERACTIVE EFFECTS OF VARIOUS
DOMAINS AND MAY PROVIDE A
GREATER DEPTH OF UNDERSTANDING
HOW RESILIENCE INTERACTS WITH
ONE ANOTHER ACROSS VARIOUS
SYSTEMS AVENUE TOWARDS IMPROVING
PAIN MANAGEMENT STRATEGIES.
THIS FINALLY BRINGS ME TO MY
LAST TOPIC OF TREATMENT
APPROACHES AND RESILIENCE
SCIENCE HAS REALLY SPURRED A LOT
OF INTEREST IN -- AND SHIFT AWAY
FROM OUR TRADITIONAL DEFICIT
MODELS OF APPROACH.
TO ONE THAT REALLY FOCUSES MORE
ON STRENGTHS AND ASSETS AND
THERE IS LITTLE CONSENSUS IN
TERMS WHAT ACTUALLY COMPRISES
RESILIENCE INTERVENTION AND XOEN
NEPTDS THAT COULD BE IMBEDDED IN
ONE AND RESILIENCE BASED
INTERVENTIONS FOLK YS ON
TARGETING PSYCHOLOGICAL HEALTH
AND STRATEGIES AND INTERVENTIONS
THAT ARE USED IMPLEMENTING MORE
STRENGTH BASED APPROACH AND DR.
HASSETT TALKED ABOUT SOME TODAY
AND MANY OF THE STRATEGIES ARE
THOSE OF ACTS OF KINDNESS AND
HOPEFUL THINKING THAT HAVE BEEN
BORROWED FROM POSITIVE
PSYCHOLOGY LITERATURE THAT HAVE
BEEN IMBEDDED WITHIN POSITIVE
ACTIVITY INTERVENTIONS THAT ARE
THERAPIES THAT INCLUDE A
COLLECTION OF VARIOUS STRATEGIES
AND IF WE THINK ABOUT MECHANISMS
THAT ARE UNDERLYING EFFECTS OF
INTERVENTIONS IT IS GENERALLY
BELIEVED THAT THESE
INTERVENTIONS WORK BY INCREASING
POSITIVE EMOTIONS AND BEHAVIORS
AND WAY THAT PEOPLE THINK AND
FEEL ABOUT THINGS AND BRINGS ME
TO A STUDY WE JUST RECENTLY
WRAPPED UP THAT IS USING A LOT
OF THE SAME STRATEGIES I JUST
REVIEWED AND LEVERAGES A LOT
FROM POSITIVE PSYCHOLOGY
LITERATURE. THIS IS A GROUP
BASED INTERVENTION FOR OLDER
ADULTS WITH CHRONIC LOW BACK
PAIN THAT IS 7 WEEKS IN DURATION
AND FOLLOWED INDIVIDUALS SINGLE
HARM TRIAL AND ACTIVITIES YOU
SEE HERE ENGAGING PATIENTS IN
MREN PLEASANT ACTIVITIES TAKING
CONCEPTS FROM ACCEPTANCE AND
COMMITMENT THERAPIES AND VALUES
BASED TARGETING AND VARIETY OF
CONCEPTS AND STRATEGIES IMBEDDED
IN THIS AND STUDY AIMED AS PILOT
FEASIBILITY AND ACCEPTABILITY
STUDY AND INTERESTED IN WHETHER
OR NOT WE COULD MOVE NEEDLE ON
PAIN RELATED OUTCOMES AND IN
GENERAL WE FOUND THAT PATIENTS
ENJOYED THE INTERVENTION AND
THEY FOUND IT HIGHLY ACCEPTABLE
AND WE ARE SEEING SOME REALLY
NICE EFFECTS FOR SOME PAIN
OUTCOMES FROM PRETO POST AND
SEEING REDUCTIONS IN PAIN
INTENSITY AND INTERFERENCE AND
DEPRESSION WAS NOT EXCEPTIONALLY
HIGH IN THIS PARTICULAR SAMPLE
WE DO ALSO SEE REDUCTIONS IN
DEPRESSIVE SYMPTOMS AND
IMPROVEMENTS IN QUALITY OF LIFE
WITH RESPECT TO SATISFACTION AND
OVERALL HEALTH THAT IS WHAT IS
REALLY EXCITING ABOUT THIS IS
EFFECTS HAVE HELD UP OVER TIME
AND TWLEE MONTH FOLLOW UP AND
PATIENTS ARE STILL USING LOTS OF
SAME STRATEGIES AND WE SEE
MAINTENANCE OF EFFECTS THAT IS A
REALLY NICE ILLUSTRATION OF
BENEFITS OF THESE TYPES OF
THERAPIES AND HANDFUL OF SMALL
STUDIES USING POSITIVE
INTERVENTIONS FOR CHRONIC PAIN
AND EFFECTS HAVE CHANGED FROM
MODERATE TO LARGE.
I WANT TO POINT OUT THERE IS
VARIABILITY ACROSS SOME STUDIES
USING POSITIVE ACTIVITY
INTERVENTIONS AND EFFECTS DUE TO
PEN ON OUTCOME IS INTEREST THAT
IS BEING ASSESSED AND IS ALSO
NOT A LOT OF INFORMATION ON LONG
TERM EFFECTS OF TYPES OF
INTERVENTION THAT IS AN AREA TO
GROW IN TERMS OF RESEARCH AND
FINDING OUT HOW THESE DIFFERENT
STRATEGIES WORK AND WHO DO THEY
WORK WELL FOR AND GOING BACK TO
DEFINITION AND THINKING ABOUT IT
DR. HASSETT ELUDED TO IN HER OWN
TALK AND INTERACTIONS COULD BE
RESILIENCE ENHANCING IN SOME WAY
OR ANOTHER WHETHER THROUGH
INCREASING POSITIVE COGNITIVE
APPRAISALS OR EVEN IMPROVING
POSITIVE INTERACTIONS BETWEEN
CHILD AND PARENT AND THINKING
ABOUT ALSO IT CAN IMPROVE
PHYSICAL RESILIENCE POSSIBLY
REDUCING MUSCLE TENSION YOU CAN
DO THROUGH MASSAGE THERAPY AND
HAVE TO THINK ABOUT CURRENT
INTERVENTIONS THAT COULD BE
RESILIENCE ENHANCING AND IN WHAT
WAY ARE THEY RESILIENCE
ENHANCING AND WHAT AREA OF
RESILIENCE ARE THEY TAPPING INTO
AND OTHER THERAPIES LIKE
MINDFULNESS HAVE RESULTED IN
BENEFICIAL EFFECTS IN CHRONIC
PAIN AND FOR EXAMPLE RECENT
TRIAL CONDUCTED BY ERIC GARL AND
THAT IS INTEGRATED TREATMENT
MINDFULNESS ORIENTED RECOVERY
ENHANCEMENT AND TARGETING
INDIVIDUALS WITH CHRONIC PAIN
AND HAD OPIOID USE DISORDER THAT
FOCUSED ON THREE CORE COMPONENTS
INVOLVING MINDFULNESS AND
SAVORING AND REAPPRAISAL
PROCESSES AND IN THE 8 WEEK
TRIAL THEY FOUND THAT
INTERVENTION LED TO POSITIVE
EFFECTS IN PAIN OUTCOMES AND SAW
REDUCTIONS IN OPIOID MISUSE AND
DOSAGES AND IS KIND OF PROVIDING
REALLY NICE SUPPORT FOR
INTEGRATING VARIOUS STRATEGIES
TOGETHER IN TERMS OF IMPROVING
PAIN OUTCOMES AND SHOWS EFFECTS
THAT CAN EXTEND BEYOND CHRONIC
PAIN AND BE HELPFUL FOR
POPULATIONS THAT ARE HIGHLY
COMORBID WITH IT AND SUMMING UP,
THERE IS REALLY NICE EVIDENCE
THAT IS SUPPORTING ROLE OF
RESILIENCE IN TERMS OF PROMOTING
MORE EFFECTIVE PAIN OUTCOMES AND
NOW ADVANCING OUR UNDERSTANDING
OF RESILIENCE IS GOING TO
REQUIRE MORE IN DEPTH
EXAMINATION OF RESILIENCE ACROSS
MULTIPLE SYSTEMS AND IMAGINE
THAT HAS TO BE HUGE
METHODOLOGICAL HURDLE AND THINK
ABOUT WHICH SYSTEMS YOU ARE
TRYING TO MODEL AND THINKING
ABOUT ALSO THEIR INTERACTIVE
PATTERNS THAT THEY HAVE WITH ONE
ANOT
ANOTHER.
I WOULD LIKE TO BE OPTIMISTIC
THIS COULD HAPPEN AT LEAST AT
SOME POINT AND FOR IT TO BE VERY
SUCCESSFUL WE HAVE TO STEP
OUTSIDE OF OUR OWN DISCIPLINES
AND COLLABORATE AND NETWORK WITH
OTHER SCIENTISTS OUTSIDE OF OUR
OWN DISCIPLINE TO BE ABLE TO
THINK ABOUT YOU KNOW WHAT
RESILIENCE IS AND HOW EXACTLY WE
CAN GO ABOUT MODELING THAT
ACROSS THESE VARIOUS OTHER
SYSTEMS AND DOING SO MIGHT HAVE
POTENTIAL FOR INFORMING OUR OWN
CLINICAL PRANTHIS AND HUMANS
HAVE INCREDIBLE POTENTIAL TO
WEATHER ADVERSITY AND BE ABLE TO
ADAPT TO CHANGE AND NEED
EFFECTIVE RESOURCES AND TOOLS TO
BE ABLE TO DO SO.
THINKING ABOUT CURRENT
STRATEGIES THERAPIES BUILT UPON
FOUNDATION OF RESILIENCE HELPS
IMPROVE PAIN OUTCOMES IN
ORGANIZATIONS WE ARE WORKING
WITH AND HELP MITIGATE RISK FOR
CHRONIC PAIN.
SO, BEFORE WE TRANSITION TO THE
NEXT SPEAKER I WANT TO
ACKNOWLEDGE MY FUNDING RESOURCES
AND AMAZING PEOPLE THAT I WORK
WITH AT THE UNIVERSITY OF
FLORIDA IN MY LABORATORY AND,
AGAIN, BIG THANK YOU TO NIH PAIN
CONSORTIUM.
THANK YOU.
>>THANK YOU. THANK YOU SO MUCH
FOR THE EXCITING TALK AND FOR
HIGHLIGHTING OF THE
OPPORTUNITIES FOR INTERAND
MULTI-DISCIPLINARY RESEARCH OF
RESILIENCE.
THIS IS REALLY GREAT AND I WOULD
LIKE TO ENCOURAGE EVERYBODY TO
THINK ABOUT THE QUESTIONS FOR
OUR SPEAKER AND WE WILL TAKE ALL
OF THE QUESTIONS AT Q & A AT THE
END OF THE SESSION.
NEXT SPEAKER'S NAME WAS
MENTIONED ACTUALLY SEVERAL TIMES
DURING THE KEYNOTE AND PLEASURE
TO INTRODUCE KIM SIBILLE IN
DIVISION OF PAIN MEDICINE.
I'M SO SORRY OKAY. DR. SIBILLE
WILL BE THE LAST BUT NOT LEAST
SPEAKER AND DEFINITELY IS A BIG,
BIG PLEASURE TO INTRODUCE LUDA
WHO IS A CANDIDATE RESEARCH HERE
IN HUMAN PAIN GENETICS AT MCGILL
UNIVERSITY AND CENTER FOR
RESEARCH AND PAIN AND HAS MD AND
PHD IN FIELD OF MOLECULAR
BIOLOGY AND FROM THE RUSSIAN
STATE MEDICAL UNIVERSITY AND HER
RESEARCH IS FOCUSED ON
DETERMINING THAT MOLECULAR
MECHANISMS UNDERLINE HUMAN PAIN
STATES AND DEVELOPMENT OF
CHRONIC PAIN CONDITIONS AND
ENABLING NEW APPROACHES TO
IDENTIFYING NEW DRUG TARGETS AND
TREATMENT RESPONSES TO
ANALGESICS AND DIAGNOSTICS AND
HAVE A RICH HISTORY OF
COLLABORATION AND IS MY DEFINITE
PLEASURE TO INTRODUCE LUDA.
>>HELLO. THANK YOU VERY MUCH
FOR BEING HERE. SO, I WILL --
HM.
OKAY. SO, I WILL TALK ABOUT
TRANSLATIONAL APPROACHES TO
START MECHANISMS UNDERLYING PAIN
RESISTANCE IN PAIN RESOLUTION
AND TALK WILL BE IN LINE WITH
[INDISCERNIBLE] ON VERY, VERY
MOLECULAR AND GENETIC LEVEL.
OKAY. I WOULD LIKE TO MENTION
THIS COMPANY THAT I WILL CONSULT
AND HAVE AN IMPLICATION WITH ONE
[INDISCERNIBLE] AGAIN.
I DON'T DISCUSS ANY PRODUCT OF
THE COMPANY TODAY.
BUT, AGAIN, I WOULD LIKE TO
MENTION THAT WE SUBMIT PATENT
APPLICATION FOR THIS GENERAL
IDEA OF ENHANCED INFLAMMATORY
RESPONSE THAT TRIGGERS
RESOLUTION AND IS SOMETHING I
WILL TALK TODAY ABOUT.
SO, I'M A JEANETTE SIFRT R- SYST
-- GENETICIST.
I WILL START MY JOURNEY USING
HUMAN DATA AND IN THIS STORY I
WOULD LIKE TO TELL YOU TODAY I
START FROM HUMAN IN THIS
GENOMEWIDE TRANSCRIPTOMICS DATA.
IT THIS DATA WAS FROM A COHORT
THAT HAS BEEN -- LET ME SEE IF I
SHOW IT.
SORRY.
>>YOU CAN OPEN THIS RIGHT HERE.
WHY IS IT NOT DOING IT.
>>SORRY YES. COHORT WAS FROM
ITALY.
WAS BY [INDISCERNIBLE] FROM
PARMA UNIVERSITY AND WE HAD
PEOPLE WITH ACUTE BACK PAIN.
SOME PEOPLE IN THREE MONTHS
RESOLVED PAIN AND SOME DIDN'T;
RIGHT?
SO, WE CALLED THEM RESOLVERS IN
PERSISTENT GROUP.
WE HAD BLOOD FROM THE PEOPLE.
WE LOOKED AT DIFFERENTIAL
EXPRESSION AND IS RESULTS AND
THESE PLOTS AND IF YOU NEVER
LOOK AT GENOMEWIDE
TRANSCRIPTOMICS DATA DON'T WORRY
I WILL TAKE YOU THAT IS A LITTLE
EASY AS A POINTER AND WILL BE
MANAGED TO DO THIS AND THIS
ANALYSIS HAS BEEN DONE BY MARK
WHO IS IN THE RIGHT UPPER
CORNER. WE DID DIFFERENT
ANALYSIS IN TERMS OF DIFFERENT
GENE EXPRESSION AND IN -- SO,
HERE, WHAT YOU SEE IN THE
QUADRANT IS THIS ANALYSIS GENE
EXPRES
EXPRESSION.
MY.
EVERYTHING THAT IS PIFSHG --
WHAT IS MOST [INDISCERNIBLE]
HERE IS COMPARISON OF TRANSCRIPT
OHMS CHANGE OVER TIME. I THINK
THAT I WAS VERY HAPPY TO HEAR
TODAY DURING THE DAY THIS MANTRA
OF TIME THAT HAS CHANGED AND IS
RESPONSE AND WHAT WE SAW. YOU
SEE, IN PEOPLE WITH PERSISTENT
PAIN P OVER THREE MONTHS NOTHING
CHANGED AND IS NOTHING CHANGE
AND IS ALL NEW BLACK LINE.
THE GENES TRANSCRIBED IN BLOOD
CHANGE EXPRESSION IN PEOPLE THAT
RESOLVE BLOOD PAIN AND YOU DON'T
HAVE TO BE GENETICISTS TO SEE
WHERE ACTION IS.
YOU SEE A CHRISTMAS TREE ON
RIGHT FOR PEOPLE THAT RESOLVE
PAIN AND THAT IS A HUGE
REVOLUTION THAT IS LOOKING FOR
DATA A FEW MONTHS AND MAIN
QUESTION I ASK FOR MYSELF WHY
I'M SO CONFUSED.
DATA IS CLEAR AND I THOUGHT
ABOUT PAIN AS ACTIVE
PATHOLOGICAL PROCESS AND NEED TO
FIND ACTIVE PATHOLOGICAL PROCESS
AND NEED TO FIND GENE AND FIND
GENE TARGET THAT WE REVEAL IN
[INDISCERN
[INDISCERNIBLE].
DATA SUGGESTS IT IS NOT LIKE
THIS PEOPLE RESOLVING PAIN HAVE
ALL THIS ACTION AROUND
RESOLUTION.
WHEN YOU HAVE GENES ALSO IT
DOESN'T SEEM TO MAKE SENSE TO
LOOK AT WHAT IS THE GENE, WHICH
GENE?
WE NEED TO LOOK AT IF WE CAN
COMBINE THIS DATA IN TYPE OF BIG
[INDISCERNIBLE] BIOLOGICAL
PATHWAYS AND BH WE DID THIS MOST
SIGNIFICANT FROM SPECIFIC
PATHWAY WAS MANY, MANY PATHWAYS
ACTUALLY AND YOU SEE LOTS OF
PROCESSES AGAIN IN IMMUNE SYSTEM
FROM PEOPLE THAT RESOLVE PAIN
AND MOST -- OKAY. YEAH. I
FORGOT.
SO, THE MOST SIGNIFICANT
SPECIFIC PATHWAY WE SAW WAS
INFLAMMATORY RESPONSE.
IN NEAR INFLAMMATION AND ACUTE
INFLAMMATORY RESPONSE AND ACUTE
STAGE BETWEEN PEOPLE THAT
RESOLVE AND NOT RESOLVE PAIN AND
AGAIN IS VERY CONFUSING AND WHY
IT WAS CONFUSING IS PEOPLE THAT
RESOLVE PAIN HAVE HIGH
INFLAMMATORY RESPONSE IN ACUTE
STAGE.
WE ALWAYS THINK -- I MEAN, I
ALWAYS THOUGHT AND WE DO
DIFFERENTLY AND THINK CHRONIC
PAIN IS CHRONIC INFLAMMATION.
SO, INFLAMMATION IS BAD AND WE
NEED TO INHIBIT INFLAMMATION AND
ALL OF A SUDDEN WE SEE THAT IT
IS PEOPLE THAT RESOLVE PAIN AND
UPREGULATION OF ACUTE
INFLAMMATORY RESPONSE THAT THEN
GOES DOWN THAT IS THREE ON VERY
RIGHT AND IS GOING DOWN VERY
QUICKLY AND BY THREE MONTHS AND,
AGAIN, NOTHING HAPPEN IN PEOPLE
THAT DON'T RESOLVE PAIN.
SO, THEN IT WAS ALSO VERY
INTERESTING WHEN WE LOOK.
OKAY.
BUT SOME CHANGES TO PEOPLE THAT
DON'T RESOLVE PAIN AND WE KNOW
IT IS [INDISCERNIBLE] PEOPLE;
RIGHT?
ABOVE AND IN 4 BELOW AND 4 AND
REALLY CONTINUOUS.
PEOPLE THAT RESOLVE PAIN DOING
SOMETHING THAT IS ABSOLUTELY
DIFFERENT FROM THEIR BLOOD AND
THOSE THAT DON'T RESOLVE PAIN OR
IS ORDER OF MAGNITUDE OR
DIFFERENTIATE THEM AND ACTUALLY
IN THIS SLIDE IT IS NOT OBVIOUS
AND WHAT WE DID HERE IS
CORRELATED PATHWAY OF THE PEOPLE
THAT RESOLVE PAIN AND DIDN'T
RESOLVE PAIN OVER THREE MONTHS
AND LOW LEFT CORNER TELLS YOU
THAT THIS PATHWAY IS CONTINUE
THIS GROUP CORRELATING VERY HIGH
AND VERY LOW AND [INDISCERNIBLE]
THAT IS .42. IN OTHER WORDS,
YES. PEOPLE THAT DON'T RESOLVE
PAIN ARE ALSO TRYING TO DO SAME
THINGS.
THEN WHAT IS THE DIFFERENCE?
DIFFERENCE IS IN ORDER OF
MAGNITUDE THAT IS WHY WE DON'T
SEE ANYTHING IN THE BLOOD OF THE
PEOPLE THAT ARE PERSISTENT NOT
BECAUSE NOTHING HAPPENED BUT
THEY DON'T CROSS SIGNIFICANT
LINES.
SO, ALL OF THE PROCESS IS VERY
LOW OR VERY LOAF MAGNITUDE OF
RESPONSE AND CAN CALCULATE.
GOLDEN LINE IN LOW LEFT GRAPH IS
THE KIND OF IDEAL CORRELATION
AND REAL CORRELATION IS MAGENTA
LINE AND DIFFERENCE BETWEEN THEM
IS 30-FOLD.
ALL RIGHT?
SO, IT IS INTENSITY.
SO, WE, YOU KNOW, I WILL SKIP A
LOT OF DETAIL AND RESULTS AND WE
HAD ANOTHER COHORT THAT WAS
FACIAL PAIN AND HAS ACUTE AND
CHRONIC PAIN AND ACUTE TEAM D
PATIENT THAT WAS [INDISCERNIBLE]
FOR SIX MONTHS AND WE ALSO HAVE
CONTROL IN VERY CHRONIC PATIENT
AND WE FINALLY CAME UP WITH A
MODEL THAT IS THIS.
SO, IN ACUTE STAGE, THOSE WHO
UPREGULATE INFLAMMATORY
RESPONSE, THEY TRIGGER MULTIPLE
EVENTS INCLUDING DOWNREGULATION
OF INFLAMMATION AND THEN THERE
ARE PEOPLE THAT ARE GOING IN
ANTIINFLAMMATORY RESPONSE BEYOND
BASELINE AND HAVE STRONG
INFLAMMATORY RESPONSE AND
SUBJECT THAT WON'T RESOLVE PAIN
INFLAMMATORY RESPONSE AND ACUTE
STAGE WAS VERY LOW AND NOT
RESPONSIVE; RIGHT SF.
I HEARD TODAY A LOT OF TIME THE
WORD DYNAMIC MARKERS AND LOVE
DYNAMIC MARKERS THAT IS DYNAMIC
RESPONSE THAT YOU NEED THOSE
THAT DON'T HAVE DYNAMIC RESPONSE
HAVE INFLAMMATORY RESPONSE THAT
IS GRADUALLY INCREASING AND
INCREASING INCREASING AND NEVER
TRIGGER ANTIINFLAMMATORY
RESPONSE IN ADAPTIVE RESPONSES
AND OVER TIME WE SEE IN PATIENTS
THAT ARE REOCCURRING THEY HAVE
LOW GRADE INFLAMMATION.
SO, BUT EVERY TIME WHEN WE WALK,
IT THIS IS A PROBLEM WORKING
WITH HUMAN SAMPLES AND WHEN YOU
DO THAT YOU CAN MAKE HYPOTHESIS
THAT IS ACTUALLY ALL CORRELATION
AND HOW YOU CAN BE SURE ABOUT
CAUSATION.
WELL, THIS IS WHAT OUR ANIMAL IS
FOR.
SO, WE CAN MANIPULATE ANIMAL AND
CHECK OUT HYPOTHESIS AND NEXT
POINT WILL BE ANIMAL MECHANISTIC
STUDY AND THIS STARTED WITH --
THIS STARTED WITH
[INDISCERNIBLE] AND MANY KNOW
HIM AND THIS UNIVERSITY WE HAVE
IN LUNCH AND TELLING HIM ABOUT
ALL THESE RESULTS AND JEFF TELL
ME NO, NO, NO.
WHAT YOU ARE TELLING ME IS
INFLAMMATION IS GOOD IN ACUTE
STAGE THAT WE CAN INHIBIT IT.
IT CAN'T BE BECAUSE ALL OF US
FOR [INDISCERNIBLE]; RIGHT?
INHIBITORY INFLAMMATION WITH
[INDISCERNIBLE] AND IS
ANELGEEZIC THAT WE KNOW IS
ANALGESIC AND JEFF SAID HOW LONG
DO WE WATCH MICE? DON'T WATCH
THEM FOLLOWING TIME.
LET'S DO EXPERIMENT VERY EASY
AND OKAY. JEFF AND LUKUS IS
POST DOC; RIGHT?
WHERE I AM?
OKAY. SORRY THEY DO THIS VERY
FIRST -- THEY DID FIRST
EXPERIMENT WITH [INDISCERNIBLE]
AND WE DID ACTUALLY MANY, MANY
OTHER MODELS AND RESULT WAS
SAME.
CREATING ACUTE INFLAMMATION IN
MOUSE AND YOU TREAT ANIMAL FOR
SIX DAYS WITH DECHLA METAZONE
AND MEASURE OVER TIME THE
SENSITIVITY TO NOXIOUS STIMULUS.
SO, THIS WAS -- THIS WAS THE
RESULTS ON THE LEFT.
HERE, YOU SEE DECHLA METAZONE
LINE IS BLACK QUADRANT AND SALON
LINE IS OPEN CIRCLE AND OKAY
THIS IS A SAFE WAY TO CREATE
INFLAMMATORY PAIN MODEL AND MICE
GET [INDISCERNIBLE] AND DEVELOP
HYPER ALGEEZIA AND OPEN CIRCLED
IN BLUE QUADRANT AND BECOME
SENSITIVE TO NOXIOUS STIMULI AND
IN 21 DAY THEY ARE FINE AND
COMPLETELY RESOLVE AND MICE WHO
RECEIVE DECHLA METAZONE ARE
ANALGESIC IMMEDIATELY AND YOU
SEE QUADRANT THAT IS MUCH HIGHER
AND THEN IT SWITCH. YOU KNOW,
WE DON'T TREAT THEM ANYMORE AND
WE JUST WATCHING THEM AND THEY
DEVELOP THIS FLU EFFECT FOR LONG
TIME AND TOOK THEM 140 DAYS TO
COME BACK.
YOU SEE 21 DAYS VERSUS 140 DAYS.
SO, LIKE I SAID, THIS IS -- WE
DID IT FOR ANY OTHER -- FOR MANY
OTHER MODELS AND [INDISCERNIBLE]
PAIN AND INDUCED LOW BACK PAIN
AND POST-OP ITERATIVE PAIN AND A
FEW OTHERS THAT ALWAYS THE SAME
AND AGAIN MANY EXPERIMENTS IN
PAPER WE PUBLISH IN SCIENCE
TRANSLATIONAL MEDICINE LAST
YEAR.
SO, I WILL SHOW YOU ONE THAT I
THINK IS IMPORTANT ALSO AND HOW
ABOUT THE QUESTION THAT IS FIRST
OF ALL IS IT ONLY DECHLA
METAZONE THAT IS REALLY
INFLAMMATION AND SECOND THAT IS
RELATED TO THIS SHOULDN'T
INHIBIT INFLAMMATION OR PAIN
THAT IS ADAPTIVE.
WHAT LUKUS DID IS TOOK ALL MAJOR
DRUG PATHWAY ANALGESIC DRUG
PATHWAY AND GABBA PEN CONTINUE
AND BLOCKER CHANNELS AND
MORPHINE. IN MICE AND TREAT
THEM FOR 6 DAYS AND ANSWER IS
ONLY IN [INDISCERNIBLE] THAT IS
GREEN LINE HERE THAT LEADS TO
HYPERALGEEZIC STATE AND NONE OF
THE OTHER ANALGESIC DRUGS.
IN THIS PAPER LAST STEP WAS --
LOOK. CAN WE FIND ANY EVIDENCE
FOR EXISTING DATA SETS THAT
BASICALLY WAS SAYING THAT WE
NEED INFLAMMATORY RESPONSE AND
SHOULDN'T INHIBIT IT AND LOOK AT
EXISTING DATA AND LOOK AT UK
BIOBANK HALF A MILLION PEOPLE
AND DATA AND BIOBANK QUESTION IN
LAST FEW MONTHS HAVE YOU
EXPERIENCED ANY FOLLOWING
INTERFERE WITH USUAL ACTIVITY?
THERE WAS A CHOICE OF
[INDISCERNIBLE] SITE AND NEXT
QUESTION DID YOU HAVE PAIN FOR
MORE THAN THREE MONTHS?
TAKING BACK PAIN PEOPLE 88,000
AND WE SAID, OKAY. THOSE THAT
SAID YES I HAVE PAIN BUT IS LESS
THAN 3 MONTHS IS ACUTE PAIN,
PEOPLE. UK BIOBANK HAD --
BROUGHT MANY OF THEM 2 TO 6
YEARS LATER AND WE ASK QUESTION
IF BY THE WAY WE HAVE A DRUG USE
DATA IN UK BIOBANK AND IN USE OF
THE PARTICULAR DRUG AND ACUTE
BACK PAIN STAGE EFFECT
PROBABILITY OF PEOPLE STILL
REPORTING CHRONIC BACK PAIN 2 TO
6 YEARS LATER.
AND ANSWER WAS YES; RIGHT?
IT WAS ACTUALLY IN
[INDISCERNIBLE].
MODEL 1, WE -- WE TEST IF USE IS
VERSUS ANYTHING ELSE THAT WAS A
RISK FOR [INDISCERNIBLE] -- FOR
STILL REPORTING BACK PAIN AND
CHRONIC BACK PAIN 2 TO 6 YEARS
LATER AND ANSWER WAS -- WAS IT
2.7 TIMES OR 1.7 TIMES MORE
LIKELY VERY SIGNIFICANT?
IT WASN'T TRUE FOR
ANTIDEPRESSANT THAT IS MODEL 2
AND 3 AND ONLY THREE DRUGS YOU
HAD ENOUGH MORE THAN 10 PEOPLE
AND THAT IS PER CATEGORY AND END
STATE SIGNIFICANT FULL MODEL AND
DRUG MODEL 4 AND IT IS
CONTINUING ON CHANGE WHEN WE
CONTROL ALSO FOR PSYCHOLOGICAL
DISTRESS AND NUMBER OF PAIN
SITES.
AND SO IN THE LAST TWO SLIDES I
ALSO WOULD LIKE TO SHOW YOU NOW
NEW DATA.
IT IS NOW RELATED TO HUMAN CELL
STIMULATION STUDY AND DATA WE
DIDN'T PUBLISH YET THAT WAS AN
IDEA THAT WAS STIMULATED AND,
OKAY. IF WE NEED A RESPONSE AND
IF YOU NEED THE RESPONSE, THEN
THAT DOESN'T MEAN PEOPLE WITH
VERY CHRONIC PAIN, THEY HAVE
IMPAIRED RESPONSE TO STIMULI
THAT WAS A VERY SIMPLE IDEA
TAKING NEWT TRA FILLS FROM
ALREADY WE HAVE THIS DATA AND WE
ANALYZE IT WITH NEW IDEAS;
RIGHT?
WE HAD NEUTROPHILS COMBINED AND
I DIDN'T TELL YOU INFLAMMATORY
RESPONSE WILL SHOW YOU THIS
VARIANCE THAT IS BY NEWT TRA
FILLS THAT IS VERY FIRST STEP
TAKING NEWT TRA FILLS FROM
CONTROLLING INDIVIDUAL IN
FIBROMYALGIA PATIENT STIMULATING
THAT AND SEE RESPONSE TO
STIMULATION.
AGAIN, YOU CAN GUESS AFTER ALL
MY STORIES WHAT IS THE CONTROL
AND WHERE IS FIBROMYALGIA
PATIENTS; RIGHT?
FIBROMYALGIA PATIENTS HAS A
BLUNT RESPONSE TO STIMULATION
AND THEY RESPONDED VERY BLUNT.
THIS WAS DONE BY SAHILL WHO IS
IN RIGHT CORNER.
ONE MORE SLIDE IS THAT IT IS
REALLY CROSS IN KNOWN MARKET TO
TAKE BASICALLY ALL INFLAMMATORY
MARKERS HERE INTERLEUKIN ONE
BETA CNF YOU SEE ACTIVATED AND
NONACTIVATED. YES. IN
NONACTIVATED CELLS PERSISTENT
PAIN IN FIBROMYALGIA PATIENT
SUBJECT HAS HIGHER MARKERS AND
IS SO LITTLE YOU DON'T SEE IT
VERY WELL; RIGHT?
YOU SEE THERE IS ALWAYS HIGHER
THAT AFTER STIMULATION, THEY --
THEY DON'T RESPOND SO WELL.
SO, THE LINES CROSS AND THEY CAN
RESPOND, YES.
AND THIS IS NOW CHRONIC PAIN
PATIENTS THIS IS FIBROMYALGIA
AND CAN'T BE MORE CHRONIC. THIS
IS -- I HAVE THIS DATA TOO.
SORRY VERY -- WHAT THIS SHOWS IS
THIS WE HAVE DATA A FEW YEARS
LATER WE ASK PEOPLE HOW THEY ARE
DOING AND DIFFERENCE HERE IS
PEOPLE WITH PERSISTENT PATIENT
AND FIBROMYALGIA PATIENT HAVE
MORE BLUNT RESPONSE TO LPS THAN
PEOPLE THAT ARE SIGNIFICANTLY
BETTER AFTER 4 TO 5 YEARS THIS
IS CHRONIC FIBROMYALGIA PATIENT
AND THIS COHORT AND PEOPLE DOING
BETTER AND PEOPLE WHOSE
NEUTROPHILS RESPOND BETTER TO
STIMULATION.
WITH THIS, I WANT TO LEAVE YOU
WITH THIS FOR POINTS THAT FIRST
THERE IS ACTIVE ADAPTIVE
COMPONENT IN IMMUNE SYSTEM IN
ACUTE PAIN TRANSITION NOT SAYING
IT IS ONLY INFLAMMATION BUT THAT
IS ONE OF THEM AND SIMILAR TO
COMPONENT OF SYSTEM PAY
CONTRIBUTE TO CHRONIC PAIN
DISTRIBUTION AND ENHANCING
RESPONSES IN CHRONIC PAIN
DISTRIBUTION TRIGGERING
RESOLUTION AND DATA AT LEAST
MINE. INHIBIT IN IXMUNL
RESPONSES IMMUNE PHYSICAL INJURY
LEADING TO CHRONIC PAIN AND TOO
PAGE CLINIFICATION OR FURTHER
PAIN CLINIFICATION MIGHT BE MOST
IMPORTANT AND WHAT I INTERNALIZE
FROM ALL THIS WE MIGHT START TO
TARGET ACTIVATION OF IMMUNE
RESPONSE AND REACTIVATION OF
IMMUNE RESPONSE IN PASH YENTSS
INSTEAD OF INHIBITION OF SOME
RESPONSES AS A TREATMENT.
SO, I WANT TO THANK YOU VERY
MUCH FOR YOUR ATTENTION AND ALL
MY COLLEAGUES IN PAIN AND
GENETIC PROGRAM. THANK YOU.
>>THANK YOU. THANK YOU SO MUCH
FOR THIS NOVEL VIEW ON PAIN AND
TRANSITION FROM ACUTE TO CHRONIC
PAIN AND AGAIN I KNOW THAT YOU
SHOULD HAVE MANY, MANY QUESTIONS
THAT WE WILL BE ANSWERING IN A
LITTLE BIT AND LAST BUT
DEFINITELY NOT LEAST SPEAKER IS
KIM SIBILLE PROFESSOR IN
ANESTHESIOLOGY IN DIVISION OF
PAIN MEDICINE IN COLLEGE OF
MEDICINE AT UNIVERSITY OF
FLORIDA AND DIRECTOR OF PAIN
TRAIL AND TRANSLATIONAL RESEARCH
IN ASSESSMENT AND INTERVENTION
LAB AND HAS A BACKGROUND IN
EXERCISE SCIENCE AND MASTER'S
DEGREE IN CLINICAL PSYCHOLOGY
AND CONCENTRATIONS IN U
UROPHYSIOLOGICAL PSYCHOLOGY AND
POST DOCTORAL TRAINING IN
CLINICAL PAIN RESEARCH AND LAB
INVESTIGATES BIOLOGICAL
INTERFACE OF CHRONIC PAIN AND
CONTRIBUTING TO HOUSING -- PAST
13 YEARS INVESTIGATING
ALLOSTATIC LOAD, AN INDICATOR OF
WHOLE PERSON STRESS RELATED
FUNCTION.
KIM?
>>THANK YOU FOR THE
INTRODUCTION.
I GREATLY APPRECIATE THE
OPPORTUNITY TO BE HERE FOR THIS
VERY IMPORTANT SYMPOSIUM AND I
WANT TO THANK THE AUDIENCE AND
THOSE OF -- IN ATTENDANCE HERE
WITH US IN PERSON AND THOSE
VIRTUALLY.
WE REALLY APPRECIATE THE SUPPORT
AND INTEREST IN THE TOPIC.
SO, IT IS REALLY HAS BEEN A
FANTASTIC DAY.
THE TOPICS THAT HAVE BEEN
COVERED AND FINDINGS AND IT IS
REALLY QUITE IMPRESSIVE.
I HAVE A QUESTION FOR YOU GUYS.
OKAY. THERE WE GO. ALL RIGHT?
SO, HOW MANY -- UH-OH.
WORKED FOR ME.
OH, THERE WE GO HOW IS THAT?
EVERYBODY SEE IT HOW MANY AGREE
THAT WHAT WE NEED NOW IS
THEORETICALLY SUFFICIENTORITIED
EVIDENCE-BASED NOT CONCEPTUAL
BUT FUNCTION ALE MODEL FOR
CHRONIC PAIN ENCOMPASSES
BRAETDTH OF TOPICS WE COVERED
TODAY THAT HAS BIOMARKERS FOR
RESEARCH AND PATIENT CARE. WHO
BELIEVES WE NEED THIS? IF WE
NEED THIS, HANDS UP. LET'S SEE
IF THIS WILL WORK. HOW ABOUT
THAT? THAT GOOD?
EVERYBODY -- I THINK WE HAVE IT.
SO, FOR NEXT 15 MINUTES I WILL
SHARE A BODY OF EVIDENCE TO
SUGGEST THAT, THAT MODEL EXISTS.
FIRST I WILL REINTRODUCE
ALOSTASIS AND PROVIDE AN
OVERVIEW OF RELEVANCE TO CHRONIC
PAIN AND WILL TALK ABOUT
BENEFITS OF RESILIENCE EXTENDING
BEYOND PAIN SYMPTOMS AND
PSYCHOSOCIAL SYMPTOMS AND ALSO
TALK ABOUT THIS RELATIONSHIP OF
ALLOSTATIC LOAD WHOLE PERSON
BALANCE AND IMPORTANCE OF
RESILIENCE FOR TREATMENT.
SO, I THINK WE ALL WOULD AGREE
THAT CHRONIC PAIN EFFECTS THE
WHOLE PERSON.
PHYSICALLY, MENTALLY,
SPIRITUALLY, SOCIALLY.
SO, IF THAT IS THE CASE, IT
WOULD SEEM THAT WHAT WE REALLY
NEED IS A BIOMARKER FOR CHRONIC
PAIN THAT IS A WHOLE PERSON
MEAS
MEASURE.
ALOSTASIS IS A WHOLE PERSON
PROC
PROCESS THEORY UNDERLYING
ALOSTASIS IS BODIES ARE DESIGNED
TO ADAPT AND STRESS CHALLENGE TO
PROMOTE OPTIMAL FUNCTIONING AND
STABILITY.
EXAMPLES OF ALOSTASIS ARE ALL
AROUND US.
STRESS AND CHALLENGE PROMOTE
STRENGTHENING, GROWTH AND
CHAFRJS.
IN FACT, IT IS ONLY WHEN STRESS
PERSISTS WITHOUT ADEQUATE
RECOVERY THAT WE START TO SEE
INDICATIONS OF WHAT WE THINK OF
AS ALLOSTATIC LOAD OR ALLOSTATIC
OV
OVERLOAD.
ARE THERE MEASURES FOR
ALLOSTATIC LOAD?
ABSOLUTELY. WE CAN LOOK INTO
THE BRAIN AND FUNCTIONAL AND
STRUCTURAL MEASURES AND LOOK AT
STRESS SYSTEMS FUNCTIONING WITH
CLINICAL COMPOSITE OR BATTERY
SOMETIMES PHRASING USE LOOKING
AT TELOMERE LENGTH THAT IS A
DOWNSTREAM MEASURE OF STRESS
SYSTEM FUNCTIONING THAT IS
IMPORTANT TO KEEP IN MIND ABOUT
MEASURES THAT THEY ARE COMPLEX
AND ARE DYNAMIC AND ARE N
NON-LINEAR IN NATURE AND PROMISE
I DIDN'T PAY DR. DECHENKO TO SAY
FOR PRESENTATION WHAT THIS WILL
LOOK LIKE AND SOMEONE THAT IS
HEALTHY AND ADAPTIVE PHYSIOLOGY
WILL HAVE A ROBUST RESPONSE AND
A ROBUST RECOVERY.
WHEN INDIVIDUALS ARE STARTING TO
SHOW SIGNS OF A--LO STATIC LOAD,
THEY WILL HAVE A SLOWER RESPONSE
AND FOR THEM TO HAVE DELAYED OR
SLOWER RECOVERY AND WHEN
INDIVIDUALS IN A PHYSIOLOGICAL
STATE OF ALLOSTATIC OVERLOAD,
THEY TEND TO HAVE A BLUNDED
RESPONSE.
BUT VERY DEFINITELY A BLUNTED
RECOVERY.
MUCH OF WHAT WE HEARD IN THE
TALK PRIOR.
IMPORTANTLY LONG TERM ALLOSTATIC
LOAD IS ASSOCIATED WITH
MORBIDITY AND MORTALITY.
WHAT DOES IT LOOK LIKE FOR
CHRONIC PAIN AND WHAT IS
ALLOSTATIC LOAD OF CHRONIC PAIN
AND REFERRING TO NON-LINEAR
MODEL THAT YOU CAN THINK OF IT
AS INVERTED U OR DOSE RESPONSE
AND IS ALSO KNOWN AS HORMESIS
THAT IS ESSENTIALLY FUNDAMENTAL
BIOLOGICAL PRINCIPLE THAT IS NOT
NEW INFORMATION BUT IS ACROSS
PLANTS ANIMALS AND HUMAN BEINGS
IN REGARDS TO PHYSIOLOGICAL
FUNCTIONING AND THINKING OF
CHRONIC PAIN, PROBLEM THAT I
BELIEVE HAS BEEN CAUSING SOME
INCONSISTENCIES LOOKING AT
NEUROBIOLOGICAL AND
PHYSIOLOGICAL MEASURES IS HOW WE
MEASURE CHRONIC PAIN AND IN
ORDER TO CAPTURE PHYSIOLOGICAL
INTERFACE, PRINCIPLES NEED TO BE
CONSIDERED AND FREQUENCY OF PAIN
THAT IS INTERMITTENT AND
PERSISTENT AND INTENSITY OF THAT
PAIN AND DURATION HOW LONG
SOMEONE HAS BEEN LIVING WITH
CHRONIC PAIN AND TOTAL PAIN
SITES THAT IS PROBABLY ONE MORE
SENSITIVE MEASURE FOR SEVERITY
OF CHRONIC PAIN AND WITH THAT IN
MIND SOMEONE IN EARLY STAGES OF
CHRONIC PAIN IS STILL GOING TO
HAVE ADAPTIVE SYSTEM. MODERATE
STAGES OF CHRONIC PAIN THAT IS 3
TO 5 YEARS DEPENDING ON
INTENSITY AND SEVERITY AND WILL
START SHOWING SIGNS OF
ALLOSTATIC LOAD AND INDIVIDUALS
THAT WE WOULD CONSIDER MORE OF
ALLOSTATIC OVERLOAD STATE AND
MORE SEVERE CHRONIC PAIN AND
MORE OF OUR STAGE 5 AND YOU WILL
SEE PHYSIOLOGICAL DISREGULATION
WE WERE TALKING ABOUT AND WE
HAVE SHOWN THAT CHRONIC PAIN
STAGE IS POSITIVELY ASSOCIATED
WITH NUMBER OF MEASURES OF A--LO
STATIC LOAD AND SHOWN IT IS
ASSOCIATED WITH HIGHER CLINICAL
COMPOSITE AND POPULATION STUDIES
AND SHOWN IT IS ASSOCIATED WITH
SHORTER TELOMERE LENGTH AND
CLINICAL STUDIES AND REPORTED IT
IS ASSOCIATED WITH THINNER
CORTICAL AREAS IN THE BRAIN AND
IT GETS INTERESTING.
BECAUSE WE KNOW THIS
RELATIONSHIP BETWEEN
NEUROBIOLOGICAL AND
PHYSIOLOGICAL MARKERS IN CHRONIC
PAIN IS NON-LINEAR AND CHRONIC
PAIN STAGE IS 1 TO 5 CATEGORY
THEN OUR COLLABORATOR DR. TANNER
WENT AHEAD AND MADE A NON-LINEAR
QUADRATIC TERM THAT I WANT TO
SEE IF I CAN -- MY LITTLE -- IT
WON'T SHOW HOW ABOUT IF I DO
THIS. THERE WE GO. HOW MANY
SEE THIS U IN THERE?
COME ON. CHECKING TO SEE IF YOU
ARE AWAKE. SEE HORMESISU?
ORANGE ARCH. YES? THIS IS
STRATIFIED BY TWO SOCIO
DEMOGRAPHIC GROUPS NON-HISPANIC
BLACK ADULTS THAT HAVE
SIGNIFICANTLY GREATER SOCIO
DEMOGRAPHIC RISK AND WHITE
ADULTS WITH SIGNIFICANTLY
GREATER SOCIO DEMOGRAPHIC
BUFFERS AND YOU SEE IT LOOKS
LIKE EVEN THOUGH THESE
INDIVIDUALS THAT ARE BETWEEN 0
AND 3 THAT ARE MORE SEVERE
STAGES OF CHRONIC PAIN ONE GROUP
SHOWS WHAT WE CONSIDER TO BE
MORE ADAPTIVE AND ONE GROUP
SHOWING THEY ARE IN ALLOSTATIC
OVERLOAD STATE AND TAKING BAR
GRAPH FOR BETTER IDEA OF PATTERN
AND LOW STAGE FOR GROUPS IS
QUITE SIMILAR AND HIGH STAGES OF
CHRONIC PAIN IS CLINICALLY
STATISTICALLY SIGNIFICANTLY
DIFFERENT AND WE ARE TALKING
ABOUT TEMPORAL LOBE OF THE BRAIN
THIS AREA IS A RISK FACTOR FOR
ALZHEIMER'S DISEASE AND WE
BELIEVE WHAT IS GOING ON IS
ESSENTIALLY IN LINE WITH
ALOSTASIS THEORY AND THAT
ALLOSTATIC LOAD IS RESULT OF
CUMULATIVE BURDEN NOT JUST ONE
AND TESTED THIS GOING BACK
SAYING LET'S LOOK AT SOCIO
ENVIRONMENTAL FACTORS AND LOOK
AT THAT RISK. SO, SOCIO
ENVIRONMENTAL RISK WAS ADDED UP.
IT WAS A RANGE OF 0 TO 8.
FOR EVERY INCREASING RISK FACTOR
THERE WAS A SCORE AND HAD HIGH
LOW CHRONIC PAIN STAGE AND SAME
GROUP I SHOWED YOU AND LOOKING
AT THEM BY SOCIO ENVIRONMENTAL
RISK AND LOW AND HIGH CHRONIC
PAIN STAGE.
WHAT WE SEE IS A SIGNIFICANT
ESSENTIALLY DOSE RESPONSE
RELATIONSHIP THAT IS FOR EACH
ADDITIVE ASSOCIATIVE
ENVIRONMENTAL RISK INCREASING
STAGE OF PAIN THINNER TEMPORAL
LOBE.
OKAY. OBJECTIVE NO. 1,
RELATIONSHIP THAT IS BETWEEN
CHRONIC PAIN AND SOCIO
ENVIRONMENTAL RISK AND
ALLOSTATIC LOAD SHOWING CHRONIC
PAIN AND SOCIO ENVIRONMENTAL
RISKS ARE STRESSORS ADDING TO
ALLOSTATIC LOAD AND KNOW THAT
HIGHER ALLOSTATIC LOAD IS
ASSOCIATED WITH GREATER
PAIN-RELATED SYMPTOMS AND WHAT
ABOUT RESILIENCE?
RESILIENCE FACTORS IMPROVE
RESPONSE TO STRESS AND
CHALLENGE.
WE HAVE HEARD FROM A NUMBER OF
PRESENTERS TODAY ABOUT
PSYCHOSOCIAL RESILIENCE AND
FACTORS IN CHRONIC PAIN.
I WAS DELIGHTED IN 27 TAENWHEN
THIS PUBLICATION CAME OUT GIVING
MORE CREDIBILITY TO WORK WE ARE
INVOLVED IN AND DR. MCFARLAND
AND COLLEAGUES IN UK DATA SET
DID A COUPLE THINGS THAT WERE
REALLY IMPORTANT AND NO. 1 WITH
METAANALYSIS THEY IMPROVED THAT
IN FACT PEOPLE LIVING WITH
CHRONIC WIDESPREAD PAIN
EXPERIENCE EXCESS MORTALITY AND
SECOND THING THEY DID IS SHOWED
THAT, THAT MORTALITY RISK WAS
REDUCED WITH EVERY ADDITIVE
HEALTH BEHAVIOR THAT IS
INCREDIBLE. NICELY IN THE 2016
PUBLICATION WITH TROMSA STUDY
LOOKING AT ALLOSTATIC LOAD
CLINICAL COMPOSITE WE SHOWED THE
SAME THING, LOWER ALLOSTATIC
LOAD CLINICAL COMPOSITE WITH
EACH HEALTH BEHAVIOR.
SO, THIS WHOLE IDEA IT WAS
ADDITIVE AND WE CLEARLY
IDENTIFIED BIOBEHAVIORAL AND
PSYCHOSOCIAL FACTORS COULD WE
CREATE INDEX THAT COULD BE
USEFUL FOR CLINICIANS? IN
COLLABORATION WITH A FEW
COLLEAGUES INCLUDING DR. BARTLY
OVER HERE TO MY RIGHT, WE
WORKING WITH DATA WE HAD IN A
CURRENT DATA SET, WE LOOKED AT
TOBACCO USE WASTE RATIO POSITIVE
EFFECT AND LOW NEGATIVE EFFECT
THAT IS RESILIENCE THERE ACTIVE
COPING PERCEIVED STRESS AND
SOCIAL SUPPORT USING CLINICAL
NORMS AND WE CREATED A SCORING
AND SO ESSENTIALLY RANGE IS 0 TO
8 AND IS ADDITIVE FOR EVERY
RESILIENCE FACTOR AND TOOK
RESILIENCE INDEX AND FIRST
LOOKED AT IT IN RELATION TO
TELOMERE LENGTH STUDY OF 79
ADULTS INDIVIDUALS WITH AND
WITHOUT KNEE PAIN AND WHAT WE
FOUND WAS THERE WAS A
SIGNIFICANT ADDITIVE PATTERN
BETWEEN RESILIENCE INDEX AND
TELOMERE LENGTH AND WE WERE
CURIOUS WHAT EXACTLY THAT MIGHT
MEAN CLINICALLY AND WHEN WE
LOOKED AT LOW RESILIENCE GROUP
AND HIGH RESILIENCE GROUP WE
SHOWED AN APPROXIMATE --
LITERALLY APPROXIMATE 10-YEAR
DIFFERENCE THAT IS BETWEEN LOW
AND HIGH RESILIENCE IN CELLULAR
AGING.
SO, WE THOUGHT LET'S MOVE INTO
THE BRAIN.
WE PREVIOUSLY PUBLISHED I SHOWED
YOU ON PAIN RELATED AREAS OF THE
BRAIN AND WE WERE INTERESTED
WHAT HAPPENS WITH RESILIENCE AND
DO WE SEE IT IN THE BRAIN?
REMEMBER OTHER -- REMEMBER I
SHOWED YOU IT IS COMPLICATED
WITH DIFFERENT SOCIO DEMOGRAPHIC
FACTORS VERY MUCH SO AND WILL
IMITATION LOOKING AT BRAIN
STRUCTURE WE WILL TALK ABOUT
NEXT LOOKING AT RESILIENCE IN
THE BRAIN WE FOUND SIGNIFICANT
ASSOCIATIONS FOR RIGHT AMYG
DOULA AND POST CENTRAL GYRUS AND
MOST SIGNIFICANT FOR RIGHT AMYG
DOULA AND INTERESTINGLY ENOUGH
IT IS ACTIVATED BOTH WITH
INHIBITION AND NO SCEPT SUSCEPTD
STRESS AROUSAL AND TO DO
CROSS-SECTION ALLEY AND WITH
THAT IN MIND COLLEAGUE DR.
TANNER IS VERY MUCH INTERESTED
IN SOME MACHINE LEARNING METHODS
FOR LOOKING AT BRAIN STRUCTURE
AND WE LOOKED AT BRAIN AGE USING
DEEP BRAIN NET MODEL.
THIS IS IN 1 SDO 63 ADULTS
REPORTING CHRONIC PAIN AND MOST
OF THE INDIVIDUALS HAVE KNEE
PAIN AND WE USE SAME EXACT
RESILIENCE INDEX WITH MEDIAN
SPLIT.
5 TO 8 IS HIGH RESILIENCE AND WE
SHOW WITH CO-VARIATES IN THE
MODEL ASSOCIATED WITH BRAIN AGE
THAT WE STILL SHOW RELATIONSHIP
IS SIGNIFICANTLY DIFFERENT WITH
APPROXIMATE FOUR YEARS
DIFFERENCE IN BRAIN AGE.
THOSE ARE JUST THOSE ADDITIVE
RESILIENCE MEASURES I WAS
SHOWING YOU.
OUR NEXT STEP WAS LET'S IMPROVE
RESILIENCE INDEX A LITTLE
FURTHER.
WASTE HIP RATIO IS NOT PRACTICAL
IN A CLINICAL SETTING AND WASTE
CIRCUMFERENCE IS STRONGER WAY TO
EVALUATE ADIPOSITY AND LEAVING
IT TO WASTE THAT IS A LITTLE
MORE REALISTIC TO CAPTURE AND
ADDED PROMISED SLEEP THAT IS
HIGHLY IMPORTANT BIOBEHAVIORAL
INTERVENTION THAT IS NICE AND
VALIDATED MEASURE THROUGH
PROMISE AND SO USING VALIDATED
CLINICAL NORMS AND EIGHT
MEASURES WE IMPROVE THE SCORING
THAT IS THREE LEVEL SCORING
RATHER THAN DICHOTOMOUS SCORING
AND RANGE IS 0 TO 16 AND GIVING
AN IDEA WHAT A CLINICAL
COMPOSITE LOOKS LIKE AND HOW WE
DID THIS IS IT REPRESENTS FOUR
STRESS SYSTEMS CARDIOVASCULAR
NORRO ENDOCRINE IMMUNE AND
METABOLIC AND CURRENT METHOD
DETERMINING RANGE LOOKING AT
QUARTILE -- HIGH RISK IS LOWER
QUARTILE ON 3 AND IF IN EITHER
QUARTILE YOU GET A SCORE OF 1
AND EVERYBODY ELSE GETS 0 AND
ALLOSTATIC LOAD FOR EACH
PARTICIPANT RANGES BETWEEN 0 AND
10 WE LOOKED AT RELATIONSHIP
INDEX AND ALLOSTATIC CLINICAL
COMPOSITE AND AGE SEX AND SOCIO
DEMOGRAPHIC GROUP CO-VARIATES IF
IN THE MODEL PAIN INTENSITY WAS
ASSOCIATED WITH ALLOSTATIC LOAD
INDEX AND LOOKING AT RESILIENCE
INDEX THAT TOO WAS ASSOCIATED
AND ARE YOU FOLLOWING ME?
OVER HERE IN THE MIDDLE COLUMN
WITH ALLOSTATIC LOAD CLINICAL
COMPOSITE AND COMBINING BOTH IN
THE MODEL YOU SEE CHARACTERISTIC
PAIN INTENSITY IS NO LONGER
SIGNIFICANT PREDICTOR AND
RESILIENCE REMAINS SIGNIFICANT
PREDICTOR AND INTERPRETATION IS
RESILIENCE FACTORS BUFFER
BIOLOGICAL BURDEN OF CHRONIC
PA
PAIN.
SO, MY OBJECTIVE NO. 2 WAS TO
LOOK AT THIS BIOBEHAVIORAL AND
PSYCHOSOCIAL RESILIENCE
INTERFACE. IN FACT THERE IS
FINDINGS THAT SUGGEST THEY ARE
ASSOCIATED WITH BIOMARKERS OF
ALLOSTATIC LOAD.
YOU GUYS ARE READY FOR A LITTLE
BIT OF A SUMMARY?
OKAY.
SO, HERE WE GO.
WE KNOW THAT CHRONIC PAIN AND
SOCIO ENVIRONMENTAL FACTORS ARE
ASSOCIATED WITH ALLOSTATIC LOAD
AND WE ALSO HAVE SHOWN ACROSS A
NUMBER OF DIFFERENT STUDIES THAT
MODIFIABLE FACTORS SUCH AS
QUALITY SLEEP AND SOCIAL SUPPORT
AND NUTRITIOUS DIET AND HEALTHY
WEIGHT AND LOW PERCEIVED STRESS
AND REGULAR PHYSICAL ACTIVITY
ARE ASSOCIATED WITH LOWER
ALLOSTATIC LOAD AND LOWER
ALLOSTATIC LOAD IS ASSOCIATED
WITH LOWER PAIN-RELATED
SYMPTOMS.
SO, BY TARGETING RESILIENCE
FACTORS WE NOT ONLY REDUCE
CLINICAL SYMPTOMS BUT BUFFER
WHOLE PERSON BURDEN OF CHRONIC
PAIN.
NOW, WHEN WE STARTED THIS TALK,
I ASKED YOU ALL IF WE WERE READY
FOR A FUNCTIONAL MODEL.
FOR CHRONIC PAIN.
WE WANT ONE THAT IS
THEORETICALLY SUPPORTED AND THAT
THERE IS GOOD EVIDENCE AND THAT
IS ASSOCIATED WITH WHOLE PERSON
BALANCE.
THAT IS SENSITIVE TO RISK AND
RESILIENCE FACTORS AND THAT
OFFERS BIOMARKERS FOR RESEARCH
AND THAT WE ARE CURRENTLY
WORKING ON PATIENT CARE PART.
SO, THE ANSWER SEEMS LIKE YES TO
ME.
WITH THAT I WOULD LIKE TO
EXPRESS GREAT APPRECIATION FOR
FUNDING THAT SUPPORTED OUR
RESEARCH AND THE INCREDIBLE TEAM
OF COLLABORATORS AND COLLEAGUES
THAT WORK WITH US ON THE PAIN
TRAIL.
AND ALL OF THE PUBLICATIONS THAT
I RAN THROUGH RATHER QUICKLY ARE
AVAILABLE WITH LINKS ON OUR
WEBSITE. I ALSO HAVE INCLUDED
MY E-MAIL IN CASE ANYONE WOULD
LIKE TO GET AHOLD OF ME AND ASK
ANY QUESTIONS OR OFFER ANY
COMMENTS.
THANK YOU AGAIN FOR BEING HERE
AND WISHING YOU HAPPY AND
HEALTHY TRAILS TO EACH OF YOU.
THANK YOU.
>>THANK YOU. THANK YOU VERY,
VERY MUCH.
THIS IS GREAT.
NOW, WE ARE READY FOR THE -- FOR
ALL OF THE QUESTIONS THAT YOU
MAY HAVE AND PLEASE DO USE THE
MICS.
AND, YOU KNOW, JUST TO GIVE YOU
A LITTLE BIT OF TIME TO COME UP
WITH A QUESTION. I HAVE MY OWN
QUESTIONS TO THE SPEAKERS.
SO, I WOULD LIKE TO START MAYBE
WITH EMILY.
SO, THE QUESTION WOULD BE -- SO,
THIS IS A VERY INTERESTING
CONCEPT TO HAVE THIS REDISTILL
INDEX THAT COULD BE A REALLY
GREAT FOR CLINICAL PRACTICE AND
WHAT WOULD THE OTHER MEASURES OF
RESILIENCE THAT YOU WOULD LIKE
TO OFFER MAYBE FOR MECHANISTIC
TRANSLATIONAL RESEARCH MORE THAN
JUST [INDISCERNIBLE].
>>CAN YOU HEAR ME?
>>YEAH. GREAT QUESTION. YOU
CAN IMAGINE THAT THERE IS AN
INCREDIBLE AMOUNT OF DIFFERENT
FACTORS THAT ONE COULD INCLUDE
IN VARIOUS MODELING PROCEDURES
AND I'M HOPING TO DO SOME OF
THIS WORK WITH KNEE ARTHROMRAFTY
SOON AND THINKING OF DIFFERENT
FACTORS. SLEEP OBVIOUSLY IS
VERY IMPORTANT AND THINKING OF
BEHAVIORAL FACTORS SLEEP AND
DIET NUTRITION AND EXERCISE AND
HOW MUCH PHYSICAL ACTIVITY ONE
GETS THAT ARE INCREDIBLY
IMPORTANT FACTORS WE WOULD LIKE
TO INCLUDE IN MULTISYSTEM
RESILIENCE MODEL AND TRADITIONAL
PSYCHOLOGICAL MODELS NO THE JUST
RESILIENCE MEASURES SUCH AS HOPE
AND OPTIMISM AND RISK FACTORS
THAT IS IMPORTANT TO LOOK AT
THAT AND INTERACTIVE EFFECTS
WITH VARIOUS KIND OF MORE
TRADITIONAL POSITIVE
PSYCHOLOGICAL MEASURES
CATASTROPHIZING AND PERCEIVED
STRESS AND LOOKING ALSO AT THIS
ACROSS VARIOUS BIOLOGICAL
SYSTEMS AND CORTISOL AND HEART
RATE VARIABILITY AND EVIDENCE
THAT THOSE ARE AFFILIATED WITH
RESILIENCE RESPONSES CUTTING
ACROSS VARIOUS DOMAINS AND
LOOKING AT IT IN TERMS OF THOSE
WOULD BE KIND OF IMPORTANT
FACTORS I WOULD THINK WOULD BE
IMPORTANT TO INCLUDE IN SOME
MODELS AND I WOULD BE ACTUALLY
INTERESTED TO HEAR ABOUT THAT
FROM THE OTHER PANELISTS HERE
LIKE WHAT WOW INCLUDE IN YOUR
VARIOUS MODELS AS WELL?
>>YOU KNOW, OF COURSE IN MY
EXPERTISE AND VIEW I WILL
INCLUDE NAMING MARKER OF
RESPONSE.
AND I THINK THAT IF WE LOOK AT
OTHER DISCIPLINES FOR EXAMPLE IN
DIABETES, MARKER IS NOT LEVEL OF
GLUCOSE BUT MARKER IS RIGHT OF
[INDISCERNIBLE] OF GLUCOSE.
I THINK THIS IS AT LEAST I WOULD
LIKE TO THINK NOW HOW I CAN COME
UP WITH A RESPONSE THAT WILL BE
REFLECTIVE OF OUR -- ASKING TWO
DIFFERENT QUESTIONS.
FIRST, WHERE BODY OF PERSON IS.
>>YEAH.
>>FIRST IS CAN PERSON RESPOND
TO THERAPY OR STIMULATION?
SECOND, IF NOT, THEN WHY AND
WHAT WE CAN DO ABOUT THIS AND AS
A MARKER I THINK RATE OF RIGHTS
WOULD BE VERY GOOD MARKER.
>>UNDERSTANDING THAT DYNAMIC.
>>RIGHT. HOW WELL PERSON CAN
RESPOND.
>>RIGHT. YEAH.
>>OKAY.
>>HAVING BEEN A CLINICIAN FOR A
NUMBER OF YEARS WORKING IN AREA
OF HEALTH BEHAVIOR CHANGE I TEND
TO BE PROGRAMATIC AND I THINK
ABOUT WHAT I CAN PUT IN
PHYSICIANS HANDS SOMETHING THEY
CAN LOOK AT AND ANSWER QUICKLY
AND FIGURE OUT WHERE TO SEND
PEOPLE AND THINK THAT SIMPLER WE
KEEP THINGS AND MORE TARGETED,
THE GREATER THE LIKELIHOOD WE
WILL SEE BENEFIT. IN REGARD TO
RESILIENCE INDEX, I THINK WHERE
WE ARE HEADING NOW ARE YOU KNOW,
KEY MODIFIABLE AND TARGETED
AREAS ERRAND THERE MORE?
ABSOLUTELY. YOU KNOW, IF WE CAN
IDENTIFY A NUMBER OF KEY LESS
THAN 10 AND SOMETHING THAT COULD
BE DONE IN 10 TO 15 MINUTES;
RIGHT?
AND WE KNOW HAVE AN IMPACT AND
THINK WHEN WE LOOK AT
DIFFERENCES IN CLINICAL PAIN AND
SYMPTOM RESPONSE AND SEE A
SIGNAL IN THE BRAIN IN TELOMERE
LENGTH AND CLINICAL CAN CAN
COMPOSITE OF STRESS FUNCTIONING
IS INCREDIBLE FOR SOMETHING AS
SLEEPING A LITTLE MORE AND
MAINTAINING A HEALTHY BMI AND
HAVING A MORE POSITIVE PATTERN
OF THINKING.
INCREDIBLE PARTICULARLY WHEN
MEASURES ARE ASSOCIATED WITH
INCREASED MORBIDITY AND
MORTALITY AND THAT IS MY VOTE.
THE OTHER THING IS WE WERE
STARTING TO TALK ABOUT IT. IT
IS NOT SO MUCH WHAT YOU HAVE
ASKED. I THINK THAT WITH DR.
CHEKOS'S WORK YOU HEARD ABOUT IT
IN OTHER TALKS I WILL PUSH AS
YOU SAW THAT HORMESIS ISSUE AND
WE HAVE TO THINK DIFFERENTLY
ABOUT CHRONIC PAIN AND THINK WE
HAVE TO BE THOUGHTFUL ABOUT AS
RESEARCHERS AND HEALTH CARE
PROVIDERS, THERE WILL BE SOME
PEOPLE THAT RESPOND VERY QUICKLY
BECAUSE SYSTEMS ARE ADAPTIVE AND
PHYSIOLOGICALLY RESPONSIVE SOME
PEOPLE ARE STARTING TO SHOW
PHYSIOLOGICAL DISREGULATION AND
ARE PEOPLE THAT HAVE BEEN LIVING
WITH LONG-TERM PAIN AND OTHER
LIFE STRESSORS AND SYSTEMS ARE
NOT ADAPTIVE. THAT DOESN'T MEAN
THAT SOMETHING WON'T WORK.
IT JUST MEANS THAT WE HAVE NOT
EVEN STARTED LOOKING AT YET. WE
KNOW IN AGING RESEARCH THAT I
THINK APPLIES HERE THAT IS THAT
THERE WILL BE SLOWER TO RESPOND.
THEY MAY NEED MORE
INTERVENTIONS.
THANK YOU.
>>THANK YOU. THANK YOU SO
MUCH. I HAVE NOW THE -- ANOTHER
QUESTION THAT IS TO OUR
SPEAKERS.
THIS IS ABOUT ADAPTIVE FORMATIVE
RESPONSE THAT IS SO SUBSTANTIAL
IN THE STUDY AND DATA THAT YOU
DEMONSTRATED THAT HOW IT
HAPPENED THAT IT WAS COMPLETELY
OVERLOOKED?
YOU KNOW, ALL OF THE PREVIOUS
RESEARCH ON PAIN AND CHRONIC
PAIN.
>>YEAH. THIS IS A GOOD
QUESTION.
AND I CAN SUGGEST TWO MAJOR
REGIONS THAT I THINK THE REASON
WE CAN TREAT PAIN EFFICIENTLY IS
WE ARE MISSING SOMETHING AND I
GUESS WE ARE TRYING THINGS AND
WE ARE MISSING SOMETHING.
I THINK THAT WE HAVE, YOU KNOW,
TWO MAJOR PROBLEMS.
SO, MOSTLY BECAUSE WE -- WE --
ALTHOUGH WE SAY IT IS ACUTE AND
CHRONIC PAIN THAT IS NOT THE
SAME PAIN, I THINK IN OUR MIND
NOW WE STILL THINK IS CHRONIC
PAIN AND JUST ACUTE PAIN THAT
DID NOT RESULT; RIGHT?
THAT IS WHY WE THINK THAT --
THAT ALL BIOLOGICAL PROCESSES
SHOULD BE LINEAR AND INTERESTING
TO SEE AND WE NEVER TALK ABOUT
THIS USING SAME WORD; RIGHT?
RESPONSES ARE NOT LINEAR.
ALL OUR CONCEPTUAL MODELS
SUGGEST THAT RESPONSES ARE
LINEAR.
SO, IF CHRONIC PAIN IN PATIENTS
HAVE INFLAMMATION MEANS, AGAIN,
THE -- AND IT SHOULD BE -- THERE
SHOULD BE INCREASING AND IT IS A
BIG PROCESS AND INFLAMMATION IS
BAD.
SO, WE -- WE -- IF WE THINK THAT
IT MIGHT NOT BE LINEAR, WE
SHOULD MEASURE OUR MARKER
FREQUENTLY.
AND LOOK AT THE PATTERN AGAIN
RATHER THAN SUGGEST IF YOU HAVE
TWO MEASURES, THIS IS HOW
RESPONSE SHOULD EVOLVE.
ALSO, WORKING WITH HUMAN, NOW
IMAGINE THAT EVERY TIME TALKING
TO HUMAN ABOUT HUMAN EACH
PATIENT IS A LITTLE IN A
DIFFERENT STAGE OF INVERTED
U-SHAPE THAT IS VERY DIFFICULT
TO GET SYNCHRONIZED PEOPLE AND
THINK WE SIMPLY GET VERY LUCKY
WE HAVE SUCH A BLACK AND WHITE
RESPONSE.
THIS COHORT IS VERY SYNCHRONIZED
AND WE CAN TALK ABOUT HOW IT HAS
BEEN ACHIEVED AND IT WAS AND IN
COMPARISON OF ANY OTHER COHORT I
LOOK AFTER AND FINALLY WOULD
LIKE TO SAY ONE MORE THOUGHT
THAT BECAUSE WE THINK THAT EVEN
WITH -- BECAUSE WE THINK THAT
KIND OF CHRONIC PAIN AND JUST
ACUTE PAIN IS THE SAME AND JUST
CONTINUE AND WE MEASURE IN MICE
ALL THE TIME IS ANALGESIC
RESPONSE THAT IS, AGAIN, HOW WE
THINK AND WE THINK ABOUT
IMMEDIATE ANALGESIA THAT IS
RATHER THAN ABOUT THIS IS
MODIFYING TREATMENT.
WE ARE LOOKING FOR ANALGESIC,
REALLY. WE HAVE THEM AND NO
PROBLEM; RIGHT?
TO CONTROL ACUTE PAIN.
YEAH. I THINK I SHOULD START
HERE.
I SHOULD TOP HERE; RIGHT?
>>THANK YOU. THANK YOU VERY
MUCH.
WE HAVE NOT THAT LONG TO THE END
OF THE SESSION.
SO, IF YOU HAVE QUESTIONS, THIS
WOULD BE THE BEST TIME FOR YOU
TO ASK THEM.
WE HAVE A QUESTION. GREAT.
>>THANK YOU. THANK YOU FOR THE
GREAT TALKS AND I WAS REALLY
INTERESTED IN WHAT DOCTOR WAS
SAYING ABOUT DYNAMIC PROCESSES
PLAYING OUT WITHIN PEOPLE OVER
TIME AND NOTICING LOTS OF
THEORIES WE ARE TALKING ABOUT
TODAY ARE BASED ON DIFFERENCES
BETWEEN PEOPLE AND PEOPLE WITH
MORE RESILIENCE TEND TO BE
PROTECTED WITH NEGATIVE OUTCOME
AND INTERESTED IN HOW YOU ARE
EXAMINING THIS OVER TIME AND SO
PROCESSES VARY WITHIN OURSELVES
AND FOR EXAMPLE MY RESILIENCE IS
HIGHER RELATIVE TO MY AVERAGE
HOW IT PLAYS OUT IN TERMS OF
PAIN IMPAIRMENT AND IF YOU HAVE
IDEAS ABOUT THAT.
>>YOU CAN START.
>>I THINK IF I UNDERSTAND THE
QUESTION CORRECTLY I THINK
WITHIN THE PERSON, YEAH. I
THINK WE FIRST OF ALL AS A
GENETICIST WE HAVE I'M SURE
DIFFERENT ABILITY TO RESPOND AND
DIFFERENT RESILIENCE AND BIG
PART OF THEM AND RESPONSE IS
GENETICALLY CODED OR CODED BY
ALL OUR PREVIOUS EXPERIENCES
HOWEVER OF COURSE WE HAVE A BIG
FREEDOM AND WE HAVE LARGE
MARGINS OF HOW WE CAN EFFECT IT.
AND I THINK THAT WE HEARD THAT
THERE IS A LOT ABOUT -- THAT
WHAT LEADS TO EXERTION OF THE
SYSTEM BECAUSE WE SAW THIS
EXHAUSTION OF THE IMMUNE SYSTEM
RESPONSE FOR NEUTROPHILS
MICROPHAGES AND IN CELLS OF
PEOPLE WITH CHRONIC PAIN AND SO
IT IS A MULTIPLE FACTOR THAT
ADD, ADD, ADD, ADD TO INABILITY
OF SYSTEM TO WRITE RESPONSE.
SO, I GUESS ALSO REMOVING FACTOR
THAT WE CAN REMOVE AND MODIFY
AND IMPROVE THEM WHETHER IMPROVE
OUR INDIVIDUAL ABILITY FOR
RESILIENCE AND ADAPTIVE
RESPONSE.
>>WOULD YOU LIKE TO ADD
SOMETHING?
>>I WAS PROCESSING WHAT YOU
WERE SAYING. I THINK THAT IS
IMPORTANT TO FOCUS IN ON THE
DYNAMICS BECAUSE, YOU KNOW, WHEN
-- IF LOOKING AT VARIOUS
PROFILES HOW ONE PERSON
FUNCTIONS AT ONE POINT IN TIME
WILL BE VERY DIFFERENT HOW THEY
FUNCTION IN VARIOUS POINTS OF
TIME AND DEPENDS ON ENVIRONMENT
AND CONTEXTUAL FACTORS AND
STRESSORS THAT ARE IMPORTANT
THAT IS LIKELY DETERMINED BY
EACH INDIVIDUAL PERSON AND
LOOKING THAT INDIVIDUAL
DIFFERENCES I THINK ARE VERY
IMPORTANT AND IT TAPS INTO
CONCEPT OF WHAT RESILIENCE IS
THAT IS DYNAMIC ACROSS PEOPLE
AND WITHIN PEOPLE.
>>IF I COULD ADD, LET'S SEE,
TWO POINTS THAT COME TO MIND IS
WITH COMMENTS THAT ARE BEING
MADE.
SO, YOU KNOW, WHEN WE -- WHEN WE
THINK ABOUT PHYSIOLOGICAL
FUNCTIONING AND INDIVIDUAL
DIFFERENCES.
WE ARE ALL GOING TO VARY. OUR
LIFE IS DYNAMIC; RIGHT?
FOR THE MOST PART, UNLESS THOSE
STRESSORS ARE OF SIGNIFICANT
MAGNITUDE AND PERSISTING FOR
SIGNIFICANT AMOUNT OF TIME, YOU
ARE NOT GOING TO HIT THAT
PHYSIOLOGICAL DISREGULATION THAT
IS CONSISTENT WITH A SIFT THEME
IS BECOMING FATIGUED AND
NONRESPONSIVE THAT FACTORS WILL
STAY DYNAMIC. PEOPLE WILL
REMAIN HEALTHY EVEN THOUGH THERE
MIGHT BE PERIODS WHERE THEY ARE
NOT FEELING WELL.
MAKE SENSE?
THAT WHEN WE ARE THINKING ABOUT
THIS HERMESIS AND BIOLOGICAL
DISREGULATION AND WEAR AND TEAR
IS WHEN SOMETHING HAS BEEN
LONG-TERM PERSISTENT AND
DEBILITATING BEFORE YOU START TO
SEE THAT EXHAUSTION AND
HOPEFULLY THAT HELPS TO ANSWER
THAT QUESTION, THAT INDIVIDUAL
VARIABILITY IS HOPEFULLY
INDIVIDUAL VARIABILITY.
THAT IS ACTUALLY HEALTHY.
IT SHOULD BE DYNAMIC AND SHOULD
BE REBUST AND YOU SHOULD HAVE
RAPID RECOVERY AND GO UP AND
DOWN AND FLUCTUATE A LITTLE BIT
AND THAT IS OKAY AND AN ADAPTIVE
SYSTEM THAT I WANT TO MAKE SURE
IS CLEAR AND WHEN WE UNDERSTAND
AND START TO SEE THIS EXHAUSTION
BLUNTED, THAT IS DIFFERENT AND
IS LONG-TERM BURDEN THAT IS NOW
GOTTEN A SYSTEM IN A REALLY
DEBILL TATED STATE AND ROLE OF
RESILIENCE WHEN WE HAVE AND YOU
THINK THAT, GOSH. WHEN WE HAVE
SOMEONE WHO IS PHYSIOLOGICALLY
WORN OUGHT LACK OF BETTER
PHRASING WE CAN COME IN AND GET
THEM SLEEPING BETTER AND IMPROVE
THEIR DIET AND MAYBE ADD
PHYSICAL ACTIVITY. ALL OF THAT
PULLS BACK SOME OF THE
PHYSIOLOGICAL AROUSAL AND
DISREGULATION SUPPRESSING THE
SYSTEM AND THAT IS WHERE WE ARE
BECAUSE WE HAVE NOT BEEN
THINKING OF THIS AS FORMESIS
DOSE RESPONSE AND WE HAVEN'T
BEEN THINKING AND YOU KNOW WE
HAVE BEEN SEEING INCONSISTENCIES
AND FINDINGS BECAUSE WE HAVE
BEEN THINKING LINEARLY AND NOW
THAT WE HAVE AN IMPROVED MODEL I
WILL ARGUE AND WE CAN START TO
DIFFERENTIATE WHO IS WHERE AND
WE CAN START TO TEST WHAT WE
NEED TO DO TO HELP INDIVIDUALS
RECALIBRATE AND HELP TO BOLSTER
THESE INDIVIDUALS SO THEY DON'T
GO INTO LOAD OR OVERLOAD SIDE.
IS THAT --
>>ONE MORE QUESTION.
THIS IS ALONG THE OVERALL FOCUS
OF THIS YEAR IN [INDISCERNIBLE]
FOCUSING ON WHOLE PERSON HEALTH
AND HOW PAIN IS WHOLE PERSON
PROBLEM AND WHAT WOULD BE THE
EXAMPLES OF NONINVASETIVE
STRATEGIES AND THERAPIES TO
PROMOTE A WHOLE PERSON BALANCE
THAT IS A QUESTION TO ALL OF
YOU.
>>I WILL START. WE ARE ON THE
TOP OF MY HEAD AND WITH MICS
CLOSE TO YOU. YES.
WELL, SO -- SO, THIS IS -- YOU
KNOW, PROBABLY THIS IS AN
INTEREST AREA FOR ALL OF US.
SOME -- WHEN DR. WAS ONE OF MY
MENTORS AND SO WE HAD ACTUALLY
-- HE HAD ILLUMINATED BACK IN
2013 I GUESS BENEFITS OF
INTERMITTENT FASTING AND WE WERE
INTERESTED IN THAT PRACTICAL AND
COMMENTING EARLIER THERE IS SO
MUCH BENEFIT TO SIMPLE
STRATEGIES OF INTERMITTENT
FASTING REDUCING INFLAMMATION
AND METABOLIC APPROACHES AND
WITH MINIMUM TO 8 TO 16 HOURS OF
FOOD RESTRICTION THAT COULD BE
AS SIMPLE AS EARLY DINNER AND
LATE BREAK FAST THAT WE CAN --
NOTHING ELSE COMPLICATED ABOUT
IT AND GETTING PEOPLE TO DO THAT
A FEW TIMES THERE IS HEALTH
BENEFITS IMPROVING HOW WE SLEEP
AND HEALTH CBT THERE IS THINGS
LIKE WEIGHTED BLANKETS AND KNOW
EXERCISE CAN HELP AND ALL
STRATEGIES WHEN YOU THINK OF TAI
CHI AND YOGA AND STRATEGIES THAT
CAN KONL TRIBUTE TO LINE UNOF
INDEX WE WERE SHOWING WITH
BIOLOGICAL AS WELL AS FUNCTIONAL
HEALTH BENEFITS.
>>I DON'T KNOW IF I HAVE
ANYTHING TO ADD ON TO THAT. IT
ENCOMPASSES MULTIPLE DIFFERENT
STRATEGIES AND THINKING ABOUT
THIS HOLISTICALLY TAPPING INTO
PHYSICAL AND MENTAL HEALTH AND
WHETHER IT BE THROUGH ENGAGING
IN VARIOUS PSYCHOLOGICAL
ADAPTIVE COPING RESPONSES TRYING
TO AUGMENT THAT SYSTEM AND DIET
AND EXERCISE AND TALKED A LITTLE
ABOUT GUT MICROBIOME THIS
MORNING DURING ONE TALK AND
INTERESTING RESEARCH STEMMING
FROM THAT LOOKING AT GUT
MICROBIOME AND INFLAMMATION AND
LINKAGES TO PAIN AND THINK IT
WILL TAKE MULTIPLE THINGS AND
RESOURCES AND MULTIPLE
STRATEGIES BUT YOU HAVE TO THINK
ABOUT THE UNIQUE PERSON AND WHAT
MAY WORK FOR ONE PERSON IS NOT
NECESSARILY GOING TO WORK FOR
ANOTHER ONE.
IT NEEDS TO BE INDIVIDUALIZED
TAPPING INTO PRECISION MEDICINE
APPROACH.
>>QUESTION ADD TO WHAT IS SAID
FROM MY POINT OF VIEW. WE HAVE
TO HELP PEOPLE TO UPREGULATE
INFLAMMATORY RESPONSES BODY
WOULD START TO DOWNREGULATE
INFLAMMATORY RESPONSES
TRIGGERING ADAPTIVE RESPONSES
AND THINKING ABOUT APPROACHES WE
KNOW WORK FOR CHRONIC PAIN
PATIENT MANY ARE ALREADY DOING
THIS. ACCU PUNCTURE CONTROLS
LOCAL INFORMATION.
EXERCISE CREATE AGAIN CONTROL
LOCAL INFLAMMATION AND MASSAGE
THERAPY DO THE SAME NOT ONLY
COMPONENT BUT COULD BE ONE OF
THE COMPONENT.
>>I WANT TO ADD ON TO EXTENT WE
CAN POSSIBLY DO THIS IS TO
INTERVENE CRITICAL VERY
SENSITIVE DEVELOPMENTAL PERIODS
DOING STRATEGY AT EARLY STAGE OF
LIFE WHEN THERE IS A LOT OF
NEUROPLASTICITY HAPPENING AND
LEARNING AND GROWTH WOULD BE
EXCELLENT WAY TO MITIGATE
PROGRESSIONS TO CHRONIC PAIN
BEFORE IT GETS TOO WORSE AND
LEARN AT EARLY AGE.
>>WE HAVE ONE VERY LAST
QUESTION TO PANEL FOR VERY, VERY
BRIEF ANSWERS AND WE HAVE A
MINUTE TO CONCLUDE THE SESSION.
>>OKAY. QUESTION IS PARTIALLY
ANSWERED AND THINK IT IS A
CONFERENCE ABOUT PAIN AND
COULDN'T WE HAVE EXACT SAME
DISCUSSION AT A CONFERENCE ON
SAY POST ACUTE COVID SYNDROME?
OR VARIETY OF OTHER AREAS WHERE
THERE IS A STRESSOR AND RESPONSE
AND SOMEBODY CAN RESPOND
VIGOROUSLY AND RESOLVE OR
RESPOND PERHAPS WITH MORE OF A
STRUGGLE AND CONTINUE TO HAVE
CHRONIC SENTIMENTS THAT TO ME IS
BLUEPRINT FOR HEALTH; RIGHT?
IT IS IMPORTANT WE THINK ABOUT
THIS VERY NICE CONCEPT MAPPING
OUT NICELY ON WHOLE PERSON
HEALTH CONCEPTS THAT WE ARE
REALLY VERY INTERESTED IN NCCIH
AND THANKING EVERYBODY FOR
WONDERFUL CONVERSATIONS THAT IS
REALLY GREAT. THANK YOU.
>>SINCE WE HAVE AN OPPORTUNITY
I WANT TO PUT OUT THERE HAVE
BEEN NIH CALLS FOR BIOMARKERS
FOR PAIN.
I -- I DON'T KNOW IF I CAN WISH
OR HOPE OR REQUEST THAT WHAT IS
GIVEN AND PRESENTED TODAY THAT
WE NEED TO MAKE THAT REQUEST
BROADER AND THAT IS RECEPTIVE TO
RECOGNIZING CHRONIC PAIN IS A
WHOLE PERSON CONDITION.
WE HAVE TO REALLY THINK ABOUT
BIOMARKERS THAT ARE REFLECTIVE
OF WHOLE PERSON HEALTH.
>>THANK YOU VERY MUCH.
>>THIS IS A GREAT POINT WHERE
WE CAN CONCLUDE THE SESSION AND
THANKS FOR YOUR ATTENTION AND
THANK YOU FOR FASCINATING TALK.
>>>>[APPLAUSE].
>>GO AHEAD.
>>I VT PLEASURE OF DOING THE
MITCHELL MAX AWARD THIS
AFTERNOON. I HAVE BEEN INVOLVED
IN SYMPOSIA FOR 18 YEARS NOW 14
YEARS IT HAS BEEN SINCE WE
STARTED AWARDS AND FIRST TIME I
GOT BEST TASK OF SYMPOSIUM AND
GOT TO PRESENT AWARDS THAT IS
WONDERFUL PART OF THE DAY AND
THANKING LEA TO ACTUALLY SET UP
THE COMPONENT OF THE SYMPOSIUM
THAT IS TO HIGHLIGHT IMPORTANT
WORK OF EARLY STAGE CAREER
INVESTIGATORS THAT IS IMPORTANT
FOR US AS FUTURE DIRECTION OF
PAIN RESEARCH THAT WE ARE MOST
HAPPY TO RECOGNIZE INCREDIBLE
WORK WE HAVE SEEN PRESENTED HERE
TODAY AND OVER THE YEARS AND SO
IT REALLY IS MY PLEASURE TO
ANNOUNCE THIS YEAR'S AWARDEE.
THE CONSORTIUM AND NIH PAIN
CONSORTIUM THAT DEFINITELY
RECOGNIZES IMPORTANCE OF
SUPPORTING EARLY STAGE
INVESTIGATORS AND HOW IMPORTANT
IT IS TO HIGHLIGHT AMAZING
VARIETY AND THE SCHOLARLY WORK
THAT THEY HAVE PRESENTED.
MITCHELL MAX WAS VERY COMMITTED
TO PAIN RESEARCH AND SPENT MOST
OF HIS CAREER HERE AT NIH. HE
ALSO FOUND THAT ONE OF THE MOST
IMPORTANT PARTS OF HIS JOB WAS
TO TRAIN NEW INVESTIGATORS AND
HE DID A PHENOMENAL JOB AT THAT.
THREE PRESENTERS WE HAD TODAY
WERE JUDGED AS FAR AS
PRESENTATIONS GO BY PANEL OF
STAFF ACROSS THE NIH.
AND THEY WERE BASED ON SELECTIVE
CRITERIA AND PRESENTATION
QUALITY AND INNOVATION OF THE
WORK AND THE KNOWLEDGE PRESENTED
BY THE PRESENTERS.
THREE FINALISTS ARE -- HAVE DONE
EQUALLY WONDERFUL JOB AND MADE
IT REALLY DIFFICULT FOR
PANELISTS WHO VOTED ON CRITERIA
TO COME UP WITH THE FINAL
AWARDEE.
WISH WE COULD GIVE THREE BUT IS
NOT SET UP TO DO THAT.
SO WHAT I WOULD LIKE TO SAY IS
THAT I WAS SO IMPRESSED TODAY BY
THE BREADTH OF THE WORK THAT WAS
PRESENTED AND ALSO THE
SCIENTIFIC MEANINGFULNESS OF ALL
THESE DIFFERENT TOPICS WE HAD
DR. FRUMKIN TALK TO US ABOUT
IMPROVING PREDICTIVE ACCURACY
WHO IS LIKELY TO HAVE PROCEDURES
ON SPINE AND TALKING ABOUT
CORRELATION OF SYSTEM CLUSTERS
IN CANCER SURVIVORS AND RELATING
TO BDNF GENOTYPE AND TYLER
NELSON TALKED TO US ABOUT MEANS
FOR DISCOVERY OF NEW ANALGESIC
TARGETS IN ANIMAL MODELS AND
WITH THAT SAID I HAVE ENVELOPE
PLEASE AND WINNER FOR 2023 MAX
AWARD IS TYLER NELSON AND HIS
PRESENTATION UNCOVERING
THERAPEUTIC SPINAL CORD TARGETS
FOR TREATMENT OF NUROPATHIC PAIN
AND TYLER HAS TO LEAVE SHORTLY
SO WE WILL BE VERY QUICK IN OUR
PRESENTATION PLEASE DON'T GO
AWAY. AS TYLER WALKS UP TO THE
STAGE HERE TO JOIN ME I WILL
GIVE YOU A TINY BIT MORE
INFORMATION ON HIS BACKGROUND.
HE IS CURRENTLY POST DOCTORAL
ASSISTANT RESEARCH SCIENTIST AT
NEW YORK UNIVERSITY'S PAIN
RESEARCH CENTER PHD FROM
NEUROBIOLOGY UNIVERSITY OF
PITTSBURGH SCHOOL OF MEDICINE AS
TRAINEE THERE AT PITTSBURGH
CENTER FOR PAIN RESEARCH AND
DOCTORAL RESEARCH FOCUSED ON
SPINAL CORD CIRCUITRY THAT IS
UNDERLYING NEUROPATHIC PAIN HE
CONTINUED THAT WORK FROM TODAY'S
CONVERSATION AND HE SUPPORTED
WORK FROM NUMBER OF GRANTS IF
NIH INCLUDING 232 AWARD
INSTITUTIONAL AWARD AND F32
INDIVIDUAL AWARD AND F99 MEANT
TO BE TRANSITION AWARD INTOAGE
INDEPENDENT INVESTIGATOR AND ON
HIS WAY -- ROLE IN MANIFESTATION
AND MAINTENANCE OF NEUROPATHIC
PAIN AND WE TODAY RECOGNIZE AND
VERY PLEASED TO RECOGNIZE TYLER
FOR EXCELLENT POSTER
PRESENTATION AND THEN THE ORAL
PRESENTATION HE DELIVERED THIS
AFTERNOON AND WE WILL PRESENT
HIM WITH A FEW DIFFERENT THINGS
AND WANT TO MENTION FIRST HE IS
ONE OF SEVERAL TALENTED RISING
STARS IN PAIN RESEARCH INCLUDING
TWO CO-PRESENTERS TODAY ON 14
ACTUALLY 13. LE BE FOURTEENTH
PRIOR AWARDEE FROM MITCHELL MAX
AWARD AND TAKES ME BACK A LITTLE
BIT AS A WALK DOWN MEMORY LANE
AND VERY FIRST AWARDEE WAS CARA
RAMOS WHO IS NOW AFTER VERY MANY
SHORT YEARS A VICE PRESIDENT OF
NEUROSCIENCE AND SOCIETY AT DANA
FOUNDATION AND YOU HAVE A LOT OF
BIG SHOES TO FILL. AND CARA'S
-- WE AWARDED CARA WITH A PLAQUE
FOR THE RECOGNITION OF HER
WONDERFUL PRESENTATION THAT WE
ALSO HAVE FOR TYLER.
AND A COINCIDENCE HAPPENED
DURING THAT FIRST AWARD CEREMONY
THAT IS STORY LANDIS DIRECTOR OF
NINDS NOW SURPRISED TO CARA THAT
SHE WAS ABOUT TO BE AWARDED A
FELLOWSHIP AWARD FROM NINDS.
THAT WAS HER SURPRISE ON STAGE
AND WE CAN'T REPEAT THAT. I'M
SORRY THAT WAS A COINCIDENCE.
WE DO HAVE YOUR PLAQUE.
I WILL SEND YOU A BOOK CALLED
BEAUTIFUL BRAIN THAT IS AN
ILLUSTRATIVE VERSION OF RAMONA
CAHAHAL'S DRAWINGS AND T-SHIRT
FROM NIH THAT YOU ARE HERE AND
THANK YOU SO MUCH.
>>OKAY. NOW, I HAVE THE
PLEASURE OF INTRODUCING LAURA
AND DON'T KNOW IF THIS IS ON THE
AGENDA. THERE IS LAURA. LAURA
HAS DONE SOME AMAZING WORK
HELPING TO DEVELOP ENHANCE
WORKFORCE OF CLINICAL PAIN
RESEARCHERS THAT GOES OR IS
COUPLED UP WITH WORK WE ARE
DOING FOR ADDITIONAL TRAINING
PROGRAMS FOR PRECLINICAL AND
[INDISCERNIBLE] RESEARCH AND
PAIN.
AGAIN, THIS IS THE FUTURE OF OUR
RESEARCH. WE WANT REALLY TO
PROMOTE SOME GOOD EFFORTS.
LAURA HAS PUT TOGETHER MANY
PROGRAMS TO ENHANCE CLINICAL
RESEARCH NETWORK.
THIS AFTERNOON, SHE WILL TALK
YOU TO SPECIFICALLY ABOUT A
RECENT PROGRAM THAT WAS JUST
FUNDED AND JUST LAUNCHED AND
LOOKS TO BE SUPER, SUPER
EXCITING AND THANK YOU TO LAURA
FOR GETTING THAT GOING AND
HANDING THE MICROPHONE OVER TO
YOU.
>>>>OKAY. THANK YOU LINDA AND
EVERYONE. WE ARE WRAPPING UP.
REALLY QUICK AND BRIEF
PRESENTATION I WANT TO GIVE A
LITTLE BACKGROUND ABOUT THE
PURPOSE NETWORK. IM I'M LAURA
PURPOSE OF HEAL FUNDED THIS
NETWORK IN OCTOBER OF 2022 AND
LITTLE BACKGROUND IF YOU ARE NOT
AWARE WHAT THE PURPOSE NETWORK
IS SO YOU MIGHT CONSIDER JOINING
US ON THE JOURNEY OF PURPOSE
NETWORK AND PURPOSE STANDS FOR
POSITIVELY UNITING RESEARCHERS A
PAIN TO OPINE SYNTHESIZE AND
ENGAGE AND GOAL OF THE NETWORK
IS TO CONNECT PAIN RESEARCHERS
ACROSS CONTINUUM OF PAIN
RESEARCH FROM ALL DISCIPLINES
AND AT ALL CAREER STAGES THAT IS
A COORDINATING CENTER AND THE
GOAL IS REALLY TO ESTABLISH AND
RUN A DIGITAL PLATFORM THAT WILL
HAVE EVENTS THROUGHOUT THE YEAR
AND WAY TO CONNECT SOCIALLY AND
THROUGHOUT YOUR RESEARCH AND
THROUGHOUT THE YEAR AND WE ARE
ORGANIZING AND RUNNING AN ANNUAL
MEETING.
SO, THE PURPOSE NETWORK WILL
PROVIDE A CENTRALIZED COMMUNITY
FOR RESEARCHERS ACROSS CONTINUUM
OF BASIC TRANSLATIONAL AND
CLINICAL RESEARCH AND WILL OFFER
ONGOING WEBINARS AND TRAINING
OPPORTUNITIES AND WE WILL
DELIVER WEBINARS AND WEEKLY
DIGESTS BY E-MAIL AND E-MAIL
MULTI-DISCIPLINARY
COLLABORATIONS WHEN DEVELOPING
GRANT APPLICATIONS AND
AGGREGATING INFORMATION ABOUT
PAIN RESEARCH ABOUT FUNDING
OPPORTUNITIES AND JOB
OPPORTUNITIES.
SO, AS OF YESTERDAY, MONDAY,
JUNE 5TH, WE HAVE 994
RESEARCHERS OR NIH STAFF WHO
JOINED THE PURPOSE ALREADY AND
ALREADY FUNDED NIH RESEARCHERS
TO JOIN THE NETWORK AND THOSE
INTERESTED IN NIH FUNDING OR
STAFF MEMBERS TO JOIN THE
PURPOSE NETWORK.
AND JUST TO QUICKLY GO OVER SOME
FEATURES OF THE DIGITAL PLATFORM
IF YOU HAVE NOT HAD A CHANCE TO
CHECK IT OUT, THERE IS A PEOPLE
SECTION WHERE YOU CAN FIND
PEOPLE'S PROFILES YOU MIGHT WANT
TO COLLABORATE WITH ON RESEARCH
OPPORTUNITIES AND ONGOING
STUDIES AND PROJECTS SECTION.
YOU CAN UPLOAD INFORMATION ABOUT
YOUR PROJECTS OR STUDIES SO
OTHER RESEARCHERS COULD GET A
SENSE OF WORK YOU ARE DOG AND
MIGHT BE ABLE TO COLLABORATE
WITH IN THE FUTURE AND YOU CAN
FIND FUNDING ANNOUNCEMENTS.
RIGHT NO YOU THERE IS LOTS OF
NIH AND HEAL INITIATIVE FUNDING
ANNOUNCEMENTS AND KNOW WE HAVE
INNER AGENCY COLLEAGUES IN THE
ROOM AND ONLINE AND WOULD LOVE
TO ENCOURAGE BA, DOD, FDA, CDC
COLLEAGUES TO POST ANY FUNDING
ANNOUNCEMENTS ON HERE AS WELL
AND YOU CAN POST JOB
OPPORTUNITIES UP HERE.
YOU CAN FIND UPCOMING EVENTS
AND/OR MEETINGS OCCURRING ON OR
OFF THE PLATFORM AND WEBINARS
AND TRAININGS WILL BE POSTED IN
THE MEDIA CENTER.
YOU CAN ESTABLISH INFORMAL
MENTORING RELATIONSHIPS BY
REGISTERING AS A MENTOR OR AS A
MENTEE.
WE HAD THE FIRST ANNUAL PURPOSE
MEETING BETWEEN MAY 11TH AND MAY
13TH, 2023 AND FIRST YEAR MOSTLY
FOCUSED ON PROVIDING EDUCATIONAL
CONTENT AND TRAINING FOR
GRADUATE STUDENTS POST DOCS AND
EARLY STAGE INVESTIGATORS AND
SESSIONS ARE RECORDED AND WILL
BE POSTED ON THE PURPOSE NETWORK
AND IF YOU DIDN'T HAVE A CHANCE
TO ATTEND, WE WOULD LOVE TO HAVE
YOU LISTEN IN TO SEE SOME
SESSIONS AFTER THE FACT AND THAT
BEING SAID ONLY FEEDBACK WE
DIDN'T RECORD FEEDBACK SESSIONS
OR SOME WORKSHOPS AND SECOND
ANNUAL PURPOSE MEETING DATES AND
LOCATIONS WILL BE ANNOUNCED THIS
SUMMER.
PLEASE STAY TUNED. WE WOULD
REALLY LOVE TO HAVE EVERYBODY
ATTEND THIS MEETING.
SECOND MEETING WE WILL REALLY GO
BEYOND JUST EARLY STAGE
INVESTIGATORS AND WE WILL ALSO
HAVE CONTENT FOR MID-STAGE
INVESTIGATORS AWELL AS LATER
CAREER INVESTIGATORS AS WELL.
SO, JUST TO GIVE YOU A SENSE
WHAT WILL HAPPEN ON PURPOSE
PLATFORM THIS YEAR AND WHY YOU
MIGHT WANT TO CHECK IT OUT.
THIS SUMMER YOU WILL BEGIN TO
SEE WEBINARS ON THE PLATFORM AND
WILL BEGIN TO HAVE OFFICE HOURS
WITH NIH PROGRAM OFFICERS AND
WILL HAVE OFFICE HAD HOURS WITH
RESEARCHERS WHO WILL HELP REVIEW
AIMS PAGES AS WELL AS RESEARCH
CONTENT IDEAS AND PURPOSE
ADMINISTRATORS WILL ALSO HOLD
OFFICE HOURS.
WE ARE HOPING THAT THE COMMUNITY
GROUPS WILL BEGIN TO BECOME A
BIT MORE ACTIVE AND YOU WILL
CONTINUE TO SEE ANNOUNCEMENTS
BOTH FUNDING ANNOUNCEMENTS AND
OTHER JOB OPPORTUNITIES AND
ACTIVE NOFOS THAT WILL BE POSTED
ON THE WEBSITE.
THE PURPOSE -- THE PLATFORM
PARTICIPANTS WILL BE ABLE TO
SHARE INFORMATION ABOUT STUDIES
AND PROJECTS AND WORK ON
DEVELOPING PROJECT PROPOSALS IN
PROTECTED SPACES AND AGAIN
ANNOUNCING JOB OPPORTUNITIES AND
WEBINAR TRAININGS THAT PEOPLE
MIGHT BE INTERESTED IN.
YOU MIGHT BE ABLE TO MEET
COLLEAGUES ACROSS SPECTRUM OF
PAIN RESEARCH AND FOSTERING
OPPORTUNITIES AND HEAL
INITIATIVE AWARDED THIS GRANT
SUPPORTING PURPOSE NETWORK TO
JACOB COVER STONE AT
[INDISCERNIBLE] EDUCATION AND IF
YOU HAVE QUESTIONS ABOUT THE
PURPOSE NETWORK FEEL FREE TO
REACH OUT TO HIM AND THERE ARE
TWO NIH LEADS FOR PURPOSE
NETWORK AND I'M PROGRAM OFFICER
FOR THIS GRANT AND NETWORK AND
DON ELLY TORRES IS PROJECT
SCIENTIST. IF YOU HAVE
QUESTIONS OR FEEDBACK FEEL FREE
TO REACH OUT TO US.
REQUEST AS WE WRAP UP HERE FOR
THOSE THAT HAVE NOT JOINED THE
PURPOSE NETWORK WE WOULD LOVE TO
HAVE YOU JOIN AND HAVE THE
WEBSITE HERE AS WELL AS THE Q.R.
CODE AND WOULD LOSS TO ALSO HEAR
YOUR FEEDBACK AND AS I SAID WE
WANT TO GET A SENSE WHAT CONTENT
YOU ARE LOOKING FOR, FOR THE
PLATFORM AND HOW PLATFORM CAN
MEET NEEDS OF ALL CAREER STAGES
AND WHAT PEOPLE ARE LOOKING FOR,
FOR THE SECOND ANNUAL MEETING.
WITH THAT I WANT TO THANK YOU
FOR TIME FOR LETTING ME PRESENT
ABOUT THE PURPOSE NETWORK. WE
ARE EXCITE TODAY HAVE THIS
COORDINATING CENTER CONNECT PAIN
FUNDED RESEARCHERS ACROSS THE
NIH AND FEEL FREE TO REACH OUT
TO ME OR PURPOSE NETWORK IF YOU
HAVE QUESTIONS OR COMMENTS OR
FEEDBACK AND WITH THAT I WILL
WRAP IT UP.
>>OKAY. WE WILL WRAP UP THE
18TH ANNUAL NIH PAIN SYMPOSIUM
CONSORTIUM AND THANKING 100
PEOPLE WATCHING VIRTUALLY AND
APPRECIATE YOU LISTENING IN AND
SENDING YOUR QUESTIONS THIS
FIRST DAY AND WANT TO THANK
SPEAKERS AND CONGRATULATE THE
MITCHELL MAX WINNER AS WELL AS
THE OTHER PRESENTERS AND WE WILL
BEGIN AGAIN TOMORROW AT 8:30
A.M.. PLEASE JOIN IF IN PERSON
AND REGISTRATION STARTS AT 8
O'CLOCK PROMPTLY AND IF JOINING
VIRTUALLY TUNE IN BEFORE 8:30.
LOOKING FORWARD TO SEEING YOU
TOMORROW. THANK YOU, EVERYONE.