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>>WELCOME TO

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DAY TWO OF THE 18TH ANNUAL PAIN

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CONSORTIUM SYMPOSIUM.

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I'M A PROGRAM DIRECTOR AT THE

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NATIONAL INSTITUTE ON AGING AND

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ONE OF THE SYMPOSIUM CO-CHAIRS

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ALONG WITH MY COLLEAGUE DR

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DR. MELISSA GE HM WHO YOU HEARD

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FROM YESTERDAY MORNING.

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IT'S MY JOY TO BE WITH ALL OF

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YOU ONLINE AND ON THIS SPACE.

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YESTERDAY'S PANELISTS PROVIDED

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SOME INSPIRING,

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THOUGHT-PROVOKING AND NOVEL

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CONSIDERATIONS WHEN IT COMES TO

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PAIN AND RESILIENCY,

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PARTICULARLY THROUGH THE LENS OF

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THE WHOLE PERSON.

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TODAY'S LINEUP EQUALLY PROMISES

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NOT TO DISAPPOINT.

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IT IS MY PRIVILEGE TO INTRODUCE

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DR. HELENE LANGEVIN TO PROVIDE

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THIS MORNING'S OPENING REMARKS.

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AS DIRECTOR OF THE NATIONAL

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CENTER FOR COMPLEMENTARY AND

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INTEGRATIVE HEALTH OR NCCIH, DRE

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FEDERAL GOVERNMENT'S LEAD AGENCY

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FOR RESEARCH ON THE FUNDAMENTAL

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SCIENCE, USEFULNESS AND SAFETY

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OF COMPLEMENTARY AND INTEGRATIVE

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HEALTH APPROACHES AND THEIR

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ROLES IN IMPROVING HEALTH AND

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HEALTHCARE.

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IN ADDITION TO HER MANY ROLES AT

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NIH, DR. LANGEVIN I IS A MEMBERF

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THE PAIN CONSORTIUM EXECUTIVE

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COMMITTEE CURRENTLY THE CHAIR OF

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THE PAIN RESEARCH COORDINATING

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COMMITTEE.

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A FEDERAL ADVISORY COMMITTEE

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CREATED TO ENHANCE PAIN RESEARCH

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EFFORTS AND TO PROMOTE

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COLLABORATION ACROSS THE

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GOVERNMENT WITH THE ULTIMATE

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GOALS OF ADVANCING THE

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FUNDAMENTAL UNDERSTANDING OF

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PAIN AND IMPROVING PAIN-RELATED

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TREATMENT STRATEGIES.

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DR. LANGEVIN RECEIVED HER MD

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FROM MCGILL UNIVERSITY IN

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MONTREAL.

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SHE COMPLETED A POSTDOCTORAL

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RESEARCH FELLOW SHIM IN

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NEUROCHEMISTRY AT CAMBRIDGE AND

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A RESIDENCY IN INTERNAL MEDICINE

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AND FELLOWSHIP IN ENDOCRINOLOGY

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AND METABOLISM AT THE JOHNS

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HOPKINS HOSPITAL.

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PRIOR TO JOINING NIH,

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DR. LANGEVIN WAS THE DIRECTOR OF

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THE CENTER FOR INTEGRATIVE

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MEDICINE JOINTLY BASED AT

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BRIGHAM AND PROVE SO IN

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RESIDENCE AT HARVARD.

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PROFESSOR OF NEUROLOGICAL

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SCIENCES AT THE UNIVERSITY OF

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VERMONT.

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OVER HER DISTINGUISHED CAREER,

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DR. LANGEVIN'S RESEARCH

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INTERESTS HAVE CENTERED AROUND

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THE ROLE OF CONNECTIVE TISSUE

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AND CHRONIC MUSCULOSKELETAL

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PAIN, THE MECHANISMS OF

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ACUPUNCTURE, MANUAL AND

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MOVEMENT-BASED THERAPIES AND THE

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EFFECTS OF STRETCHING ON

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INFLAMMATION RESOLUTION

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MECHANISMS WITHIN THE CONNECTIVE

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TISSUES.

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PLEASE JOIN ME IN WELCOMING

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DR. HELENE LANGEVIN.

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[APPLAUSE]

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>>THANK YOU SO MUCH, AND
IT'S

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REALLY MY PLEASURE TO BE

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INTRODUCING THIS SECOND DAY OF

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THIS WONDERFUL SYMPOSIUM, AND I

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THINK YOU WILL ALL AGREE WITH ME

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THAT YESTERDAY WAS TRULY INSP 

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INSPIRING IN MANY WAYS.

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WE HEARD NOT ONLY SOME WONDERFUL

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PRESENTATIONS THAT WERE ABOUT

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SOME VERY CUTTING EDGE SCIENCE

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BUT ALSO INVITING US TO THINK OF

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PAIN MANAGEMENT IN NEW WAYS.

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SUCH AS, FOR EXAMPLE, MOVING

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BEYOND TEMPORARY ANALGESIA TO

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VIEW PAIN IN THE CONTEXT OF

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RESILIENCE AND A WHOLE PERSON.

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I THINK IT'S WORTH TAKING A

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MOMENT TO STOP AND THINK ABOUT

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THIS.

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BECAUSE A LOT OF TIMES WHEN WE

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THINK OF PAIN MANAGEMENT, WE

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THINK OF SUPPRESSING PAIN.

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BUT WHAT WE ALSO KNOW IS THAT

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PAIN, IF WE THINK OF PAIN IN THE

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CONTEXT OF THE WHOLE PERSON,

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THEN WE CAN REALLY LOOK AT OTHER

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FACTORS THAT MAY INFLUENCE THAT

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RELATIONSHIP OF THE PERSON TO

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THE SYMPTOM THAT THEY ARE

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HAVING, AND AS WAS DEMONSTRATED

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BY A LOT OF TALKS YESTERDAY,

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IT'S A LOT MORE COMPLEX THAN

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SIMPLY ANALGESIA, MEANING

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TEMPORARY PAIN RELIEF.

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WE HEARD THAT RESILIENCE IS A

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DYNAMIC FACTOR, A DYNAMIC

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PROCESS, INVOLVING MULTIPLE

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FACTORS THAT CAN BE SUPPORTED

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AND ENHANCED.

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WE HEARD ABOUT POSITIVE EMOTI 

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EMOTIONS, OPTIMISM, AND

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LIFESTYLE, HAVING PROTECTIVE

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EFFECTS ON MULTIPLE

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PHYSIOLOGICAL SYSTEMS, AS WELL

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AS REDUCING CHRONIC PAIN.

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SO THIS KIND OF DYNAMIC

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INTERPLAY BETWEEN RESILIENCE AND

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AN INDIVIDUAL SORT OF

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RELATIONSHIP TO THEIR SYMPTOMS

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IS VERY, VERY IMPORTANT.

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WE ALSO HEARD ABOUT NON-LINEAR

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PHYSIOLOGICAL RESPONSES.

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FOR EXAMPLE, HOW A ROBUST ACUTE

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INFLAMMATORY RESPONSE CAN

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PARADOXICALLY, OR MAYBE NOT SO

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PARADOXICALLY, BE A NECESSARY

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STEP TOWARDS RECOVERY.

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AND THAT SUPPRESSING THIS

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INFLAMMATORY RESPONSE WITH, FOR

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EXAMPLE, NONSTEROIDAL

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ANTI-INFLAMMATORY DRUGS, MAY NOT

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BE SUCH A GOOD IDEA.

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AND TODAY, WE WILL BE HEARING

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ABOUT MORE CUTTING EDGE PAIN

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TREATMENTS.

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NANOMEDICINES, PSYCHEDELICS, AND

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NOVEL FORMS OF MOVEMENT-BASED

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THERAPIES.

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BUT FIRST, WE WILL BE HEARING

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THE VERY IMPORTANT VOICE OF A

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PERSON, AN INDIVIDUAL LIVING

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WITH CHRONIC PAIN.

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MISS NICOLE HEMMENWAY, WHO IS

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THE CEO OF THE U.S. PAIN

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FOUNDATION.

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UNFORTUNATELY, NICOLE WILL NOT

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BE ABLE TO BE WITH US IN PERSON

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TODAY, BUT WE ARE VERY HAPPY

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THAT SHE CAN JOIN US VIRTUALLY.

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NICOLE HAS BEEN INVOLVED WITH

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THE U.S. PAIN FOUNDATION FOR

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MANY YEARS, AND BEFORE THAT, SHE

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WAS THE DIRECTOR OF THE

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INVISIBLE PROJECT, AN ONLINE AND

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PRINT MAGAZINE FROM THE U.S.

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PAIN FOUNDATION, THAT HIGHLIGHTS

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THE EXPERIENCES OF PEOPLE LIVING

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WITH PAIN.

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IN ADDITION TO BEING AN ADVOCATE

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FOR PEOPLE WITH CHRONIC PAIN,

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NICOLE IS ALSO AN AUTHOR WHO

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FIRMLY BELIEVES THAT ALL PATIENT

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HAVE AN IMPORTANT STORY TO TELL.

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AND WE WHOLEHEARTEDLY AGREE.

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HER BOOK, ENTITLED "NO, IT'S NOT

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IN MY HEAD, THE JOURNEY OF A

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CHRONIC PAIN SURVIVOR FROM

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WHEELCHAIR TO MARATHON,"

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DESCRIBES BOTH THE CHALLENGES

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AND TRIUMPHS OF HER STRUGGLE

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WITH COMPLEX REGIONAL PAIN

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SYNDROME, A DEBILITATING

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NEUROLOGICAL DISORDER THAT IS

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POORLY UNDERSTOOD AND VERY

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DIFFICULT TO TREAT.

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AND WE KNOW THAT IT'S IMPORTANT

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NOT ONLY TO LISTEN TO PATIENTS,

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OF COURSE, IN CLINICAL WORK, BUT

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ALSO IN RESEARCH, THAT RESEARCH

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THAT IS INFORMED BY THE VOICE OF

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PATIENTS IS ENHANCED.

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THERE IS NO POSSIBLE DOUBT ABOUT

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THAT.

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AND THAT PATIENT-INFORMED

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RESEARCH IS -- AND

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PATIENT-PARTICIPATORY RESEARCH

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IS REALLY MAKING GREAT STRIDES

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IN TELLING US THAT WE CAN DESIGN

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BETTER RESEARCH THIS WAY WHEN WE

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REALLY LISTEN TO WHAT PATIENTS

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HAVE TO TELL US.

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SO WELCOME, NICOLE.

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I GUESS WE'RE GOING TO BE

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PLAYING A TAPE OR IS SHE GOING

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TO BE ON ZOOM?

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SHE'S GOING TO BE -- WE'RE GOING

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TO BE PLAYING A VIDEO.

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WELCOME, NICOLE.

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[APPLAUSE]

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>>GOOD MORNING, EVERYONE.

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I AM SO SORRY THAT I CAN'T BE

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WITH YOU TODAY IN PERSON, BUT I

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WANT TO THANK THE NIH PAIN

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CONSORTIUM FOR THIS INCREDIBLE

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OPPORTUNITY.

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AS A PERSON WHO HAS LIVED WITH

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PAIN FOR NEARLY THREE DECADES,

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AS WELL AS THE CEO OF THE U.S.

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PAIN FOUNDATION, I AM TRULY

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HONORED BOTH PERSONALLY AND

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PROFESSIONALLY TO BE HERE WITH

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YOU TODAY.

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TODAY I'M GOING TO BE SHARING MY

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ONGOING JOURNEY WITH PAIN WITH

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YOU.

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WHAT I'VE EXPERIENCED, HOW I

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HAVE COPED, AND WHY WE NEED MORE

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THERAPEUTICS AND UNDERSTANDING

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AROUND CHRONIC PAIN.

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I KNOW ALL TOO WELL THAT PAIN

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CHANGES WHO YOU ARE, WHAT YOU'RE

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ABLE TO DO, AND HOW YOU LIVE.

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IT ROBS YOU OF YOUR INDEPENDENCE

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AND SELF-WORTH.

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I HAVE LEARNED MANY LESSONS OVER

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THE YEARS THAT HAVE BROUGHT ME

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TO WHERE I AM NOW AS A MOM, A

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WIFE, A FRIEND, A PATIENT

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ADVOCATE, AND A PERSON WITH

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PAIN.

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SO LET'S START AT THE BEGINNING.

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IN 1994, A GAME OF BASKETBALL

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CAUSED ME TO SPRAIN MY LEFT

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ANKLE.

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MY DOCTORS BELIEVED IT WOULD

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HEAL QUICKLY BUT AFTER THREE

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MONTHS OF PHYSICAL THERAPY AND

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CRUTCHES, I STILL COULD NOT BEAR

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ANY WEIGHT ON MY LEFT LEG.

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IT WAS ALSO HYPERSENSITIVE TO

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TOUCH, PURPLISH IN COLOR, AND

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SWOLLEN.

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IT TOOK MY DOCTORS ABOUT FIVE

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MONTHS, BUT AT THE AGE OF 13, I

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WAS DIAGNOSED WITH COMPLEX

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REGIONAL PAIN SYNDROME, OR CRPS.

259
00:09:30,560 --> 00:09:32,680
CRPS IS A NEUROLOGICAL DISEASE

260
00:09:32,680 --> 00:09:34,680
THAT CAUSES SYMPTOMS SUCH AS

261
00:09:34,680 --> 00:09:38,880
SEVERE BURNING PAIN, DECREASED

262
00:09:38,880 --> 00:09:39,840
CIRCULATION, EXTREME SENSITIVITY

263
00:09:39,840 --> 00:09:44,960
TO TOUCH, AND LOSS OF LIMB

264
00:09:44,960 --> 00:09:45,400
MOBILITY.

265
00:09:45,400 --> 00:09:47,160
LUCKILY, AN EPIDURAL NERVE BLOCK

266
00:09:47,160 --> 00:09:49,800
FOLLOWED BY MONTHS OF AGGRESSIVE

267
00:09:49,800 --> 00:09:52,400
PHYSICAL THERAPY PUT ME INTO

268
00:09:52,400 --> 00:09:53,560
REMISSION.

269
00:09:53,560 --> 00:09:55,160
THE ONLY STIPULATION WAS THAT I

270
00:09:55,160 --> 00:09:57,560
NEEDED TO AVOID PARTICIPATING IN

271
00:09:57,560 --> 00:10:00,640
PHYSICAL ACTIVITIES FOR TWO

272
00:10:00,640 --> 00:10:01,280
YEARS.

273
00:10:01,280 --> 00:10:04,120
I FOLLOWED MY DOCTOR'S ADVICE

274
00:10:04,120 --> 00:10:05,880
EXPLICITLY, AND SOON LIFE

275
00:10:05,880 --> 00:10:09,280
RETURNED TO NORMAL.

276
00:10:09,280 --> 00:10:11,560
HIGH SCHOOL BEGAN, AND THAT WAS

277
00:10:11,560 --> 00:10:17,040
WHEN EVERYTHING CHANGED AGAIN.

278
00:10:17,040 --> 00:10:19,000
AT THAT TIME, I WAS 17 AND ALL I

279
00:10:19,000 --> 00:10:21,520
COULD THINK ABOUT WAS ATTENDING

280
00:10:21,520 --> 00:10:23,760
COLLEGE, BEING INDEPENDENT, AND

281
00:10:23,760 --> 00:10:25,360
STARTING MY ADULT LIFE.

282
00:10:25,360 --> 00:10:27,320
I REALLY THOUGHT THAT I HAD MY

283
00:10:27,320 --> 00:10:30,160
ENTIRE LIFE PLANNED OUT BEFORE I

284
00:10:30,160 --> 00:10:31,880
WAS 18 YEARS OLD.

285
00:10:31,880 --> 00:10:34,640
YET TWO WEEKS INTO MY SE SENIOR

286
00:10:34,640 --> 00:10:36,920
YEAR OF HIGH SCHOOL, EVERYTHING

287
00:10:36,920 --> 00:10:37,360
CHANGED.

288
00:10:37,360 --> 00:10:38,840
IT WAS A FLUKE INCIDENT.

289
00:10:38,840 --> 00:10:41,080
I TRIED TO GIVE MY BEST FRIEND A

290
00:10:41,080 --> 00:10:42,520
HIGH FIVE WHEN HER HAND SOMEHOW

291
00:10:42,520 --> 00:10:43,160
MISSED.

292
00:10:43,160 --> 00:10:45,480
INSTEAD, MY RIGHT RING AND

293
00:10:45,480 --> 00:10:46,480
PINKIE FINGER MADE DIRECT

294
00:10:46,480 --> 00:10:50,800
CONTACT WITH HER LEFT PALM.

295
00:10:50,800 --> 00:10:52,240
INSTANTLY, I FELT BURNING PAIN,

296
00:10:52,240 --> 00:10:55,200
AND WITHIN AN HOUR, MY RIGHT

297
00:10:55,200 --> 00:10:57,960
HAND MORPHED INTO A CLAW, AND

298
00:10:57,960 --> 00:10:59,200
THEN EVENTUALLY CLENCHED DOWN

299
00:10:59,200 --> 00:11:00,800
INTO A FIST.

300
00:11:00,800 --> 00:11:03,080
AND THAT FIST WOULD REMAIN FOR

301
00:11:03,080 --> 00:11:07,040
MOST OF THE NEXT FIVE YEARS.

302
00:11:07,040 --> 00:11:08,440
WITHIN THE SPAN OF SECONDS, I

303
00:11:08,440 --> 00:11:11,080
WENT FROM BEING A NORMAL

304
00:11:11,080 --> 00:11:12,880
TEENAGER TO A PAIN PATIENT

305
00:11:12,880 --> 00:11:17,080
LIVING IN AGONY.

306
00:11:17,080 --> 00:11:18,400
INITIALLY, MY DOCTORS BELIEVED I

307
00:11:18,400 --> 00:11:19,880
HAD PULLED TWO TENDONS AND IT

308
00:11:19,880 --> 00:11:21,080
WAS THE PAIN THAT WAS CAUSING MY

309
00:11:21,080 --> 00:11:23,200
HANDS TO STAY CLOSED.

310
00:11:23,200 --> 00:11:25,280
YET AS TIME WENT BY AND I STILL

311
00:11:25,280 --> 00:11:29,000
WAS UNABLE TO MOVE MY FINGERS,

312
00:11:29,000 --> 00:11:32,960
THOSE TREATING ME BEGAN

313
00:11:32,960 --> 00:11:33,720
QUESTIONING MY PAIN.

314
00:11:33,720 --> 00:11:36,240
I WAS THEN UNDER CONSTANT

315
00:11:36,240 --> 00:11:37,200
SCRUTINY BY MY DOCTORS.

316
00:11:37,200 --> 00:11:40,040
I WAS SEEING DOCTOR AFTER

317
00:11:40,040 --> 00:11:41,240
DOCTOR, BEING POKED AND PRODDED

318
00:11:41,240 --> 00:11:42,280
BY NUMEROUS SPECIALISTS.

319
00:11:42,280 --> 00:11:45,000
I WAS SEARCHING FOR ANSWERS.

320
00:11:45,000 --> 00:11:45,840
MEANWHILE, THEY WERE ALL

321
00:11:45,840 --> 00:11:47,360
DIFFERING IN OPINION AS TO WHAT

322
00:11:47,360 --> 00:11:49,240
WAS REALLY WRONG WITH ME.

323
00:11:49,240 --> 00:11:51,440
MOST OF THEM BELIEVING THAT I

324
00:11:51,440 --> 00:11:54,200
HAD CONVERSION DISORDER.

325
00:11:54,200 --> 00:11:55,480
THROUGHOUT MY FIRST SEMESTER OF

326
00:11:55,480 --> 00:11:58,200
MY SENIOR YEAR, RATHER THAN

327
00:11:58,200 --> 00:12:00,640
EFFECTIVELY TREAT MY PAIN, I WAS

328
00:12:00,640 --> 00:12:03,080
REQUIRED TO UNDERGO A SERIES OF

329
00:12:03,080 --> 00:12:06,000
PSYCHOLOGICAL TESTING.

330
00:12:06,000 --> 00:12:07,560
ALL BECAUSE THOSE TREATING ME

331
00:12:07,560 --> 00:12:09,440
COULD NOT BELIEVE THAT I WAS IN

332
00:12:09,440 --> 00:12:12,680
THAT MUCH PAIN AND YET LOOKED SO

333
00:12:12,680 --> 00:12:14,760
NORMAL.

334
00:12:14,760 --> 00:12:16,480
IT WAS FROM THIS DIAGNOSTIC

335
00:12:16,480 --> 00:12:17,840
NIGHTMARE THAT I LEARNED THE

336
00:12:17,840 --> 00:12:18,840
HARSH REALITY OF LIVING WITH

337
00:12:18,840 --> 00:12:21,560
PAIN.

338
00:12:21,560 --> 00:12:22,760
OFTENTIMES, THOSE THAT ARE

339
00:12:22,760 --> 00:12:24,840
SUFFERING ARE THE ONES THAT ARE

340
00:12:24,840 --> 00:12:27,520
JUDGED AND HELD SUSPECT.

341
00:12:27,520 --> 00:12:29,440
PAIN IS SUBJECTIVE.

342
00:12:29,440 --> 00:12:30,960
WITH DIFFERENT LEVELS OF

343
00:12:30,960 --> 00:12:33,160
TOLERANCE AND PERSONAL WAYS OF

344
00:12:33,160 --> 00:12:34,960
DEFINING THE INTENSITY IN THE

345
00:12:34,960 --> 00:12:37,440
SYMPTOMS AND THE ANGUISH THAT

346
00:12:37,440 --> 00:12:39,080
WE'RE GOING THROUGH, PAIN IS THE

347
00:12:39,080 --> 00:12:41,840
INVISIBLE DISEASE THAT GOES

348
00:12:41,840 --> 00:12:43,280
UNDIAGNOSED AND INADEQUATELY

349
00:12:43,280 --> 00:12:44,160
TREATED.

350
00:12:44,160 --> 00:12:46,560
IT IS THE INVISIBLE DISEASE THAT

351
00:12:46,560 --> 00:12:50,400
MAKES THOSE LIVING WITH PAIN

352
00:12:50,400 --> 00:12:52,480
FEEL ALONE, ABANDONED AND

353
00:12:52,480 --> 00:12:56,200
MISUNDERSTOOD.

354
00:12:56,200 --> 00:12:58,080
FOR ME, THE FEELINGS OF BEING

355
00:12:58,080 --> 00:12:59,480
DISMISSED AND MARGINALIZED BY

356
00:12:59,480 --> 00:13:00,320
HEALTHCARE PROVIDERS

357
00:13:00,320 --> 00:13:01,760
SIGNIFICANTLY IMPEDED MY ABILITY

358
00:13:01,760 --> 00:13:04,760
TO MOVE FORWARD.

359
00:13:04,760 --> 00:13:06,040
I COULD NOT ACKNOWLEDGE THAT I

360
00:13:06,040 --> 00:13:08,240
WAS LIVING WITH A CHRONIC

361
00:13:08,240 --> 00:13:10,560
DISEASE, BECAUSE INSTEAD, I WAS

362
00:13:10,560 --> 00:13:13,400
HAVING TO PROVE OVER AND OVER

363
00:13:13,400 --> 00:13:17,320
THAT MY PAIN WAS REAL.

364
00:13:17,320 --> 00:13:19,520
EVEN AFTER FINALLY RECEIVING MY

365
00:13:19,520 --> 00:13:21,920
SECOND CRPS DIAGNOSIS HALFWAY

366
00:13:21,920 --> 00:13:24,000
THROUGH MY SENIOR YEAR OF HIGH

367
00:13:24,000 --> 00:13:27,080
SCHOOL, I STILL HAD SUCH ANXIETY

368
00:13:27,080 --> 00:13:29,560
ANY TIME I VISITED A SPECIALIST

369
00:13:29,560 --> 00:13:30,600
BECAUSE I ALWAYS THOUGHT THAT

370
00:13:30,600 --> 00:13:32,480
THEY WERE NOT GOING TO BELIEVE

371
00:13:32,480 --> 00:13:38,440
ME OR HEAR WHAT I WAS SAYING.

372
00:13:38,440 --> 00:13:40,600
WHILE I SPENT THE LAST FIVE

373
00:13:40,600 --> 00:13:43,800
WEEKS OF MY HIGH SCHOOL

374
00:13:43,800 --> 00:13:45,000
INPATIENT AT A CHILDREN'S

375
00:13:45,000 --> 00:13:47,520
HOSPITAL, I WAS LUCKY ENOUGH TO

376
00:13:47,520 --> 00:13:49,160
ATTEND COLLEGE THAT FALL OUT OF

377
00:13:49,160 --> 00:13:51,920
STATE.

378
00:13:51,920 --> 00:13:53,320
UNFORTUNATELY, MY HEALTH

379
00:13:53,320 --> 00:13:54,880
REGRESSED, FORCING ME TO TAKE A

380
00:13:54,880 --> 00:13:56,080
MEDICAL LEAVE FOLLOWING MY

381
00:13:56,080 --> 00:13:57,280
FRESHMAN YEAR.

382
00:13:57,280 --> 00:13:58,600
SO WHEN I SHOULD HAVE BEEN

383
00:13:58,600 --> 00:14:00,560
ASSERTING MY INDEPENDENCE,

384
00:14:00,560 --> 00:14:02,440
INSTEAD I HAD TO RELY ON MY

385
00:14:02,440 --> 00:14:05,240
PARENTS TO ASSIST ME IN MY MOST

386
00:14:05,240 --> 00:14:06,920
BASIC NEEDS, SUCH AS GETTING

387
00:14:06,920 --> 00:14:08,560
DRESSED, FEEDING MYSELF, AND

388
00:14:08,560 --> 00:14:11,160
EVEN WASHING MY HAIR.

389
00:14:11,160 --> 00:14:12,920
I THEN SPENT THE MAJORITY OF THE

390
00:14:12,920 --> 00:14:14,760
NEXT FIVE YEARS IN HOSPITALS,

391
00:14:14,760 --> 00:14:16,000
DOCTORS' OFFICES AND MEDICAL

392
00:14:16,000 --> 00:14:17,840
FACILITIES.

393
00:14:17,840 --> 00:14:20,040
EVERY DAY BROUGHT A NEW ROUND OF

394
00:14:20,040 --> 00:14:21,040
APPOINTMENTS, WHICH AFTER A

395
00:14:21,040 --> 00:14:23,320
WHILE BEGAN TO SEEM NORMAL.

396
00:14:23,320 --> 00:14:25,520
I UNDERWENT NUMEROUS PROCEDURES

397
00:14:25,520 --> 00:14:27,200
AND TRIED DIFFERENT

398
00:14:27,200 --> 00:14:28,480
INTERVENTIONS, SUCH AS NERVE

399
00:14:28,480 --> 00:14:30,920
BLOCKS AND IMPLANTED

400
00:14:30,920 --> 00:14:32,080
STIMULATORS, CATHETERS, AND

401
00:14:32,080 --> 00:14:33,840
PUMPS.

402
00:14:33,840 --> 00:14:35,600
I ALSO WAS BEING PRESCRIBED HIGH

403
00:14:35,600 --> 00:14:39,120
DOSES OF MEDICATIONS.

404
00:14:39,120 --> 00:14:40,520
I DEALT WITH CO-MORBID

405
00:14:40,520 --> 00:14:42,000
CONDITIONS AND SIDE EFFECTS FROM

406
00:14:42,000 --> 00:14:43,360
MY MEDICATIONS TOO.

407
00:14:43,360 --> 00:14:47,480
SOME OF THOSE INCLUDED MIGRAINE,

408
00:14:47,480 --> 00:14:49,920
NAUSEA, VISION AND HEARING

409
00:14:49,920 --> 00:14:53,760
IMPAIRMENT, LOW BLOOD PRESSURE,

410
00:14:53,760 --> 00:14:57,160
COGNITIVE PROBLEMS, ACID REFLUX,

411
00:14:57,160 --> 00:15:00,640
INFLAMMATION, IRRITABLE BOWEL

412
00:15:00,640 --> 00:15:02,320
SYNDROME, DISEQUILIBRIUM, NIGHT

413
00:15:02,320 --> 00:15:04,480
SWEATS, AND OPIOID-INDUCED

414
00:15:04,480 --> 00:15:05,480
CONSTIPATION.

415
00:15:05,480 --> 00:15:07,520
WITHIN THE SPAN OF TWO YEARS, I

416
00:15:07,520 --> 00:15:09,920
WAS HOSPITALIZED ON FIVE

417
00:15:09,920 --> 00:15:11,840
DIFFERENT OCCASIONS FOR SLEEP

418
00:15:11,840 --> 00:15:14,440
DEPRIVATION AND PAIN CONTROL.

419
00:15:14,440 --> 00:15:16,640
WHILE I WAS IN THE PULMONARY

420
00:15:16,640 --> 00:15:19,560
CARE UNIT, I WOULD BE HEAVILY

421
00:15:19,560 --> 00:15:21,880
MEDICATED IN A LAST DITCH EFFORT

422
00:15:21,880 --> 00:15:23,960
TO EASE THE EVER-GROWING PAIN.

423
00:15:23,960 --> 00:15:31,720
AND EACH TIME -- A 1-INCH BINDER

424
00:15:31,720 --> 00:15:33,160
CONTAINING GENERAL INFORMATION

425
00:15:33,160 --> 00:15:35,040
ON CRPS FOR THE STAFF TO READ.

426
00:15:35,040 --> 00:15:36,680
THIS WAS A NECESSITY, BECAUSE

427
00:15:36,680 --> 00:15:37,880
THE MAJORITY OF THEM WERE NOT

428
00:15:37,880 --> 00:15:39,640
FAMILIAR WITH THIS DISEASE, OR

429
00:15:39,640 --> 00:15:41,360
EVEN HOW TO WORK WITH A PERSON

430
00:15:41,360 --> 00:15:44,440
THAT'S LIVING WITH EXCRUCIATING,

431
00:15:44,440 --> 00:15:46,920
DEBILITATING, CHRONIC PAIN.

432
00:15:46,920 --> 00:15:49,240
WE DISCOVERED THIS DURING ONE OF

433
00:15:49,240 --> 00:15:51,320
MY EARLIER E.R. VISIT, WHEN A

434
00:15:51,320 --> 00:15:53,280
DOCTOR BROUGHT IN HIS MEDICAL

435
00:15:53,280 --> 00:15:54,480
TECHS AND HALF OF HIS STAFF TO

436
00:15:54,480 --> 00:15:56,440
MY ROOM.

437
00:15:56,440 --> 00:15:58,160
HE OPENED UP HIS BOOK, HE

438
00:15:58,160 --> 00:16:01,960
POINTED TO THE TWO PARAGRAPHS

439
00:16:01,960 --> 00:16:03,720
PERTAINING TO COMPLEX REGIONAL

440
00:16:03,720 --> 00:16:04,920
PAIN SYNDROME, AND THEN HE TOLD

441
00:16:04,920 --> 00:16:06,600
US THAT HE HAD NEVER MET ANYONE

442
00:16:06,600 --> 00:16:08,280
WITH THIS DISEASE, AND HE WAS

443
00:16:08,280 --> 00:16:10,480
INTERESTED IN SEEING HOW CRPS

444
00:16:10,480 --> 00:16:14,240
MANIFESTS IN THE BODY.

445
00:16:14,240 --> 00:16:15,240
BECAUSE OF THE MARGIN UNTIL

446
00:16:15,240 --> 00:16:17,640
NUMBER OF EDUCATIONAL HOURS

447
00:16:17,640 --> 00:16:18,720
FOCUSED ON PAIN MANAGEMENT IN

448
00:16:18,720 --> 00:16:21,640
MEDICAL SCHOOLS, PATIENTS

449
00:16:21,640 --> 00:16:22,880
SOMETIMES TURN INTO TEACHERS FOR

450
00:16:22,880 --> 00:16:24,840
HEALTHCARE PROVIDERS.

451
00:16:24,840 --> 00:16:26,280
AND ADDITIONALLY, BECAUSE OF THE

452
00:16:26,280 --> 00:16:28,360
LACK OF THERAPEUTICS TO TREAT

453
00:16:28,360 --> 00:16:31,240
CHRONIC PAIN, THOSE LIVING WITH

454
00:16:31,240 --> 00:16:32,960
IT ALSO BECOME THE TRIAL AND

455
00:16:32,960 --> 00:16:34,240
ERROR PART OF A SCIENCE

456
00:16:34,240 --> 00:16:36,120
EXPERIMENT.

457
00:16:36,120 --> 00:16:38,600
THIS IS WHY WE NEED MORE

458
00:16:38,600 --> 00:16:40,360
RESEARCH, AND WE NEED MORE

459
00:16:40,360 --> 00:16:42,800
EDUCATION OUT THERE AROUND PAIN

460
00:16:42,800 --> 00:16:46,280
IN TODAY'S SOCIETY.

461
00:16:46,280 --> 00:16:47,920
IN TIME, I ENDED UP LOSING

462
00:16:47,920 --> 00:16:50,200
MOBILITY IN BOTH MY HANDS AND

463
00:16:50,200 --> 00:16:51,520
ARMS, AND NOT KNOWING WHAT TO

464
00:16:51,520 --> 00:16:53,080
DO, MY FAMILY AND I SOUGHT OUT A

465
00:16:53,080 --> 00:16:55,240
SECOND OPINION.

466
00:16:55,240 --> 00:16:56,920
THE SPECIALIST WE SAW ALSO

467
00:16:56,920 --> 00:16:59,920
CONCLUDED THAT I HAD CRPS AND

468
00:16:59,920 --> 00:17:01,080
THAT IT WAS INDEED JUST

469
00:17:01,080 --> 00:17:03,160
SPREADING THROUGHOUT MY BODY.

470
00:17:03,160 --> 00:17:04,520
HE SAID HE WOULD TRY A DIFFERENT

471
00:17:04,520 --> 00:17:06,560
TYPE OF NERVE BLOCK TO SEE IF

472
00:17:06,560 --> 00:17:07,840
THAT WOULD HELP IMPROVE MY

473
00:17:07,840 --> 00:17:09,480
CURRENT STATE, BUT HE WOULDN'T

474
00:17:09,480 --> 00:17:11,440
MAKE ANY PROMISES.

475
00:17:11,440 --> 00:17:13,640
WHEN THE PROCEDURE DID NOT HELP,

476
00:17:13,640 --> 00:17:14,760
HE CALLED A CONFERENCE WITH MY

477
00:17:14,760 --> 00:17:16,480
PARENTS AND ME.

478
00:17:16,480 --> 00:17:18,080
IT WAS THEN THAT HE PROCEEDED TO

479
00:17:18,080 --> 00:17:19,680
TELL US ABOUT HIS BROTHER AND

480
00:17:19,680 --> 00:17:21,320
HIM AND HOW THEY BOTH WERE GOING

481
00:17:21,320 --> 00:17:22,680
BALD.

482
00:17:22,680 --> 00:17:24,920
HIS BROTHER WAS HAVING A VERY

483
00:17:24,920 --> 00:17:26,360
HARD TIME ACCEPTING THE LOSS OF

484
00:17:26,360 --> 00:17:28,480
HIS HAIR.

485
00:17:28,480 --> 00:17:29,960
WHERE MY DOCTOR WAS COPING WITH

486
00:17:29,960 --> 00:17:32,520
THE SAME LOSS, IN A HEALTHY,

487
00:17:32,520 --> 00:17:33,480
PROPER MANNER.

488
00:17:33,480 --> 00:17:36,200
HE THEN LOOKED AT ME AND SAID: 

489
00:17:36,200 --> 00:17:38,520
THIS IS WHAT I NEEDED TO DO TOO.

490
00:17:38,520 --> 00:17:41,800
I NEEDED TO STOP LIVING IN

491
00:17:41,800 --> 00:17:43,840
DENIAL AND ACCEPT REALITY.

492
00:17:43,840 --> 00:17:47,480
THAT I HAD CRPS, THERE WAS NO

493
00:17:47,480 --> 00:17:49,000
WAY IT WAS GOING TO GET BETTER,

494
00:17:49,000 --> 00:17:53,640
AND I HAD TO DEAL WITH IT.

495
00:17:53,640 --> 00:17:57,000
I WAS SHOCKED THAT ANYONE,

496
00:17:57,000 --> 00:17:58,880
ESPECIALLY A HEALTHCARE

497
00:17:58,880 --> 00:18:01,840
PROVIDER, WOULD EVER COMPARE A

498
00:18:01,840 --> 00:18:03,000
LIFE-ALTERING RARE DISEASE TO

499
00:18:03,000 --> 00:18:05,320
THE LOSS OF HAIR.

500
00:18:05,320 --> 00:18:07,320
SO I JUST ASKED HIM, ARE YOU

501
00:18:07,320 --> 00:18:09,480
SAYING THAT IF I WAS YOUR

502
00:18:09,480 --> 00:18:10,800
DAUGHTER, YOU WOULDN'T EVEN LOOK

503
00:18:10,800 --> 00:18:12,400
OR TRY TO FIND SOMETHING TO MAKE

504
00:18:12,400 --> 00:18:14,400
A DIFFERENCE?

505
00:18:14,400 --> 00:18:17,240
I THINK THAT MY RESPONSE

506
00:18:17,240 --> 00:18:19,320
SURPRISED HIM, AS HE QUICKLY

507
00:18:19,320 --> 00:18:21,840
BECAME APOLOGETIC AND STARTED

508
00:18:21,840 --> 00:18:23,280
WORKING TO TRY TO FIND DIFFERENT

509
00:18:23,280 --> 00:18:24,920
AVENUES TO MANAGE MY CHRONIC

510
00:18:24,920 --> 00:18:26,320
PAIN.

511
00:18:26,320 --> 00:18:27,560
LOOKING BACK NOW, I DO BELIEVE

512
00:18:27,560 --> 00:18:30,160
HE THOUGHT HE WAS HELPING BY

513
00:18:30,160 --> 00:18:34,000
TRYING TO SAY THAT I NEEDED TO

514
00:18:34,000 --> 00:18:36,200
ACKNOWLEDGE THAT I HAD A CHRONIC

515
00:18:36,200 --> 00:18:37,160
DISEASE, WHICH MEANT THAT I WAS

516
00:18:37,160 --> 00:18:38,880
GOING TO HAVE IT FOR THE REST OF

517
00:18:38,880 --> 00:18:40,760
MY LIFE, AND THAT I NEEDED TO

518
00:18:40,760 --> 00:18:42,840
START TO LOOK AT FINDING MY NEW

519
00:18:42,840 --> 00:18:44,400
NORMAL.

520
00:18:44,400 --> 00:18:47,360
YET HIS MANNER AND APPROACH WAS

521
00:18:47,360 --> 00:18:49,960
ALL WRONG.

522
00:18:49,960 --> 00:18:50,840
THIS EXPERIENCE TAUGHT ME A

523
00:18:50,840 --> 00:18:53,760
GREAT LESSON -- OR GREAT COUPLE

524
00:18:53,760 --> 00:18:54,960
LESSONS, TO BE HONEST, BUT THE

525
00:18:54,960 --> 00:18:56,080
ONE THAT I REALLY WANTED TO

526
00:18:56,080 --> 00:18:58,480
IMPART ON YOU IS HOW IMPORTANT

527
00:18:58,480 --> 00:19:00,520
IT IS TO REMEMBER THE FEELINGS

528
00:19:00,520 --> 00:19:03,200
OF THE PERSON WITH PAIN.

529
00:19:03,200 --> 00:19:05,280
OVER THE YEARS, I VISITED

530
00:19:05,280 --> 00:19:07,320
NUMEROUS DOCTORS, COUNTLESS

531
00:19:07,320 --> 00:19:08,920
DOCTORS, IN AN ATTEMPT TO HEAL

532
00:19:08,920 --> 00:19:10,760
OR EVEN TO FIND WAYS TO MANAGE

533
00:19:10,760 --> 00:19:12,360
MY PAIN.

534
00:19:12,360 --> 00:19:13,920
THEY ALL TRIED TO HELP ME IN

535
00:19:13,920 --> 00:19:15,880
THEIR OWN WAY, BUT IF I DID NOT

536
00:19:15,880 --> 00:19:18,200
RESPOND TO TREATMENTS, I FELT

537
00:19:18,200 --> 00:19:20,800
THE BLAME WAS PLACED ON ME.

538
00:19:20,800 --> 00:19:22,240
THAT SOMETHING WAS WRONG WITH

539
00:19:22,240 --> 00:19:23,320
ME.

540
00:19:23,320 --> 00:19:27,040
THAT I FAILED, OR THAT I WASN'T

541
00:19:27,040 --> 00:19:28,840
ACCEPTING MY LIFE AS IT IS, OR

542
00:19:28,840 --> 00:19:31,200
THAT I WASN'T TRYING TO MOVE ON

543
00:19:31,200 --> 00:19:33,960
IN THE APPROPRIATE WAY THAT THEY

544
00:19:33,960 --> 00:19:35,720
WANTED.

545
00:19:35,720 --> 00:19:38,320
ESSENTIALLY, I FELT CONSTANTLY

546
00:19:38,320 --> 00:19:40,200
JUDGED AND PUSHED ASIDE AND

547
00:19:40,200 --> 00:19:43,760
IGNORED BY MY OWN PROVIDERS.

548
00:19:43,760 --> 00:19:44,920
MY LATE TEENS AND EARLY 20s

549
00:19:44,920 --> 00:19:47,640
WERE REALLY DIFFICULT FOR ME.

550
00:19:47,640 --> 00:19:50,520
MY FRIENDS WHO ARE ABSOLUTELY

551
00:19:50,520 --> 00:19:51,680
AMAZING, THEY WERE IN COLLEGE

552
00:19:51,680 --> 00:19:53,360
AND THEY WERE EXPERIENCING

553
00:19:53,360 --> 00:19:55,320
THINGS THAT I WOULD NEVER GET

554
00:19:55,320 --> 00:19:55,840
TO.

555
00:19:55,840 --> 00:19:57,520
I COULDN'T RELATE TO THEM, SO I

556
00:19:57,520 --> 00:20:00,120
STARTED TO ISOLATE MYSELF.

557
00:20:00,120 --> 00:20:01,800
AT THAT TIME, SOCIAL MEDIA

558
00:20:01,800 --> 00:20:03,000
DIDN'T EVEN EXIST, SO THERE WAS

559
00:20:03,000 --> 00:20:05,400
NO WAY TO CONNECT TO AN ONLINE

560
00:20:05,400 --> 00:20:08,360
COMMUNITY FOR SUPPORT OR

561
00:20:08,360 --> 00:20:10,000
INFORMATION OR HOPE.

562
00:20:10,000 --> 00:20:12,040
SO THE ONLY PERSON THAT I

563
00:20:12,040 --> 00:20:14,040
ACTUALLY KNEW THE FIRST EIGHT

564
00:20:14,040 --> 00:20:15,800
YEARS THAT I WAS LIVING WITH

565
00:20:15,800 --> 00:20:17,280
CRPS WAS A WOMAN WHO WAS THREE

566
00:20:17,280 --> 00:20:20,400
YEARS OLDER THAN MY PARENTS.

567
00:20:20,400 --> 00:20:22,280
SHE WAS MY LIFELINE.

568
00:20:22,280 --> 00:20:24,040
SHE BECAME ONE OF MY DEAREST

569
00:20:24,040 --> 00:20:25,120
FRIENDS.

570
00:20:25,120 --> 00:20:27,000
BECAUSE SHE UNDERSTOOD WHAT I

571
00:20:27,000 --> 00:20:28,960
WAS GOING THROUGH ON A DAY IN

572
00:20:28,960 --> 00:20:32,240
AND DAY OUT BASIS.

573
00:20:32,240 --> 00:20:33,520
THE OTHER THING THAT WAS REALLY

574
00:20:33,520 --> 00:20:34,760
HARD WAS THERE WAS A GREAT DEAL

575
00:20:34,760 --> 00:20:35,960
OF SHAME THAT COMES WITH LIVING

576
00:20:35,960 --> 00:20:37,600
WITH A CHRONIC DISEASE AND

577
00:20:37,600 --> 00:20:38,680
CHRONIC PAIN.

578
00:20:38,680 --> 00:20:40,680
I SAW MYSELF AS A BURDEN TO MY

579
00:20:40,680 --> 00:20:41,960
FAMILY.

580
00:20:41,960 --> 00:20:46,760
FOR EXAMPLE, MY BROTHER SPENT

581
00:20:46,760 --> 00:20:48,960
BIRTHDAY AFTER BIRTHDAY IN MY

582
00:20:48,960 --> 00:20:50,480
HOSPITAL ROOM.

583
00:20:50,480 --> 00:20:52,040
I ALSO REMEMBER THAT I FELT A

584
00:20:52,040 --> 00:20:55,520
LOT LIKE A FRAUD, BECAUSE

585
00:20:55,520 --> 00:20:57,400
EXTERNALLY,, I WAS ACTING SO

586
00:20:57,400 --> 00:20:59,600
STRONG AND BRAVE, BUT

587
00:20:59,600 --> 00:21:01,880
INTERNALLY, I WAS BREAKING DOWN.

588
00:21:01,880 --> 00:21:04,160
IT JUST FELT LIKE I WAS BEING

589
00:21:04,160 --> 00:21:08,000
SWALLOWED UP BY A BIG ABYSS.

590
00:21:08,000 --> 00:21:09,760
BUT THEN, SOMETHING INCREDIBLE

591
00:21:09,760 --> 00:21:11,480
HAPPENED.

592
00:21:11,480 --> 00:21:13,880
A DEFINING MOMENT ON MY HEALTH

593
00:21:13,880 --> 00:21:17,200
JOURNEY WAS WHEN A HEALTHCARE

594
00:21:17,200 --> 00:21:18,360
PROFESSIONAL FINALLY VALIDATED

595
00:21:18,360 --> 00:21:20,240
MY PAIN.

596
00:21:20,240 --> 00:21:22,000
THIS WAS YEARS AFTER RECEIVING

597
00:21:22,000 --> 00:21:23,080
MY DIAGNOSIS.

598
00:21:23,080 --> 00:21:27,440
WHEN I FINALLY MET SOMEONE WHO,

599
00:21:27,440 --> 00:21:29,080
RIGHT AWAY, LOOKED AT ME AND

600
00:21:29,080 --> 00:21:30,760
TRULY BELIEVED WHAT I WAS GOING

601
00:21:30,760 --> 00:21:33,600
THROUGH.

602
00:21:33,600 --> 00:21:34,920
THAT RECOGNITION CHANGED THE

603
00:21:34,920 --> 00:21:37,480
ENTIRE COURSE OF MY LIFE.

604
00:21:37,480 --> 00:21:38,960
FIRST OF ALL, I FOUND MY VOICE

605
00:21:38,960 --> 00:21:40,720
AGAIN, AND I BEGAN TO RESEARCH

606
00:21:40,720 --> 00:21:42,680
NEW TREATMENT OPTIONS, HAVE

607
00:21:42,680 --> 00:21:45,000
DISCUSSION WITH MY HEALTHCARE

608
00:21:45,000 --> 00:21:46,640
PROVIDERS, AND LOOK OUTSIDE THE

609
00:21:46,640 --> 00:21:47,320
BOX.

610
00:21:47,320 --> 00:21:49,400
THE WAY I LOOKED AT PAIN

611
00:21:49,400 --> 00:21:51,640
MANAGEMENT SHIFTED DRAMATICALLY,

612
00:21:51,640 --> 00:21:54,360
FROM A PRIMARY FOCUS ON

613
00:21:54,360 --> 00:21:56,040
MEDICATIONS AND TRADITIONAL PAIN

614
00:21:56,040 --> 00:21:59,960
MANAGEMENT OPTIONS TO A MORE

615
00:21:59,960 --> 00:22:00,560
MULTIDISCIPLINARY APPROACH TO

616
00:22:00,560 --> 00:22:02,920
CARE.

617
00:22:02,920 --> 00:22:04,400
I REFUSED TO GIVE UP ON MYSELF,

618
00:22:04,400 --> 00:22:06,840
AND I STARTED TO RECOGNIZE THAT

619
00:22:06,840 --> 00:22:09,920
WHILE I MAY LIVE WITH PAIN, I

620
00:22:09,920 --> 00:22:12,560
DID NOT NEED TO LIVE IN PAIN

621
00:22:12,560 --> 00:22:14,720
ANYMORE.

622
00:22:14,720 --> 00:22:17,040
I BECAME INTERESTED IN

623
00:22:17,040 --> 00:22:20,080
NUTRITION, MASSAGE, TAI CHI,

624
00:22:20,080 --> 00:22:23,520
GUIDED IMAGERY, ACUPUNCTURE,

625
00:22:23,520 --> 00:22:25,920
BIOFEEDBACK, OCCUPATIONAL

626
00:22:25,920 --> 00:22:27,440
THERAPY, INFUSION THERAPY, AND

627
00:22:27,440 --> 00:22:29,600
ENERGY WORK, AND I STARTED TO

628
00:22:29,600 --> 00:22:31,160
INCORPORATE MORE OF THESE

629
00:22:31,160 --> 00:22:32,680
THERAPIES INTO MY PAIN PLAN.

630
00:22:32,680 --> 00:22:34,000
AND I NOTICED SOMETHING VERY

631
00:22:34,000 --> 00:22:35,760
INTERESTING.

632
00:22:35,760 --> 00:22:37,800
WHILE NONE OF THESE TECHNIQUES

633
00:22:37,800 --> 00:22:40,880
ALONE MADE A HUGE IMPACT ON MY

634
00:22:40,880 --> 00:22:43,360
PAIN, TOGETHER THEY ADDED UP.

635
00:22:43,360 --> 00:22:48,200
SO FOR EXAMPLE, IF I HAD A 5%

636
00:22:48,200 --> 00:22:50,080
REDUCTION IN MY PAIN FROM

637
00:22:50,080 --> 00:22:53,480
LOOKING AT MY DIET AND A 5%

638
00:22:53,480 --> 00:22:55,000
REDUCTION FROM GOING TO MASSAGE

639
00:22:55,000 --> 00:22:58,720
AND ANOTHER 10% DECREASE FROM

640
00:22:58,720 --> 00:22:59,960
ACUPUNCTURE, WELL, TOGETHER THAT

641
00:22:59,960 --> 00:23:02,240
IS A 20% REDUCTION IN MY PAIN

642
00:23:02,240 --> 00:23:03,640
AND SYMPTOMS.

643
00:23:03,640 --> 00:23:06,040
AND THAT CAN MAKE A HUGE IMPACT

644
00:23:06,040 --> 00:23:07,480
ON QUALITY OF LIFE FOR PEOPLE

645
00:23:07,480 --> 00:23:10,000
WITH PAIN.

646
00:23:10,000 --> 00:23:13,800
I ALSO REALIZED FROM THIS NEW

647
00:23:13,800 --> 00:23:16,800
FOUND FREEDOM AND GROWTH AND

648
00:23:16,800 --> 00:23:19,920
CONFIDENCE IN MYSELF AND FINDING

649
00:23:19,920 --> 00:23:21,160
MY IDENTITY AGAIN THAT I WAS

650
00:23:21,160 --> 00:23:22,880
MANAGING MY EXPECTATIONS AS WELL

651
00:23:22,880 --> 00:23:24,320
AS MY MENTAL AND EMOTIONAL

652
00:23:24,320 --> 00:23:28,680
HEALTH BETTER.

653
00:23:28,680 --> 00:23:30,280
HOWEVER, EVEN WITH THIS NEW

654
00:23:30,280 --> 00:23:31,720
FOUND FREEDOM OF NOT BEING

655
00:23:31,720 --> 00:23:33,520
DEFINED BY MY PAIN, MY HEALTH

656
00:23:33,520 --> 00:23:37,000
WAS CONTINUING TO DECLINE.

657
00:23:37,000 --> 00:23:39,080
BY 2002, I WAS WRITTEN OFF AS

658
00:23:39,080 --> 00:23:41,560
BEING UNTREATABLE AND INCURABLE.

659
00:23:41,560 --> 00:23:44,200
AT THAT TIME, I HAD NO USE OF MY

660
00:23:44,200 --> 00:23:46,000
RIGHT HAND, I HAD VERY MINIMAL

661
00:23:46,000 --> 00:23:50,120
USE OF MY RIGHT ARM, AND I WAS

662
00:23:50,120 --> 00:23:52,440
IN EXCRUCIATING AGONY.

663
00:23:52,440 --> 00:23:55,400
MY CRPS HAD CONTINUED TO SPREAD,

664
00:23:55,400 --> 00:23:57,800
AND WHEN I WAS AT MY WORST, I

665
00:23:57,800 --> 00:24:01,000
WAS ACTUALLY CONFINED TO A BED

666
00:24:01,000 --> 00:24:02,680
OR USED A WHEELCHAIR.

667
00:24:02,680 --> 00:24:05,160
IT WAS THEN THAT MY FAMILY

668
00:24:05,160 --> 00:24:06,920
LEARNED OF THE NONINVASIVE

669
00:24:06,920 --> 00:24:08,240
MEDICAL DEVICE USED TO TREAT MY

670
00:24:08,240 --> 00:24:10,080
CONDITION.

671
00:24:10,080 --> 00:24:12,600
THE DOCTOR, WHO IS A PODIATRIST,

672
00:24:12,600 --> 00:24:13,920
HAD ACTUALLY DEVELOPED THE

673
00:24:13,920 --> 00:24:15,880
THERAPY FOLLOWING HIS OWN CRPS

674
00:24:15,880 --> 00:24:18,120
DIAGNOSIS.

675
00:24:18,120 --> 00:24:19,960
WITH NO OTHER OPTIONS, MY

676
00:24:19,960 --> 00:24:21,520
PARENTS AND I WENT TO HIS CLINIC

677
00:24:21,520 --> 00:24:23,600
IN SOUTH TEXAS.

678
00:24:23,600 --> 00:24:27,000
THE NEXT 10 MONTHS CAN BE SUMMED

679
00:24:27,000 --> 00:24:29,920
UP AS PURE TORTURE AND

680
00:24:29,920 --> 00:24:31,480
UNRELENTING AGONY.

681
00:24:31,480 --> 00:24:33,800
MY WEIGHT INCREASED BY OVER

682
00:24:33,800 --> 00:24:34,760
80 POUNDS DUE TO FLUID

683
00:24:34,760 --> 00:24:36,400
RETENTION.

684
00:24:36,400 --> 00:24:38,600
I WAS HAVING CHRONIC MIGRAINE

685
00:24:38,600 --> 00:24:40,680
THAT FORCED ME TO WEAR

686
00:24:40,680 --> 00:24:43,120
SUNGLASSES AT ALL TIMES.

687
00:24:43,120 --> 00:24:45,360
SMELLS AND SOUNDS BOTHERED ME.

688
00:24:45,360 --> 00:24:47,560
MY STOMACH HURT SO BADLY THAT I

689
00:24:47,560 --> 00:24:49,560
HAD TO KEEP A HOT WATER BOTTLE

690
00:24:49,560 --> 00:24:51,960
ON IT CONSTANTLY AS I LAID

691
00:24:51,960 --> 00:24:54,360
CURLED IN A FETAL POSITION.

692
00:24:54,360 --> 00:24:56,600
BUT DUE TO THE HEAT, I DEVELOPED

693
00:24:56,600 --> 00:24:58,520
SECOND DEGREE BURNS ON MY

694
00:24:58,520 --> 00:24:59,200
ABDOMEN.

695
00:24:59,200 --> 00:25:01,240
I COULDN'T BATHE FOR OVER 10

696
00:25:01,240 --> 00:25:04,320
MONTHS OR HAVE ANY FABRIC TOUCH

697
00:25:04,320 --> 00:25:06,840
MY LIMBS BECAUSE OF THE

698
00:25:06,840 --> 00:25:07,600
HYPERSENSITIVITY I WAS

699
00:25:07,600 --> 00:25:09,680
EXPERIENCING.

700
00:25:09,680 --> 00:25:12,720
I SUFFERED FROM SEVERE

701
00:25:12,720 --> 00:25:16,160
CONSTIPATION, IBS, AND THE

702
00:25:16,160 --> 00:25:17,640
FUNCTIONING IN MY KIDNEYS WERE

703
00:25:17,640 --> 00:25:21,080
ALSO GREATLY IMPACTED.

704
00:25:21,080 --> 00:25:24,880
OFTEN, I FOUND MYSELF JUST

705
00:25:24,880 --> 00:25:26,440
COUNTING SECONDS AND WHEN I

706
00:25:26,440 --> 00:25:28,320
REACHED 60, IT WAS A HUGE

707
00:25:28,320 --> 00:25:29,640
ACCOMPLISHMENT BECAUSE I KNOW

708
00:25:29,640 --> 00:25:31,240
THAT I HAD SURVIVED ANOTHER

709
00:25:31,240 --> 00:25:32,800
MINUTE.

710
00:25:32,800 --> 00:25:34,800
THERE WERE QUITE A FEW TIMES

711
00:25:34,800 --> 00:25:36,080
DURING THIS PERIOD WHERE I

712
00:25:36,080 --> 00:25:37,720
REALLY JUST DIDN'T KNOW IF MY

713
00:25:37,720 --> 00:25:41,280
BODY WAS GOING TO MAKE IT.

714
00:25:41,280 --> 00:25:44,840
FORTUNATELY, THOUGH, WITH TIME,

715
00:25:44,840 --> 00:25:46,360
THE THERAPY BEGAN TO WORK AND I

716
00:25:46,360 --> 00:25:48,000
SAW SIGNIFICANT IMPROVEMENT IN

717
00:25:48,000 --> 00:25:50,960
MY OVERALL HEALTH.

718
00:25:50,960 --> 00:25:52,600
NOW I AM IN MY 40s WITH FULL

719
00:25:52,600 --> 00:25:55,680
MOBILITY OF ALL MY LIMBS, I HAVE

720
00:25:55,680 --> 00:25:58,000
COMPLETED A HALF MARATHON, AND

721
00:25:58,000 --> 00:26:00,480
I'VE EVEN WROTE A MEMOIR

722
00:26:00,480 --> 00:26:03,360
DETAILING MY STRUGGLES AND

723
00:26:03,360 --> 00:26:04,640
TRIUMPHS, NAVIGATING THE MEDICAL

724
00:26:04,640 --> 00:26:06,400
SYSTEM WITH CRPS.

725
00:26:06,400 --> 00:26:08,360
I AM A FIRM BELIEVER THAT EACH

726
00:26:08,360 --> 00:26:10,560
AND EVERY ONE OF US HAS A STORY

727
00:26:10,560 --> 00:26:12,880
TO TELL, AND A UNIQUE

728
00:26:12,880 --> 00:26:14,640
PERSPECTIVE THAT CAN MAKE A

729
00:26:14,640 --> 00:26:16,800
DIFFERENCE IN INFLUENCING THE

730
00:26:16,800 --> 00:26:18,680
WORLD AND IN CHANGING THE WAY WE

731
00:26:18,680 --> 00:26:19,760
SEE PEOPLE THAT LIVE WITH

732
00:26:19,760 --> 00:26:22,120
CHRONIC PAIN.

733
00:26:22,120 --> 00:26:24,680
I ALSO GOT MARRIED AND I NOW

734
00:26:24,680 --> 00:26:26,880
HAVE THREE BOYS WHO KEEP ME ON

735
00:26:26,880 --> 00:26:30,000
MY TOES AND VERY ACTIVE.

736
00:26:30,000 --> 00:26:32,120
BARBECUES WITH FRIENDS, PULLING

737
00:26:32,120 --> 00:26:33,840
WEEDS, SPENDING TIME IN AN

738
00:26:33,840 --> 00:26:37,360
INFRARED SAUNA, WATCHING MY BOYS

739
00:26:37,360 --> 00:26:39,360
PLAY BASEBALL, FAMILY WORKOUTS,

740
00:26:39,360 --> 00:26:42,200
ALL THESE ACTIVITIES, I CAN DO

741
00:26:42,200 --> 00:26:43,840
AND PARTICIPATE IN, AND THEY

742
00:26:43,840 --> 00:26:46,480
BRING ME SO MUCH PEACE.

743
00:26:46,480 --> 00:26:49,000
WHILE I STILL DO LIVE WITH PAIN,

744
00:26:49,000 --> 00:26:50,880
I HAVE FOUND TREATMENTS AND

745
00:26:50,880 --> 00:26:51,920
SELF-MANAGEMENT TECHNIQUES THAT

746
00:26:51,920 --> 00:26:54,920
REALLY FIT MY LIFESTYLE AND

747
00:26:54,920 --> 00:26:56,960
BODY'S NEEDS, AND IT HAS GIVEN

748
00:26:56,960 --> 00:27:00,920
ME BACK A GREAT QUALITY OF LIFE.

749
00:27:00,920 --> 00:27:02,800
SO THAT WITH ALL OF THAT, IT IS

750
00:27:02,800 --> 00:27:04,640
NOW MY CONTINUED MISSION THROUGH

751
00:27:04,640 --> 00:27:06,800
MY WORK WITH U.S. PAIN

752
00:27:06,800 --> 00:27:09,000
FOUNDATION TO HELP OTHERS FIND

753
00:27:09,000 --> 00:27:11,640
INFORMATION AND SUPPORT WHILE

754
00:27:11,640 --> 00:27:14,000
ALSO ADVOCATING FOR EQUITABLE

755
00:27:14,000 --> 00:27:18,000
ACCESS TO PROPER PAIN CARE AND

756
00:27:18,000 --> 00:27:20,600
TREATMENTS.

757
00:27:20,600 --> 00:27:23,320
AS YOU PROBABLY KNOW, RECENT

758
00:27:23,320 --> 00:27:24,920
POPULATION HEALTH DATA REPORTED

759
00:27:24,920 --> 00:27:30,360
BY THE CDC SHOWED THAT DURING

760
00:27:30,360 --> 00:27:32,320
2021, 51.6 MILLION ADULT

761
00:27:32,320 --> 00:27:34,520
AMERICANS EXPERIENCED CHRONIC

762
00:27:34,520 --> 00:27:34,960
PAIN.

763
00:27:34,960 --> 00:27:39,560
OF THAT NUMBER, 17.1 MILLION

764
00:27:39,560 --> 00:27:41,520
EXPERIENCED HIGH IMPACT CHRONIC

765
00:27:41,520 --> 00:27:43,240
PAIN, WHICH MEANS PAIN THAT

766
00:27:43,240 --> 00:27:45,240
LIMITS THEIR DAILY LIFE OR

767
00:27:45,240 --> 00:27:48,040
ABILITY TO WORK MOST DAYS OR

768
00:27:48,040 --> 00:27:48,720
EVERY DAY IN THE PAST THREE

769
00:27:48,720 --> 00:27:52,280
MONTHS.

770
00:27:52,280 --> 00:27:53,800
THOSE NUMBERS ARE STAGGERING,

771
00:27:53,800 --> 00:27:55,440
AND IT SHOWS THE REAL-LIFE

772
00:27:55,440 --> 00:28:00,080
BURDEN ON OUR NATION DUE TO

773
00:28:00,080 --> 00:28:00,920
CHRONIC PAIN.

774
00:28:00,920 --> 00:28:04,280
SO THE U.S. PAIN FOUNDATION IS A

775
00:28:04,280 --> 00:28:05,280
NATIONAL NON-PROFIT WITH A

776
00:28:05,280 --> 00:28:07,760
MISSION TO EMPOWER, CONNECT,

777
00:28:07,760 --> 00:28:11,480
EDUCATE AND ADVOCATE FOR ALL

778
00:28:11,480 --> 00:28:12,920
INDIVIDUALS, KIDS AND ADULTS,

779
00:28:12,920 --> 00:28:15,000
WHO LIVE WITH A CHRONIC ILLNESS

780
00:28:15,000 --> 00:28:18,200
OR SERIOUS INJURY THAT CAUSES

781
00:28:18,200 --> 00:28:19,920
PAIN, AS WELL AS FURTHER CARE

782
00:28:19,920 --> 00:28:23,040
PARTNERS AND CLINICIANS.

783
00:28:23,040 --> 00:28:24,880
AS WE WORK TO HELP PEOPLE WITH

784
00:28:24,880 --> 00:28:28,560
PAIN, WE KEEP IN MIND FOUR

785
00:28:28,560 --> 00:28:29,720
VALUES THAT GUIDE OUR OVERALL

786
00:28:29,720 --> 00:28:30,600
EFFORTS.

787
00:28:30,600 --> 00:28:32,480
WE BELIEVE THAT PEOPLE WITH

788
00:28:32,480 --> 00:28:34,880
CHRONIC PAIN ARE UNDERSERVED,

789
00:28:34,880 --> 00:28:38,280
OVERLOOKED, AND MISUNDERSTOOD.

790
00:28:38,280 --> 00:28:40,560
THAT CHRONIC PAIN HAS ENORMOUS

791
00:28:40,560 --> 00:28:43,760
EMOTIONAL, SOCIAL AND FINANCIAL

792
00:28:43,760 --> 00:28:45,200
CONSEQUENCES, NOT ONLY FOR

793
00:28:45,200 --> 00:28:47,440
INDIVIDUALS AND THEIR FAMILIES,

794
00:28:47,440 --> 00:28:50,080
BUT ALSO SOCIETY AT LARGE.

795
00:28:50,080 --> 00:28:51,400
THAT EACH PERSON WITH PAIN IS

796
00:28:51,400 --> 00:28:53,240
UNIQUE AND DESERVES AN

797
00:28:53,240 --> 00:28:54,880
INDIVIDUALIZED TREATMENT PLAN,

798
00:28:54,880 --> 00:28:57,280
AND THAT PATIENTS SHOULD HAVE

799
00:28:57,280 --> 00:28:58,480
AFFORDABLE ACCESS TO ALL TYPES

800
00:28:58,480 --> 00:29:03,320
OF TREATMENT.

801
00:29:03,320 --> 00:29:05,720
IN 2022, U.S. PAIN CONDUCTED A

802
00:29:05,720 --> 00:29:07,520
SURVEY TO BETTER UNDERSTAND THE

803
00:29:07,520 --> 00:29:09,760
PUBLIC HEALTH CRISIS OF CHRONIC

804
00:29:09,760 --> 00:29:12,520
PAIN.

805
00:29:12,520 --> 00:29:15,040
RESPONDENTS INCLUDED 2,275

806
00:29:15,040 --> 00:29:16,680
PEOPLE WITH PAIN, WHICH WE

807
00:29:16,680 --> 00:29:18,320
DEFINED AS PAIN LASTING THREE

808
00:29:18,320 --> 00:29:21,280
MONTHS OR LONGER.

809
00:29:21,280 --> 00:29:22,720
WHEN LOOKING AT PAIN AND

810
00:29:22,720 --> 00:29:24,560
DISABILITY OVERALL, AN

811
00:29:24,560 --> 00:29:25,640
OVERWHELMING NUMBER OF

812
00:29:25,640 --> 00:29:27,400
RESPONDENTS SAID THEY CONSIDERED

813
00:29:27,400 --> 00:29:31,040
THEMSELVES DISABLED.

814
00:29:31,040 --> 00:29:33,000
OVER TWO THIRDS FELT STIGMATIZED

815
00:29:33,000 --> 00:29:34,320
BY THEIR PAIN.

816
00:29:34,320 --> 00:29:36,920
NEARLY ALL REPORTED THAT PAIN

817
00:29:36,920 --> 00:29:39,000
HAS RESTRICTED THEIR ABILITY TO

818
00:29:39,000 --> 00:29:42,960
ENGAGE IN ROUTINE ACTIVITIES.

819
00:29:42,960 --> 00:29:44,160
AND WHILE SPECIFIC CONDITIONS

820
00:29:44,160 --> 00:29:45,960
VARIED WIDELY, A COMMON THEME

821
00:29:45,960 --> 00:29:48,680
WAS THE PREVALENCE OF

822
00:29:48,680 --> 00:29:50,640
COMORBIDITIES.

823
00:29:50,640 --> 00:29:53,320
NEARLY ALL REPORTED LIVING WITH

824
00:29:53,320 --> 00:29:55,080
MULTIPLE CONDITIONS OR DISEASES.

825
00:29:55,080 --> 00:29:57,400
SO AS YOU CAN SEE FROM SOME OF

826
00:29:57,400 --> 00:30:00,680
OUR FINDINGS FROM OUR SURVEY,

827
00:30:00,680 --> 00:30:03,520
THE INDIVIDUALS THAT COME TO

828
00:30:03,520 --> 00:30:06,160
U.S. PAIN ARE SIGNIFICANTLY

829
00:30:06,160 --> 00:30:09,440
IMPACTED BY THEIR PAIN.

830
00:30:09,440 --> 00:30:12,920
SO THEN WHAT DO WE DO TO HELP?

831
00:30:12,920 --> 00:30:15,480
WELL, WE ARE DEEPLY INVESTED IN

832
00:30:15,480 --> 00:30:16,720
HELPING OUR INDIVIDUALS THROUGH

833
00:30:16,720 --> 00:30:20,280
OUR PROGRAMS AND SERVICES SHOWN

834
00:30:20,280 --> 00:30:21,960
HERE THAT ARE ALL FREE TO

835
00:30:21,960 --> 00:30:22,720
PATIENT, THEIR FAMILIES AND

836
00:30:22,720 --> 00:30:23,600
THEIR PROVIDERS.

837
00:30:23,600 --> 00:30:26,200
A HUGE FACTOR IN IMPROVING

838
00:30:26,200 --> 00:30:27,400
OVERALL HEALTH OUTCOMES IS

839
00:30:27,400 --> 00:30:28,200
EDUCATION.

840
00:30:28,200 --> 00:30:31,040
AND SO FROM OUR PERSPECTIVE, WE

841
00:30:31,040 --> 00:30:32,800
BELIEVE THAT ONCE AN INDIVIDUAL

842
00:30:32,800 --> 00:30:34,640
IS EQUIPPED WITH KNOWLEDGE, THEY

843
00:30:34,640 --> 00:30:38,480
START TO FEEL EMPOWERED AGAIN.

844
00:30:38,480 --> 00:30:40,000
WHICH GIVES THEM CONFIDENCE.

845
00:30:40,000 --> 00:30:42,080
THEY START TO CONNECT WITH A

846
00:30:42,080 --> 00:30:43,120
COMMUNITY AND THEY FIND THEIR

847
00:30:43,120 --> 00:30:44,720
VOICE WHICH ALLOWS THEM TO

848
00:30:44,720 --> 00:30:46,440
ADVOCATE FOR BETTER HEALTH

849
00:30:46,440 --> 00:30:50,160
OUTCOMES GOING FORWARD.

850
00:30:50,160 --> 00:30:51,600
WE PROVIDE DIFFERENT EDUCATIONAL

851
00:30:51,600 --> 00:30:53,120
RESOURCES AND MONTH-LONG

852
00:30:53,120 --> 00:30:54,960
INFORMATIONAL INITIATIVES.

853
00:30:54,960 --> 00:30:57,400
ANOTHER THING THAT WE HAVE IS A

854
00:30:57,400 --> 00:30:59,000
PEDIATRIC PROGRAM TO REALLY

855
00:30:59,000 --> 00:31:00,880
VALIDATE THE EXPERIENCES OF KIDS

856
00:31:00,880 --> 00:31:03,720
LIVING WITH PAIN, AND HELP THEM

857
00:31:03,720 --> 00:31:04,840
ALONG THEIR JOURNEYS TO MAKE

858
00:31:04,840 --> 00:31:07,880
SURE THAT THEY NOT ONLY HAVE AN

859
00:31:07,880 --> 00:31:10,000
OPPORTUNITY TO JUST BE A KID,

860
00:31:10,000 --> 00:31:14,000
BUT THAT THEY ALSO UNDERSTAND

861
00:31:14,000 --> 00:31:15,880
THAT THEY MATTER, THAT THEY ARE

862
00:31:15,880 --> 00:31:17,120
RECOGNIZED AND HEARD, AND THAT

863
00:31:17,120 --> 00:31:19,600
WE CAN HELP THEM FIND THE TOOLS

864
00:31:19,600 --> 00:31:21,440
AND RESOURCES AND SUPPORT SO

865
00:31:21,440 --> 00:31:23,360
THAT THEY CAN MANAGE THEIR

866
00:31:23,360 --> 00:31:24,680
CONDITIONS BETTER AND HAVE A

867
00:31:24,680 --> 00:31:26,040
BETTER QUALITY OF LIFE GOING

868
00:31:26,040 --> 00:31:30,000
FORWARD.

869
00:31:30,000 --> 00:31:32,200
OUR FLAGSHIP PROGRAM, WHICH IS

870
00:31:32,200 --> 00:31:33,720
ACTUALLY HOW I GOT INVOLVED

871
00:31:33,720 --> 00:31:35,600
ORIGINALLY WITH U.S. PAIN, IS

872
00:31:35,600 --> 00:31:37,000
THE INVISIBLE PROJECT.

873
00:31:37,000 --> 00:31:39,200
AND IT IS A PRINT AND ONLINE

874
00:31:39,200 --> 00:31:40,840
MAGAZINE THAT SHARES THE

875
00:31:40,840 --> 00:31:42,680
PERSONAL STORIES AND PHOTOGRAPHS

876
00:31:42,680 --> 00:31:43,680
OF PEOPLE LIVING WITH CHRONIC

877
00:31:43,680 --> 00:31:45,520
PAIN.

878
00:31:45,520 --> 00:31:47,160
AND THE GOAL IS REALLY TO

879
00:31:47,160 --> 00:31:50,120
HIGHLIGHT THE UNIQUE JOURNEY OF

880
00:31:50,120 --> 00:31:52,440
EACH PERSON AND THE NECESSITY OF

881
00:31:52,440 --> 00:31:53,840
FINDING AN INDIVIDUALIZED

882
00:31:53,840 --> 00:31:57,240
TREATMENT PLAN.

883
00:31:57,240 --> 00:31:58,440
BEYOND THE COMPELLING PATIENT

884
00:31:58,440 --> 00:32:00,200
STORIES IN EACH MAGAZINE, WE

885
00:32:00,200 --> 00:32:01,960
ALSO INCLUDE ARTICLES FROM

886
00:32:01,960 --> 00:32:03,400
LEADING EXPERTS ON DIFFERENT

887
00:32:03,400 --> 00:32:06,640
TOPICS THAT RANGE FROM THE VALUE

888
00:32:06,640 --> 00:32:08,200
OF CLINICAL TRIALS TO

889
00:32:08,200 --> 00:32:09,160
SELF-MANAGEMENT STRATEGIES FOR

890
00:32:09,160 --> 00:32:10,240
PAIN.

891
00:32:10,240 --> 00:32:12,120
THESE MAGAZINES ARE FREE FOR

892
00:32:12,120 --> 00:32:14,640
ANYONE AND WE DISTRIBUTE THEM

893
00:32:14,640 --> 00:32:16,400
BROADLY TO PATIENTS AND

894
00:32:16,400 --> 00:32:18,600
CAREGIVERS, TO HEALTHCARE

895
00:32:18,600 --> 00:32:20,560
PROFESSIONALS, TO HOSPITALS, TO

896
00:32:20,560 --> 00:32:22,920
SCHOOLS, TO RESEARCHERS, AND

897
00:32:22,920 --> 00:32:29,520
EVEN TO POLICY MAKERS.

898
00:32:29,520 --> 00:32:32,360
SUPPORT IS SO IMPORTANT.

899
00:32:32,360 --> 00:32:36,200
WE KNOW THAT CHRONIC PAIN DEEPLY

900
00:32:36,200 --> 00:32:37,600
IMPACTS MENTAL HEALTH, AND SO

901
00:32:37,600 --> 00:32:39,240
U.S. PAIN OFFERS A NATIONAL

902
00:32:39,240 --> 00:32:44,480
NETWORK OF SUPPORT GROUPS.

903
00:32:44,480 --> 00:32:44,680
 THAT

904
00:32:44,680 --> 00:32:46,040
WAS ACTUALLY DEVELOPED BY A

905
00:32:46,040 --> 00:32:47,040
CLINICAL SOCIAL WORKER WHO LIVES

906
00:32:47,040 --> 00:32:47,800
WITH PAIN.

907
00:32:47,800 --> 00:32:50,440
ALL OF OUR VOLUNTEER LEADERS GO

908
00:32:50,440 --> 00:32:52,600
THROUGH A COMPREHENSIVE TRAINING

909
00:32:52,600 --> 00:32:54,480
PROGRAM AND CONTINUALLY RECEIVE

910
00:32:54,480 --> 00:32:56,320
ONGOING GUIDANCE.

911
00:32:56,320 --> 00:32:58,720
OUR MONTHLY GROUPS ARE OFFERED

912
00:32:58,720 --> 00:33:00,680
ONLINE FOR FREE, AND THEY

913
00:33:00,680 --> 00:33:02,120
PROVIDE COMPASSIONATE SUPPORT

914
00:33:02,120 --> 00:33:04,600
AND EVIDENCE-BASED EDUCATION TO

915
00:33:04,600 --> 00:33:06,840
HELP PEOPLE WITH PAIN RECLAIM

916
00:33:06,840 --> 00:33:10,600
THEIR QUALITY OF LIFE WHILE ALSO

917
00:33:10,600 --> 00:33:12,720
LEARNING MORE ABOUT ACCEPTANCE

918
00:33:12,720 --> 00:33:15,560
AND PACING AND

919
00:33:15,560 --> 00:33:16,640
BOUNDARY-SETTINGS, RESILIENCE

920
00:33:16,640 --> 00:33:17,440
AND COPING.

921
00:33:17,440 --> 00:33:19,200
WE PROVIDE THREE DIFFERENT TYPES

922
00:33:19,200 --> 00:33:20,920
OF GROUPS.

923
00:33:20,920 --> 00:33:22,120
WE HAVE NATIONAL GROUPS THAT ARE

924
00:33:22,120 --> 00:33:23,800
AVAILABLE TO ANYONE WITH CHRONIC

925
00:33:23,800 --> 00:33:25,360
PAIN, AND TYPICALLY FOCUS ON A

926
00:33:25,360 --> 00:33:27,000
MONTHLY THEME OR TOPIC.

927
00:33:27,000 --> 00:33:29,520
WE HAVE STATE-BASED GROUPS WHICH

928
00:33:29,520 --> 00:33:32,280
GIVE INDIVIDUALS THE OPPORTUNITY

929
00:33:32,280 --> 00:33:33,920
TO FIND A LOCAL COMMUNITY OF

930
00:33:33,920 --> 00:33:35,000
SUPPORT.

931
00:33:35,000 --> 00:33:37,200
AND THEN WE HAVE SPECIALIZED

932
00:33:37,200 --> 00:33:37,560
GROUPS.

933
00:33:37,560 --> 00:33:39,280
SOME OF THOSE INCLUDE OUR

934
00:33:39,280 --> 00:33:41,360
CAREGIVERS AND CARE PARTNER

935
00:33:41,360 --> 00:33:45,000
GROUP, A VETERAN GROUP, A BIPOC

936
00:33:45,000 --> 00:33:46,960
AND LGBTQ+ COMMUNITIES GROUP,

937
00:33:46,960 --> 00:33:49,640
AND OTHERS.

938
00:33:49,640 --> 00:33:51,240
ADDITIONALLY, WE HAVE SPECIAL

939
00:33:51,240 --> 00:33:52,840
INTEREST GROUPS, LIKE A READING

940
00:33:52,840 --> 00:33:54,720
ROOM, A MINDFUL MEDITATION

941
00:33:54,720 --> 00:33:56,960
GROUP, A CREATIVE ARTS GROUP, AS

942
00:33:56,960 --> 00:33:59,520
WELL AS A FUNCTIONAL NUTRITION.

943
00:33:59,520 --> 00:34:01,920
WE ARE HERE TO HELP PEOPLE, TO

944
00:34:01,920 --> 00:34:03,720
HELP THEM FIND THEIR WAY TO

945
00:34:03,720 --> 00:34:06,120
CONNECT THEM TO PEER-TO-PEER

946
00:34:06,120 --> 00:34:08,160
SUPPORT, AND ALSO FIND TOOLS

947
00:34:08,160 --> 00:34:11,000
THAT CAN REALLY EMPOWER THEM

948
00:34:11,000 --> 00:34:14,720
ALONG THEIR JOURNEYS.

949
00:34:14,720 --> 00:34:15,880
SO FINALLY, THE LAST THING I

950
00:34:15,880 --> 00:34:18,880
WANTED TO TALK ABOUT THAT WE

951
00:34:18,880 --> 00:34:22,720
SPEND A GREAT DEAL OF AMOUNT OF

952
00:34:22,720 --> 00:34:24,320
TIME ON AND IS A BIG PRIORITY

953
00:34:24,320 --> 00:34:25,360
FOR US IS ADVOCACY.

954
00:34:25,360 --> 00:34:27,800
WE HAVE A DEDICATED ADVOCACY

955
00:34:27,800 --> 00:34:29,040
PROGRAM THAT WORKS TO ADDRESS

956
00:34:29,040 --> 00:34:31,480
POLICY AND LEGISLATION,

957
00:34:31,480 --> 00:34:33,440
IMPACTING THE HEALTH OF MORE

958
00:34:33,440 --> 00:34:34,560
THAN 21 PERCENT OF THE U.S.

959
00:34:34,560 --> 00:34:36,920
POPULATION.

960
00:34:36,920 --> 00:34:38,920
IN ESSENCE, WE ARE AIMING TO

961
00:34:38,920 --> 00:34:42,000
MAKE BEST PRACTICES AND PAIN

962
00:34:42,000 --> 00:34:43,960
CARE AVAILABLE AND ACCESSIBLE.

963
00:34:43,960 --> 00:34:46,280
SO THAT WE ALL HAVE THE

964
00:34:46,280 --> 00:34:49,120
OPPORTUNITY TO MANAGE OUR PAIN,

965
00:34:49,120 --> 00:34:51,880
FIND COMMUNITY SUPPORT, AND LIVE

966
00:34:51,880 --> 00:34:53,720
A FULFILLING LIFE DESPITE OUR

967
00:34:53,720 --> 00:34:57,560
CHRONIC CONDITIONS OR INJURIES.

968
00:34:57,560 --> 00:34:59,840
OUR OVERALL OBJECTIVE IS TO

969
00:34:59,840 --> 00:35:02,160
ELEVATE THAT PATIENT VOICE,

970
00:35:02,160 --> 00:35:04,360
INCREASE DISEASE STATE

971
00:35:04,360 --> 00:35:05,880
EDUCATION, IMPROVE PAIN CARE

972
00:35:05,880 --> 00:35:09,360
THROUGH POLICY CHANGE, EXPAND

973
00:35:09,360 --> 00:35:11,360
OUTREACH TO UNDERSERVED AND

974
00:35:11,360 --> 00:35:13,120
MARGINALIZED COMMUNITIES, AND

975
00:35:13,120 --> 00:35:15,720
PROVIDE COMPREHENSIVE RESOURCES

976
00:35:15,720 --> 00:35:17,040
TO ENSURE INDIVIDUALS ARE

977
00:35:17,040 --> 00:35:18,560
SUPPORTED AND EMPOWERED ALONG

978
00:35:18,560 --> 00:35:21,440
THEIR JOURNEYS.

979
00:35:21,440 --> 00:35:24,160
FOR US, IT IS ABOUT HELPING A

980
00:35:24,160 --> 00:35:25,280
PERSON SEE THAT PAIN IS JUST A

981
00:35:25,280 --> 00:35:28,760
PART OF THEM, BUT IT DOES NOT

982
00:35:28,760 --> 00:35:32,720
NEED TO ENCOMPASS ALL OF THEM.

983
00:35:32,720 --> 00:35:36,240
SO AS I WRAP UP TODAY, I WANTED

984
00:35:36,240 --> 00:35:38,720
TO JUST LEAVE YOU WITH A COUPLE

985
00:35:38,720 --> 00:35:40,600
KEY TAKEAWAYS.

986
00:35:40,600 --> 00:35:42,440
FIRST AND FOREMOST IS THAT

987
00:35:42,440 --> 00:35:46,000
CHRONIC PAIN CAN STRIKE ANYONE.

988
00:35:46,000 --> 00:35:48,480
ANY AGE, ANY RACE AND ETHNICITY,

989
00:35:48,480 --> 00:35:50,960
ANY SEX, ANY SOCIOECONOMIC

990
00:35:50,960 --> 00:35:53,160
STATUS.

991
00:35:53,160 --> 00:35:54,160
ANYONE.

992
00:35:54,160 --> 00:35:56,480
CHRONIC PAIN DOES NOT

993
00:35:56,480 --> 00:35:58,120
DISCRIMINATE, AND THE

994
00:35:58,120 --> 00:35:59,400
CONSEQUENCES OF LIVING WITH IT

995
00:35:59,400 --> 00:36:02,400
ARE DEVASTATING.

996
00:36:02,400 --> 00:36:04,240
NOT ONLY TO THE PERSON THAT IS

997
00:36:04,240 --> 00:36:06,640
EXPERIENCING IT THEMSELVES, BUT

998
00:36:06,640 --> 00:36:08,440
ALSO TO THEIR LOVED ONES.

999
00:36:08,440 --> 00:36:10,640
IT AFFECTS RELATIONSHIPS, THE

1000
00:36:10,640 --> 00:36:15,320
ABILITY TO WORK, THE SOCIAL

1001
00:36:15,320 --> 00:36:18,640
INTERACTIONS, DAY-TO-DAY LIVING,

1002
00:36:18,640 --> 00:36:20,920
SELF WORTH, FINANCES, EVERYTHING

1003
00:36:20,920 --> 00:36:22,440
ABOUT ONE'S LIFE IS IMPACTED BY

1004
00:36:22,440 --> 00:36:25,080
CHRONIC PAIN.

1005
00:36:25,080 --> 00:36:26,560
AND WHEN I SAY CHRONIC PAIN, I

1006
00:36:26,560 --> 00:36:27,920
SAY THAT BECAUSE IT MEANS IT

1007
00:36:27,920 --> 00:36:28,240
CHRONIC.

1008
00:36:28,240 --> 00:36:31,160
IT MEANS THAT IT IS NOT GOING

1009
00:36:31,160 --> 00:36:33,440
AWAY.

1010
00:36:33,440 --> 00:36:34,880
CHRONIC PAIN MUST BE SEEN AS A

1011
00:36:34,880 --> 00:36:36,080
DISEASE IN AND OF ITSELF.

1012
00:36:36,080 --> 00:36:38,360
WE REALLY NEED TO UNDERSTAND ITS

1013
00:36:38,360 --> 00:36:39,800
MAGNITUDE, AND ITS IMPACT ON

1014
00:36:39,800 --> 00:36:41,240
SOCIETY.

1015
00:36:41,240 --> 00:36:43,880
WE HAVE TO START INVESTING

1016
00:36:43,880 --> 00:36:45,360
SIGNIFICANT DOLLARS INTO

1017
00:36:45,360 --> 00:36:45,920
RESEARCH.

1018
00:36:45,920 --> 00:36:48,440
WE NEED BETTER TREATMENTS OUT

1019
00:36:48,440 --> 00:36:51,840
THERE THAT REALLY INCLUDE AN

1020
00:36:51,840 --> 00:36:52,480
INDIVIDUALIZED MULTIDISCIPLINARY

1021
00:36:52,480 --> 00:36:54,920
APPROACH TO CARE.

1022
00:36:54,920 --> 00:36:56,480
WE NEED PROVIDERS WHO WILL

1023
00:36:56,480 --> 00:36:58,320
LISTEN AND MAKE THAT HUMAN

1024
00:36:58,320 --> 00:37:00,840
CONNECTION WITH THEIR PATIENTS.

1025
00:37:00,840 --> 00:37:03,160
WE NEED TO BETTER ADDRESS THE

1026
00:37:03,160 --> 00:37:04,680
BIOPSYCHOSOCIAL ASPECTS OF PAIN.

1027
00:37:04,680 --> 00:37:07,840
WE NEED POLICY CHANGES.

1028
00:37:07,840 --> 00:37:09,240
WE NEED FURTHER PUBLIC AWARENESS

1029
00:37:09,240 --> 00:37:11,440
AROUND THE PLATE OF CHRONIC PAIN

1030
00:37:11,440 --> 00:37:14,080
IN AMERICA, AND GLOBALLY.

1031
00:37:14,080 --> 00:37:16,680
AND I SAY ALL OF THIS BECAUSE IT

1032
00:37:16,680 --> 00:37:20,120
IS SO IMPORTANT AS I HAVE LIVED

1033
00:37:20,120 --> 00:37:22,680
WITH PAIN ALMOST MY ENTIRE LIFE,

1034
00:37:22,680 --> 00:37:25,200
I HAVE GONE THROUGH SOME VERY

1035
00:37:25,200 --> 00:37:27,720
LOW LOWS AND SOME AMAZING HIGHS,

1036
00:37:27,720 --> 00:37:29,480
AND THE ONE THING THAT I WANT TO

1037
00:37:29,480 --> 00:37:35,800
STRESS IS THAT CHRONIC PAIN

1038
00:37:35,800 --> 00:37:39,360
CHANGES WHO YOU ARE.

1039
00:37:39,360 --> 00:37:41,000
AND WE NEED TO DO MORE TO HELP

1040
00:37:41,000 --> 00:37:43,400
THOSE THAT ARE LIVING WITH IT.

1041
00:37:43,400 --> 00:37:44,920
WITH THAT SAID, I ALSO DO WANT

1042
00:37:44,920 --> 00:37:49,200
TO STRESS, THOUGH, THAT PAIN

1043
00:37:49,200 --> 00:37:50,600
DOESN'T NEED TO DEFINE ONE'S

1044
00:37:50,600 --> 00:37:50,800
LIFE.

1045
00:37:50,800 --> 00:37:52,680
THERE ARE WAYS TO MANAGE IT, AND

1046
00:37:52,680 --> 00:37:54,800
WE NEED TO HELP INDIVIDUALS FIND

1047
00:37:54,800 --> 00:37:56,200
THOSE COPING TECHNIQUES AND MAKE

1048
00:37:56,200 --> 00:37:57,840
SURE THAT THEY HAVE ACCESS TO

1049
00:37:57,840 --> 00:38:04,560
THEM GOING FORWARD.

1050
00:38:04,560 --> 00:38:05,720
SO WITH ALL OF THAT, I AGAIN

1051
00:38:05,720 --> 00:38:06,840
JUST WANT TO SAY THANK YOU SO

1052
00:38:06,840 --> 00:38:08,560
MUCH TO THE NIH PAIN CONSORTIUM

1053
00:38:08,560 --> 00:38:10,800
FOR THIS INCREDIBLE OPPORTUNITY

1054
00:38:10,800 --> 00:38:14,680
TO SHARE MY LIVED EXPERIENCES ON

1055
00:38:14,680 --> 00:38:15,800
SUCH A LARGE PLATFORM.

1056
00:38:15,800 --> 00:38:17,640
I ALSO WANT TO TAKE A MOMENT TO

1057
00:38:17,640 --> 00:38:19,280
THANK THOSE IN ATTENDANCE AND

1058
00:38:19,280 --> 00:38:21,880
THOSE THAT ARE TUNING IN.

1059
00:38:21,880 --> 00:38:25,200
TO ANY OF THE PROVIDERS OUT

1060
00:38:25,200 --> 00:38:26,200
THERE WHO ARE COMMITTED TO

1061
00:38:26,200 --> 00:38:27,400
HELPING PEOPLE LIVING WITH

1062
00:38:27,400 --> 00:38:31,000
CHRONIC PAIN, THANK YOU SO MUCH

1063
00:38:31,000 --> 00:38:32,640
FOR LOOKING MORE AT OUR QUALITY

1064
00:38:32,640 --> 00:38:34,320
OF LIFE RATHER THAN SEEING US AS

1065
00:38:34,320 --> 00:38:36,720
A NUMBER.

1066
00:38:36,720 --> 00:38:38,680
FOR MYSELF, IT IS THOSE SMALL

1067
00:38:38,680 --> 00:38:40,360
THINGS THAT WE WANT BACK.

1068
00:38:40,360 --> 00:38:41,920
TO BE ABLE TO MAKE A MEAL FOR

1069
00:38:41,920 --> 00:38:45,280
OUR FAMILIES, TO GO TO WORK, TO

1070
00:38:45,280 --> 00:38:47,480
ATTEND CHURCH OR TEMPLE, TO GO

1071
00:38:47,480 --> 00:38:50,000
TO OUR KIDS' BASEBALL GAMES, TO

1072
00:38:50,000 --> 00:38:52,520
HAVE COFFEE WITH A FRIEND, OR

1073
00:38:52,520 --> 00:38:54,240
EVEN BE ABLE TO JUST RECEIVE A

1074
00:38:54,240 --> 00:38:58,640
HUG FROM A LOVED ONE.

1075
00:38:58,640 --> 00:39:00,400
SMALL, MUNDANE ACTIVITIES ARE

1076
00:39:00,400 --> 00:39:01,480
BIG MILESTONES AND MEAN THE

1077
00:39:01,480 --> 00:39:02,480
WORLD TO PEOPLE WITH CHRONIC

1078
00:39:02,480 --> 00:39:04,480
PAIN.

1079
00:39:04,480 --> 00:39:06,200
TO THE SCIENTISTS AND

1080
00:39:06,200 --> 00:39:08,880
RESEARCHERS OUT THERE, FIRST AND

1081
00:39:08,880 --> 00:39:10,520
FOREMOST, THANK YOU, AND PLEASE,

1082
00:39:10,520 --> 00:39:12,680
DO NOT STOP RESEARCHING.

1083
00:39:12,680 --> 00:39:14,640
THERE ARE MILLIONS OF PEOPLE

1084
00:39:14,640 --> 00:39:17,120
EACH DAY WHO WAKE UP WONDERING

1085
00:39:17,120 --> 00:39:19,720
IF THIS WILL BE THE DAY THAT A

1086
00:39:19,720 --> 00:39:20,800
NEW MEDICAL ADVANCEMENT WILL

1087
00:39:20,800 --> 00:39:22,000
HAPPEN.

1088
00:39:22,000 --> 00:39:24,120
THE WORK YOU DO IN DRUG

1089
00:39:24,120 --> 00:39:26,720
DEVELOPMENT AND PAIN RESEARCH IS

1090
00:39:26,720 --> 00:39:28,800
PARAMOUNT TO OUR FUTURES.

1091
00:39:28,800 --> 00:39:30,440
WE NEED YOU.

1092
00:39:30,440 --> 00:39:32,480
WE MAY NEVER KNOW YOUR NAMES,

1093
00:39:32,480 --> 00:39:34,640
BUT THE IMPACT FROM YOUR

1094
00:39:34,640 --> 00:39:37,120
RESEARCH IS LIFE-CHANGING AND

1095
00:39:37,120 --> 00:39:38,120
LIFE-ALTERING.

1096
00:39:38,120 --> 00:39:40,320
YOU ARE OUR HIDDEN CHAMPIONS.

1097
00:39:40,320 --> 00:39:43,320
YOU ARE OUR HEROS.

1098
00:39:43,320 --> 00:39:44,960
PLEASE DO NOT GIVE UP ON US.

1099
00:39:44,960 --> 00:39:48,440
PLEASE CONTINUE TO RESEARCH.

1100
00:39:48,440 --> 00:39:50,200
WE NEED YOU SO, SO MUCH.

1101
00:39:50,200 --> 00:39:53,240
AND TO ANYONE ELSE WHO IS

1102
00:39:53,240 --> 00:39:54,240
LISTENING THAT IS LIVING WITH

1103
00:39:54,240 --> 00:39:56,560
PAIN, KNOW THAT YOU'RE NOT

1104
00:39:56,560 --> 00:39:58,080
ALONE, YOU ARE SEEN, YOU ARE

1105
00:39:58,080 --> 00:40:00,120
HEARD, YOU ARE UNDERSTOOD, AND

1106
00:40:00,120 --> 00:40:02,080
THERE ARE RESOURCES OUT THERE TO

1107
00:40:02,080 --> 00:40:03,920
PROVIDE YOU MORE SUPPORT AND

1108
00:40:03,920 --> 00:40:05,800
EDUCATION.

1109
00:40:05,800 --> 00:40:07,000
AGAIN, I AM SO SORRY THAT I

1110
00:40:07,000 --> 00:40:09,280
COULD NOT BE THERE IN PERSON

1111
00:40:09,280 --> 00:40:10,720
TODAY, BUT PLEASE, MY CONTACT

1112
00:40:10,720 --> 00:40:12,600
INFORMATION IS ON THE SCREEN IF

1113
00:40:12,600 --> 00:40:13,920
YOU HAVE ANY QUESTIONS OR WOULD

1114
00:40:13,920 --> 00:40:15,240
JUST LIKE TO CONNECT, PLEASE

1115
00:40:15,240 --> 00:40:16,760
REACH OUT TO ME.

1116
00:40:16,760 --> 00:40:18,640
AND AGAIN, THANK YOU SO MUCH TO

1117
00:40:18,640 --> 00:40:20,960
THE NIH PAIN CONSORTIUM FOR

1118
00:40:20,960 --> 00:40:23,800
ALLOWING ME THE OPPORTUNITY TO

1119
00:40:23,800 --> 00:40:24,200
BE HERE TODAY.

1120
00:40:24,200 --> 00:40:26,880
THANK YOU ALL SO MUCH.

1121
00:40:26,880 --> 00:48:09,600
[APPLAUSE]

1122
00:48:09,600 --> 00:48:12,160
IN MANY RESPECTS, THE

1123
00:48:12,160 --> 00:48:14,280
NK1 RECEPTOR IS THE POSTER CHILD

1124
00:48:14,280 --> 00:48:16,120
FOR FAILURE IN DRUG DISCOVERY TO

1125
00:48:16,120 --> 00:48:20,040
TREAT PAIN.

1126
00:48:20,040 --> 00:48:22,080
NOW, THIS IS A PHOTOGRAPH OF THE

1127
00:48:22,080 --> 00:48:22,920
GOLDEN GATE BRIDGE.

1128
00:48:22,920 --> 00:48:25,560
I SPENT MOST OF MY CAREER IN

1129
00:48:25,560 --> 00:48:26,840
SAN FRANCISCO, AND MY WIFE TOOK

1130
00:48:26,840 --> 00:48:29,400
CARE OF AN IRONWORKER ON THE

1131
00:48:29,400 --> 00:48:31,040
GOLDEN GATE BRIDGE WHO HAD

1132
00:48:31,040 --> 00:48:32,600
INJURED HIMSELF, HE WAS IN

1133
00:48:32,600 --> 00:48:34,320
CONSIDERABLE PAIN, BUT AS A

1134
00:48:34,320 --> 00:48:36,000
REWARD FOR HER GOOD CARE, HE

1135
00:48:36,000 --> 00:48:39,160
GAVE HER A PASS TO ASCENT TO THE

1136
00:48:39,160 --> 00:48:41,240
TOP OF ONE OF THESE TOWERS IN A

1137
00:48:41,240 --> 00:48:43,400
VERY CLAUSE TROPHOBIC ELEVATOR

1138
00:48:43,400 --> 00:48:46,840
MANY HUNDREDS OF FEET ABOVE THE

1139
00:48:46,840 --> 00:48:48,280
PACIFIC OCEAN.

1140
00:48:48,280 --> 00:48:50,280
ALAS SHE TOOK A TIP CAP

1141
00:48:50,280 --> 00:48:52,120
SAN FRANCISCO SUMMER DAY WHEN

1142
00:48:52,120 --> 00:48:53,120
THE GOLDEN GATE BRIDGE WAS

1143
00:48:53,120 --> 00:48:53,960
SHROUDED IN FOG.

1144
00:48:53,960 --> 00:48:56,160
I SHOW THIS SLIDE, HOWEVER, TO

1145
00:48:56,160 --> 00:48:57,600
ILLUSTRATE THAT ALTHOUGH WE HAVE

1146
00:48:57,600 --> 00:48:58,680
CONSIDERABLE CLARITY IN OUR

1147
00:48:58,680 --> 00:49:00,440
UNDERSTANDING OF HOW G PROTEIN

1148
00:49:00,440 --> 00:49:01,320
COUPLED RECEPTORS FUNCTION AND

1149
00:49:01,320 --> 00:49:03,720
SIGNAL AT THE PLASMA MEMBRANE,

1150
00:49:03,720 --> 00:49:05,160
AND INDEED RECEPTORS AT THE

1151
00:49:05,160 --> 00:49:06,400
PLASMA MEMBRANE ARE A MAJOR

1152
00:49:06,400 --> 00:49:10,240
TARGET FOR DRUG DISCOVERY.

1153
00:49:10,240 --> 00:49:13,080
SIGNALING IN ENDOSOMES IS

1154
00:49:13,080 --> 00:49:13,840
SHROUDED IN THE FOG OF

1155
00:49:13,840 --> 00:49:14,160
UNCERTAINTY.

1156
00:49:14,160 --> 00:49:15,680
WE DON'T FULLY UNDERSTAND THE

1157
00:49:15,680 --> 00:49:17,440
MECHANISMS, WE DON'T KNOW

1158
00:49:17,440 --> 00:49:21,920
WHETHER GPCR SIGNALING IN

1159
00:49:21,920 --> 00:49:23,160
ENDOSOMES DRIVES SUSTAINED PAIN

1160
00:49:23,160 --> 00:49:24,760
AND IT'S NOT CERTAIN IF THEY'RE

1161
00:49:24,760 --> 00:49:25,760
PERHAPS THE BEST TARGET FOR

1162
00:49:25,760 --> 00:49:26,680
TREATMENT OF SUSTAINED PAIN.

1163
00:49:26,680 --> 00:49:27,720
AND THESE ARE THE QUESTIONS THAT

1164
00:49:27,720 --> 00:49:28,960
I WANT TO ADDRESS IN THE

1165
00:49:28,960 --> 00:49:32,360
REMAINDER OF MY TALK.

1166
00:49:32,360 --> 00:49:35,120
TO UNDERSTAND THE MECHANISM, WE

1167
00:49:35,120 --> 00:49:39,040
DEVELOPED PHYSICAL APPROACHES,

1168
00:49:39,040 --> 00:49:41,840
THE FIRST ONE WAS BRETT.

1169
00:49:41,840 --> 00:49:43,440
BRETT IS AN ASSAY WHICH MEASURES

1170
00:49:43,440 --> 00:49:46,960
THE PROXIMITY BETWEEN PROTEINS.

1171
00:49:46,960 --> 00:49:48,480
AND WE DEVELOPED A FORM OF BRETT

1172
00:49:48,480 --> 00:49:54,960
WHICH WE CALL NANOBIT BRET.

1173
00:49:54,960 --> 00:50:00,240
HERE ONE COMPONENT OF

1174
00:50:00,240 --> 00:50:02,000
LUCIFERASE, A NATURAL PEPTIDE,

1175
00:50:02,000 --> 00:50:07,400
WAS CONJUGATED EXPRESSED IN HEK

1176
00:50:07,400 --> 00:50:07,760
CELLS.

1177
00:50:07,760 --> 00:50:13,040
THE OTHER COMPONENT WAS

1178
00:50:13,040 --> 00:50:17,760
CONJUGATED TO CAAX, SO IF THESE

1179
00:50:17,760 --> 00:50:19,440
TWO PROTEINS ARE IN CLOSE

1180
00:50:19,440 --> 00:50:22,240
PROXIMITY, WE HAVE AN INTACT

1181
00:50:22,240 --> 00:50:25,640
LUCIFERASE ENZYME.

1182
00:50:25,640 --> 00:50:28,920
WE THEN EXPRESSED IN CELLS MANY

1183
00:50:28,920 --> 00:50:30,880
G PROTEINS WHICH ARE KEY

1184
00:50:30,880 --> 00:50:34,760
EFFECTORS OF RECEPTOR SIGNALING

1185
00:50:34,760 --> 00:50:36,000
TAGGED WITH YFP.

1186
00:50:36,000 --> 00:50:37,640
IF THESE THREE PROTEINS ARE IN

1187
00:50:37,640 --> 00:50:40,360
CLOSE PROXIMITY WHEN WE ADD THE

1188
00:50:40,360 --> 00:50:43,720
SUBSTRATE FOR LUCIFERASE, A BRET

1189
00:50:43,720 --> 00:50:45,000
SIGNAL CAN BE MEASURED.

1190
00:50:45,000 --> 00:50:47,080
TO ASSESS SIGNALING, WE

1191
00:50:47,080 --> 00:50:51,080
EXPRESSED GENETICALLY ENCODED

1192
00:50:51,080 --> 00:50:52,720
FOSTER RESIDENCE ENERGY TRANSFER

1193
00:50:52,720 --> 00:50:55,040
OR FRET BIOSENSORS INTO CELLS.

1194
00:50:55,040 --> 00:51:00,360
THESE REVERSIBLY -- OR

1195
00:51:00,360 --> 00:51:02,640
EXTRACELLULAR SIGNAL REGULATED

1196
00:51:02,640 --> 00:51:06,920
KINASES, AND DEPHOSPHORYLATED

1197
00:51:06,920 --> 00:51:07,720
BIPHOSPHATASES AND THEY WERE

1198
00:51:07,720 --> 00:51:12,120
TARGETED TO THE -- THESE TWO

1199
00:51:12,120 --> 00:51:15,400
APPROACHES ALLOWED US TO STUDY

1200
00:51:15,400 --> 00:51:16,400
SIGNALING IN LIVING CELLS WITH

1201
00:51:16,400 --> 00:51:19,680
HIGH SPATIAL AND TEMPORAL

1202
00:51:19,680 --> 00:51:23,160
FIDELITY.

1203
00:51:23,160 --> 00:51:24,560
UPON STIMULATION OF CELLS WITH

1204
00:51:24,560 --> 00:51:29,080
SUBSTANCE P, WE SEE A SIGNALING

1205
00:51:29,080 --> 00:51:31,080
COMPLEX OR SIGNALOSOME SIGNAL AT

1206
00:51:31,080 --> 00:51:33,120
THE PLASMA MEMBRANE, THAT'S THE

1207
00:51:33,120 --> 00:51:38,200
TRIANGLES, COMPRISING THE

1208
00:51:38,200 --> 00:51:41,000
NEUNEURO -- AND SECONDS LATER,

1209
00:51:41,000 --> 00:51:43,320
THAT'S THE CIRCLES, WE SEE THE

1210
00:51:43,320 --> 00:51:45,840
SAME COMPLEX ASSEMBLING IN EARLY

1211
00:51:45,840 --> 00:51:48,400
ENENDOSOMES, SO SIGNALING

1212
00:51:48,400 --> 00:51:50,240
COMPLEXES FORM IN EARLY

1213
00:51:50,240 --> 00:51:51,400
ENDOSOMES, AND IF WE EXPRESSED

1214
00:51:51,400 --> 00:51:56,080
IN CELLS A DOMINANT NEGATIVE

1215
00:51:56,080 --> 00:51:57,320
MUTANT, WE CAN INHIBIT THE

1216
00:51:57,320 --> 00:51:58,880
ASSEMBLY OF THIS SIGNALING

1217
00:51:58,880 --> 00:52:03,480
COMPLEX IN EARLY ENDOSOMES.

1218
00:52:03,480 --> 00:52:06,320
THIS IS A RESULT OF A FRET

1219
00:52:06,320 --> 00:52:07,640
BIOSENSOR EXPERIMENT AND HERE

1220
00:52:07,640 --> 00:52:08,720
THE BIOSENSORS IS TARGETED TO

1221
00:52:08,720 --> 00:52:10,680
THE NUCLEUS.

1222
00:52:10,680 --> 00:52:14,920
WE'RE MEASURING ACTIVITY IN HEK

1223
00:52:14,920 --> 00:52:15,760
CELLS.

1224
00:52:15,760 --> 00:52:17,280
IF WE STIMULATE WITH SUBSTANCE P

1225
00:52:17,280 --> 00:52:19,000
IN RED WE SEE A GRAD RULE AND

1226
00:52:19,000 --> 00:52:21,000
SUSTAINED ACTIVATION OF ERK IN

1227
00:52:21,000 --> 00:52:24,200
THE NUCLEUS, A PSEUDOCOLOR

1228
00:52:24,200 --> 00:52:24,640
IMAGES SHOWN HERE.

1229
00:52:24,640 --> 00:52:29,920
IN BLUE, IF WE TREAT CELLS WITH

1230
00:52:29,920 --> 00:52:38,360
DNGO, DISCOVERED IN ALL STRAIL ,

1231
00:52:38,360 --> 00:52:39,920
IT COMPLETELY INHIBITS THIS

1232
00:52:39,920 --> 00:52:40,160
RESPONSE.

1233
00:52:40,160 --> 00:52:43,960
IF WE LOOK AT THE AREA IN THE

1234
00:52:43,960 --> 00:52:45,160
CURVE DURING THIS EXPERIMENT WE

1235
00:52:45,160 --> 00:52:51,680
CAN SEE BOTH DYNGO AND PITSTOP

1236
00:52:51,680 --> 00:52:53,440
COMPLETELY PREVENT ACTIVATION OF

1237
00:52:53,440 --> 00:52:57,600
NUCLEAR ERK AND EXPRESSION OF S

1238
00:52:57,600 --> 00:53:00,560
RNA TO KNOCK DOWN ALSO ABOLISHES

1239
00:53:00,560 --> 00:53:02,440
ERK ACTIVATION.

1240
00:53:02,440 --> 00:53:04,040
SO FROM THESE AND MANY OTHER

1241
00:53:04,040 --> 00:53:05,000
EXPERIMENTS, WE HAVE A GOOD

1242
00:53:05,000 --> 00:53:07,080
UNDERSTANDING OF HOW THIS

1243
00:53:07,080 --> 00:53:08,200
RECEPTOR SIGNALS IN DIFFERENT

1244
00:53:08,200 --> 00:53:08,960
SUBCELLULAR COMPARTMENTS OF

1245
00:53:08,960 --> 00:53:10,880
CELLS.

1246
00:53:10,880 --> 00:53:14,800
IT DOES SIGNAL TH AT THE PLASMA

1247
00:53:14,800 --> 00:53:16,320
MEMBRANE BUT SIGNALING AT THE

1248
00:53:16,320 --> 00:53:17,600
PLASMA MEMBRANE IS TRANSIENT

1249
00:53:17,600 --> 00:53:18,640
BECAUSE THEY'RE PHOSPHORYLATED

1250
00:53:18,640 --> 00:53:25,160
BY KINASES AND INTERACT WITH B 

1251
00:53:25,160 --> 00:53:26,360
BITRO ARREST TINS.

1252
00:53:26,360 --> 00:53:32,960
 ARREARRESTINS.WITHIN EARLY END,

1253
00:53:32,960 --> 00:53:35,280
SIGNALOSOMES SIGNAL, GIVING RISE

1254
00:53:35,280 --> 00:53:37,120
TO ACTIVATION OF ERK WITH

1255
00:53:37,120 --> 00:53:39,640
TRANSLATES TO THE NUCLEUS, ALSO

1256
00:53:39,640 --> 00:53:43,720
ACTIVATING PROTEIN KINASE C.

1257
00:53:43,720 --> 00:53:46,920
WE CAN BLOCK THESE SIGNALS BY

1258
00:53:46,920 --> 00:53:49,160
VARIOUS GENETICAL

1259
00:53:49,160 --> 00:53:51,320
PHARMACOLOGICAL APPROACHES TO

1260
00:53:51,320 --> 00:53:52,760
INHIBIT ENDO CYTOSIS.

1261
00:53:52,760 --> 00:53:55,080
WHICH RAISED THE QUESTION, DOES

1262
00:53:55,080 --> 00:53:58,000
THIS SIGNALING WITHIN ENDOSOMES

1263
00:53:58,000 --> 00:53:58,960
MEDIATE SUSTAINED PAIN

1264
00:53:58,960 --> 00:54:00,720
TRANSMISSION?

1265
00:54:00,720 --> 00:54:01,800
TO BEGIN TO EXAMINE THIS

1266
00:54:01,800 --> 00:54:02,760
QUESTION, WE WANTED TO KNOW

1267
00:54:02,760 --> 00:54:07,320
WHETHER THE NEUROKINEN1 RECEPTOR

1268
00:54:07,320 --> 00:54:08,920
IS INTERNALIZED IN SPINAL

1269
00:54:08,920 --> 00:54:09,800
NEURONS AFTER A PAINFUL

1270
00:54:09,800 --> 00:54:10,240
STIMULUS.

1271
00:54:10,240 --> 00:54:13,200
AND TO INVESTIGATE THIS, WE MADE

1272
00:54:13,200 --> 00:54:16,960
INTRAPLANTAR INJECTIONS OF

1273
00:54:16,960 --> 00:54:18,680
CAPSAICIN, A PAINFUL SIGNAL.

1274
00:54:18,680 --> 00:54:20,760
10 MINUTES LATER, SPINAL CORD

1275
00:54:20,760 --> 00:54:25,760
SECTIONS WERE TAKEN, AND THE

1276
00:54:25,760 --> 00:54:27,200
NEUROKINEN1 WAS LOCALIZED USING

1277
00:54:27,200 --> 00:54:28,760
A HIGHLY SPECIFIC ANTIBODY.

1278
00:54:28,760 --> 00:54:32,160
IN ANIMALS THAT HAD RECEIVED AN

1279
00:54:32,160 --> 00:54:32,840
INTRAPLANTAR INJECTION OF

1280
00:54:32,840 --> 00:54:34,600
VEHICLE, THIS THREE-DIMENSIONAL

1281
00:54:34,600 --> 00:54:35,480
PROJECTION SHOWS THAT THE

1282
00:54:35,480 --> 00:54:37,040
RECEPTOR IS CONFINED TO THE

1283
00:54:37,040 --> 00:54:39,560
PLASMA MEMBRANE OF A NEURON.

1284
00:54:39,560 --> 00:54:41,120
IN THE SPINAL CORD.

1285
00:54:41,120 --> 00:54:43,520
10 MINUTES AFTER INJECTION OF

1286
00:54:43,520 --> 00:54:47,280
CAPSAICIN, THERE IS MASSIVE ENDO

1287
00:54:47,280 --> 00:54:48,760
CYTOSIS IN THE RECEPTOR IN THE

1288
00:54:48,760 --> 00:54:50,880
SOMA AND THE IN THE NEURITES

1289
00:54:50,880 --> 00:54:53,320
WHICH IS ATTRIBUTABLE TO A

1290
00:54:53,320 --> 00:54:55,680
PAINFUL SIGNAL RESULTING IN

1291
00:54:55,680 --> 00:54:57,120
RELEASE OF SUBSTANCE P IN THE

1292
00:54:57,120 --> 00:54:58,840
SPINAL CORD WHICH ACTIVATES AND

1293
00:54:58,840 --> 00:54:59,840
BINDS THIS RECEPTOR.

1294
00:54:59,840 --> 00:55:01,720
WE THEN MADE INTRATHECAL

1295
00:55:01,720 --> 00:55:03,160
INJECTIONS OF VARIOUS DRUGS.

1296
00:55:03,160 --> 00:55:05,720
THIS IS AN INACTIVE FORM OF

1297
00:55:05,720 --> 00:55:08,200
PITSTOP, SO THIS IS AN INACTIVE

1298
00:55:08,200 --> 00:55:10,600
CONTROL, AND WE SEE MASSIVE ENDO

1299
00:55:10,600 --> 00:55:12,920
CYTOSIS, HOWEVER, IF WE INJECT

1300
00:55:12,920 --> 00:55:22,480
ACTIVE PITSTOP -- I DON'T THINK

1301
00:55:22,480 --> 00:55:23,800
THIS ONE IS GOING TO ROTATE, BUT

1302
00:55:23,800 --> 00:55:26,600
IF WE INJECT ACTIVE PITSTOP, THE

1303
00:55:26,600 --> 00:55:28,360
RECEPTOR IS CONFINED TO THE

1304
00:55:28,360 --> 00:55:30,880
PLASMA MEMBRANE AND DOES NOT

1305
00:55:30,880 --> 00:55:33,600
INTERNALIZE.

1306
00:55:33,600 --> 00:55:37,560
DOES THIS SIGNALING FROM

1307
00:55:37,560 --> 00:55:39,560
ENDOSOMES RESULT IN SUSTAINED

1308
00:55:39,560 --> 00:55:40,400
NEURAL EXCITATION.

1309
00:55:40,400 --> 00:55:46,200
I COLLABORATED WITH WENDY INLACK

1310
00:55:46,200 --> 00:55:48,240
WHO MADE RECORDINGS FROM

1311
00:55:48,240 --> 00:55:50,520
NK1 RECEPTOR LARGE NEURONS IN

1312
00:55:50,520 --> 00:55:56,320
SUPERFICIAL LA LAMINAE.

1313
00:55:56,320 --> 00:55:58,880
EXPOSED TO SUBSTANCE P AND

1314
00:55:58,880 --> 00:56:00,640
ACTION POTENTIAL FIRING WAS

1315
00:56:00,640 --> 00:56:01,680
ASSESSED.

1316
00:56:01,680 --> 00:56:03,160
IN VEHICLE TREATED SPECIMENS,

1317
00:56:03,160 --> 00:56:04,600
TREATMENT OF SUBSTANCE P

1318
00:56:04,600 --> 00:56:06,360
RESULTED IN A RAPID ONSET OF

1319
00:56:06,360 --> 00:56:07,880
FIRING WHICH WAS SUSTAINED FOR

1320
00:56:07,880 --> 00:56:09,440
ABOUT 12 MINUTES IN THIS

1321
00:56:09,440 --> 00:56:12,200
EXPERIMENT.

1322
00:56:12,200 --> 00:56:14,480
TREATMENT WITHIN ACTIVE DYNGO

1323
00:56:14,480 --> 00:56:15,840
DID NOT PREVENT THIS RESPONSE

1324
00:56:15,840 --> 00:56:19,240
BUT IF WE TREATED WITH DYNGO, WE

1325
00:56:19,240 --> 00:56:20,440
DIDN'T AFFECT THE INITIAL BURST

1326
00:56:20,440 --> 00:56:22,840
OF FIRING WHICH PRESUMABLY

1327
00:56:22,840 --> 00:56:24,040
EMANATES FROM THE PLASMA

1328
00:56:24,040 --> 00:56:27,760
MEMBRANE, BUT WE MARKEDLY

1329
00:56:27,760 --> 00:56:28,680
ATTENUATED THE RESPONSE HERE

1330
00:56:28,680 --> 00:56:29,760
SHOWN IN ORANGE.

1331
00:56:29,760 --> 00:56:31,720
WE CONFIRMED THESE FINDINGS

1332
00:56:31,720 --> 00:56:34,480
USING A GENETIC APPROACH IN

1333
00:56:34,480 --> 00:56:35,920
WHICH WE MADE KNOCK-IN MICE

1334
00:56:35,920 --> 00:56:39,520
EXPRESSING THE FULL LENGTH HUMAN

1335
00:56:39,520 --> 00:56:42,080
NK1 RECEPTOR, OR A TRUNCATED

1336
00:56:42,080 --> 00:56:43,000
INTERNALIZATION DEFECTIVE FORM

1337
00:56:43,000 --> 00:56:45,480
OF THE NK1 RECEPTOR WHICH

1338
00:56:45,480 --> 00:56:46,680
CORRESPONDS TO A NATURALLY

1339
00:56:46,680 --> 00:56:48,000
OCCURRING VARIANT IN HUMANS.

1340
00:56:48,000 --> 00:56:49,680
AND WE FOUND IN MICE EXPRESSING

1341
00:56:49,680 --> 00:56:52,120
THE FULL LENGTH NK1 RECEPTOR

1342
00:56:52,120 --> 00:56:54,200
SUBSTANCE P RESULTED IN THE

1343
00:56:54,200 --> 00:56:56,800
SUSTAINED ACTIVATION, WHEREAS IN

1344
00:56:56,800 --> 00:57:00,520
MICE EXPRESSING THE TRUNCATED

1345
00:57:00,520 --> 00:57:01,080
INTERNALIZATION DEFECTIVE

1346
00:57:01,080 --> 00:57:03,440
MUTANT, THE SUSTAINED FIRING IS

1347
00:57:03,440 --> 00:57:04,880
MARKEDLY ATTENUATED.

1348
00:57:04,880 --> 00:57:07,560
SUGGESTING THAT ENDOSOMAL

1349
00:57:07,560 --> 00:57:09,480
SIGNALING OF THE NK1 RECEPTOR IS

1350
00:57:09,480 --> 00:57:10,360
RESPONSIBLE FOR SUSTAINED

1351
00:57:10,360 --> 00:57:12,960
ACTIVATION OF SPINAL NEURONS.

1352
00:57:12,960 --> 00:57:15,080
DOES THAT RESULT IN NOCICEPTION?

1353
00:57:15,080 --> 00:57:17,800
WELL, WE STUDIED THE EFFECTS OF

1354
00:57:17,800 --> 00:57:19,160
INHIBITING ENDO CYTOSIS IN TWO

1355
00:57:19,160 --> 00:57:20,720
MODELS OF NOCICEPTION.

1356
00:57:20,720 --> 00:57:23,120
THE FIRST WAS INFLAMMATORY PAIN

1357
00:57:23,120 --> 00:57:24,840
IN MEDIATED OR INDUCED IN MICE

1358
00:57:24,840 --> 00:57:28,840
BY AN INTRAPLANTAR INJECTION OF

1359
00:57:28,840 --> 00:57:29,720
COMPLETE ADJUVANT.

1360
00:57:29,720 --> 00:57:32,440
ONE DAY AFTER INJECTION OF CFA,

1361
00:57:32,440 --> 00:57:34,840
WE MADE INTRATHECAL INJECTIONS

1362
00:57:34,840 --> 00:57:40,960
OF SH RNA TO DYNAMIN 1 OR

1363
00:57:40,960 --> 00:57:42,800
AAK1 WHICH IS ANOTHER ENZYME

1364
00:57:42,800 --> 00:57:44,240
THAT'S IMPORTANT FOR ENDOCYTOSIS

1365
00:57:44,240 --> 00:57:46,680
OR A CONTROL, AND MEASURED

1366
00:57:46,680 --> 00:57:52,560
MECHANICAL A ALLODYNIA OVER TIM.

1367
00:57:52,560 --> 00:57:53,840
IN ANIMALS THAT RECEIVED

1368
00:57:53,840 --> 00:57:55,560
CONTROLLED SH RNA, THAT'S THE

1369
00:57:55,560 --> 00:57:57,000
GREY CIRCLES, THERE IS A

1370
00:57:57,000 --> 00:58:00,720
SUSTAINED MECHANICAL ALLODYNIA

1371
00:58:00,720 --> 00:58:03,680
AND THERMAL HYPERALGESIA WHICH

1372
00:58:03,680 --> 00:58:06,280
LASTS FOR ABOUT SIX DAYS,

1373
00:58:06,280 --> 00:58:11,680
TREATMENT WITH -- AGAIN THE

1374
00:58:11,680 --> 00:58:14,000
ANALGESIA LASTS FOR SIX DAYS.

1375
00:58:14,000 --> 00:58:17,840
WE OBTAINED SIMILAR RESULTS IN A

1376
00:58:17,840 --> 00:58:22,240
NEURONEUROPATHIC PAIN MODEL 10 S

1377
00:58:22,240 --> 00:58:23,360
AFTER SPARED NERVE INJURY.

1378
00:58:23,360 --> 00:58:25,280
IN CONTROLS THERE IS SUSTAINED

1379
00:58:25,280 --> 00:58:27,040
MECHANICAL ALLODYNIA AND COLD

1380
00:58:27,040 --> 00:58:29,240
ALLODYNIA, COMPLETELY REVERSED

1381
00:58:29,240 --> 00:58:31,680
BY DISRUPTION OR KNOCKDOWN OF

1382
00:58:31,680 --> 00:58:33,440
DYNAMIN 1 AND AAK1 IN THESE

1383
00:58:33,440 --> 00:58:36,640
EXPERIMENTS.

1384
00:58:36,640 --> 00:58:40,840
NOW THE OBSERVATION THAT THE

1385
00:58:40,840 --> 00:58:43,040
NEUROKIE NEN 1 RECEPTOR IS

1386
00:58:43,040 --> 00:58:44,120
MASSIVELY INTERNALIZED AFTER A

1387
00:58:44,120 --> 00:58:45,520
PAINFUL STIMULUS AND THAT THE

1388
00:58:45,520 --> 00:58:46,440
RECEPTOR CONTINUES TO SIGNAL

1389
00:58:46,440 --> 00:58:48,120
FROM ENDOSOMES AND THAT THIS

1390
00:58:48,120 --> 00:58:49,920
SIGNALING IS NECESSARY FOR

1391
00:58:49,920 --> 00:58:51,840
SUSTAINED ACTIVATION OF SPINAL

1392
00:58:51,840 --> 00:58:55,120
NEURONS AND NOCICEPTIVE

1393
00:58:55,120 --> 00:58:56,880
TRANSMISSION RAISED THE

1394
00:58:56,880 --> 00:58:59,160
QUESTION, ARE GPCRs IN

1395
00:58:59,160 --> 00:59:04,360
ENDOSOMES OR EGPCRs A VALID

1396
00:59:04,360 --> 00:59:06,880
AND PERHAPS SUPERIOR TARGET

1397
00:59:06,880 --> 00:59:08,520
COMPARED TO CONVENTIONAL DRUGS

1398
00:59:08,520 --> 00:59:10,120
WHICH WOULD BLOCK THE RECEPTOR

1399
00:59:10,120 --> 00:59:11,320
AT THE CELL SURFACE.

1400
00:59:11,320 --> 00:59:12,840
WE'VE USED SEVERAL APPROACHES TO

1401
00:59:12,840 --> 00:59:13,880
ADDRESS THIS ISSUE.

1402
00:59:13,880 --> 00:59:17,160
THE FIRST IS TO USE ENDO CYTOSIS

1403
00:59:17,160 --> 00:59:18,560
INHIBITORS AND I DESCRIBED THE

1404
00:59:18,560 --> 00:59:19,840
RESULTS OF EXPERIMENTS IN WHICH

1405
00:59:19,840 --> 00:59:21,840
WE'D INJECTED VARIOUS INHIBITORS

1406
00:59:21,840 --> 00:59:23,760
OF ENDOCYTOSIS INTRATHECALLY.

1407
00:59:23,760 --> 00:59:26,120
WE NOW KNOW THAT THESE DRUGS CAN

1408
00:59:26,120 --> 00:59:27,360
BLOCK PAIN TRANSMISSION IN TWO

1409
00:59:27,360 --> 00:59:28,760
WAYS.

1410
00:59:28,760 --> 00:59:31,080
FIRSTLY, THEY BLOCK ENDOSOMAL

1411
00:59:31,080 --> 00:59:32,720
SIGNALING OF G PROTEIN COUPLED

1412
00:59:32,720 --> 00:59:34,280
RECEPTORS WHICH TRANSMIT PAINFUL

1413
00:59:34,280 --> 00:59:35,720
SIGNALS, BUT SECONDLY, AS WE

1414
00:59:35,720 --> 00:59:37,360
DESCRIBED IN THIS RECENT

1415
00:59:37,360 --> 00:59:41,080
PUBLICATION, THEY ALSO BLOCK THE

1416
00:59:41,080 --> 00:59:43,840
DYNAMIN DEPENDENT TREATMENT OF

1417
00:59:43,840 --> 00:59:46,400
VESICLES WHICH IS NECESSARY FOR

1418
00:59:46,400 --> 00:59:51,280
SUSTAINED NEUROTRANSMISSION.

1419
00:59:51,280 --> 00:59:52,400
THE SECOND APPROACH HAS BEEN TO

1420
00:59:52,400 --> 00:59:55,320
DEVELOP SMALL MOLECULES THAT

1421
00:59:55,320 --> 00:59:56,760
PREFERENTIALLY REACT WITH

1422
00:59:56,760 --> 00:59:57,800
RECEPTORS AND ENDOSOMES.

1423
00:59:57,800 --> 00:59:59,560
TO DO SO, A SMALL MOLECULE WOULD

1424
00:59:59,560 --> 01:00:01,360
HAVE TO CROSS THE PLASMA

1425
01:00:01,360 --> 01:00:04,080
MEMBRANE, DIFFUSE THROUGH THE

1426
01:00:04,080 --> 01:00:09,520
CYTOSOL, CROSS THE END  THE ENDL

1427
01:00:09,520 --> 01:00:14,040
PROTEIN IN A MULTI-PROTEIN

1428
01:00:14,040 --> 01:00:17,800
SIGNALOSOME IN THE ENVIRONMENT

1429
01:00:17,800 --> 01:00:18,800
OF EARLY ENDO SOMES.

1430
01:00:18,800 --> 01:00:21,080
WE RECENTLY USED MOLECULAR

1431
01:00:21,080 --> 01:00:23,280
MODELING TO DOCK A CLINICALLY

1432
01:00:23,280 --> 01:00:25,480
USED ANTAGONIST RECEPTOR WITH

1433
01:00:25,480 --> 01:00:26,680
THE CRYSTAL STRUCTURE OF THE

1434
01:00:26,680 --> 01:00:29,320
HUMAN NK1 RECEPTOR, AND

1435
01:00:29,320 --> 01:00:30,560
IDENTIFIED RESIDUES THAT WE

1436
01:00:30,560 --> 01:00:34,200
COULD MODIFY TO CHANGE THE

1437
01:00:34,200 --> 01:00:39,480
ACIDITY AND LIPOFELICITY OF

1438
01:00:39,480 --> 01:00:42,600
ANALOGS OF NETUPITANT.

1439
01:00:42,600 --> 01:00:45,520
IN THE CA CAPSAICIN ASSAY, WE FD

1440
01:00:45,520 --> 01:00:48,440
WHEREAS A DIFFERENT ANALOG THAT

1441
01:00:48,440 --> 01:00:50,240
ARE BOTH CLINICALLY USED HAVE

1442
01:00:50,240 --> 01:00:52,560
THIS TRANSIENT ANALGESIC EFFECT

1443
01:00:52,560 --> 01:00:54,440
BY MEASURING MECHANICAL

1444
01:00:54,440 --> 01:00:54,760
ALLODYNIA.

1445
01:00:54,760 --> 01:00:57,160
MANY OF THE ANALOGS HAD A MUCH

1446
01:00:57,160 --> 01:01:00,120
LARGER AND SUSTAINED ANALGESIC

1447
01:01:00,120 --> 01:01:01,040
EFFECT, DEMONSTRATING THAT IT

1448
01:01:01,040 --> 01:01:02,200
MIGHT BE POSSIBLE TO GENERATE

1449
01:01:02,200 --> 01:01:05,000
SMALL MOLECULES THAT WILL BLOCK

1450
01:01:05,000 --> 01:01:06,000
RECEPTORS AND ENDOSOMES IN THIS

1451
01:01:06,000 --> 01:01:09,960
WAY.

1452
01:01:09,960 --> 01:01:13,800
THE THIRD APPROACH HAS BEEN TO

1453
01:01:13,800 --> 01:01:24,480
DEVELOP TR AN ANTAGONIST WITH TE

1454
01:01:25,720 --> 01:01:33,280
COMPONENTS, COULD BE A SMALL

1455
01:01:33,280 --> 01:01:39,720
MOLECULE ANTAGONIST OR A

1456
01:01:39,720 --> 01:01:40,240
PEPTIDIC ANTAGONIST.

1457
01:01:40,240 --> 01:01:42,560
WE FOUND AN INTRATHECAL

1458
01:01:42,560 --> 01:01:47,960
INJECTION OF A SPANTIDE PROBE

1459
01:01:47,960 --> 01:01:51,000
STRONGLY REVERSED CAPSAICIN

1460
01:01:51,000 --> 01:01:54,320
NOCICEPTION IN MICE, WHEREAS

1461
01:01:54,320 --> 01:01:57,840
CONVENTIONAL SPANTIDE UNDER

1462
01:01:57,840 --> 01:01:58,920
THESE CIRCUMSTANCES AT THE SAME

1463
01:01:58,920 --> 01:02:01,880
DOSE HAD NO THERAPEUTIC EFFECT.

1464
01:02:01,880 --> 01:02:03,120
AND THE FINAL APPROACH WHICH I

1465
01:02:03,120 --> 01:02:04,680
WANT TO SPEND THE REST OF MY

1466
01:02:04,680 --> 01:02:07,280
TALK DISCUSSING IS TO USE

1467
01:02:07,280 --> 01:02:08,400
STIMULUS RESPONSIVE

1468
01:02:08,400 --> 01:02:10,160
NANOPARTICLES.

1469
01:02:10,160 --> 01:02:11,480
NOW NANOPARTICLES HAVE THE

1470
01:02:11,480 --> 01:02:14,200
PROPERTY OF ENTERING CELLS

1471
01:02:14,200 --> 01:02:18,720
USUALLY BY DYNAMIN-INDEPENDENT

1472
01:02:18,720 --> 01:02:19,800
ENDOCYTOSIS AND THEY ACCUMULATE

1473
01:02:19,800 --> 01:02:24,000
IN ENDOSOMES.

1474
01:02:24,000 --> 01:02:25,760
WE -- TO TARGET RECEPTORS IN

1475
01:02:25,760 --> 01:02:28,440
ENDOSOMES WHERE THE ACIDIC

1476
01:02:28,440 --> 01:02:29,280
ENDOSOMAL ENVIRONMENT COULD BE

1477
01:02:29,280 --> 01:02:33,040
USED AS A TRIGGER TO PROMOTE

1478
01:02:33,040 --> 01:02:33,880
NANOPARTICLE DISASSEMBLY AND

1479
01:02:33,880 --> 01:02:38,200
CARGO RELEASE.

1480
01:02:38,200 --> 01:02:41,120
THEREFORE, WE DEVELOPED

1481
01:02:41,120 --> 01:02:42,160
PH-TUNEABLE NANOPARTICLES WHICH

1482
01:02:42,160 --> 01:02:46,440
WERE COMPOSED OF A HYDROPHILIC

1483
01:02:46,440 --> 01:02:48,840
SHELL OF MONOMERS DESIGNED TO

1484
01:02:48,840 --> 01:02:50,760
PROMOTE LONG CIRCULATING

1485
01:02:50,760 --> 01:02:54,280
HALF-LIFE AND CELLULAR UPTAKE,

1486
01:02:54,280 --> 01:02:56,560
AND A HYDROPHOBIC CORE OF

1487
01:02:56,560 --> 01:02:59,120
MONOMERS DESIGNED TO REDUCE

1488
01:02:59,120 --> 01:03:03,800
CELLULAR TOXICITY AND THIS KEY

1489
01:03:03,800 --> 01:03:07,080
COMPONENT TO PROMOTE

1490
01:03:07,080 --> 01:03:09,080
PH-DEPENDENT DISASSEMBLY.

1491
01:03:09,080 --> 01:03:15,000
SO THE DIPMA MONOMER HAS A PKA

1492
01:03:15,000 --> 01:03:19,320
OF 6.1, S TO CAUSE THE

1493
01:03:19,320 --> 01:03:21,160
NANOPARTICLE TO DISASSEMBLE AND

1494
01:03:21,160 --> 01:03:23,040
RELEASE ITS CARGO NEXT TO THE

1495
01:03:23,040 --> 01:03:24,400
RECEPTOR THAT WE WANT TO

1496
01:03:24,400 --> 01:03:25,400
ANTAGONIZE.

1497
01:03:25,400 --> 01:03:28,600
AS A CONTROL, WE DEVELOPED

1498
01:03:28,600 --> 01:03:29,560
STABLE NANOPARTICLES WITH THE

1499
01:03:29,560 --> 01:03:34,520
SAME HEE DROA HYDROPHILIC SHELLA

1500
01:03:34,520 --> 01:03:35,040
DIFFERENT CORE.

1501
01:03:35,040 --> 01:03:37,040
THIS WOULD NOT BE PROTEIN ATED

1502
01:03:37,040 --> 01:03:39,240
AND, THEREFORE, IN THEORY,

1503
01:03:39,240 --> 01:03:40,360
SHOULDN'T DISASSEMBLEMENT AND WE

1504
01:03:40,360 --> 01:03:44,360
USED THESE PARTICLES TO

1505
01:03:44,360 --> 01:03:46,360
ENCAPSULATE A HYDROPHOBIC DRUG

1506
01:03:46,360 --> 01:03:49,440
CLINICALLY USED TO TREAT

1507
01:03:49,440 --> 01:03:51,160
CHEMOTHERAPY-INDUCED NAUSEA AND

1508
01:03:51,160 --> 01:03:52,520
VOMITING BUT WHICH HAS FAILED IN

1509
01:03:52,520 --> 01:03:55,320
CLINICAL TRIALS OF PAIN.

1510
01:03:55,320 --> 01:03:57,720
THE CONCEPT IS THAT THESE

1511
01:03:57,720 --> 01:04:01,240
MONOMERS WOULD SELF-ASSEMBLE IN

1512
01:04:01,240 --> 01:04:03,760
AAN AQUEOUS ENVIRONMENT AND THAT

1513
01:04:03,760 --> 01:04:07,360
THIS WOULD BE REVERSED WHEN THE

1514
01:04:07,360 --> 01:04:10,680
NANOPARTICLE ENTERS ENDOSOMES

1515
01:04:10,680 --> 01:04:12,440
AND DISASSEMBLES.

1516
01:04:12,440 --> 01:04:13,880
THESE TRANSMISSION

1517
01:04:13,880 --> 01:04:14,800
ELECTROMICROGRAPH IMAGES SHOW

1518
01:04:14,800 --> 01:04:16,040
THE PARTICLES THAT ARE

1519
01:04:16,040 --> 01:04:17,880
SPHERICAL, THEY ARE UNIFORM,

1520
01:04:17,880 --> 01:04:20,520
THEY'RE WELL DISPERSED.

1521
01:04:20,520 --> 01:04:22,640
THEY ARE BETWEEN 30 TO

1522
01:04:22,640 --> 01:04:24,840
40-NANOMETERS IN DIAMETER, HAVE

1523
01:04:24,840 --> 01:04:28,000
A SMALL SURFACE NEGATIVE CHARGE,

1524
01:04:28,000 --> 01:04:31,000
AND TO EXAMINE THE PH-DEPENDENT

1525
01:04:31,000 --> 01:04:33,960
DISASSEMBLY IN A TEST TUBE, WE

1526
01:04:33,960 --> 01:04:36,240
GENERATED PARTICLES CONTAINING

1527
01:04:36,240 --> 01:04:42,080
THE DYN NILE RED.

1528
01:04:42,080 --> 01:04:43,440
IT ONLY FLORES IN THE PARTICLE

1529
01:04:43,440 --> 01:04:45,640
AND IS QUENCHED IN AN AQUEOUS

1530
01:04:45,640 --> 01:04:46,040
ENVIRONMENT.

1531
01:04:46,040 --> 01:04:47,840
SO IF THE SIGNAL DISAPPEARS IT

1532
01:04:47,840 --> 01:04:49,600
INDICATES THAT THE PARTICLE IS

1533
01:04:49,600 --> 01:04:51,680
DISASSEMBLING.

1534
01:04:51,680 --> 01:04:54,680
AND WE TOOK THE DIPMA PARTICLES

1535
01:04:54,680 --> 01:04:57,600
IN RED AND THE STABLE BMA

1536
01:04:57,600 --> 01:04:58,760
PARTICLES IN ORANGE, PUT THEM IN

1537
01:04:58,760 --> 01:05:00,200
A TEST TUBE OF GRADED PH AND

1538
01:05:00,200 --> 01:05:02,600
NOTED THAT IF WE REDUCE THE PH,

1539
01:05:02,600 --> 01:05:05,520
THE FLUORESCENCE OF THE CONTROL

1540
01:05:05,520 --> 01:05:06,960
BMA PARTICLES IS UNCHANGED

1541
01:05:06,960 --> 01:05:08,680
BECAUSE THEY DON'T DISASSEMBLE,

1542
01:05:08,680 --> 01:05:11,680
BUT THE FLUORESCENCE OF THE

1543
01:05:11,680 --> 01:05:13,200
DIPMA PARTICLES DECLINES ONCE WE

1544
01:05:13,200 --> 01:05:16,600
GO TO BELOW PH6, CONSISTENT WITH

1545
01:05:16,600 --> 01:05:17,440
PARTICLE DISASSEMBLY AND DRUG

1546
01:05:17,440 --> 01:05:17,800
RELEASE.

1547
01:05:17,800 --> 01:05:21,920
SO WE HAVE A PH-TUNEABLE

1548
01:05:21,920 --> 01:05:22,880
NANOPARTICLE DRUG DELIVERY

1549
01:05:22,880 --> 01:05:26,480
STRATEGY.

1550
01:05:26,480 --> 01:05:28,320
WELL, DO THE PARTICLES

1551
01:05:28,320 --> 01:05:29,320
DISASSEMBLE WHEN THEY'RE TAKEN

1552
01:05:29,320 --> 01:05:30,000
UP INTO CELLS?

1553
01:05:30,000 --> 01:05:33,160
HERE WE GENERATED PARTICLES

1554
01:05:33,160 --> 01:05:39,200
EXPRESSING CUMERIN58.

1555
01:05:39,200 --> 01:05:40,160
IT DOESN'T FLORES IN THE

1556
01:05:40,160 --> 01:05:42,160
PARTICLE, IT ONLY FLORES IN AN

1557
01:05:42,160 --> 01:05:42,800
AQUEOUS ENVIRONMENT.

1558
01:05:42,800 --> 01:05:45,320
SO IF THE CELL GOES GREEN, THE

1559
01:05:45,320 --> 01:05:47,640
PARTICLES DISASSEMBLE, SO WE

1560
01:05:47,640 --> 01:05:49,280
TOOK HEK CELLS, WE ADDED THE

1561
01:05:49,280 --> 01:05:51,800
PARTICLES AT ZERO MINUTES, AND

1562
01:05:51,800 --> 01:05:52,840
IF YOU LOOK CAREFULLY, YOU CAN

1563
01:05:52,840 --> 01:05:53,960
SEE WITHIN A FEW MINUTES THE

1564
01:05:53,960 --> 01:05:56,200
CELLS ARE GOING BRIGHT GREEN,

1565
01:05:56,200 --> 01:06:00,040
INDICATING PARTICLE UPTAKE AND

1566
01:06:00,040 --> 01:06:00,800
DISASSEMBLY.

1567
01:06:00,800 --> 01:06:04,320
WE QUANTIFIED THIS SIGNAL OVER

1568
01:06:04,320 --> 01:06:07,760
TIME AND NOTICED MARKED

1569
01:06:07,760 --> 01:06:08,960
DISASSEMBLY WITHIN ABOUT 10

1570
01:06:08,960 --> 01:06:10,160
MINUTES AND WITHIN 30 MINUTES,

1571
01:06:10,160 --> 01:06:11,240
THE CELLS ARE BRIGHT GREEN, THE

1572
01:06:11,240 --> 01:06:12,560
PARTICLES HAVE DISASSEMBLED.

1573
01:06:12,560 --> 01:06:16,800
WE TREATED CELLS WITH PITSTOP,

1574
01:06:16,800 --> 01:06:19,000
THE PLET RIN INHIBITOR AND

1575
01:06:19,000 --> 01:06:21,440
DYNGO, THE DYNAMIC INHIBITOR,

1576
01:06:21,440 --> 01:06:23,840
AND STRONGLY INHIBITED

1577
01:06:23,840 --> 01:06:24,560
NANOPARTICLE DISASSEMBLY.

1578
01:06:24,560 --> 01:06:26,000
WE ALSO TREATED CELLS WITH

1579
01:06:26,000 --> 01:06:33,680
AMMONIUM CHLORIDE OR 

1580
01:06:33,680 --> 01:06:34,440
BAFILOMYCINA, AND AGAIN, WE

1581
01:06:34,440 --> 01:06:35,960
COULD STRONGLY INHIBIT

1582
01:06:35,960 --> 01:06:39,360
NANOPARTICLE DISASSEMBLY.

1583
01:06:39,360 --> 01:06:42,520
BY MAKING NANOPARTICLES LABELED

1584
01:06:42,520 --> 01:06:44,560
WITH CYANINE 5, WE COULD TRACK

1585
01:06:44,560 --> 01:06:46,120
WHERE THEY WENT IN THE CELL AND

1586
01:06:46,120 --> 01:06:48,920
DISCOVERED THAT THEY COLOCALIZED

1587
01:06:48,920 --> 01:06:51,000
WITH THE RE ACCEPTOR IN

1588
01:06:51,000 --> 01:06:52,320
ENDOSOMES, HERE IT WAS TAGGED

1589
01:06:52,320 --> 01:06:54,200
WITH GREEN FLUORESCENT PROTEIN

1590
01:06:54,200 --> 01:06:55,760
AND WE TREATED CELLS WITH

1591
01:06:55,760 --> 01:06:57,440
SUBSTANCE P TO DRIVE ENDOCYTOSIS

1592
01:06:57,440 --> 01:06:58,240
AT THIS RECEPTOR.

1593
01:06:58,240 --> 01:07:00,640
SO WE CAN DELIVER NANOPARTICLES

1594
01:07:00,640 --> 01:07:02,360
TO ENDOSOMES CONTAINING THE

1595
01:07:02,360 --> 01:07:04,680
RECEPTOR WE WANT TO ANTAGONIZE,

1596
01:07:04,680 --> 01:07:06,800
AND THEY DISASSEMBLE AND RELEASE

1597
01:07:06,800 --> 01:07:08,600
DRUG IN THE ACIDIC ENDOSOMAL

1598
01:07:08,600 --> 01:07:09,960
ENVIRONMENT.

1599
01:07:09,960 --> 01:07:11,400
DO THEY PREVENT ENDOSOMAL

1600
01:07:11,400 --> 01:07:13,560
SIGNALING?

1601
01:07:13,560 --> 01:07:16,480
WELL, WE RETURNED TO OUR NUCLEAR

1602
01:07:16,480 --> 01:07:17,800
ERK ASSAY IN THIS EXPERIMENT,

1603
01:07:17,800 --> 01:07:20,480
AND FOUND IN HEK CELLS TREATED

1604
01:07:20,480 --> 01:07:22,120
WITH VEHICLE, THAT SUBSTANCE P

1605
01:07:22,120 --> 01:07:24,120
CAUSED AN ACTIVATION OF ERK IN

1606
01:07:24,120 --> 01:07:29,440
THE NUCLEUS, FREE OF PREPITANT,

1607
01:07:29,440 --> 01:07:33,160
HAD NO EFFECT, BUT IN A DIPMA

1608
01:07:33,160 --> 01:07:34,080
NANOPARTICLE COMPLETELY BLOCKED

1609
01:07:34,080 --> 01:07:34,640
THAT RESPONSE.

1610
01:07:34,640 --> 01:07:37,080
WE THEN LOOKED AT THE EXCITATION

1611
01:07:37,080 --> 01:07:40,480
OF SPINAL NEURONS WITH THE

1612
01:07:40,480 --> 01:07:41,120
ELECTROPHYSIOLOGICAL APPROACH.

1613
01:07:41,120 --> 01:07:42,280
AS BEFORE, WE FOUND THE

1614
01:07:42,280 --> 01:07:43,960
TRANSIENT EXPOSURE TO SUBSTANCE

1615
01:07:43,960 --> 01:07:45,280
P RESULTED IN A SUSTAINED

1616
01:07:45,280 --> 01:07:46,920
ACTIVATION OF NEURONS.

1617
01:07:46,920 --> 01:07:48,760
THEY CONTINUE TO FIRE ACTION

1618
01:07:48,760 --> 01:07:49,520
POTENTIALS.

1619
01:07:49,520 --> 01:07:52,360
THIS WAS MILDLY INHIBITED BY

1620
01:07:52,360 --> 01:07:55,840
CONVENTIONAL AP REPITANT.

1621
01:07:55,840 --> 01:07:57,480
THE STABLE NANOPARTICLES DID NOT

1622
01:07:57,480 --> 01:08:02,280
INHIBIT THE RESPONSE, BUT THE

1623
01:08:02,280 --> 01:08:03,040
DIPMA NANOPARTICLES COMPLETELY

1624
01:08:03,040 --> 01:08:03,920
PREVENTED THE SUSTAINED

1625
01:08:03,920 --> 01:08:08,040
RESPONSE.

1626
01:08:08,040 --> 01:08:10,520
AFTER INTRATHECAL INJECTION OF

1627
01:08:10,520 --> 01:08:15,200
CYANINE 5 LABELED NANO -- DIPMA

1628
01:08:15,200 --> 01:08:16,520
NANOPARTICLES, WHOLE ANIMAL

1629
01:08:16,520 --> 01:08:17,520
IMAGING REVEALED THAT THE

1630
01:08:17,520 --> 01:08:18,600
PARTICLES REMAINED AT THE SITE

1631
01:08:18,600 --> 01:08:22,720
OF INJECTION FOR UP TO 24 HOURS.

1632
01:08:22,720 --> 01:08:25,120
IF WE COLLECTED TISSUES AND

1633
01:08:25,120 --> 01:08:26,520
LOCALIZED THE PARTICLES, WE

1634
01:08:26,520 --> 01:08:29,880
COULD DETECT THEM IN SUPERFICIAL

1635
01:08:29,880 --> 01:08:34,240
NEURONS IN LAMB NAYE2 AND 1 IN

1636
01:08:34,240 --> 01:08:35,360
THE SPINAL CORD, WHETHER THERE

1637
01:08:35,360 --> 01:08:36,640
WAS UP A TAKE IN NEURONS

1638
01:08:36,640 --> 01:08:38,920
STAINING WITH THE NEURONAL

1639
01:08:38,920 --> 01:08:42,680
MARKER PGP9.5.

1640
01:08:42,680 --> 01:08:44,480
THIS THREE DIMENSIONAL ROTATION

1641
01:08:44,480 --> 01:08:46,480
SHOWS THE NEURONS IN THE SPINAL

1642
01:08:46,480 --> 01:08:51,720
CORD ARE CHOCK FULL OF CYANINE .

1643
01:08:51,720 --> 01:08:54,080
AND FINALLY, WE QUANTIFIED THE

1644
01:08:54,080 --> 01:08:55,400
LEVELS OF APREP TANT IN THE

1645
01:08:55,400 --> 01:08:56,800
SPINAL COURT BY EXTRACTING

1646
01:08:56,800 --> 01:08:59,960
TISSUE AND MEASURING APREP TANT

1647
01:08:59,960 --> 01:09:01,600
BY MASS SPECTROMETRY.

1648
01:09:01,600 --> 01:09:04,600
ONE HOUR OR FOUR HOURS AFTER

1649
01:09:04,600 --> 01:09:04,840
INJECTION.

1650
01:09:04,840 --> 01:09:10,200
IN BLUE, UNEP CAPSULATED

1651
01:09:10,200 --> 01:09:11,360
APREPTANT IS CLEARED FROM THE

1652
01:09:11,360 --> 01:09:15,400
SPINAL CORD WHEREAS IN RED AND

1653
01:09:15,400 --> 01:09:19,880
ORANGE, IT IS RETAINED FOR MUCH

1654
01:09:19,880 --> 01:09:23,480
LONGER TIMES AND AT HIGHER

1655
01:09:23,480 --> 01:09:29,200
LEVELS.

1656
01:09:29,200 --> 01:09:33,200
FINALLY WE MEASURED THE

1657
01:09:33,200 --> 01:09:34,840
THERAPEUTIC -- CAUSED BY AN

1658
01:09:34,840 --> 01:09:35,800
INJECTION OF COMPLETE ADJUVANT

1659
01:09:35,800 --> 01:09:38,640
INTO THE PORE, AND THE DRUGS ARE

1660
01:09:38,640 --> 01:09:40,840
INJECTED INTRATHECALLY 48 HOURS

1661
01:09:40,840 --> 01:09:43,760
AFTER INTRAPLANTAR INJECTION.

1662
01:09:43,760 --> 01:09:50,640
IN BLUE, FREE APREPITANT HAD A

1663
01:09:50,640 --> 01:09:51,280
NOCICEPTIVE EFFECT.

1664
01:09:51,280 --> 01:09:52,280
IN ORANGE THE STABLE PARTICLES

1665
01:09:52,280 --> 01:09:55,040
HAD THE SAME EFFECT BUT IN RED,

1666
01:09:55,040 --> 01:09:59,320
THE DIPMA PH-TUNEABLE

1667
01:09:59,320 --> 01:10:00,880
NANOPARTICLES HAD A LARGER AND

1668
01:10:00,880 --> 01:10:01,960
MORE SUSTAINED EFFECT.

1669
01:10:01,960 --> 01:10:04,360
IN MODELS OF NEUROPATHIC PAIN IN

1670
01:10:04,360 --> 01:10:10,960
BOTH RATS AND MICE, WE FOUND THE

1671
01:10:10,960 --> 01:10:12,560
SAME RESULTS, THEY HAD A MINOR

1672
01:10:12,560 --> 01:10:14,440
EFFECT BUT SHOWN HERE IN THE

1673
01:10:14,440 --> 01:10:15,640
PALE PINK AND HERE IN THE RED,

1674
01:10:15,640 --> 01:10:18,000
THE DIPMA PARTICLE HS A MUCH

1675
01:10:18,000 --> 01:10:21,360
LARGER AND MORE STAINED

1676
01:10:21,360 --> 01:10:24,320
ANTINOCICEPTIVE ACTION.

1677
01:10:24,320 --> 01:10:25,400
FINALLY, WE WANTED TO KNOW

1678
01:10:25,400 --> 01:10:27,160
WHETHER TARGETING ENDOSOMAL

1679
01:10:27,160 --> 01:10:28,920
SIGNALING COULD BE A TREATMENT

1680
01:10:28,920 --> 01:10:31,920
FOR PAINFUL DISORDERS.

1681
01:10:31,920 --> 01:10:33,240
AND NOW WE'RE FOCUSING ON A

1682
01:10:33,240 --> 01:10:36,160
DIFFERENT RECEPTOR,

1683
01:10:36,160 --> 01:10:38,960
PROTEASE-ACTIVATED RECEPTOR, OR

1684
01:10:38,960 --> 01:10:40,600
PAR2.

1685
01:10:40,600 --> 01:10:42,880
PAR 2 IS A RECEPTOR WHICH IS

1686
01:10:42,880 --> 01:10:44,640
ACTIVATED BY PROTEASES FROM A

1687
01:10:44,640 --> 01:10:46,240
VARIETY OF SOURCES.

1688
01:10:46,240 --> 01:10:47,440
THIS RECEPTOR IS HIGHLY

1689
01:10:47,440 --> 01:10:49,000
EXPRESSED IN THE DIGESTIVE

1690
01:10:49,000 --> 01:10:54,320
SYSTEM, WHERE IT'S FOUND IN

1691
01:10:54,320 --> 01:10:55,280
COLONOCYTES AND ALSO A

1692
01:10:55,280 --> 01:10:56,920
SUBPOPULATION OF PRIMARY SENSORY

1693
01:10:56,920 --> 01:10:57,280
NEURONS.

1694
01:10:57,280 --> 01:10:57,960
IT'S WELL ESTABLISHED THAT

1695
01:10:57,960 --> 01:11:00,040
ACTIVATION OF THIS RECEPTOR

1696
01:11:00,040 --> 01:11:03,920
LEADS TO CHANGES IN INFLAMMA 

1697
01:11:03,920 --> 01:11:06,120
INFLAMMATION, IT INVOKES INS

1698
01:11:06,120 --> 01:11:09,120
FLAMATION, ALSO SENSITIZATION OF

1699
01:11:09,120 --> 01:11:10,880
ION CHANNELS CAUSING PAIN AND

1700
01:11:10,880 --> 01:11:11,560
INFLAMMATION.

1701
01:11:11,560 --> 01:11:13,000
DURING INFLAMMATORY DISEASE,

1702
01:11:13,000 --> 01:11:15,000
PROTEASES THAT CAN DERIVE FROM

1703
01:11:15,000 --> 01:11:16,840
INFLAMMATORY CELLS SUCH AS MAST

1704
01:11:16,840 --> 01:11:18,600
CELLS AND MACROPHAGES, AS WELL

1705
01:11:18,600 --> 01:11:19,960
AS A VERY LARGE NUMBER OF

1706
01:11:19,960 --> 01:11:22,040
PROTEASES WHICH ARE POORLY

1707
01:11:22,040 --> 01:11:24,360
CHARACTERIZED BUT WHICH IS

1708
01:11:24,360 --> 01:11:26,040
SECRETED BY BACTERIA IN THE

1709
01:11:26,040 --> 01:11:27,880
COLON, CAN CLEAVE AND ACTIVATE

1710
01:11:27,880 --> 01:11:30,520
THIS RECEPTOR TO TRIGGER PAIN.

1711
01:11:30,520 --> 01:11:32,480
AND THIS RECEPTOR HAS BEEN

1712
01:11:32,480 --> 01:11:35,200
STRONGLY IMPLICATED IN IRRITABLE

1713
01:11:35,200 --> 01:11:37,400
BOWEL SYNDROME PAIN, WHERE THERE

1714
01:11:37,400 --> 01:11:39,840
IS AN INCREASED INFLUX OF MAST

1715
01:11:39,840 --> 01:11:44,240
CELLS THAT RELEASE THE EP SIEM E

1716
01:11:44,240 --> 01:11:45,760
TRYPTASE THAT CAUSES PAIN AND

1717
01:11:45,760 --> 01:11:50,240
ALSO SECRETION OF FORMS OF

1718
01:11:50,240 --> 01:11:53,000
TRYPSIN BY COLONIC EPITHELIAL

1719
01:11:53,000 --> 01:11:53,640
CELLS.

1720
01:11:53,640 --> 01:11:55,880
TO SELECTIVELY LOCALIZE THIS WEE

1721
01:11:55,880 --> 01:12:01,160
ACCEPTORTHISRECEPTOR IN THE COLE

1722
01:12:01,160 --> 01:12:02,960
GENERATED KNOCK-IN MICE

1723
01:12:02,960 --> 01:12:05,920
EXPRESSING PAR 2 FUSED TO GREEN

1724
01:12:05,920 --> 01:12:07,040
FLUORESCENT PROTEIN, AND USED

1725
01:12:07,040 --> 01:12:09,120
PROBES TO GREEN FLUORESCENT

1726
01:12:09,120 --> 01:12:10,520
PROTEIN TO SPECIFICALLY LOCALIZE

1727
01:12:10,520 --> 01:12:12,560
THE RECEPTOR IN MOUSE COLONIC

1728
01:12:12,560 --> 01:12:13,920
TISSUES.

1729
01:12:13,920 --> 01:12:16,080
WE OBSERVED THAT THE RECEPTOR IS

1730
01:12:16,080 --> 01:12:19,160
VERY HIGHLY EXPRESSED BY

1731
01:12:19,160 --> 01:12:19,880
EPITHELIAL CELLS IN THE SMALL

1732
01:12:19,880 --> 01:12:23,120
AND LARGE INTESTINE AS SHOWN

1733
01:12:23,120 --> 01:12:24,000
HERE.

1734
01:12:24,000 --> 01:12:26,640
IT'S ALSO EXPRESSED IN A

1735
01:12:26,640 --> 01:12:28,280
SUBPOPULATION OF PRIMARY SENSORY

1736
01:12:28,280 --> 01:12:30,080
NEURONS WITH CELL BODIES IN THE

1737
01:12:30,080 --> 01:12:31,640
DORSAL ROOT GANGLIA AS SHOWN

1738
01:12:31,640 --> 01:12:35,560
HERE.

1739
01:12:35,560 --> 01:12:38,280
UNDER BASAL CIRCUMSTANCES IN THE

1740
01:12:38,280 --> 01:12:43,200
NORMAL COLON, PAR 2 IS HIGHLY

1741
01:12:43,200 --> 01:12:48,160
LOCALIZED TO THE BASOLATERAL

1742
01:12:48,160 --> 01:12:52,200
MEMBRANE OF COLONOCYTES.

1743
01:12:52,200 --> 01:12:56,520
HERE IN MICE -- FROM THE PLASMA

1744
01:12:56,520 --> 01:13:02,840
MEMO WRAIMEMBRANE TO ENDOSOMES S

1745
01:13:02,840 --> 01:13:05,880
IS ATTRIBUTABLE TO MULTIPLE --

1746
01:13:05,880 --> 01:13:07,120
IN THE INFLAMED INTESTINE.

1747
01:13:07,120 --> 01:13:08,400
COULD THE RECEPTOR CONTINUE TO

1748
01:13:08,400 --> 01:13:12,880
SIGNAL FROM END SOMES ENDOSOMES?

1749
01:13:12,880 --> 01:13:15,920
BY STUDYING RECEPTOR SIGNALING

1750
01:13:15,920 --> 01:13:17,440
USING THE BRET ASSAY THAT I

1751
01:13:17,440 --> 01:13:19,480
DESCRIBED BEFORE, WE COULD SEE

1752
01:13:19,480 --> 01:13:22,760
ASSEMBLY OF A SIGNALING COMPLEX

1753
01:13:22,760 --> 01:13:24,840
COMPRISING PAR 2 AND HERE G

1754
01:13:24,840 --> 01:13:27,360
ALPHA Q IN MULTIPLE

1755
01:13:27,360 --> 01:13:28,040
INTRACELLULAR COMPARTMENTS WITH

1756
01:13:28,040 --> 01:13:30,080
TIME, INCLUDING THE PLASMA

1757
01:13:30,080 --> 01:13:31,800
MEMBRANE, EARLY ENDOSOMES,

1758
01:13:31,800 --> 01:13:34,640
RECYCLING ENDOSOMES, LATE

1759
01:13:34,640 --> 01:13:40,640
ENDOSOMES AND THE SYS AND TRANS

1760
01:13:40,640 --> 01:13:42,720
GOLGI SEPARATOR, SO MULTIPLE

1761
01:13:42,720 --> 01:13:43,600
COMPARTMENTS WHEN IT'S

1762
01:13:43,600 --> 01:13:43,920
ACTIVATED.

1763
01:13:43,920 --> 01:13:45,880
WE SOUGHT TO DEVELOP

1764
01:13:45,880 --> 01:13:46,680
NANOPARTICLE ANTAGONISTS TO

1765
01:13:46,680 --> 01:13:49,120
BLOCK THE SIGNALING OF THIS

1766
01:13:49,120 --> 01:13:50,880
RECEPTOR, AND HERE DEVELOPED

1767
01:13:50,880 --> 01:13:53,280
DIFFERENT ANTAGONISTS.

1768
01:13:53,280 --> 01:14:00,200
THEIN WHICH WE TOOK THE DENDROMR

1769
01:14:00,200 --> 01:14:03,000
PANAM AND CONJUGATED TO

1770
01:14:03,000 --> 01:14:04,560
CHOLESTEROL AND TO REDUCE

1771
01:14:04,560 --> 01:14:05,240
CELLULAR TOXICITY.

1772
01:14:05,240 --> 01:14:16,240
AND WE ENCANS L ENCAPSULATED --D

1773
01:14:16,600 --> 01:14:16,880
ASED3451.

1774
01:14:16,880 --> 01:14:19,480
THEY'RE LARGER THAN THE DIPMA

1775
01:14:19,480 --> 01:14:22,960
PARTICLES, ALMOST 200 NANOMETERS

1776
01:14:22,960 --> 01:14:24,120
IN DIAMETER, THEY HAVE A

1777
01:14:24,120 --> 01:14:25,280
POSITIVE CHARGE, AND WE CAN SEE

1778
01:14:25,280 --> 01:14:26,520
A SUSTAINED RELEASE OF CARGO

1779
01:14:26,520 --> 01:14:30,560
WHICH WAS QUANTIFIED BY H PLC.

1780
01:14:30,560 --> 01:14:33,000
HERE IT'S NOT PH DEPENDENT, BUT

1781
01:14:33,000 --> 01:14:34,160
THE KEY THING ABOUT THESE

1782
01:14:34,160 --> 01:14:35,360
PARTICLES IS THAT THEY CONTINUE

1783
01:14:35,360 --> 01:14:36,720
TO RELEASE DRUG FOR UP TO TWO

1784
01:14:36,720 --> 01:14:39,600
DAYS AND PROBABLY LONGER.

1785
01:14:39,600 --> 01:14:41,440
OFFERING THE POSSIBILITY OF

1786
01:14:41,440 --> 01:14:43,840
SUSTAINED ANTAGONISM OF THE

1787
01:14:43,840 --> 01:14:45,280
RECEPTOR.

1788
01:14:45,280 --> 01:14:47,440
LIKE THE DIPMA PARTICLES, THESE

1789
01:14:47,440 --> 01:14:48,880
PARTICLES WERE READILY TAKEN UP

1790
01:14:48,880 --> 01:14:50,680
INTO CELLS WHERE THEY

1791
01:14:50,680 --> 01:14:52,080
CO-LOCALIZED WITH A MARKER FOR

1792
01:14:52,080 --> 01:14:53,560
EARLY ENDOSOMES, AND WE KNOW

1793
01:14:53,560 --> 01:14:55,280
THESE EARLY ENDOSOMES CONTAIN

1794
01:14:55,280 --> 01:14:56,240
PAR 2.

1795
01:14:56,240 --> 01:15:00,160
AND BY USING THE NANOBIT BRET

1796
01:15:00,160 --> 01:15:03,520
ASSAY, WE OBSERVED THAT THESE

1797
01:15:03,520 --> 01:15:05,720
NANOPARTICLES STRONGLY INHIBITED

1798
01:15:05,720 --> 01:15:11,840
ASSEMBLY OF PAR 2 AND G ALPHA Q

1799
01:15:11,840 --> 01:15:14,440
SIGNALOSOMES AND END SOMES IN A

1800
01:15:14,440 --> 01:15:15,960
CONCENTRATION-DEPENDENT MANNER.

1801
01:15:15,960 --> 01:15:19,000
FINALLY WE EXAMINED THEIR

1802
01:15:19,000 --> 01:15:19,640
THERAPEUTIC EFFICACY.

1803
01:15:19,640 --> 01:15:21,200
IN THESE EXPERIMENTS, WE INDUCED

1804
01:15:21,200 --> 01:15:28,760
COLITIS IN MICE BY TREATING THEM

1805
01:15:28,760 --> 01:15:30,080
AND THEN ONCE INFLAMMATION WAS

1806
01:15:30,080 --> 01:15:32,480
ESTABLISHED WE MADE INTRACOLONIC

1807
01:15:32,480 --> 01:15:34,840
INJECTIONS OF FLUORESCENT

1808
01:15:34,840 --> 01:15:36,360
NANOPARTICLES OR NANOPARTICLES

1809
01:15:36,360 --> 01:15:38,320
CONTAINING THE ANTAGONIST.

1810
01:15:38,320 --> 01:15:40,160
WE NOTED THE FLUORESCENT

1811
01:15:40,160 --> 01:15:41,440
NANOPARTICLES SHOWN HERE IN RED

1812
01:15:41,440 --> 01:15:46,280
WERE MASSIVELY TAKEN UP BY

1813
01:15:46,280 --> 01:15:47,400
COLONOCYTES AND RETAINED UP TO

1814
01:15:47,400 --> 01:15:48,760
EIGHT HOURS, WHICH IS AS LONG AS

1815
01:15:48,760 --> 01:15:49,720
WE DID THE EXPERIMENT.

1816
01:15:49,720 --> 01:15:52,520
IN ASSAYS OF MECHANICAL

1817
01:15:52,520 --> 01:15:54,520
ALLODYNIA, WE FOUND THAT

1818
01:15:54,520 --> 01:15:57,480
INJECTION OF TNBS INTO THE COLON

1819
01:15:57,480 --> 01:15:59,880
CAUSES SUSTAINED MECHANICAL

1820
01:15:59,880 --> 01:16:02,920
ALLODYNIA, WHICH WAS STRONGLY

1821
01:16:02,920 --> 01:16:04,600
INHIBITED IN BLUE BY A

1822
01:16:04,600 --> 01:16:06,320
NANOPARTICLE CONTAINING A PAR

1823
01:16:06,320 --> 01:16:08,040
2 ANTAGONIST.

1824
01:16:08,040 --> 01:16:11,040
COLITIS ALSO REDUCED SPONTANEOUS

1825
01:16:11,040 --> 01:16:11,560
NOCICEPTIVE BEHAVIOR.

1826
01:16:11,560 --> 01:16:13,400
HERE WE MEASURED ABDOMINAL

1827
01:16:13,400 --> 01:16:15,240
GROOMING OF THE ANIMALS, AND THE

1828
01:16:15,240 --> 01:16:16,240
NANOPARTICLE COMPLETELY RESTORED

1829
01:16:16,240 --> 01:16:18,440
THIS BACK TO NORMAL.

1830
01:16:18,440 --> 01:16:25,640
AND NOTABLY, ASED3451 ALONE HAD

1831
01:16:25,640 --> 01:16:27,480
ABSOLUTELY NO EFFECT AND THESE

1832
01:16:27,480 --> 01:16:28,440
TREATMENTS ALSO PREVENTED

1833
01:16:28,440 --> 01:16:29,720
INFLAMMATION.

1834
01:16:29,720 --> 01:16:33,680
SO THIS SLIDE, THIS CARTOON

1835
01:16:33,680 --> 01:16:34,960
SUMMARIZES OUR UNDERSTANDING OF

1836
01:16:34,960 --> 01:16:37,600
RECEPTOR SIGNALING AND

1837
01:16:37,600 --> 01:16:38,680
ENDOSOMES.

1838
01:16:38,680 --> 01:16:40,440
SUBSTANCE P BINDS TO NEUROKIE

1839
01:16:40,440 --> 01:16:41,920
NIN ONE RECEPTOR, IT COUPLES THE

1840
01:16:41,920 --> 01:16:43,800
G PROTEINS AT THE PLASMA

1841
01:16:43,800 --> 01:16:45,920
MEMBRANE, IT IS PHOSPHORYLATED

1842
01:16:45,920 --> 01:16:48,240
BY A KINASE AND INTERACTS WITH

1843
01:16:48,240 --> 01:16:51,520
BEE TROA ARREST TINS.

1844
01:16:51,520 --> 01:16:54,480
BETRO ARREST TINS CAN DETERMINE

1845
01:16:54,480 --> 01:16:56,400
SIGNALING, THEY'RE ALSO ADAPTER

1846
01:16:56,400 --> 01:16:59,680
PROTEINS FOR AP2 AND CLATHRIN.

1847
01:16:59,680 --> 01:17:01,680
MEDIATING CLATHRIN DEPENDENT

1848
01:17:01,680 --> 01:17:03,480
INTERNALIZATION, AND ASSEMBLY OF

1849
01:17:03,480 --> 01:17:05,800
A LARGE SIGNALOSOME WHICH IS

1850
01:17:05,800 --> 01:17:07,520
RETAINED IN ENDOSOMES FOR

1851
01:17:07,520 --> 01:17:08,640
PROLONGED PERIODS, GIVING RISE

1852
01:17:08,640 --> 01:17:11,560
TO KINASES WHICH CAN TRANS

1853
01:17:11,560 --> 01:17:15,320
LOCATE TO THE NUCLEUS WHERE THEY

1854
01:17:15,320 --> 01:17:16,080
COULD REGULATE GENE

1855
01:17:16,080 --> 01:17:16,920
TRANSCRIPTION.

1856
01:17:16,920 --> 01:17:18,520
THEY ALSO ACTIVATE KINASES IN

1857
01:17:18,520 --> 01:17:20,400
THE CYTOSOL AND SECOND

1858
01:17:20,400 --> 01:17:22,240
MESSENGERS IN THE CYTOSOL WHICH

1859
01:17:22,240 --> 01:17:23,680
CAN SENSITIZE ION CHANNELS AND

1860
01:17:23,680 --> 01:17:26,400
THE SUSTAINED ENDOSOMAL

1861
01:17:26,400 --> 01:17:28,680
SIGNALING DRIVES LONG LASTING

1862
01:17:28,680 --> 01:17:30,880
NEURONAL EXCITATION AND

1863
01:17:30,880 --> 01:17:32,040
SUSTAINED NOCICEPTION IN ANIMAL

1864
01:17:32,040 --> 01:17:33,560
MODELS.

1865
01:17:33,560 --> 01:17:35,240
WE HAVE STUDIED THE IMPORTANCE

1866
01:17:35,240 --> 01:17:37,840
OF ENDOSOMAL SIGNALING AS I

1867
01:17:37,840 --> 01:17:39,560
DESCRIBED IN NEUROPATHIC AND

1868
01:17:39,560 --> 01:17:40,560
INFLAMMATORY PAIN.

1869
01:17:40,560 --> 01:17:41,760
WE'VE ALSO INVESTIGATED THE ROLE

1870
01:17:41,760 --> 01:17:45,920
OF ENDOSOMAL SIGNALING OF THE

1871
01:17:45,920 --> 01:17:47,360
CGLP RECEPTOR IN MIGRAINE PAIN

1872
01:17:47,360 --> 01:17:48,120
AND EVIDENCE THAT IT MAY

1873
01:17:48,120 --> 01:17:49,960
CONTRIBUTE TO THE PAIN

1874
01:17:49,960 --> 01:17:51,760
ASSOCIATED WITH INFLAMMATORY

1875
01:17:51,760 --> 01:17:53,400
BOWEL DISEASE AND IRRITABLE

1876
01:17:53,400 --> 01:17:56,920
BOWEL SYNDROME.

1877
01:17:56,920 --> 01:17:59,080
OUR RESULTS SUGGEST THAT

1878
01:17:59,080 --> 01:18:00,800
RECEPTORS IN ENDOSOMES CAN

1879
01:18:00,800 --> 01:18:02,880
GENERATE SUSTAINED SIGNALS IN

1880
01:18:02,880 --> 01:18:06,840
SUBCELLULAR COMPARTMENTS, THAT

1881
01:18:06,840 --> 01:18:09,160
TARGETING RECEPTORS IN ENDOSOMES

1882
01:18:09,160 --> 01:18:11,320
IS A NEW APPROACH FOR DRUG

1883
01:18:11,320 --> 01:18:13,080
DELIVERY, AND POSSIBLY A

1884
01:18:13,080 --> 01:18:14,800
THERAPEUTIC STRATEGY WITH BROAD

1885
01:18:14,800 --> 01:18:17,000
IMPLICATIONS, REMEMBERING THAT

1886
01:18:17,000 --> 01:18:19,400
30% OF DRUGS TARGET G PROTEIN

1887
01:18:19,400 --> 01:18:21,640
COUPLED RECEPTORS, AND IT RAISES

1888
01:18:21,640 --> 01:18:23,080
THE POSSIBILITY THAT THE

1889
01:18:23,080 --> 01:18:24,160
POSSIBILITY THAT FAILURE OF SOME

1890
01:18:24,160 --> 01:18:25,680
DRUGS IN CLINICAL TRIALS MAY BE

1891
01:18:25,680 --> 01:18:27,760
RELATED TO THEIR INABILITY TO

1892
01:18:27,760 --> 01:18:30,200
ENGAGE WITH RECEPTORS WHICH ARE

1893
01:18:30,200 --> 01:18:32,800
OFTEN, I BELIEVE, INTERNALIZED

1894
01:18:32,800 --> 01:18:34,200
DURING CHRONIC DISEASE AND

1895
01:18:34,200 --> 01:18:35,960
AGONIST GENERATION.

1896
01:18:35,960 --> 01:18:39,720
AND I WOULD LIKE TO CLOSE BY

1897
01:18:39,720 --> 01:18:43,280
THANKING MY COLLABORATORS, AND

1898
01:18:43,280 --> 01:18:44,200
I'M PARTICULARLY GRATEFUL FOR

1899
01:18:44,200 --> 01:18:45,600
FUNDING FROM THE NATIONAL

1900
01:18:45,600 --> 01:18:46,280
INSTITUTES OF HEALTH AND THE

1901
01:18:46,280 --> 01:18:49,400
HEAL INITIATIVE, THE DEPARTMENT

1902
01:18:49,400 --> 01:18:53,360
OF DEFENSE AND THE AUSTRALIAN

1903
01:18:53,360 --> 01:18:54,720
HEALTH AND AUSTRALIAN HEALTH

1904
01:18:54,720 --> 01:18:56,200
COUNCIL AND TO DISCLOSE THAT

1905
01:18:56,200 --> 01:18:59,560
FUNDING IN MY LAB IS SUPPORTED

1906
01:18:59,560 --> 01:19:09,760
IN PART BY TAKEDA AND -- ENDOSOE

1907
01:19:09,760 --> 01:19:10,440
THERAPEUTICS AND THANK YOU FOR

1908
01:19:10,440 --> 01:19:10,840
YOUR ATTENTION.

1909
01:19:10,840 --> 01:19:13,720
>>OKAY, WE'LL PAUSE FOR A

1910
01:19:13,720 --> 01:19:14,560
MINUTE AND THINK ABOUT THE

1911
01:19:14,560 --> 01:19:17,080
QUESTIONS YOU MIGHT WANT TO ASK.

1912
01:19:17,080 --> 01:19:18,720
DR. BUNNETT, WE'RE GOING TO HAVE

1913
01:19:18,720 --> 01:19:20,040
A Q & A AT THE END OF THE

1914
01:19:20,040 --> 01:19:20,560
SESSION.

1915
01:19:20,560 --> 01:19:22,520
AND WE'RE GOING TO TRANSITION

1916
01:19:22,520 --> 01:19:26,160
NOW TO A DIFFERENT FORM OF

1917
01:19:26,160 --> 01:19:27,120
INTERVENTION, AND IT'S MY

1918
01:19:27,120 --> 01:19:30,560
PLEASURE TO INTRODUCE

1919
01:19:30,560 --> 01:19:31,840
DR. SUSMITA KASHIKAR-ZUCK,

1920
01:19:31,840 --> 01:19:32,480
DISTINGUISHED CLINICAL

1921
01:19:32,480 --> 01:19:34,680
PSYCHOLOGIST AND PROFESSOR OF

1922
01:19:34,680 --> 01:19:36,560
PEDIATRICS AND CLINICAL

1923
01:19:36,560 --> 01:19:38,800
ANESTHESIOLOGY AT CINCINNATI

1924
01:19:38,800 --> 01:19:39,680
CHILDREN'S HOSPITAL MEDICAL

1925
01:19:39,680 --> 01:19:41,000
CENTER AND UNIVERSITY OF

1926
01:19:41,000 --> 01:19:43,200
CINCINNATI COLLEGE OF MEDICINE.

1927
01:19:43,200 --> 01:19:45,360
SUSMITA RESEARCHES PEDIATRIC

1928
01:19:45,360 --> 01:19:45,680
PAIN.

1929
01:19:45,680 --> 01:19:49,160
SHE IS THE FOUNDING PSYCHOLOGIST

1930
01:19:49,160 --> 01:19:51,360
OF THE MULTIDISCIPLINARY

1931
01:19:51,360 --> 01:19:53,520
PEDIATRIC PAIN CLINIC AT

1932
01:19:53,520 --> 01:19:54,120
CINCINNATI CHILDREN'S HOSPITAL

1933
01:19:54,120 --> 01:19:55,960
AND HOLDS POSITIONS AS ASSOCIATE

1934
01:19:55,960 --> 01:19:57,440
DIRECTOR OF THE PEDIATRIC PAIN

1935
01:19:57,440 --> 01:19:59,920
RESEARCH CENTER AND CO-DIRECTOR

1936
01:19:59,920 --> 01:20:02,160
OF THE NIAMS SUPPORTED CENTER

1937
01:20:02,160 --> 01:20:04,440
FOR CLINICAL RESEARCH.

1938
01:20:04,440 --> 01:20:06,400
SHE'S ALSO A PROLIFIC MENTOR AND

1939
01:20:06,400 --> 01:20:07,720
HAS CONTRIBUTED SIGNIFICANTLY TO

1940
01:20:07,720 --> 01:20:09,360
THE SUCCESS OF MANY PAIN

1941
01:20:09,360 --> 01:20:10,800
RESEARCHERS.

1942
01:20:10,800 --> 01:20:13,200
HER WORK FOCUSES ON COGNITIVE

1943
01:20:13,200 --> 01:20:15,600
BEHAVIORAL AND INTEGRATIVE

1944
01:20:15,600 --> 01:20:18,520
TREATMENTS FOR CHRONIC

1945
01:20:18,520 --> 01:20:21,040
MUSCULOSKELETAL PAIN IN

1946
01:20:21,040 --> 01:20:22,600
CHILDREN, AS WELL AS LONGITUDAL

1947
01:20:22,600 --> 01:20:24,400
STUDIES AND PATIENT-REPORTED

1948
01:20:24,400 --> 01:20:25,280
OUTCOME MEASURES.

1949
01:20:25,280 --> 01:20:28,360
TODAY SHE'LL PRESENT HER GROUND

1950
01:20:28,360 --> 01:20:30,000
BREAKING WORK ON THE

1951
01:20:30,000 --> 01:20:30,960
FIBROMYALGIA INTEGRATIVE

1952
01:20:30,960 --> 01:20:34,360
TRAINING TEAMS PROGRAM KNOWN AS

1953
01:20:34,360 --> 01:20:36,200
FIT TEAMS WHICH COMBINES

1954
01:20:36,200 --> 01:20:37,960
COGNITIVE BEHAVIORAL THERAPY AND

1955
01:20:37,960 --> 01:20:38,840
SPECIALIZED NEUROMUSCULAR

1956
01:20:38,840 --> 01:20:39,920
EXERCISE TRAINING FOR

1957
01:20:39,920 --> 01:20:41,880
ADOLESCENTS WITH JUVENILE

1958
01:20:41,880 --> 01:20:42,880
FIBROMYALGIA.

1959
01:20:42,880 --> 01:20:45,480
SHE'LL ALSO DISCUSS A LARGE

1960
01:20:45,480 --> 01:20:46,680
ONGOING MULTISITE TRIAL AND THE

1961
01:20:46,680 --> 01:20:47,360
POTENTIAL APPLICATION OF THIS

1962
01:20:47,360 --> 01:20:49,240
TREATMENT TO OTHER CHRONIC PAIN

1963
01:20:49,240 --> 01:20:57,560
CONDITIONS IN YOUTH.

1964
01:20:57,560 --> 01:20:58,680
>>THANK YOU FOR THAT

1965
01:20:58,680 --> 01:20:59,280
INTRODUCTION, MARK.

1966
01:20:59,280 --> 01:21:02,000
AND YEAH, A LITTLE CHANGE GEARS

1967
01:21:02,000 --> 01:21:03,640
HERE.

1968
01:21:03,640 --> 01:21:07,680
THAT WAS A FASCINATING

1969
01:21:07,680 --> 01:21:10,960
PRESENTATION, SO WE GO FROM

1970
01:21:10,960 --> 01:21:12,160
NANOPARTICLES AND RECEPTOR

1971
01:21:12,160 --> 01:21:14,560
SIGNALING AND NOW WE GO TO

1972
01:21:14,560 --> 01:21:16,760
TEENAGERS.

1973
01:21:16,760 --> 01:21:18,080
SO THANK YOU, FIRST OF ALL, FOR

1974
01:21:18,080 --> 01:21:19,600
INVITING ME TO PRESENT.

1975
01:21:19,600 --> 01:21:21,520
IT REALLY IS AN HONOR TO BE

1976
01:21:21,520 --> 01:21:23,480
HERE, AND REALLY, REALLY

1977
01:21:23,480 --> 01:21:26,040
ENERGIZING TO BE HERE IN PERSON

1978
01:21:26,040 --> 01:21:28,720
WITH SO MANY FANTASTIC

1979
01:21:28,720 --> 01:21:30,280
RESEARCHERS AND ATTENDEES.

1980
01:21:30,280 --> 01:21:32,800
AND FOR THOSE OF YOU WHO ARE

1981
01:21:32,800 --> 01:21:35,120
ATTENDING REMOTELY, PLEASE NOD

1982
01:21:35,120 --> 01:21:39,040
AND SMILE, AND WHEN I TALK, I

1983
01:21:39,040 --> 01:21:40,480
RESPOND TO AUDIENCE

1984
01:21:40,480 --> 01:21:41,440
PARTICIPATION BECAUSE I HAVE

1985
01:21:41,440 --> 01:21:45,360
PEOPLE HERE WHO NOD AND SMILE.

1986
01:21:45,360 --> 01:21:46,360
SO ANYWAY.

1987
01:21:46,360 --> 01:21:50,200
SO LET'S JUMP RIGHT IN HERE, AND

1988
01:21:50,200 --> 01:21:51,800
TALK ABOUT NON-PHARMACOLOGIC

1989
01:21:51,800 --> 01:21:53,360
THERAPIES FOR CHRONIC

1990
01:21:53,360 --> 01:21:54,040
MUSCULOSKELETAL PAIN IN

1991
01:21:54,040 --> 01:21:56,680
CHILDREN.

1992
01:21:56,680 --> 01:21:59,720
SO I HAVE SPENT THE LAST COUPLE

1993
01:21:59,720 --> 01:22:03,320
OF DECADES OF MY LIFE, OF MY

1994
01:22:03,320 --> 01:22:07,920
RESEARCH LIFE, REALLY STUDYING

1995
01:22:07,920 --> 01:22:08,800
FIBROMYALGIA SYNDROME IN

1996
01:22:08,800 --> 01:22:09,120
CHILDREN.

1997
01:22:09,120 --> 01:22:10,520
AND BELIEVE IT OR NOT, THERE IS

1998
01:22:10,520 --> 01:22:12,720
STILL SOME SKEPTICISM ABOUT

1999
01:22:12,720 --> 01:22:14,560
WHETHER CHILDREN CAN TRULY

2000
01:22:14,560 --> 01:22:15,760
SUFFER FROM SOME OF THE CHRONIC

2001
01:22:15,760 --> 01:22:18,240
PAIN CONDITIONS THAT MOST OF YOU

2002
01:22:18,240 --> 01:22:20,000
WHO ARE IN THE ADULT PAIN WORLD

2003
01:22:20,000 --> 01:22:22,440
PRETTY MUCH TAKE FOR GRANTED

2004
01:22:22,440 --> 01:22:24,800
THAT, YOU KNOW, ADULTS DO HAVE

2005
01:22:24,800 --> 01:22:25,920
FIBROMYALGIA, THEY DO HAVE

2006
01:22:25,920 --> 01:22:26,920
HEADACHES, THEY HAVE MIGRAINES,

2007
01:22:26,920 --> 01:22:30,680
THEY HAVE IBS AND OTHER THINGS.

2008
01:22:30,680 --> 01:22:31,720
CHRONIC PAIN CONDITIONS IN

2009
01:22:31,720 --> 01:22:36,960
CHILDREN ARE MORE RARE, BUT THEY

2010
01:22:36,960 --> 01:22:39,480
DO EXIST.

2011
01:22:39,480 --> 01:22:41,000
AND I THINK NICOLE DID A GREAT

2012
01:22:41,000 --> 01:22:44,280
JOB THIS MORNING TALKING TO US

2013
01:22:44,280 --> 01:22:48,120
ABOUT HOW WHEN CHRONIC PAIN

2014
01:22:48,120 --> 01:22:49,760
BEGINS IN CHILDHOOD AND LASTS

2015
01:22:49,760 --> 01:22:51,920
THROUGHOUT YOUNG ADULTHOOD AND

2016
01:22:51,920 --> 01:22:53,120
BEYOND, THERE IS REALLY A NEED

2017
01:22:53,120 --> 01:22:56,440
FOR US TO CATCH THESE SYNDROMES

2018
01:22:56,440 --> 01:22:58,200
EARLY AND REALLY HELP AS MUCH AS

2019
01:22:58,200 --> 01:23:03,960
WE POSSIBLY CAN.

2020
01:23:03,960 --> 01:23:06,880
SO JUST REAL QUICK DISCLOSURES,

2021
01:23:06,880 --> 01:23:09,480
I RECEIVE SUPPORT FROM THE NIH,

2022
01:23:09,480 --> 01:23:11,480
FROM THE CHILDHOOD ARTHRITIS AND

2023
01:23:11,480 --> 01:23:13,480
RHEUMATOLOGY RESEARCH ALLIANCE,

2024
01:23:13,480 --> 01:23:16,520
THE AR THRIET FOUNDATION, AND

2025
01:23:16,520 --> 01:23:17,840
CINCINNATI CHILDREN'S HOSPITAL

2026
01:23:17,840 --> 01:23:18,600
RESEARCH FOUNDATION FOR MY

2027
01:23:18,600 --> 01:23:20,320
RESEARCH.

2028
01:23:20,320 --> 01:23:23,840
AND MY OBJECTIVES TODAY ARE TO

2029
01:23:23,840 --> 01:23:26,400
DESCRIBE THE KEY COMPONENTS OF A

2030
01:23:26,400 --> 01:23:29,720
NOVEL NON-PHARMACOLOGIC

2031
01:23:29,720 --> 01:23:31,240
THERAPEUTIC APPROACH OF

2032
01:23:31,240 --> 01:23:34,320
MUSCULOSKELETAL PAIN, AND THEN

2033
01:23:34,320 --> 01:23:35,640
REALLY TALK -- THIS HAS BEEN A

2034
01:23:35,640 --> 01:23:36,720
WORK IN PROGRESS FOR SEVERAL

2035
01:23:36,720 --> 01:23:38,440
YEARS, SO I WANT TO TALK ABOUT

2036
01:23:38,440 --> 01:23:40,640
SORT OF THE CREATION, AND THEN

2037
01:23:40,640 --> 01:23:44,280
SORT OF THE RECREATION DURING

2038
01:23:44,280 --> 01:23:45,680
COVID OF THE FIT TEENS PROGRAM

2039
01:23:45,680 --> 01:23:48,440
FOR JUVENILE FIBROMYALGIA, AND

2040
01:23:48,440 --> 01:23:51,080
REALLY TRY TO DIVE A LITTLE BIT

2041
01:23:51,080 --> 01:23:54,320
DEEPER INTO HOW WE ARE TRYING TO

2042
01:23:54,320 --> 01:23:56,600
ADDRESS THE PSYCHOLOGICAL, THE

2043
01:23:56,600 --> 01:23:58,800
SOCIAL, AND THE PHYSICAL

2044
01:23:58,800 --> 01:24:00,880
COMPONENTS THAT WE CAN JOINTLY

2045
01:24:00,880 --> 01:24:02,600
ADDRESS AS PART OF THIS

2046
01:24:02,600 --> 01:24:05,680
INTEGRATED PROGRAM.

2047
01:24:05,680 --> 01:24:07,000
SO I'LL TALK ABOUT HOW WE

2048
01:24:07,000 --> 01:24:08,520
DEVELOP THE PROGRAM, SOME OF OUR

2049
01:24:08,520 --> 01:24:09,840
EARLY RESULTS, AND THEN TALK

2050
01:24:09,840 --> 01:24:11,240
ABOUT SORT OF HOW WE TRANSITION

2051
01:24:11,240 --> 01:24:13,560
TO A TELEHEALTH FORMAT DURING

2052
01:24:13,560 --> 01:24:16,920
COVID, AND THEN TALK ABOUT -- A

2053
01:24:16,920 --> 01:24:17,880
LITTLE BIT MORE ABOUT THE

2054
01:24:17,880 --> 01:24:18,680
PROGRESS OF THE TRIAL THAT WE

2055
01:24:18,680 --> 01:24:22,520
ARE DOING, AND THE

2056
01:24:22,520 --> 01:24:23,480
IMPLICATIONS OF HOW THIS COULD

2057
01:24:23,480 --> 01:24:25,240
REALLY INFORM CARE MOVING

2058
01:24:25,240 --> 01:24:29,800
FORWARD.

2059
01:24:29,800 --> 01:24:30,800
SO I LIKE THAT WE'RE TALKING

2060
01:24:30,800 --> 01:24:32,360
ABOUT MEDICATIONS AND DRUG

2061
01:24:32,360 --> 01:24:33,880
DEVELOPMENT, BECAUSE CLEARLY

2062
01:24:33,880 --> 01:24:34,960
THERE'S A LOT OF WORK GOING ON

2063
01:24:34,960 --> 01:24:37,600
IN THIS AREA, AND MORE IS

2064
01:24:37,600 --> 01:24:42,600
NEEDED, BUT FOR THE MOMENT, FOR

2065
01:24:42,600 --> 01:24:44,040
JUVENILE FIBROMYALGIA, THERE ARE

2066
01:24:44,040 --> 01:24:45,760
CURRENTLY NO FDA-APPROVED

2067
01:24:45,760 --> 01:24:47,840
MEDICATIONS, AND MEDICATIONS ARE

2068
01:24:47,840 --> 01:24:51,320
PRESCRIBED OFF LABEL FOR

2069
01:24:51,320 --> 01:24:53,440
CHILDREN, BUT YOU KNOW, THERE

2070
01:24:53,440 --> 01:24:55,320
REALLY ISN'T A VERY CONSISTENT

2071
01:24:55,320 --> 01:24:58,320
STANDARD OF CARE OR A LOT OF

2072
01:24:58,320 --> 01:25:02,040
REALLY GREAT TRIALS FOR DRUG

2073
01:25:02,040 --> 01:25:03,520
TREATMENT OF FIBROMYALGIA.

2074
01:25:03,520 --> 01:25:04,640
NOW, MANY OF OUR PATIENTS DO

2075
01:25:04,640 --> 01:25:07,080
COME IN, THEY'VE HAD TRIALS OF

2076
01:25:07,080 --> 01:25:09,000
DIFFERENT TYPES OF MEDICATIONS,

2077
01:25:09,000 --> 01:25:12,520
LOW DOSE TRY SICKLY MEDICATIONS,

2078
01:25:12,520 --> 01:25:14,480
ANALGESICS, NSAID-TYPE

2079
01:25:14,480 --> 01:25:16,240
MEDICATIONS, AND ALSO SOME

2080
01:25:16,240 --> 01:25:17,880
ANTICANTICONVULSANTS AND SO ON,D

2081
01:25:17,880 --> 01:25:22,120
WHAT WE FIND IS THAT MANY OF

2082
01:25:22,120 --> 01:25:23,320
THESE MEDICATIONS ARE NOT

2083
01:25:23,320 --> 01:25:25,080
TOLERATED VERY WELL IN THE LONG

2084
01:25:25,080 --> 01:25:26,400
TERM SO OFTENTIMES THERE ARE

2085
01:25:26,400 --> 01:25:29,440
CHANGES IN MEDICINES THAT HAPPEN

2086
01:25:29,440 --> 01:25:30,960
AND SO ON QUITE FREQUENTLY

2087
01:25:30,960 --> 01:25:32,720
BECAUSE THE LONG TERM EFFICACY,

2088
01:25:32,720 --> 01:25:34,120
WE REALLY DON'T KNOW A LOT

2089
01:25:34,120 --> 01:25:37,280
ABOUT, AND SO THERE IS A LOT OF

2090
01:25:37,280 --> 01:25:40,680
VARIATION IN DRUG THERAPIES FOR

2091
01:25:40,680 --> 01:25:41,440
JUVENILE FIBROMYALGIA.

2092
01:25:41,440 --> 01:25:43,080
NOW, ME AS A PSYCHOLOGIST AND

2093
01:25:43,080 --> 01:25:44,960
SOMEBODY WHO'S WORKING ON

2094
01:25:44,960 --> 01:25:46,200
NON-PHARMACOLOGIC APPROACHES,

2095
01:25:46,200 --> 01:25:47,800
IT'S LIKE HOW DO WE DEAL WITH

2096
01:25:47,800 --> 01:25:49,720
THIS WHEN WE ARE ALSO TRYING TO

2097
01:25:49,720 --> 01:25:51,040
DO BEHAVIORAL TREATMENTS AND

2098
01:25:51,040 --> 01:25:55,320
OTHER THINGS AT THE SAME TIME?

2099
01:25:55,320 --> 01:25:58,280
SO REALLY MY PHILOSOPHY HAS BEEN

2100
01:25:58,280 --> 01:25:59,600
WE NEED TO TRY TO DO THE BEST WE

2101
01:25:59,600 --> 01:26:00,880
CAN WITH THE MEDICINES THAT ARE

2102
01:26:00,880 --> 01:26:02,440
AVAILABLE AND I TRUST AND RELY

2103
01:26:02,440 --> 01:26:05,280
ON MY RHEUMATOLOGY AND PAIN

2104
01:26:05,280 --> 01:26:06,720
PHYSICIAN PARTNERS TO HELP WITH

2105
01:26:06,720 --> 01:26:08,680
GETTING US THE PATIENTS TO THE

2106
01:26:08,680 --> 01:26:10,640
BEST POINT THAT THEY CAN BE, AND

2107
01:26:10,640 --> 01:26:14,240
THEN WE START DEALING WITH A LOT

2108
01:26:14,240 --> 01:26:17,120
OF THESE BEHAVIORAL TREATMENTS

2109
01:26:17,120 --> 01:26:18,640
AND EXERCISE-BASED TREATMENTS

2110
01:26:18,640 --> 01:26:20,040
AND I'LL TALK ABOUT HOW WE'VE

2111
01:26:20,040 --> 01:26:22,240
SORT OF REALLY RAMPED UP AND

2112
01:26:22,240 --> 01:26:22,480
ENHANCED.

2113
01:26:22,480 --> 01:26:24,440
SO WHENEVER WE DO A TRIAL, WE

2114
01:26:24,440 --> 01:26:27,560
ALWAYS HAVE SORT OF A BASELINE

2115
01:26:27,560 --> 01:26:32,000
PERIOD WHERE WE GET PATIENTS

2116
01:26:32,000 --> 01:26:33,320
STABILIZED ON WHATEVER MEDICINES

2117
01:26:33,320 --> 01:26:34,480
THAT ARE WORKING BEST FOR THEM

2118
01:26:34,480 --> 01:26:36,120
AT THAT POINT IN TIME, AND THAT

2119
01:26:36,120 --> 01:26:38,520
CAN VARY FOR THEM, AND THEN IF

2120
01:26:38,520 --> 01:26:40,920
THE PATIENTS ARE STILL

2121
01:26:40,920 --> 01:26:42,360
EXPERIENCING MODERATE OR HIGHER

2122
01:26:42,360 --> 01:26:44,520
PAIN, SO THAT WOULD BE ON A ZERO

2123
01:26:44,520 --> 01:26:49,360
TO 10 SCALE OF 4 OR ABOVE, THEN

2124
01:26:49,360 --> 01:26:51,160
WE FIND THEM ELIGIBLE TO BE IN

2125
01:26:51,160 --> 01:26:53,400
THE TRIALS.

2126
01:26:53,400 --> 01:26:57,040
SO VERY EARLY, MY FIRST STUDY

2127
01:26:57,040 --> 01:26:59,440
WAS A CBT TRIAL WHERE WE

2128
01:26:59,440 --> 01:27:00,840
COMPARED COGNITIVE BEHAVIORAL

2129
01:27:00,840 --> 01:27:01,880
THERAPY AND SHOWED THAT IT WAS

2130
01:27:01,880 --> 01:27:03,480
MORE EFFECTIVE SO THIS WAS VERY

2131
01:27:03,480 --> 01:27:06,880
CONSISTENT WITH THE LITERATURE

2132
01:27:06,880 --> 01:27:09,520
IN ADULT CHRONIC PAIN OND SO ON

2133
01:27:09,520 --> 01:27:11,600
AND IN TERMS OF EFFECT SIZES WAS

2134
01:27:11,600 --> 01:27:12,560
PERHAPS EVEN A LITTLE MORE

2135
01:27:12,560 --> 01:27:15,760
EFFECTIVE IN IMPROVING

2136
01:27:15,760 --> 01:27:17,840
PAIN-RELATED DISABILITY, AND

2137
01:27:17,840 --> 01:27:20,000
DEPRESSIVE SYMPTOMS AND, TO SOME

2138
01:27:20,000 --> 01:27:21,400
EXTENT, PAIN, AND THE EFFECTS

2139
01:27:21,400 --> 01:27:22,200
WERE DURABLE.

2140
01:27:22,200 --> 01:27:23,200
SO THIS WAS GREAT.

2141
01:27:23,200 --> 01:27:25,280
WE HAD STATISTICALLY SIGNIFICANT

2142
01:27:25,280 --> 01:27:25,520
EFFECTS.

2143
01:27:25,520 --> 01:27:27,400
WE COULD HAVE JUST, YOU KNOW,

2144
01:27:27,400 --> 01:27:28,240
FINISHED WITH PUBLISHING THAT

2145
01:27:28,240 --> 01:27:31,000
TRIAL AND SAID YEAH, CBT IS

2146
01:27:31,000 --> 01:27:32,440
GREAT, AND MOVE ON.

2147
01:27:32,440 --> 01:27:34,920
THERE WERE OTHER STUDIES,

2148
01:27:34,920 --> 01:27:36,280
THOUGH, AEROBIC EXERCISE, THERE

2149
01:27:36,280 --> 01:27:38,000
WAS A SMALL TRIAL PUBLISHED

2150
01:27:38,000 --> 01:27:39,960
SHOWING THAT AEROBIC EXERCISE

2151
01:27:39,960 --> 01:27:42,680
WAS USEFUL IN PAIN REDUCTION IN

2152
01:27:42,680 --> 01:27:44,720
TEENAGERS WITH FIBROMYALGIA, AND

2153
01:27:44,720 --> 01:27:46,760
THEN THERE WERE SOME CLINICAL

2154
01:27:46,760 --> 01:27:50,760
SORT OF CASE STUDIES AND -- FROM

2155
01:27:50,760 --> 01:27:52,320
CLINICAL PROGRAMS SHOWING THAT

2156
01:27:52,320 --> 01:27:53,320
MULTIDISCIPLINARY TREATMENT

2157
01:27:53,320 --> 01:27:57,000
COULD BE HELPFUL IN REDUCING

2158
01:27:57,000 --> 01:28:04,120
PAIN AND DISABILITY.

2159
01:28:04,120 --> 01:28:09,280
HOWEVER, CBT WITH THE HELP OF MY

2160
01:28:09,280 --> 01:28:10,560
FELLOWS BECAUSE IT'S JUST ALWAYS

2161
01:28:10,560 --> 01:28:12,080
WONDERFUL TO HAVE FELLOWS WHO

2162
01:28:12,080 --> 01:28:13,200
ALWAYS HELP YOU LOOK AT YOUR

2163
01:28:13,200 --> 01:28:14,840
DATA AND THEN QUESTION THINGS,

2164
01:28:14,840 --> 01:28:16,680
THEY'RE LIKE, YEAH, CBT WAS

2165
01:28:16,680 --> 01:28:17,960
GREAT BUT THERE WERE PEOPLE THAT

2166
01:28:17,960 --> 01:28:19,720
DIDN'T IMPROVE AS MUCH AND

2167
01:28:19,720 --> 01:28:22,240
REALLY THE IMPROVEMENT IN PAIN

2168
01:28:22,240 --> 01:28:23,440
WAS STATISTICALLY SIGNIFICANT

2169
01:28:23,440 --> 01:28:25,440
BUT REALLY SOMEWHAT SMALL.

2170
01:28:25,440 --> 01:28:27,920
ON AVERAGE, THEY REDUCED, LET'S

2171
01:28:27,920 --> 01:28:31,360
SAY, FROM A PAIN LEVEL OF 6 OR

2172
01:28:31,360 --> 01:28:32,880
6.5 TO A 5.

2173
01:28:32,880 --> 01:28:33,400
OR SOMETHING.

2174
01:28:33,400 --> 01:28:34,400
IS THAT REALLY ENOUGH?

2175
01:28:34,400 --> 01:28:39,520
I MEAN, OUR PATIENTS ARE STILL

2176
01:28:39,520 --> 01:28:40,520
REALLY SUFFERING FROM A GOOD

2177
01:28:40,520 --> 01:28:43,120
AMOUNT OF PAIN ON A DAILY BASIS,

2178
01:28:43,120 --> 01:28:44,680
AND THE ONE THING WE DID DO IN

2179
01:28:44,680 --> 01:28:48,160
OUR TRIAL IS WE HAD PATIENTS

2180
01:28:48,160 --> 01:28:50,840
WHERE HIP-MOUNTED ACCELEROMETERS

2181
01:28:50,840 --> 01:28:52,200
AND AT THE END OF THE TRIAL,

2182
01:28:52,200 --> 01:28:53,520
WHEN WE WERE LOOKING AT THEIR

2183
01:28:53,520 --> 01:28:54,520
DATA BECAUSE THEY WERE TALKING

2184
01:28:54,520 --> 01:28:55,840
ABOUT HOW THEY WERE FUNCTIONING

2185
01:28:55,840 --> 01:28:57,240
BETTER IN THEIR DAILY LIVES,

2186
01:28:57,240 --> 01:29:00,120
GETTING BACK TO SCHOOL, GOING

2187
01:29:00,120 --> 01:29:01,440
OUT WITH THEIR FRIENDS, THINGS

2188
01:29:01,440 --> 01:29:05,160
LIKE THAT, WE WERE LIKE, OH, ALL

2189
01:29:05,160 --> 01:29:06,120
RIGHT, THIS SHOULD START SHOWING

2190
01:29:06,120 --> 01:29:08,040
UP ON THEIR ACTIVITY MONITORING,

2191
01:29:08,040 --> 01:29:12,240
BUT REALLY, WE COULDN'T FIND ANY

2192
01:29:12,240 --> 01:29:13,800
REAL DIFFERENCE IN THEIR

2193
01:29:13,800 --> 01:29:15,280
PARTICIPATION IN MODERATE OR

2194
01:29:15,280 --> 01:29:18,640
VIGOROUS PHYSICAL ACTIVITY.

2195
01:29:18,640 --> 01:29:20,200
YOU SHOULD MAYBE BE GETTING BACK

2196
01:29:20,200 --> 01:29:21,600
TO SOME SPORT AND SOME OTHER

2197
01:29:21,600 --> 01:29:22,960
ACTIVITIES BUT THAT WAS NOT

2198
01:29:22,960 --> 01:29:24,360
HAPPENING AFTER CBT.

2199
01:29:24,360 --> 01:29:25,360
NOW REMEMBER, THESE ARE ALL

2200
01:29:25,360 --> 01:29:26,120
PATIENTS THAT HAVE COME IN

2201
01:29:26,120 --> 01:29:27,320
THROUGH A CLINIC, THEY HAVE

2202
01:29:27,320 --> 01:29:28,880
RECEIVED RECOMMENDATIONS FOR

2203
01:29:28,880 --> 01:29:30,520
PHYSICAL THERAPY, THEY'VE BEEN

2204
01:29:30,520 --> 01:29:32,040
THROUGH PHYSICAL THERAPY, MANY

2205
01:29:32,040 --> 01:29:32,600
OF THEM.

2206
01:29:32,600 --> 01:29:34,720
BUT REALLY, WE COULD NOT GET

2207
01:29:34,720 --> 01:29:37,080
THEM TO PARTICIPATE IN EXERCISE

2208
01:29:37,080 --> 01:29:38,120
ON A REGULAR BASIS.

2209
01:29:38,120 --> 01:29:39,960
AND TO GET THAT LEVEL OF PAIN

2210
01:29:39,960 --> 01:29:41,480
CONTROL, WE HAVE TO FIGURE OUT

2211
01:29:41,480 --> 01:29:43,680
SOME WAY TO GET THEM ENGAGED IN

2212
01:29:43,680 --> 01:29:46,760
DOING THIS ON A MORE REGULAR

2213
01:29:46,760 --> 01:29:47,840
BASIS.

2214
01:29:47,840 --> 01:29:49,480
THE OTHER PIECE OF FEEDBACK THAT

2215
01:29:49,480 --> 01:29:53,080
WE WERE GETTING FROM OUR PATIENT

2216
01:29:53,080 --> 01:29:55,120
PARTICIPANTS WAS THAT, YOU KNOW,

2217
01:29:55,120 --> 01:29:57,040
THEY HAD A NICE RELATIONSHIP

2218
01:29:57,040 --> 01:29:59,000
WITH THEIR CBT THERAPIST AND SO

2219
01:29:59,000 --> 01:30:00,880
ON, BUT THEY REALLY TRULY STILL

2220
01:30:00,880 --> 01:30:02,720
FELT PRETTY ISOLATED IN THEIR

2221
01:30:02,720 --> 01:30:02,960
PAIN.

2222
01:30:02,960 --> 01:30:07,120
AND MANY OF THEM HAD SOCIALLY

2223
01:30:07,120 --> 01:30:08,120
WITHDRAWN BECAUSE IT WAS JUST SO

2224
01:30:08,120 --> 01:30:09,760
DIFFICULT FOR THEM TO KEEP UP

2225
01:30:09,760 --> 01:30:11,400
AND I THINK AS YOU HEARD NICOLE

2226
01:30:11,400 --> 01:30:14,000
TALK ABOUT, IT'S LIKE YOU FEEL

2227
01:30:14,000 --> 01:30:15,880
LIKE YOU'RE STIGMATIZED IN A

2228
01:30:15,880 --> 01:30:17,760
WAY, AND SO THEY WERE MISSING

2229
01:30:17,760 --> 01:30:20,480
OUT A LOT ON THE SOCIAL

2230
01:30:20,480 --> 01:30:24,200
COMPONENT.

2231
01:30:24,200 --> 01:30:25,920
SO THIS WAS SOMETHING I WAS JUST

2232
01:30:25,920 --> 01:30:28,120
MULLING OVER IN MY HEAD, AND,

2233
01:30:28,120 --> 01:30:29,520
YOU KNOW, READING THE LITERATURE

2234
01:30:29,520 --> 01:30:31,880
ABOUT FEAR OF MOVEMENT, THERE

2235
01:30:31,880 --> 01:30:35,240
ARE MODELS OF WHY PHYSICAL

2236
01:30:35,240 --> 01:30:37,560
ACTIVITY CAN BE SO DIFFICULT,

2237
01:30:37,560 --> 01:30:39,400
AND AS A BEHAVIORIST, YOU

2238
01:30:39,400 --> 01:30:40,840
UNDERSTAND YOU PAIR PHYSICAL

2239
01:30:40,840 --> 01:30:44,600
ACTIVITY WITH PAIN OFTEN ENOUGH,

2240
01:30:44,600 --> 01:30:47,000
AND ANY HUMAN OR OTHER ORGANISM

2241
01:30:47,000 --> 01:30:49,600
IS GOING TO STOP DOING THAT IF

2242
01:30:49,600 --> 01:30:52,440
IT IS CONSTANTLY PAIRED WITH

2243
01:30:52,440 --> 01:30:52,640
PAIN.

2244
01:30:52,640 --> 01:30:54,080
SO WE HAVE THIS FEAR OF PHYSICAL

2245
01:30:54,080 --> 01:30:56,280
ACTIVITY THAT GOES ON.

2246
01:30:56,280 --> 01:30:59,240
AND YES, THAT IS SORT OF A

2247
01:30:59,240 --> 01:31:00,320
PSYCHOLOGICAL BEHAVIORAL CONCEPT

2248
01:31:00,320 --> 01:31:01,960
IN A SENSE, BUT PHYSICALLY WHAT

2249
01:31:01,960 --> 01:31:05,560
IS GOING ON, AND I BEGAN TO

2250
01:31:05,560 --> 01:31:07,440
REALLY TRY TO UNDERSTAND HOW

2251
01:31:07,440 --> 01:31:09,400
SOME OF MY COLLEAGUES, AND THIS

2252
01:31:09,400 --> 01:31:11,040
KIND OF HAPPENED BY ACCIDENT, I

2253
01:31:11,040 --> 01:31:14,760
WAS HEARING SOME RESEARCH

2254
01:31:14,760 --> 01:31:16,200
PRESENTED BY COLLEAGUES IN

2255
01:31:16,200 --> 01:31:17,960
SPORTS MEDICINE, AND THEY ARE

2256
01:31:17,960 --> 01:31:19,720
HUMAN PERFORMANCE SPECIALISTS.

2257
01:31:19,720 --> 01:31:23,080
THEY REALLY UNDERSTAND PHYSICAL

2258
01:31:23,080 --> 01:31:24,720
MOVEMENT, EXERCISE, HOW THE

2259
01:31:24,720 --> 01:31:26,600
MUSCLES MOVE, THE BIOMECHANICS

2260
01:31:26,600 --> 01:31:29,120
OF MOVEMENT, AND IN THEIR INJURY

2261
01:31:29,120 --> 01:31:30,640
PREVENTION RESEARCH, THEY REALLY

2262
01:31:30,640 --> 01:31:33,840
WERE ADDRESSING, HOW DO WE GET

2263
01:31:33,840 --> 01:31:36,240
THE BODY TO PERFORM AND PEAK

2264
01:31:36,240 --> 01:31:37,240
PERFORMANCE WITHOUT HURTING

2265
01:31:37,240 --> 01:31:37,800
OURSELVES?

2266
01:31:37,800 --> 01:31:40,160
AND HERE I'M THINKING, WHY ARE

2267
01:31:40,160 --> 01:31:42,520
WE NOT IN OUR MUST C MUSCULOSKEL

2268
01:31:42,520 --> 01:31:44,040
PAIN RESEARCH THINKING MORE

2269
01:31:44,040 --> 01:31:45,720
ABOUT HOW PEOPLE ARE ACTUALLY

2270
01:31:45,720 --> 01:31:47,480
MOVING THEIR BODIES?

2271
01:31:47,480 --> 01:31:49,960
HOW YOU MOVE IN TERMS OF YOUR

2272
01:31:49,960 --> 01:31:51,920
COMPETENCE, YOUR EFFICACY FOR

2273
01:31:51,920 --> 01:31:54,000
MOVEMENT, IN A SENSE, WHICH I

2274
01:31:54,000 --> 01:31:55,680
FOUND THAT OUR TEENAGERS WERE

2275
01:31:55,680 --> 01:31:56,960
REALLY LOSING TRUST IN THEIR

2276
01:31:56,960 --> 01:31:58,200
BODIES WITH ALL THIS PAIN THEY

2277
01:31:58,200 --> 01:32:00,680
WERE EXPERIENCING EVERY TIME

2278
01:32:00,680 --> 01:32:02,560
THEY WOULD TRY TO DO PHYSICAL

2279
01:32:02,560 --> 01:32:04,960
THERAPY OR EXERCISE, AND IT JUST

2280
01:32:04,960 --> 01:32:05,400
HURT.

2281
01:32:05,400 --> 01:32:06,600
AND I WAS LIKE, THERE'S GOT TO

2282
01:32:06,600 --> 01:32:09,920
BE A BETTER WAY TO DO THIS.

2283
01:32:09,920 --> 01:32:14,720
AND HOW DO WE REALLY UNDERSTAND

2284
01:32:14,720 --> 01:32:16,360
HOW WE DEVELOP A REALLY

2285
01:32:16,360 --> 01:32:18,640
SPECIALIZED PROGRAM FOR THEM TO

2286
01:32:18,640 --> 01:32:20,960
REALLY INCORPORATE SOME OF THOSE

2287
01:32:20,960 --> 01:32:23,600
PSYCHOLOGICAL CONCEPT OF COPING

2288
01:32:23,600 --> 01:32:24,440
SKILLS TRAINING WITH MORE

2289
01:32:24,440 --> 01:32:26,160
MOVEMENT.

2290
01:32:26,160 --> 01:32:28,240
AND SO WE BROUGHT TEENAGERS IN

2291
01:32:28,240 --> 01:32:33,960
TO THE LAB AND STARTED DPSH -- E

2292
01:32:33,960 --> 01:32:36,200
WERE KIDS WITH FIBROMYALGIA AS

2293
01:32:36,200 --> 01:32:37,560
WELL AS HEALTHY CONTROLS, AND WE

2294
01:32:37,560 --> 01:32:39,000
START TODAY REALLY UNDERSTAND

2295
01:32:39,000 --> 01:32:40,200
THEIR MECHANICS OF MOVEMENT.

2296
01:32:40,200 --> 01:32:41,480
BECAUSE I WAS LIKE, WELL, LET'S

2297
01:32:41,480 --> 01:32:42,600
JUST LOOK AT WHAT HE WITH HAVE

2298
01:32:42,600 --> 01:32:43,920
HERE.

2299
01:32:43,920 --> 01:32:44,920
HAVE -- AT WHAT WE HAVE HERE.

2300
01:32:44,920 --> 01:32:46,640
SO IN OUR LAB AND IN

2301
01:32:46,640 --> 01:32:47,840
COLLABORATION WITH SPORTS

2302
01:32:47,840 --> 01:32:48,600
MEDICINE, THEY WERE KIND ENOUGH

2303
01:32:48,600 --> 01:32:50,800
TO LET ME USE THEIR 3D MOTION

2304
01:32:50,800 --> 01:32:53,800
CAPTURE EQUIPMENT, WE STARTED TO

2305
01:32:53,800 --> 01:32:57,160
DO MOTION ANALYSIS OF GAIT,

2306
01:32:57,160 --> 01:32:59,000
POSTURE, BALANCE, FUNCTIONAL

2307
01:32:59,000 --> 01:33:02,480
MOVEMENTS, SO WE PUT SENSORS

2308
01:33:02,480 --> 01:33:06,560
THAT WERE REFLECTIVE MARKERS ON

2309
01:33:06,560 --> 01:33:09,000
LIKE 36 OR 38 JOINTS OF THE

2310
01:33:09,000 --> 01:33:10,720
BODY, AND YOU KNOW, THERE ARE

2311
01:33:10,720 --> 01:33:12,800
CAMERAS ALL AROUND, SO THIS IS

2312
01:33:12,800 --> 01:33:14,080
ESSENTIALLY PIXAR TECHNOLOGY,

2313
01:33:14,080 --> 01:33:17,120
WE'RE TAKING A LOOK AT THEIR

2314
01:33:17,120 --> 01:33:19,520
MOVEMENT, AND WE HAD THEM WALK

2315
01:33:19,520 --> 01:33:20,840
ON FORCE PLATES THAT WERE, YOU

2316
01:33:20,840 --> 01:33:23,200
KNOW, CALCULATING GROUND

2317
01:33:23,200 --> 01:33:24,640
REACTION FORCES AS THEY WALKED,

2318
01:33:24,640 --> 01:33:26,600
LOOKING AT THEIR GAIT, HAD THEM

2319
01:33:26,600 --> 01:33:29,600
JUMP OFF A STANDARD BOX, AND

2320
01:33:29,600 --> 01:33:33,640
TAKING A LOOK AT SORT OF THEIR

2321
01:33:33,640 --> 01:33:34,600
MOVEMENT PATTERNS.

2322
01:33:34,600 --> 01:33:35,920
AND IF YOU LOOK AT THAT STICK

2323
01:33:35,920 --> 01:33:37,600
FIGURE THERE, YOU CAN LOOK AT

2324
01:33:37,600 --> 01:33:39,880
EVERY JOINT IN THE BODY IN TERMS

2325
01:33:39,880 --> 01:33:42,120
OF HOW IT'S MOVING.

2326
01:33:42,120 --> 01:33:43,640
YOU CAN LOOK AT THE KINETICS AND

2327
01:33:43,640 --> 01:33:48,280
THE KINEMATICS OF MOVEMENT.

2328
01:33:48,280 --> 01:33:50,200
AND AS YOU SEE THEY LAND ON THE

2329
01:33:50,200 --> 01:33:54,640
FORCE PLATES AND YOU CAN SEE HOW

2330
01:33:54,640 --> 01:33:56,560
MUCH NENGS SOME WAYS IS BEING

2331
01:33:56,560 --> 01:33:58,160
ABSORBED SO YOU CAN LOOK AT

2332
01:33:58,160 --> 01:34:00,480
ASYMMETRIES AND SO ON IN

2333
01:34:00,480 --> 01:34:00,800
MOVEMENT.

2334
01:34:00,800 --> 01:34:03,120
SO WE BEGAN TO DO SORT OF A DEEP

2335
01:34:03,120 --> 01:34:07,280
DIVE INTO THAT.

2336
01:34:07,280 --> 01:34:09,760
AND I WANTED TO SHOW YOU A

2337
01:34:09,760 --> 01:34:12,280
LITTLE BIT ABOUT HOW -- THIS IS

2338
01:34:12,280 --> 01:34:14,600
JUST ONE EXAMPLE OF ONE

2339
01:34:14,600 --> 01:34:15,080
MOVEMENT.

2340
01:34:15,080 --> 01:34:17,480
SO WE WERE LOOKING AT HIP

2341
01:34:17,480 --> 01:34:17,880
ABDUCTION.

2342
01:34:17,880 --> 01:34:21,480
SO WHEN YOU TALK ABOUT FEAR OF

2343
01:34:21,480 --> 01:34:22,840
MOVEMENT, OKAY, THAT, AGAIN, IS

2344
01:34:22,840 --> 01:34:25,760
A PSYCHOLOGICAL CONCEPT, AND IN

2345
01:34:25,760 --> 01:34:27,640
OUR JUVENILE FIBROMYALGIA

2346
01:34:27,640 --> 01:34:28,640
PATIENTS, THESE ARE PATIENTS WHO

2347
01:34:28,640 --> 01:34:29,600
ALREADY HAVE PAIN AND TO SOME

2348
01:34:29,600 --> 01:34:32,160
LEVEL HAVE FEAR OF MOVEMENT

2349
01:34:32,160 --> 01:34:35,640
ALREADY, BUT WE WERE ABLE TO

2350
01:34:35,640 --> 01:34:36,760
CATEGORIZE THOSE WHO WERE IN THE

2351
01:34:36,760 --> 01:34:46,080
HIGHEST AND THE LOWEST TERTILES,

2352
01:34:46,080 --> 01:34:47,640
AND SO WE LOOKED AT LOTS OF

2353
01:34:47,640 --> 01:34:50,360
DIFFERENT JOINT ANGLES BUT I

2354
01:34:50,360 --> 01:34:51,560
JUST WANTED TO SHOW YOU THE

2355
01:34:51,560 --> 01:34:52,080
HIPS.

2356
01:34:52,080 --> 01:34:54,080
WE LOOKED AT KNEES, ANKLES AND

2357
01:34:54,080 --> 01:34:56,160
UPPER BODY MECHANICS AS WELL,

2358
01:34:56,160 --> 01:34:58,600
BUT IF YOU LOOK AT THE HIGH FEAR

2359
01:34:58,600 --> 01:34:59,920
OF MOVEMENT, SO THAT IS SORT OF

2360
01:34:59,920 --> 01:35:02,440
THE BLUE LINE ON THE LEFT SET OF

2361
01:35:02,440 --> 01:35:05,120
GRAPHS, YOU HAVE THOSE WHO HAVE

2362
01:35:05,120 --> 01:35:08,560
LOW FEAR OF MOVEMENT, SO OKAY,

2363
01:35:08,560 --> 01:35:10,680
SO HIP ABDUCTION IS THINK ABOUT

2364
01:35:10,680 --> 01:35:12,560
MAKING SNOW ANGELS, ALL RIGHT,

2365
01:35:12,560 --> 01:35:14,200
WHEN YOU'RE MOVING YOUR FEET

2366
01:35:14,200 --> 01:35:15,920
AWAY FROM THE MIDLINE, THAT'S

2367
01:35:15,920 --> 01:35:18,240
YOUR HIP ABDUCTORS DOING THE

2368
01:35:18,240 --> 01:35:18,480
MOVEMENT.

2369
01:35:18,480 --> 01:35:22,400
AND SO THIS WAS THE TASK WHICH I

2370
01:35:22,400 --> 01:35:23,280
JUST SHOWED YOU THAT LITTLE

2371
01:35:23,280 --> 01:35:24,920
STICK FIGURE, THEY SORT OF JUMP

2372
01:35:24,920 --> 01:35:26,600
OFF A BOX, LAND ON THE FORCE

2373
01:35:26,600 --> 01:35:28,520
PLATES AND THEN JUMP UP AGAIN.

2374
01:35:28,520 --> 01:35:30,240
NOW, THOSE WITH LOWER FEAR OF

2375
01:35:30,240 --> 01:35:32,520
MOVEMENT, YOU SEE SORT OF THIS

2376
01:35:32,520 --> 01:35:36,560
NICE SMOOTH ACTION OF THE HIP

2377
01:35:36,560 --> 01:35:37,680
ABDUCTORS AS YOU JUMP OFF THAT

2378
01:35:37,680 --> 01:35:39,160
BOX, AND THEN YOU'RE ABSORBING

2379
01:35:39,160 --> 01:35:42,280
THE FORCES AS YOU LAND, AND THE

2380
01:35:42,280 --> 01:35:44,800
LOWER LINE WHICH IS SORT OF THAT

2381
01:35:44,800 --> 01:35:49,520
PINK LINE IS KIND OF THIS THUMP

2382
01:35:49,520 --> 01:35:49,960
ACTION.

2383
01:35:49,960 --> 01:35:53,360
LIKE YOU KIND OF JUMP OFF THE

2384
01:35:53,360 --> 01:35:54,680
BOX BUT YOU'RE JUST FALLING IN

2385
01:35:54,680 --> 01:35:55,880
THIS LIKE REALLY FLAT WAY, WHICH

2386
01:35:55,880 --> 01:35:57,640
IS REALLY NOT ABSORBING, YOU

2387
01:35:57,640 --> 01:35:59,840
KNOW, YOU'RE NOT DOING ANY SHOCK

2388
01:35:59,840 --> 01:36:01,160
ABSORPTION IN A WAY BY LANDING

2389
01:36:01,160 --> 01:36:02,120
IN THAT FASHION.

2390
01:36:02,120 --> 01:36:04,760
THAT IS AN INJURY-PRONE WAY OF

2391
01:36:04,760 --> 01:36:05,440
DOING SOMETHING.

2392
01:36:05,440 --> 01:36:06,720
AND SO WHEN YOU THINK ABOUT FEAR

2393
01:36:06,720 --> 01:36:10,920
OF MOVEMENTS AND HOW PEOPLE

2394
01:36:10,920 --> 01:36:12,200
MIGHT BE ACTUALLY CHANGING THE

2395
01:36:12,200 --> 01:36:13,120
WAY THEY MOVE IN RESPONSE TO

2396
01:36:13,120 --> 01:36:16,960
THIS FEAR OF MOVEMENT, YOU CAN

2397
01:36:16,960 --> 01:36:19,560
SEE HOW THESE MECHANICS MIGHT

2398
01:36:19,560 --> 01:36:20,440
ACTUALLY CHANGE.

2399
01:36:20,440 --> 01:36:23,720
NOW, ON THE RIGHT SIDE ON THE

2400
01:36:23,720 --> 01:36:25,040
TOP SET OF GRAPH, YOU HAVE THE

2401
01:36:25,040 --> 01:36:27,640
LOW FEAR OF MOVEMENT, WHICH IS

2402
01:36:27,640 --> 01:36:29,880
BLUE, AND SO WE LOOKED AT THE

2403
01:36:29,880 --> 01:36:31,720
DOMINANT AND THE NON-DOMINANT

2404
01:36:31,720 --> 01:36:34,480
SIDE.

2405
01:36:34,480 --> 01:36:35,920
SO IF YOUR RIGHT LEG IS

2406
01:36:35,920 --> 01:36:38,760
DOMINANT, WE WERE LOOKING AT THE

2407
01:36:38,760 --> 01:36:40,840
CONNECTION BETWEEN THE

2408
01:36:40,840 --> 01:36:41,920
SYMMETRIES IN YOUR MOVEMENT

2409
01:36:41,920 --> 01:36:42,560
PATTERNS.

2410
01:36:42,560 --> 01:36:44,480
AND YOU LOOK AT THE LOW FEAR OF

2411
01:36:44,480 --> 01:36:45,800
MOVEMENT, YOU CAN SEE THAT THE

2412
01:36:45,800 --> 01:36:49,960
LEFT AND THE RIGHT ARE FAIRLY

2413
01:36:49,960 --> 01:36:50,720
SYMMETRIC BUT WHEN YOU LOOK AT

2414
01:36:50,720 --> 01:36:52,240
THE BOTTOM GRAPH, THE HIGH FEAR

2415
01:36:52,240 --> 01:36:55,000
OF MOVEMENT, YOU WILL SEE AN

2416
01:36:55,000 --> 01:36:58,160
ASYMMETRY.

2417
01:36:58,160 --> 01:37:00,360
SO THOSE -- THE DOMINANT AND THE

2418
01:37:00,360 --> 01:37:01,360
NON-DOMINANT SIDE ARE DOING

2419
01:37:01,360 --> 01:37:02,240
SOMETHING A LITTLE BIT

2420
01:37:02,240 --> 01:37:02,800
DIFFERENT.

2421
01:37:02,800 --> 01:37:04,960
SO REALLY WHAT YOU'RE FINDING IS

2422
01:37:04,960 --> 01:37:07,680
IT'S THE NON-DOMINANT SIDE THAT

2423
01:37:07,680 --> 01:37:09,440
IS DRIVING THESE DIFFERENCES

2424
01:37:09,440 --> 01:37:11,440
BETWEEN THE HIGH AND LOW FEAR OF

2425
01:37:11,440 --> 01:37:12,200
MOVEMENT CATEGORIES.

2426
01:37:12,200 --> 01:37:13,880
SO IN THE HIGH FEAR OF MOVEMENT,

2427
01:37:13,880 --> 01:37:15,960
THEY'RE MOVING IN AN ASYMMETRIC

2428
01:37:15,960 --> 01:37:17,160
PATTERN, WHICH IF YOU LOOK AT

2429
01:37:17,160 --> 01:37:18,360
THE SKELETON ON THE RIGHT SIDE,

2430
01:37:18,360 --> 01:37:21,760
YOU CAN SEE HOW WHEN YOU HAVE NA

2431
01:37:21,760 --> 01:37:23,080
SORT OF ASYMMETRY, THE KNEE

2432
01:37:23,080 --> 01:37:25,400
COMES IN IN THIS VALGUS POSITION

2433
01:37:25,400 --> 01:37:28,080
WHICH, AGAIN, IS AN ASYMMETRIC

2434
01:37:28,080 --> 01:37:29,840
INJURY-PRONE WAY OF BEHAVING.

2435
01:37:29,840 --> 01:37:34,880
SO IN OUR PROGRAM, WE ARE REALLY

2436
01:37:34,880 --> 01:37:36,880
INCORPORATING THE PSYCHOLOGICAL

2437
01:37:36,880 --> 01:37:38,200
ASPECTS, YOU'VE HEARD A LOT

2438
01:37:38,200 --> 01:37:40,480
ABOUT RESILIENCE TRAINING,

2439
01:37:40,480 --> 01:37:41,600
COPING SKILLS TRAINING AND SO

2440
01:37:41,600 --> 01:37:43,480
ON, USING THAT, AND USING A

2441
01:37:43,480 --> 01:37:44,920
SPECIALIZED FORM OF

2442
01:37:44,920 --> 01:37:48,840
NEUROMUSCULAR TRAINING, WHICH

2443
01:37:48,840 --> 01:37:50,160
INVOLVES CORE STRENGTH

2444
01:37:50,160 --> 01:37:51,360
EXERCISES, WAYS TO CORRECT THESE

2445
01:37:51,360 --> 01:37:53,880
SORTS OF ASYMMETRIES, SO THAT

2446
01:37:53,880 --> 01:37:55,440
PEOPLE CAN IMPROVE THEIR

2447
01:37:55,440 --> 01:37:57,000
FUNDAMENTAL MOVEMENTS.

2448
01:37:57,000 --> 01:37:58,760
SO IT IS EXERCISE TRAINING BUT

2449
01:37:58,760 --> 01:37:59,880
IT'S DONE IN A SLIGHTLY

2450
01:37:59,880 --> 01:38:03,720
DIFFERENT WAY.

2451
01:38:03,720 --> 01:38:10,400
SO WE BEGAN THIS COLLABORATION

2452
01:38:10,400 --> 01:38:11,400
AND ALSO INCORPORATING PATIENT

2453
01:38:11,400 --> 01:38:13,800
FEEDBACK TO REALLY BRING THE

2454
01:38:13,800 --> 01:38:15,040
PSYCHOLOGICAL COPING SKILLS

2455
01:38:15,040 --> 01:38:17,080
TOGETHER WITH THE NEUROMUSCULAR

2456
01:38:17,080 --> 01:38:18,520
EXERCISES AND WE DO THIS IN A

2457
01:38:18,520 --> 01:38:22,760
GROUP FORMAT TO DEAL WITH THAT

2458
01:38:22,760 --> 01:38:23,640
SOCIAL ENGAGEMENT THAT THEY'RE

2459
01:38:23,640 --> 01:38:24,000
MISSING.

2460
01:38:24,000 --> 01:38:28,520
SO WE HAVE GROUPS OF PATIENTS,

2461
01:38:28,520 --> 01:38:29,920
FOUR TO SIX IN A GROUP, WHERE WE

2462
01:38:29,920 --> 01:38:30,920
DELIVER THE TRAINING.

2463
01:38:30,920 --> 01:38:32,440
IT'S AN 8-WEEK PROTOCOL.

2464
01:38:32,440 --> 01:38:34,440
THEY COME IN TWICE A WEEK OR AT

2465
01:38:34,440 --> 01:38:36,080
LEAST THEY COME IN NOW VIRTUALLY

2466
01:38:36,080 --> 01:38:39,280
TWICE A WEEK, AND IT'S LED BY A

2467
01:38:39,280 --> 01:38:40,440
PSYCHOLOGY AND AN EXERCISE

2468
01:38:40,440 --> 01:38:40,840
TRAINER.

2469
01:38:40,840 --> 01:38:41,960
I WANT TO TALK A LITTLE BIT

2470
01:38:41,960 --> 01:38:45,000
ABOUT THE NEUROMUSCULAR TRAIN 

2471
01:38:45,000 --> 01:38:45,680
TRAINING.

2472
01:38:45,680 --> 01:38:47,680
THE CBT TECHNIQUES ARE FAIRLY

2473
01:38:47,680 --> 01:38:51,320
SPHSTANDARD BUT IT'S DEVELOPED A

2474
01:38:51,320 --> 01:38:52,440
GROUP FORMAT.

2475
01:38:52,440 --> 01:38:54,080
BUT THE NEUROMUSCULAR TRAINING

2476
01:38:54,080 --> 01:38:55,840
FOLLOWS A VERY SYSTEMATIC

2477
01:38:55,840 --> 01:38:58,600
PROGRESSIVE TYPE OF EXERCISE

2478
01:38:58,600 --> 01:38:59,840
TRAINING.

2479
01:38:59,840 --> 01:39:01,240
THE FIRST TWO WEEKS, THEY REALLY

2480
01:39:01,240 --> 01:39:04,000
JUST LEARN THE ISOMETRIC HOLDS,

2481
01:39:04,000 --> 01:39:06,040
HOW DO YOU HOLD PROPER FORM.

2482
01:39:06,040 --> 01:39:10,080
THE SECOND WEEK, OR RATHER THE

2483
01:39:10,080 --> 01:39:12,280
SECOND SET, TWO WEEKS, IS THE

2484
01:39:12,280 --> 01:39:13,840
CONCENTRIC OR CREATING MOVEMENT.

2485
01:39:13,840 --> 01:39:15,800
THEN WE HAVE THE ECCENTRIC

2486
01:39:15,800 --> 01:39:17,120
MOVEMENTS, AND THEN THE FULL

2487
01:39:17,120 --> 01:39:18,440
FUNCTIONAL MOVEMENTS.

2488
01:39:18,440 --> 01:39:19,880
AND REALLY, THE REASON THIS IS

2489
01:39:19,880 --> 01:39:24,040
DONE IS THAT IT ACTUALLY IS

2490
01:39:24,040 --> 01:39:26,000
KNOWN TO HELP REDUCE DELAYED

2491
01:39:26,000 --> 01:39:27,640
ONSET MUSCLE SORENESS, WHICH CAN

2492
01:39:27,640 --> 01:39:29,680
LEAD TO FIBROMYALGIA PATIENTS

2493
01:39:29,680 --> 01:39:31,680
THINKING THAT THIS IS A PAIN

2494
01:39:31,680 --> 01:39:32,560
FLARE-UP.

2495
01:39:32,560 --> 01:39:34,080
SO THEY'RE MOVING MUSCLES THAT

2496
01:39:34,080 --> 01:39:35,520
THEY'RE NOT USED TO MOVING, BUT

2497
01:39:35,520 --> 01:39:37,280
WE DO IT IN THIS PROGRESSIVE

2498
01:39:37,280 --> 01:39:39,600
FASHION SO THAT IT IS HUGELY

2499
01:39:39,600 --> 01:39:42,800
MORE TOLERABLE FOR THEM.

2500
01:39:42,800 --> 01:39:45,640
AND THEN THEY SLOWLY START TO

2501
01:39:45,640 --> 01:39:50,480
INCORPORATE MORE AEROBIC TYPES

2502
01:39:50,480 --> 01:39:51,280
OF PHYSICAL ACTIVITY LATER IN

2503
01:39:51,280 --> 01:39:51,680
THE PROGRAM.

2504
01:39:51,680 --> 01:39:53,200
SO THIS IS JUST BASICALLY WHAT

2505
01:39:53,200 --> 01:39:54,200
THE SESSIONS LOOK LIKE WHETHER

2506
01:39:54,200 --> 01:39:55,640
THEY WERE IN PERSON.

2507
01:39:55,640 --> 01:39:59,760
WE DID OUR PHASE ONE FEASIBILITY

2508
01:39:59,760 --> 01:40:01,200
TESTING, AND GOT SOME REALLY

2509
01:40:01,200 --> 01:40:02,880
EXCELLENT FEEDBACK ABOUT THE

2510
01:40:02,880 --> 01:40:03,960
THINGS THEY LIKED AND DIDN'T

2511
01:40:03,960 --> 01:40:05,160
LIKE ABOUT THE PROGRAM, BUT JUST

2512
01:40:05,160 --> 01:40:08,440
IN GENERAL, THERE WAS A

2513
01:40:08,440 --> 01:40:09,840
TREMENDOUS AMOUNT OF ENTHUSIASM

2514
01:40:09,840 --> 01:40:11,200
FROM THE PARTICIPANTS AND THEY

2515
01:40:11,200 --> 01:40:13,200
WERE REPORTING FEELING LESS

2516
01:40:13,200 --> 01:40:14,800
TIGHT, LESS IN PAIN, THEY WERE

2517
01:40:14,800 --> 01:40:16,160
NOT SLEEPING ALL THE TIME, THEY

2518
01:40:16,160 --> 01:40:17,880
WERE MOVING MORE, THEY FELT MORE

2519
01:40:17,880 --> 01:40:19,320
TRUST IN THEIR BODY BY THE END

2520
01:40:19,320 --> 01:40:23,280
OF TREATMENT, AND THEY REALLY

2521
01:40:23,280 --> 01:40:24,280
ENJOYED THE SOCIAL COMPONENT OF

2522
01:40:24,280 --> 01:40:27,080
BEING WITH OTHERS WHO HAD

2523
01:40:27,080 --> 01:40:29,640
CHRONIC PAIN FROM FIBROMYALGIA.

2524
01:40:29,640 --> 01:40:31,920
WE DID A PHASE TWO TRIAL WHERE

2525
01:40:31,920 --> 01:40:34,040
WE COMPARED SORT OF OUR STANDARD

2526
01:40:34,040 --> 01:40:38,360
CBT APPROACH IN A GROUP FORMAT

2527
01:40:38,360 --> 01:40:40,200
AND COMPARED THAT WITH THIS

2528
01:40:40,200 --> 01:40:41,920
COMBINED FIT TEENS PROGRAM WITH

2529
01:40:41,920 --> 01:40:44,200
THE NEUROMUSCULAR TRAINING AND

2530
01:40:44,200 --> 01:40:45,720
CBT, AND WE ASSESSED THEM AT THE

2531
01:40:45,720 --> 01:40:50,320
END OF TREATMENT AND THEN THERE

2532
01:40:50,320 --> 01:40:51,520
WAS NOTHING, THERE WERE NO

2533
01:40:51,520 --> 01:40:52,640
SESSIONS, AND THEN AFTER THREE

2534
01:40:52,640 --> 01:40:55,200
MONTHS, WE DID A FOLLOW-UP,

2535
01:40:55,200 --> 01:40:55,840
THREE-MONTH FOLLOW-UP ASSESSMENT

2536
01:40:55,840 --> 01:40:56,920
WITH THEM.

2537
01:40:56,920 --> 01:40:58,680
AND IN TERMS OF FUNCTIONAL

2538
01:40:58,680 --> 01:41:01,120
DISABILITY USING THE FUNCTIONAL

2539
01:41:01,120 --> 01:41:01,880
DISABILITY INVENTORY WHICH IS

2540
01:41:01,880 --> 01:41:05,600
THE STANDARD IN THE FIELD, WE

2541
01:41:05,600 --> 01:41:07,040
FOUND THERE WAS RELATIVELY

2542
01:41:07,040 --> 01:41:10,680
MINIMAL CHANGE IN THE CBT GROUP,

2543
01:41:10,680 --> 01:41:12,560
WHICH ACTUALLY, OVER TIME, CBT

2544
01:41:12,560 --> 01:41:14,960
DOES HAVE MORE OF AN EFFECT, AND

2545
01:41:14,960 --> 01:41:15,800
WE'VE HAD EXPERIENCE THAT THAT

2546
01:41:15,800 --> 01:41:17,480
WILL GO DOWN A LITTLE BIT, BUT

2547
01:41:17,480 --> 01:41:19,360
WHAT WE FOUND WAS A VERY QUICK

2548
01:41:19,360 --> 01:41:21,360
REDUCTION IN FUNCTIONAL

2549
01:41:21,360 --> 01:41:22,600
DISABILITY AND THAT'S SUSTAINED

2550
01:41:22,600 --> 01:41:24,280
OVER TIME.

2551
01:41:24,280 --> 01:41:26,400
WE FOUND A MUCH GREATER PAIN

2552
01:41:26,400 --> 01:41:27,840
REDUCTION THAT WAS SIGNIFICANT

2553
01:41:27,840 --> 01:41:29,480
AND MUCH GREATER THAN WHAT WE

2554
01:41:29,480 --> 01:41:32,520
HAD PREVIOUSLY FOUND WITH CBT

2555
01:41:32,520 --> 01:41:32,960
ONLY.

2556
01:41:32,960 --> 01:41:36,080
AND WE'RE NOW DOING A PHASE

2557
01:41:36,080 --> 01:41:38,480
3 MULTISITE RANDOMIZED TRIAL.

2558
01:41:38,480 --> 01:41:43,040
SO WE HAVE SIX SITES, AND WE

2559
01:41:43,040 --> 01:41:45,280
HAVE RANDOMIZED OVER 300 --

2560
01:41:45,280 --> 01:41:47,040
WELL, WE'VE GOT 390 PATIENTS

2561
01:41:47,040 --> 01:41:50,000
ENROLLED IN THE TRIAL RIGHT NOW,

2562
01:41:50,000 --> 01:41:52,120
AND WE'RE COMING TOWARDS THE END

2563
01:41:52,120 --> 01:41:52,560
OF THE TRIAL.

2564
01:41:52,560 --> 01:41:53,960
SO THEN THEY GET ASSESSED AT THE

2565
01:41:53,960 --> 01:41:55,280
END OF TREATMENT AND THEN WE

2566
01:41:55,280 --> 01:41:58,040
HAVE BOOSTERS, AND WE'RE

2567
01:41:58,040 --> 01:41:59,360
FOLLOWING THEM ALL THE WAY INTO

2568
01:41:59,360 --> 01:42:01,000
ONE YEAR, BECAUSE THE IDEA IS

2569
01:42:01,000 --> 01:42:02,880
NOT JUST TO SEE WHETHER

2570
01:42:02,880 --> 01:42:04,400
FUNCTIONAL DISABILITIES IMPROVE,

2571
01:42:04,400 --> 01:42:06,680
BUT ALSO WHETHER PAIN

2572
01:42:06,680 --> 01:42:07,480
INTENSITIES IMPROVE AND WHETHER

2573
01:42:07,480 --> 01:42:10,560
WE CAN SUSTAIN IT OVER TIME.

2574
01:42:10,560 --> 01:42:13,400
AND DUE TO THE COVID

2575
01:42:13,400 --> 01:42:14,800
RESTRICTIONS, WHICH HIT US RIGHT

2576
01:42:14,800 --> 01:42:16,400
WHEN WE WERE ALMOST MID-WAY

2577
01:42:16,400 --> 01:42:20,120
THROUGH THE TRIAL, WE CONVERTED

2578
01:42:20,120 --> 01:42:21,600
THIS ALL INTO A REMOTE FORMAT,

2579
01:42:21,600 --> 01:42:23,080
AND THAT WAS A JOURNEY THAT I

2580
01:42:23,080 --> 01:42:29,000
WILL SAVE FOR ANOTHER DAY.

2581
01:42:29,000 --> 01:42:30,840
BUT REALLY WE DID A LOT OF

2582
01:42:30,840 --> 01:42:32,840
PILOTING TO SEE IF WE COULD

2583
01:42:32,840 --> 01:42:34,280
SAFELY DELIVER THIS TREATMENT IN

2584
01:42:34,280 --> 01:42:36,080
TELEHEALTH FORMAT, AND THE SHORT

2585
01:42:36,080 --> 01:42:37,280
ANSWER IS YES, WE WERE ABLE TO

2586
01:42:37,280 --> 01:42:39,600
DO IT, AND WE HAVE FANTASTIC

2587
01:42:39,600 --> 01:42:40,680
ENGAGEMENT.

2588
01:42:40,680 --> 01:42:42,440
THE TEENS WERE, BY THEN, YOU

2589
01:42:42,440 --> 01:42:44,000
KNOW, THEY ARE DIGITAL NATIVES.

2590
01:42:44,000 --> 01:42:44,760
FOR THEM THIS WAS FINE.

2591
01:42:44,760 --> 01:42:46,400
IT TOOK US A WHILE TO MAKE SURE

2592
01:42:46,400 --> 01:42:50,800
WE STANDARDIZED OUR PROTOCOL,

2593
01:42:50,800 --> 01:42:52,360
AND WITH EACH EXERCISE THAT WE

2594
01:42:52,360 --> 01:42:54,960
HAD IN PERSON, WE CONVERTED THAT

2595
01:42:54,960 --> 01:42:56,400
TO REMOTE SO THAT THEY COULD DO

2596
01:42:56,400 --> 01:42:57,800
IT WITH EQUIPMENT THAT THEY HAD

2597
01:42:57,800 --> 01:43:04,000
IN THE HOUSE AND WE GAVE THEM

2598
01:43:04,000 --> 01:43:05,280
ONE HALF MOON SHAPED BALL

2599
01:43:05,280 --> 01:43:07,080
BECAUSE YOU CAN DO A LOT OF

2600
01:43:07,080 --> 01:43:07,720
EXERCISES JUST AROUND THAT.

2601
01:43:07,720 --> 01:43:10,480
SO WE HAVE AN IN-PERSON VERSUS A

2602
01:43:10,480 --> 01:43:12,360
REMOTE, AND SINCE WE WERE DOING

2603
01:43:12,360 --> 01:43:13,600
THIS PRETTY MUCH HALFWAY THROUGH

2604
01:43:13,600 --> 01:43:17,400
THE TRIAL, WE'VE GOT PRETTY MUCH

2605
01:43:17,400 --> 01:43:18,720
A GOOD SAMPLE SIZE OF THOSE WHO

2606
01:43:18,720 --> 01:43:20,520
RECEIVED IN-PERSON TREATMENT AND

2607
01:43:20,520 --> 01:43:21,720
THOSE WHO'VE RECEIVED THE

2608
01:43:21,720 --> 01:43:22,800
TREATMENT REMOTELY, SO THAT AT

2609
01:43:22,800 --> 01:43:23,800
THE END OF THE TRIAL, WE WILL

2610
01:43:23,800 --> 01:43:30,600
NOW BE ABLE TO TEST WHETHER THEY

2611
01:43:30,600 --> 01:43:31,440
WERE EQUIVALENT IN THEIR

2612
01:43:31,440 --> 01:43:31,800
EFFECTS.

2613
01:43:31,800 --> 01:43:33,200
I WAS GOING TO SHOW YOU SOME

2614
01:43:33,200 --> 01:43:35,000
VIDEOS ABOUT HOW WE BREAK DOWN

2615
01:43:35,000 --> 01:43:36,960
THOSE EXERCISES, BUT I CAN SHARE

2616
01:43:36,960 --> 01:43:39,040
THIS WITH YOU LATER BECAUSE I

2617
01:43:39,040 --> 01:43:40,480
SEE I HAVE A RED LIGHT GOING ON

2618
01:43:40,480 --> 01:43:43,240
HERE, SO WE WILL SKIP THAT

2619
01:43:43,240 --> 01:43:47,600
PORTION.

2620
01:43:47,600 --> 01:43:49,920
I WILL JUST TELL ABOUT THE

2621
01:43:49,920 --> 01:43:51,120
PROGRESS OF OUR TRIAL IN THAT WE

2622
01:43:51,120 --> 01:43:52,880
HAVE A TREMENDOUS AMOUNT OF

2623
01:43:52,880 --> 01:43:54,440
ENGAGEMENT IN THE TRIAL, THE

2624
01:43:54,440 --> 01:43:56,400
TEENS ARE ATTENDING ON AVERAGE

2625
01:43:56,400 --> 01:43:58,160
NEARLY 15 OUT OF THE 16

2626
01:43:58,160 --> 01:44:00,240
SESSIONS, AND SO ATTENDANCE IS

2627
01:44:00,240 --> 01:44:02,240
REALLY STRONG, AND WE HAVE OVER

2628
01:44:02,240 --> 01:44:04,640
80% COMPLETING THREE-MONTH

2629
01:44:04,640 --> 01:44:07,600
FOLLOW-UPS AND WE'RE NOW DOING

2630
01:44:07,600 --> 01:44:08,760
OUR SIX, NINE AND 12-MONTH

2631
01:44:08,760 --> 01:44:11,160
FOLLOW-UPS AND WE SHOULD BE DONE

2632
01:44:11,160 --> 01:44:14,120
PRETTY SOON WITH THIS TRIAL.

2633
01:44:14,120 --> 01:44:15,440
NOW, WHAT THIS TRIAL HAS ALLOWED

2634
01:44:15,440 --> 01:44:17,840
US TO DO IS A NUMBER OF

2635
01:44:17,840 --> 01:44:19,960
ANCILLARY STUDIES ON NEUROBUY

2636
01:44:19,960 --> 01:44:24,920
LODNEUROBIOLOGIC MECHANISMS AND

2637
01:44:24,920 --> 01:44:26,640
EVEN AT BASELINE, WE'RE ABLE TO

2638
01:44:26,640 --> 01:44:27,960
DO NEUROIMAGING STUDIES AND SO

2639
01:44:27,960 --> 01:44:30,160
ON AND THERE ARE A NUMBER OF

2640
01:44:30,160 --> 01:44:32,080
OFFSHOOT GRANTS ON PAIN RELATED

2641
01:44:32,080 --> 01:44:33,360
STIGMA, ON SOCIAL COHESION, ON

2642
01:44:33,360 --> 01:44:34,800
EXECUTIVE FUNCTION THAT HAVE

2643
01:44:34,800 --> 01:44:37,800
REALLY BEEN PART OF THIS TRIAL

2644
01:44:37,800 --> 01:44:39,440
RIGHT FROM THE BEGINNING, AND WE

2645
01:44:39,440 --> 01:44:43,480
ARE NOW ALSO ADAPTING THIS

2646
01:44:43,480 --> 01:44:44,800
TRIAL, THIS TYPE OF

2647
01:44:44,800 --> 01:44:46,160
NEUROMUSCULAR TRAINING TO OTHER

2648
01:44:46,160 --> 01:44:49,160
DISEASE CONDITIONS SUCH AS

2649
01:44:49,160 --> 01:44:50,600
CHILDREN WHO HAVE SICKLE CELL

2650
01:44:50,600 --> 01:44:53,880
DISEASE, SO WE ARE DOING A WHOLE

2651
01:44:53,880 --> 01:44:57,840
CULTURAL ADAPTATION, AND ALSO

2652
01:44:57,840 --> 01:44:58,720
LOOKING AT THE UTILITY IN

2653
01:44:58,720 --> 01:45:00,120
CHILDREN WHO HAVE RHEUMATIC

2654
01:45:00,120 --> 01:45:03,760
DISEASES AND CHRONIC PAIN.

2655
01:45:03,760 --> 01:45:08,360
SO I WILL WRAP UP QUICKLY HERE.

2656
01:45:08,360 --> 01:45:10,120
AND THE MAIN IDEA OF ALL OF THIS

2657
01:45:10,120 --> 01:45:13,640
WORK, REALLY, BOTTOM LINE, IS

2658
01:45:13,640 --> 01:45:15,560
CAN WE PREVENT CHRONIC PAIN IN

2659
01:45:15,560 --> 01:45:17,440
CHILDHOOD FROM PROGRESSING TO

2660
01:45:17,440 --> 01:45:19,720
CHRONIC PAIN AND DISABILITY IN

2661
01:45:19,720 --> 01:45:20,400
ADULTHOOD.

2662
01:45:20,400 --> 01:45:22,480
AND REALLY START THIS PROCESS

2663
01:45:22,480 --> 01:45:24,320
EARLY TO PREVENT A LOT OF

2664
01:45:24,320 --> 01:45:25,680
SUFFERING IN ADULTHOOD.

2665
01:45:25,680 --> 01:45:29,280
SO I THANK YOU FOR YOUR

2666
01:45:29,280 --> 01:45:29,800
ATTENTION, AND WANT TO

2667
01:45:29,800 --> 01:45:30,840
ACKNOWLEDGE THE TREMENDOUS TEAM

2668
01:45:30,840 --> 01:45:31,840
THAT HAS BEEN WORKING ON THIS

2669
01:45:31,840 --> 01:45:34,920
EFFORT FOR THE PAST SIX YEARS,

2670
01:45:34,920 --> 01:45:36,920
OR ACTUALLY LONGER, FROM OUR

2671
01:45:36,920 --> 01:45:38,560
PILOTING, OUR CURRENT AND FORMER

2672
01:45:38,560 --> 01:45:40,960
FELLOWS, AND ALL THE CLAP RAY

2673
01:45:40,960 --> 01:45:48,320
TORECOLLABORATORS WHO HAVE BEENT

2674
01:45:48,320 --> 01:45:48,840
OF THIS WORK.

2675
01:45:48,840 --> 01:45:50,040
THESE ARE TRAINERS WHO HAD COME

2676
01:45:50,040 --> 01:45:52,040
TO CINCINNATI, THE EXERCISE AND

2677
01:45:52,040 --> 01:45:54,040
CBT TRAINERS WHO JUST DID SUCH A

2678
01:45:54,040 --> 01:45:55,880
FABULOUS JOB FOR OUR TRIAL.

2679
01:45:55,880 --> 01:45:58,080
SO I WILL STOP THERE.

2680
01:45:58,080 --> 01:46:00,360
I THINK I'M RIGHT AT 20 MINUTES.

2681
01:46:00,360 --> 01:46:01,560
AND WE WILL TAKE QUESTIONS

2682
01:46:01,560 --> 01:46:01,760
LATER.

2683
01:46:01,760 --> 01:46:11,960
[APPLAUSE]

2684
01:46:12,960 --> 01:46:13,760
>>OKAY.

2685
01:46:13,760 --> 01:46:18,760
OUR NEXT TALK REFLECTS THE

2686
01:46:18,760 --> 01:46:20,080
RENAISSANCE IN PSYCHEDELICS

2687
01:46:20,080 --> 01:46:21,600
THERAPY FOR A VARIETY OF

2688
01:46:21,600 --> 01:46:22,400
CONDITIONS.

2689
01:46:22,400 --> 01:46:25,200
WE HAVE DR. STEVEN ROSS, ALSO

2690
01:46:25,200 --> 01:46:26,880
FROM NEW YORK UNIVERSITY, WHERE

2691
01:46:26,880 --> 01:46:28,360
HE'S A RESEARCH ASSOCIATE

2692
01:46:28,360 --> 01:46:31,000
PROFESSOR OF PSYCHIATRY AND

2693
01:46:31,000 --> 01:46:33,840
CHILD AND ADOLESCENT PSYCHIATRY

2694
01:46:33,840 --> 01:46:35,200
AT THE GROSSMAN SCHOOL OF

2695
01:46:35,200 --> 01:46:37,360
MEDICINE, FOUNDING MEMBER OF THE

2696
01:46:37,360 --> 01:46:39,120
NCU PSYCHEDELIC RESEARCH GROUP

2697
01:46:39,120 --> 01:46:41,200
AND ASSOCIATE DIRECTOR OF THE

2698
01:46:41,200 --> 01:46:43,440
NYU LANGONE CENTER FOR

2699
01:46:43,440 --> 01:46:44,200
PSYCHEDELIC MEDICINE.

2700
01:46:44,200 --> 01:46:46,160
HE'S CONTRIBUTED MANY INNOVATIVE

2701
01:46:46,160 --> 01:46:52,000
FINDINGS IN PSYCH D PSYCHEDELICS

2702
01:46:52,000 --> 01:46:54,440
RESEARCH, INCLUDING ALCOHOL USE

2703
01:46:54,440 --> 01:46:56,000
DISORDER, AND WAS RECENTLY

2704
01:46:56,000 --> 01:46:59,640
AWARDED AN R01 GRANT FROM

2705
01:46:59,640 --> 01:47:02,840
NATIONAL CANCER INSTITUTE FOR

2706
01:47:02,840 --> 01:47:04,280
THERAPY FOR CANCER RELATED

2707
01:47:04,280 --> 01:47:05,480
PSYCHIATRIC DISTRESS.

2708
01:47:05,480 --> 01:47:07,280
HIS RESEARCH INTERESTS ALSO

2709
01:47:07,280 --> 01:47:09,040
EXTEND TO LSD THERAPY, CHRONIC

2710
01:47:09,040 --> 01:47:13,120
PAIN TREATMENT, MDMA ASSISTED

2711
01:47:13,120 --> 01:47:14,880
PSYCHOTHERAPY FOR PTSD.

2712
01:47:14,880 --> 01:47:17,480
SO JOIN US NOW AS HE REVIEWS THE

2713
01:47:17,480 --> 01:47:18,280
HISTORY, EVIDENCE BASE AND

2714
01:47:18,280 --> 01:47:20,560
FUTURE OF PSYCHEDELICS THERAPY

2715
01:47:20,560 --> 01:47:21,200
RESEARCH.

2716
01:47:21,200 --> 01:47:24,240
HE'LL PRESENT EVIDENCE FOR USING

2717
01:47:24,240 --> 01:47:26,880
WHAT SICK PSYCH DELL IX IN THE

2718
01:47:26,880 --> 01:47:27,800
TREATMENT OF CHRONIC PAIN

2719
01:47:27,800 --> 01:47:29,760
INCLUDING POTENTIAL THERAPEUTIC

2720
01:47:29,760 --> 01:47:31,480
MODELS AND PUTATIVE MECHANISMS

2721
01:47:31,480 --> 01:47:32,040
OF ACTION.

2722
01:47:32,040 --> 01:47:33,280
THE TALK WILL ALSO FOCUS ON

2723
01:47:33,280 --> 01:47:35,040
RESEARCH OF PSYCHEDELICS TO

2724
01:47:35,040 --> 01:47:37,360
TREAT CANCER PAIN, EMPHASIZING

2725
01:47:37,360 --> 01:47:40,120
THEIR APPLICATIONS TO MANAGING

2726
01:47:40,120 --> 01:47:43,720
METASTATIC INDUCED CANCER AND

2727
01:47:43,720 --> 01:47:49,720
BONE PAIN.

2728
01:47:49,720 --> 01:47:51,200
>>THANK YOU FOR THE

2729
01:47:51,200 --> 01:47:51,960
INTRODUCTION.

2730
01:47:51,960 --> 01:47:54,200
THIS IS MY FIRST TIME AT NIH SO

2731
01:47:54,200 --> 01:47:55,160
I'M REALLY GRATEFUL TO BE HERE.

2732
01:47:55,160 --> 01:47:56,560
IN TERMS OF DISCLOSURES I

2733
01:47:56,560 --> 01:47:58,040
RECEIVE A COMBINATION OF FUNDING

2734
01:47:58,040 --> 01:48:00,400
FROM NIH NOT FOR PROFITS AND

2735
01:48:00,400 --> 01:48:01,880
INDUSTRY.

2736
01:48:01,880 --> 01:48:05,160
SO IN OF THE HISTORY,

2737
01:48:05,160 --> 01:48:07,200
THEY'VE BEEN USED BY INDIGENOUS

2738
01:48:07,200 --> 01:48:08,200
CULTURES FOR THOUSANDS OF YEARS

2739
01:48:08,200 --> 01:48:10,360
FOR SPIRITUAL AND RELIGIOUS

2740
01:48:10,360 --> 01:48:11,400
PURPOSES BUT WESTERN MEDICINE

2741
01:48:11,400 --> 01:48:13,360
SORT OF DISCOVERED THEM FOR

2742
01:48:13,360 --> 01:48:16,280
MEDICINAL PURPOSES IN 1943.

2743
01:48:16,280 --> 01:48:19,960
ALBERT HOFFMAN WAS A CHEMIST AND

2744
01:48:19,960 --> 01:48:21,840
SANDOS PHARMACEUTICALS WORKING

2745
01:48:21,840 --> 01:48:24,600
WITH SOME ERGOT DERIVATIVES AND

2746
01:48:24,600 --> 01:48:28,760
BY ACCIDENT HE GOT LSD, WENT

2747
01:48:28,760 --> 01:48:31,640
HOME AND HAD THE FIRST LSD

2748
01:48:31,640 --> 01:48:32,000
EXPERIENCE.

2749
01:48:32,000 --> 01:48:34,480
IT WASN'T A GOOD ONE, HE BECAME

2750
01:48:34,480 --> 01:48:35,760
DELUSIONAL, THOUGHT HIS NEIGHBOR

2751
01:48:35,760 --> 01:48:37,680
WAS GOING TO KILL HIM BUT WOKE

2752
01:48:37,680 --> 01:48:40,440
UP THE NEXT DAY REFRESHED AND

2753
01:48:40,440 --> 01:48:41,640
REALIZED HE HAD DISCOVERED

2754
01:48:41,640 --> 01:48:42,440
SOMETHING REALLY UNUSUAL.

2755
01:48:42,440 --> 01:48:43,800
THAT KICKED OFF THE NEXT 25

2756
01:48:43,800 --> 01:48:45,320
YEARS OF RESEARCH WITH

2757
01:48:45,320 --> 01:48:45,760
PSYCHEDELICS.

2758
01:48:45,760 --> 01:48:55,760
MOST OF IT WAS WITH LSD.

2759
01:48:55,760 --> 01:48:56,680
 THIS WAS A

2760
01:48:56,680 --> 01:48:58,320
BIG PART OF PSYCHIATRY.

2761
01:48:58,320 --> 01:49:00,160
THERE WERE OVER 40,000 RESEARCH

2762
01:49:00,160 --> 01:49:00,960
PARTICIPANTS, OVER A THOUSAND

2763
01:49:00,960 --> 01:49:01,760
PAPERS PUBLISHED.

2764
01:49:01,760 --> 01:49:04,040
THERE WERE PROMISING SIGNALS FOR

2765
01:49:04,040 --> 01:49:06,040
THE USE OF LSD PLUS

2766
01:49:06,040 --> 01:49:07,000
PSYCHOTHERAPY TO TREAT ALCOHOL

2767
01:49:07,000 --> 01:49:09,760
USE DISORDER AND TO TREAT

2768
01:49:09,760 --> 01:49:11,960
EXISTENTIAL DISTRESS IN ADVANCED

2769
01:49:11,960 --> 01:49:12,960
CANCER AS WELL AS CANCER PAIN.

2770
01:49:12,960 --> 01:49:15,040
BUT THE DRUGS ESCAPED THE LAB.

2771
01:49:15,040 --> 01:49:18,360
TIMOTHY LEARY AT HARVARD AFTER

2772
01:49:18,360 --> 01:49:20,520
GETTING FIRED BECAME THE PIED

2773
01:49:20,520 --> 01:49:22,960
PIPER OF PSYCHEDELICS, THEY

2774
01:49:22,960 --> 01:49:23,920
ENDED UP ON THE STREET, AND

2775
01:49:23,920 --> 01:49:25,880
THEIR USE WAS SORT OF

2776
01:49:25,880 --> 01:49:27,160
UNCONSTRAINED AND UNREGULATED

2777
01:49:27,160 --> 01:49:29,720
AND THAT LED TO SOME REALLY BAD

2778
01:49:29,720 --> 01:49:31,240
OUTCOMES, BUT IT GOT RICHARD

2779
01:49:31,240 --> 01:49:33,080
NIXON VERY CONCERNED AND LED HIM

2780
01:49:33,080 --> 01:49:34,960
TO DECLARE A WAR ON DRUGS.

2781
01:49:34,960 --> 01:49:37,200
AND THAT ESSENTIALLY AND

2782
01:49:37,200 --> 01:49:39,720
INTERESTINGLY BA BANISHED THEM M

2783
01:49:39,720 --> 01:49:40,360
THE HISTORY BOOKS.

2784
01:49:40,360 --> 01:49:43,240
WHEN I WAS A GENERAL RESIDENT

2785
01:49:43,240 --> 01:49:45,080
PSYCHIATRY AND ADDICTION

2786
01:49:45,080 --> 01:49:46,320
PSYCHIATRY FELLOW I LEARNED

2787
01:49:46,320 --> 01:49:51,080
NOTHING ABOUT THEM BUT STUDIES

2788
01:49:51,080 --> 01:49:53,040
BEGAN IN THE EARLY 1990s AT

2789
01:49:53,040 --> 01:49:54,360
THE UNIVERSITY OF NEW MEXICO AND

2790
01:49:54,360 --> 01:49:55,480
OVER THE LAST 20 YEARS THERE

2791
01:49:55,480 --> 01:49:56,800
HAVE BEEN A GROWING NUMBER OF

2792
01:49:56,800 --> 01:49:57,600
PROGRAMS OF RESEARCH.

2793
01:49:57,600 --> 01:50:01,400
OUR GROUP GOT STARTED IN 2006.

2794
01:50:01,400 --> 01:50:04,840
WE'VE BEEN CONDUCTING CLINICAL

2795
01:50:04,840 --> 01:50:07,040
TRIALS OF PSYCHEDELICS SINCE

2796
01:50:07,040 --> 01:50:07,680
THEN.

2797
01:50:07,680 --> 01:50:08,760
SOMEBODY ASKED ME TO LIST

2798
01:50:08,760 --> 01:50:09,600
PROGRAMS AND CENTERS IN THE U.S.

2799
01:50:09,600 --> 01:50:11,000
DOING THIS KIND OF RESEARCH AND

2800
01:50:11,000 --> 01:50:12,240
IT'S OVER 30, SO IT'S REALLY

2801
01:50:12,240 --> 01:50:15,040
SPREAD RECENTLY WITHIN ACADEMIA.

2802
01:50:15,040 --> 01:50:16,360
AND WHEN WE THINK OF WHAT DRUGS

2803
01:50:16,360 --> 01:50:18,640
WE'RE TALKING ABOUT, WE'RE

2804
01:50:18,640 --> 01:50:22,960
TALKING ABOUT THE SEROTONERGIC

2805
01:50:22,960 --> 01:50:23,280
PSYCHEDELICS.

2806
01:50:23,280 --> 01:50:33,800
YOU HAVE THE -- PROTOTYPE HERE

2807
01:50:34,880 --> 01:50:41,040
IS MESS CLIN.

2808
01:50:41,040 --> 01:50:42,600
MDMA WEAKLEY ACTIVATES THE

2809
01:50:42,600 --> 01:50:43,920
RECEPTOR BUT HAS UNIQUE

2810
01:50:43,920 --> 01:50:44,600
PHARMACOLOGY THAT'S BEEN

2811
01:50:44,600 --> 01:50:48,240
LEVERAGED INTO TREATING PTSD.

2812
01:50:48,240 --> 01:50:51,640
AND YOU CAN SEE HERE THIS IS

2813
01:50:51,640 --> 01:50:58,680
SILL SIGH BIN MUSHROOMS.

2814
01:50:58,680 --> 01:51:02,800
YOU SEE THE CACTUS THERE.

2815
01:51:02,800 --> 01:51:04,080
SO IN THE LAST 20 YEARS THERE

2816
01:51:04,080 --> 01:51:05,160
HAVE BEEN THREE PROGRAMS OF

2817
01:51:05,160 --> 01:51:11,640
RESEARCH THAT ARE MOST ADVANCED.

2818
01:51:11,640 --> 01:51:12,960
MAJOR DEPRESSION, ALCOHOL USE

2819
01:51:12,960 --> 01:51:14,960
DISORDER AND PSYCHIATRIC AND

2820
01:51:14,960 --> 01:51:18,880
EXISTENTIAL DISTRESS IN CANCER.

2821
01:51:18,880 --> 01:51:20,000
SO MAJOR DEPRESSION IS ONE OF

2822
01:51:20,000 --> 01:51:22,280
THE MOST MAJOR HEALTH PROBLEMS,

2823
01:51:22,280 --> 01:51:24,040
BRAIN BASED ILLNESSES THROUGHOUT

2824
01:51:24,040 --> 01:51:24,400
THE WORLD.

2825
01:51:24,400 --> 01:51:26,240
SIGNIFICANT CAUSE OF MEDICAL AND

2826
01:51:26,240 --> 01:51:28,160
PSYCHIATRIC MORBIDITY INCLUDING

2827
01:51:28,160 --> 01:51:29,160
COMPLETED SUICIDE AND OUR

2828
01:51:29,160 --> 01:51:30,640
CURRENT TREATMENTS ARE LIMITED

2829
01:51:30,640 --> 01:51:31,280
IN EFFICACY.

2830
01:51:31,280 --> 01:51:33,880
THEY TEND TO BE A PILL DAILY FOR

2831
01:51:33,880 --> 01:51:35,200
A PROLONGED PERIOD OF TIME AND

2832
01:51:35,200 --> 01:51:39,240
THEY HAVE A SIDE EFFECT BURDEN.

2833
01:51:39,240 --> 01:51:41,320
THERE HAVE BEEN SEVERAL

2834
01:51:41,320 --> 01:51:42,480
PUBLICATIONS IN THE LAST SEVERAL

2835
01:51:42,480 --> 01:51:46,320
YEARS IN THE NEW ENGLAND JOURNAL

2836
01:51:46,320 --> 01:51:48,520
OF MEDICINE AND JAMA, THIS IS

2837
01:51:48,520 --> 01:51:50,400
THE AREA THAT IS PROBABLY THE

2838
01:51:50,400 --> 01:51:51,000
MOST ADVANCED.

2839
01:51:51,000 --> 01:51:52,600
THERE'S CLOSE TO 500

2840
01:51:52,600 --> 01:51:55,920
PARTICIPANTS THAT HAVE BEEN

2841
01:51:55,920 --> 01:52:00,400
STUDIED AND IT APPEARS THAT

2842
01:52:00,400 --> 01:52:04,520
EFFECTS LAST FOR SEVERAL WEEKS.

2843
01:52:04,520 --> 01:52:07,320
THE FDA HAS GRANTED BREAKTHROUGH

2844
01:52:07,320 --> 01:52:09,280
STATUS TO TWO COMPANIES IN THIS

2845
01:52:09,280 --> 01:52:10,520
AREA AND I WOULD PREDICT OVER

2846
01:52:10,520 --> 01:52:17,120
THE NEXT TWO OR YEARS, PSI

2847
01:52:17,120 --> 01:52:18,960
LOCYBIN COULD BE RESCHEDULED FOR

2848
01:52:18,960 --> 01:52:23,400
MAJOR DEPRESSION.

2849
01:52:23,400 --> 01:52:24,680
PROBABLY ARGUABLY THE WORST DRUG

2850
01:52:24,680 --> 01:52:26,880
OF ABUSE IN TERMS OF ITS

2851
01:52:26,880 --> 01:52:28,600
MORBIDITY, MORTALITY AND

2852
01:52:28,600 --> 01:52:29,000
SOCIETAL COST.

2853
01:52:29,000 --> 01:52:31,080
WE DO HAVE PHARMACOLOGIC AND

2854
01:52:31,080 --> 01:52:33,280
BEHAVIORAL TREATMENTS BUT THEIR

2855
01:52:33,280 --> 01:52:35,320
EFFECT SIZE TEND TO BE MODEST.

2856
01:52:35,320 --> 01:52:37,080
WE HAVE THREE FDA-APPROVED

2857
01:52:37,080 --> 01:52:38,280
MEDICATIONS BUT THEY'RE RARELY

2858
01:52:38,280 --> 01:52:39,960
PRESCRIBED AND IF YOU HAVE AUD,

2859
01:52:39,960 --> 01:52:41,520
ONLY ABOUT 10% GET ANY TREATMENT

2860
01:52:41,520 --> 01:52:42,640
PER YEAR AND IT TENDS TO BE

2861
01:52:42,640 --> 01:52:43,360
SHORT LIVED.

2862
01:52:43,360 --> 01:52:45,880
IT'S A HIGHLY STIGMATIZED

2863
01:52:45,880 --> 01:52:47,040
DISORDER EVEN THOUGH WE HAVE

2864
01:52:47,040 --> 01:52:48,120
TREATMENTS, THEY TEND TO GO

2865
01:52:48,120 --> 01:52:48,480
UNUSED.

2866
01:52:48,480 --> 01:52:56,080
SO THERE IS A -- FOR AUD AND IN

2867
01:52:56,080 --> 01:52:58,480
FACT IN THE HISTORICAL ERA WITH

2868
01:52:58,480 --> 01:53:00,000
LSD, THE MOST STUDY INDICATION

2869
01:53:00,000 --> 01:53:01,160
WAS AUD.

2870
01:53:01,160 --> 01:53:02,600
BUT THESE DRUGS WERE PUT INTO

2871
01:53:02,600 --> 01:53:03,880
SCHEDULE ONE MEANING THEY HAVE

2872
01:53:03,880 --> 01:53:05,680
VERY HIGH ADDICTIVE LIABILITY,

2873
01:53:05,680 --> 01:53:16,240
NO THERAPEUTIC UTILITY -- APPEAR

2874
01:53:16,600 --> 01:53:17,640
TO BEHAVE LIKE DRUGS OF

2875
01:53:17,640 --> 01:53:18,440
ADDICTION.

2876
01:53:18,440 --> 01:53:19,680
ANIMALS DON'T CONTINUE TO

2877
01:53:19,680 --> 01:53:20,880
SELF-ADMINISTER THEM.

2878
01:53:20,880 --> 01:53:23,720
THEY FAIL TO PRODUCE

2879
01:53:23,720 --> 01:53:24,280
CONDITION-PLACED PREFERENCE.

2880
01:53:24,280 --> 01:53:25,720
AND THESE CAN BE SOME OF THE

2881
01:53:25,720 --> 01:53:27,560
MOST DIFFICULT EXPERIENCES,

2882
01:53:27,560 --> 01:53:29,000
CHALLENGING EXPERIENCES.

2883
01:53:29,000 --> 01:53:30,560
THEY'RE NOT RELIABLY REWARDING.

2884
01:53:30,560 --> 01:53:34,640
YOU HAVE ENORMOUS TACKY FLAX IS

2885
01:53:34,640 --> 01:53:37,040
THAT OCCUR SO IF YOU TAKE LSD BY

2886
01:53:37,040 --> 01:53:38,840
THREE DAYS, BY DAY THREE OR

2887
01:53:38,840 --> 01:53:40,200
FOUR, YOU HAVE ALMOST NO

2888
01:53:40,200 --> 01:53:41,400
SUBJECTIVE EFFECTS.

2889
01:53:41,400 --> 01:53:43,560
EPIDEMIOLOGIC STUDIES FAIL TO

2890
01:53:43,560 --> 01:53:46,000
FIND SILL SIGH BIN OR LSD

2891
01:53:46,000 --> 01:53:46,400
ADDICTION.

2892
01:53:46,400 --> 01:53:47,360
IF YOU LOOK AT RELATIVE HARM OF

2893
01:53:47,360 --> 01:53:50,880
A DRUG TO THE INDIVIDUAL IN

2894
01:53:50,880 --> 01:53:53,320
SOCIETY, THE MOST DAMAGING DRUGS

2895
01:53:53,320 --> 01:53:54,520
ARE ALCOHOL, TOBACCO, BUT THE

2896
01:53:54,520 --> 01:53:56,520
LEAST DAMAGING DRUGS FROM THIS

2897
01:53:56,520 --> 01:53:59,080
PERSPECTIVE ARE THE SEROTONERGIC

2898
01:53:59,080 --> 01:53:59,400
PSYCHEDELICS.

2899
01:53:59,400 --> 01:54:02,240
WILLIAM JAMES IN THE EARLY 1800S

2900
01:54:02,240 --> 01:54:06,840
OBSERVED THAT THERE WERE THESE

2901
01:54:06,840 --> 01:54:07,800
INDIVIDUALS WITH ALCOHOL USE

2902
01:54:07,800 --> 01:54:09,080
DISORDER WHO WERE HOMELESS, HE

2903
01:54:09,080 --> 01:54:10,200
NOTICED THAT SOME OF THEM FOUND

2904
01:54:10,200 --> 01:54:12,360
RELIGION AND HAD THESE SPIRITUAL

2905
01:54:12,360 --> 01:54:13,960
CONVERSIONS AND HE WAS THE FIRST

2906
01:54:13,960 --> 01:54:16,040
TO DESCRIBE THE SPIRITUAL DOMAIN

2907
01:54:16,040 --> 01:54:19,400
COMPONENT OF ADDICTION AND HOW

2908
01:54:19,400 --> 01:54:20,960
SPIRITUALITY CAN HELP THOSE WITH

2909
01:54:20,960 --> 01:54:21,720
ADDICTION.

2910
01:54:21,720 --> 01:54:23,960
BILL WILSON, ONE OF THE FOUNDERS

2911
01:54:23,960 --> 01:54:24,840
OF ALCOHOLICS ANONYMOUS,

2912
01:54:24,840 --> 01:54:27,680
ACTUALLY GOT SOBER IN 1934 BY

2913
01:54:27,680 --> 01:54:31,560
TAKING A -- ALKALOID, A POTENT

2914
01:54:31,560 --> 01:54:32,120
ANTIMUSCARINIC AGENT AND

2915
01:54:32,120 --> 01:54:33,760
SOMEWHERE BETWEEN HAVING A

2916
01:54:33,760 --> 01:54:36,200
PSYCHOTIC OR MYSTICAL-TYPE

2917
01:54:36,200 --> 01:54:37,240
EXPERIENCE ON IT AND BEING IN

2918
01:54:37,240 --> 01:54:40,160
THE DTs, HE HAD THIS MYSTICAL

2919
01:54:40,160 --> 01:54:41,720
VISION OF ALCOHOLICS ANONYMOUS,

2920
01:54:41,720 --> 01:54:46,240
THIS SORT OF MUTUAL RECOVERY.

2921
01:54:46,240 --> 01:54:47,440
UNBEKNOWNSTED TO ME IN MY

2922
01:54:47,440 --> 01:54:49,640
TRAINING, I FOUND OUT HE WENT ON

2923
01:54:49,640 --> 01:54:53,080
TO UNDERGO FIVE SESSIONS OF LSD

2924
01:54:53,080 --> 01:54:53,400
PSYCHOTHERAPY.

2925
01:54:53,400 --> 01:54:56,640
HE WAS SO -- HE WANTED TO

2926
01:54:56,640 --> 01:54:58,680
INTRODUCE LSD INTO A A AND WE

2927
01:54:58,680 --> 01:55:00,120
KNOW THAT DIDN'T HAPPEN BUT IT'S

2928
01:55:00,120 --> 01:55:02,000
INTERESTING TO CONSIDER.

2929
01:55:02,000 --> 01:55:04,720
SO IN THE EARLY ERA OF

2930
01:55:04,720 --> 01:55:06,920
PSYCHEDELICS, LSD WAS USED

2931
01:55:06,920 --> 01:55:07,680
CLINICALLY BECAUSE IT WAS

2932
01:55:07,680 --> 01:55:09,240
AVAILABLE THEN, MOSTLY IN

2933
01:55:09,240 --> 01:55:10,600
CANADA, THERE WERE SEVERAL

2934
01:55:10,600 --> 01:55:11,800
THOUSAND PEOPLE WITH ALCOHOL USE

2935
01:55:11,800 --> 01:55:14,200
DISORDER THAT WERE TREATED.

2936
01:55:14,200 --> 01:55:16,400
THE INITIAL MODEL WAS THAT THEY

2937
01:55:16,400 --> 01:55:17,520
WOULD KIND OF SCARE YOU

2938
01:55:17,520 --> 01:55:18,440
STRAIGHT, THIS WOULD BE SIMILAR

2939
01:55:18,440 --> 01:55:20,080
TO THE DTs, BUT PATIENTS

2940
01:55:20,080 --> 01:55:22,040
REPORTED HAVING THESE POSITIVE

2941
01:55:22,040 --> 01:55:23,840
MYSTICAL-TYPE EXPERIENCES AND

2942
01:55:23,840 --> 01:55:25,800
INSIGHTS ABOUT THE NATURE OF

2943
01:55:25,800 --> 01:55:27,120
REALITY AND ADDICTION AND LIFE

2944
01:55:27,120 --> 01:55:31,680
THAT HELPED THEM INTO RECOVERY.

2945
01:55:31,680 --> 01:55:35,960
NOW, THERE WE WAS SOME EARLY

2946
01:55:35,960 --> 01:55:37,080
RESEARCH SUGGESTING VERY HIGH

2947
01:55:37,080 --> 01:55:38,960
RECOVERY RATES HERE, BUT THIS IS

2948
01:55:38,960 --> 01:55:41,240
HARD TO BELIEVE BECAUSE THERE

2949
01:55:41,240 --> 01:55:42,800
REALLY WAS NOT CONVINCING

2950
01:55:42,800 --> 01:55:43,080
CONTROLS.

2951
01:55:43,080 --> 01:55:45,880
BUT RECENTLY ABOUT A DECADE AGO,

2952
01:55:45,880 --> 01:55:48,240
THERE WAS A META-ANALYSIS, THERE

2953
01:55:48,240 --> 01:55:49,000
WERE SIX RANDOMIZED CONTROL

2954
01:55:49,000 --> 01:55:51,440
TRIALS OF SINGLE DOSE LSD VERSUS

2955
01:55:51,440 --> 01:55:53,920
PLACEBO, AND WHETHER THESE WERE

2956
01:55:53,920 --> 01:55:56,080
POOLED TOGETHER, YOU COULD SEE A

2957
01:55:56,080 --> 01:55:57,080
MEDIUM EFFECT SIZE THAT FAVORED

2958
01:55:57,080 --> 01:55:59,440
THE LSD GROUP OVER PLACEBO IN

2959
01:55:59,440 --> 01:56:02,040
TERMS OF REDUCED DRINKING

2960
01:56:02,040 --> 01:56:05,560
OUTCOMES AT SIX MONTHS.

2961
01:56:05,560 --> 01:56:10,760
SO MICHAEL BOGUNSCHUTZ AND I

2962
01:56:10,760 --> 01:56:12,200
BEGAN TO LOOK AT THIS DATA.

2963
01:56:12,200 --> 01:56:16,120
WE RECENTLY PUBLISHED A STUDY,

2964
01:56:16,120 --> 01:56:18,200
TWO-DOSE OF PSILOCYBIN, AND MOST

2965
01:56:18,200 --> 01:56:19,920
OF THESE STUDIES HAD BEEN WITH

2966
01:56:19,920 --> 01:56:21,400
SINGLE OR A COUPLE DOSES.

2967
01:56:21,400 --> 01:56:22,600
THEY'RE ALL DELIVERED IN

2968
01:56:22,600 --> 01:56:24,680
CONJUNCTION WITH TWO SKILLED

2969
01:56:24,680 --> 01:56:25,320
PSYCHOTHERAPISTS.

2970
01:56:25,320 --> 01:56:27,840
I REALLY VIEW THIS AS

2971
01:56:27,840 --> 01:56:28,640
MEDICATION-ASSISTED

2972
01:56:28,640 --> 01:56:29,680
PSYCHOTHERAPY, AND IT'S REALLY

2973
01:56:29,680 --> 01:56:31,880
THE MATRIX OF THE TWO TOGETHER.

2974
01:56:31,880 --> 01:56:35,040
WE RANDOMIZED 93 INDIVIDUALS IN

2975
01:56:35,040 --> 01:56:37,200
THE STUDY THAT HAD ALCOHOL

2976
01:56:37,200 --> 01:56:38,080
DEPENDENCE THAT WEREN'T IN

2977
01:56:38,080 --> 01:56:39,520
TREATMENT AND HAD AT LEAST FOUR

2978
01:56:39,520 --> 01:56:42,520
HEAVY DRINKING DAYS PER MONTH.

2979
01:56:42,520 --> 01:56:44,040
OUR PRIMARY OUTCOME WAS

2980
01:56:44,040 --> 01:56:45,320
PERCENTAGE HEAVY DRINKING DAYS.

2981
01:56:45,320 --> 01:56:48,160
AND WHAT WE FOUND WAS IN THE

2982
01:56:48,160 --> 01:56:50,560
PSILOCYBIN GROUP, THERE WAS

2983
01:56:50,560 --> 01:56:51,800
APPROXIMATELY 83% REDUCTION IN

2984
01:56:51,800 --> 01:56:52,400
HEAVY DRINKING.

2985
01:56:52,400 --> 01:56:54,680
THERE WAS A 50% REDUCTION IN THE

2986
01:56:54,680 --> 01:56:55,120
PLACEBO GROUP.

2987
01:56:55,120 --> 01:56:57,600
THEY WERE GETTING MOTIVATIONAL

2988
01:56:57,600 --> 01:56:58,880
INTERVIEWING, WHICH WE KNOW HAS

2989
01:56:58,880 --> 01:56:59,840
AN EVIDENCE BASE TO TREAT

2990
01:56:59,840 --> 01:57:01,200
ADDICTION, BUT THERE WERE

2991
01:57:01,200 --> 01:57:02,840
SIGNIFICANT BETWEEN-GROUP

2992
01:57:02,840 --> 01:57:04,960
DIFFERENCES, EVENT SIZE OF ABOUT

2993
01:57:04,960 --> 01:57:05,120
.4.

2994
01:57:05,120 --> 01:57:07,080
WE LOOKED AT DICHOTOMOUS

2995
01:57:07,080 --> 01:57:09,680
OUTCOMES IN TERMS OF ABSTINENCE,

2996
01:57:09,680 --> 01:57:11,120
NO HEAVY DRINKING AND REDUCTION

2997
01:57:11,120 --> 01:57:13,120
OF RISK LEVEL, AND WE FOUND

2998
01:57:13,120 --> 01:57:14,320
BENEFITS IN THE PSILOCYBIN

2999
01:57:14,320 --> 01:57:16,160
GROUP.

3000
01:57:16,160 --> 01:57:17,760
SO WE'RE LOOKING TO DO MORE

3001
01:57:17,760 --> 01:57:20,160
STUDIES IN THIS AREA.

3002
01:57:20,160 --> 01:57:24,680
IN THE AREA OF EXISTENTIAL

3003
01:57:24,680 --> 01:57:25,480
DISTRESS IN CANCER, THIS IS THE

3004
01:57:25,480 --> 01:57:26,920
AREA THAT I THINK THE DATA IS

3005
01:57:26,920 --> 01:57:29,200
THE STRONGEST FOR PSYCHEDELICS.

3006
01:57:29,200 --> 01:57:31,040
AND PSYCHIATRIC DISTRESS IS

3007
01:57:31,040 --> 01:57:32,360
QUITE COMMON IN ADVANCED CANCER

3008
01:57:32,360 --> 01:57:33,560
AND EARLY STAGE CANCER IN TERMS

3009
01:57:33,560 --> 01:57:35,560
OF ANXIETY AND DEPRESSION.

3010
01:57:35,560 --> 01:57:38,720
IT'S ASSOCIATED WITH POOR

3011
01:57:38,720 --> 01:57:39,880
PSYCHIATRIC AND MEDICAL

3012
01:57:39,880 --> 01:57:41,040
OUTCOMES.

3013
01:57:41,040 --> 01:57:43,000
ANTIDEPRESSANTS TEND TO NOT WORK

3014
01:57:43,000 --> 01:57:44,920
BETTER THAN PLACEBO IN MAJOR

3015
01:57:44,920 --> 01:57:47,880
DEPRESSION IN CANCER, AND

3016
01:57:47,880 --> 01:57:49,240
EXISTENTIAL DISTRESS IS HIGHLY

3017
01:57:49,240 --> 01:57:49,520
COMMON.

3018
01:57:49,520 --> 01:57:50,600
THIS IS A PART OF MEDICINE THAT

3019
01:57:50,600 --> 01:57:53,160
I WASN'T TRAINED IN AT ALL.

3020
01:57:53,160 --> 01:57:54,840
MEDICINE REALLY IN A WAY

3021
01:57:54,840 --> 01:57:56,560
ABANDONS PATIENTS WHEN THEY'RE

3022
01:57:56,560 --> 01:57:57,920
DYING, WE'RE TRAINED TO TREAT

3023
01:57:57,920 --> 01:57:59,800
AND CURE.

3024
01:57:59,800 --> 01:58:01,480
BUT EXISTENTIAL DISTRESS, LOSS

3025
01:58:01,480 --> 01:58:03,880
OF MEANING, DEATH, ANXIETY,

3026
01:58:03,880 --> 01:58:05,200
DEMORALIZATION IS QUITE COMMON

3027
01:58:05,200 --> 01:58:07,240
IN ADVANCED CANCERS, ALSO

3028
01:58:07,240 --> 01:58:08,640
ASSOCIATED WITH POOR OUTCOMES.

3029
01:58:08,640 --> 01:58:11,800
WE HAVE SOME PSYCHOTHERAPEUTIC

3030
01:58:11,800 --> 01:58:13,760
INTERVENTIONS BUT NO

3031
01:58:13,760 --> 01:58:14,200
PSYCHOPHARMACOLOGIC

3032
01:58:14,200 --> 01:58:14,520
INTERVENTION.

3033
01:58:14,520 --> 01:58:17,160
THIS IS ANOTHER HYUN MET NEED IN

3034
01:58:17,160 --> 01:58:17,520
MEDICINE.

3035
01:58:17,520 --> 01:58:22,920
IN THE HISTORICAL ER AA, THERE S

3036
01:58:22,920 --> 01:58:24,120
INTERESTING WORK DONE BETWEEN

3037
01:58:24,120 --> 01:58:28,080
TWO GROUPS, AN INTERNIST,

3038
01:58:28,080 --> 01:58:29,120
PSYCHIATRIST AND PAIN

3039
01:58:29,120 --> 01:58:32,040
RESEARCHER, HE A END OF LIFE

3040
01:58:32,040 --> 01:58:33,680
METASTATIC CANCER WITH

3041
01:58:33,680 --> 01:58:34,760
REFRACTORY PAIN SYNDROMES HEARD

3042
01:58:34,760 --> 01:58:36,480
ABOUT THIS DRUG LSD, ORDERED

3043
01:58:36,480 --> 01:58:38,680
SOME UP AND STARTED

3044
01:58:38,680 --> 01:58:39,440
ADMINISTERING TO PATIENTS.

3045
01:58:39,440 --> 01:58:42,160
HE DID A COMPARATIVE EFFICACY

3046
01:58:42,160 --> 01:58:44,120
STUDY, COMPARED TO OPIATES, AND

3047
01:58:44,120 --> 01:58:46,680
OPEN LABEL, HE TREATED OVER 250

3048
01:58:46,680 --> 01:58:50,280
INDIVIDUALS WITH SINGLE DOSE L 

3049
01:58:50,280 --> 01:58:50,880
LSD.

3050
01:58:50,880 --> 01:58:52,920
STAN DPROF ADMINISTERED AN

3051
01:58:52,920 --> 01:58:54,120
OUTPATIENT PROGRAM AND HERE THEY

3052
01:58:54,120 --> 01:58:55,600
REALLY DEVELOPED THE MODEL OF

3053
01:58:55,600 --> 01:58:57,520
TWO THERAPISTS WITH PREPARATION.

3054
01:58:57,520 --> 01:59:03,560
AND THESE ARE DOSING DAY,

3055
01:59:03,560 --> 01:59:04,800
SOMEONE IS AT OUR CENTER FOR

3056
01:59:04,800 --> 01:59:05,800
EIGHT HOURS AND WE ASK THEM TO

3057
01:59:05,800 --> 01:59:07,320
STATE THEIR INTENTION FOR THE

3058
01:59:07,320 --> 01:59:09,000
DAY, WE GIVE THEM THE PILL, THEY

3059
01:59:09,000 --> 01:59:11,000
LIE SUPINE, WE GIVE THEM EYE

3060
01:59:11,000 --> 01:59:12,080
SHADES AND A PRESELECTED PROGRAM

3061
01:59:12,080 --> 01:59:13,920
OF MUSIC AND WE ASK THEM TO

3062
01:59:13,920 --> 01:59:19,640
FOCUS INTERNALLY.

3063
01:59:19,640 --> 01:59:21,920
SO THIS DATA WAS INTERESTING,

3064
01:59:21,920 --> 01:59:23,120
OVER 300 INDIVIDUALS, ALL OPEN

3065
01:59:23,120 --> 01:59:24,320
LABEL, BUT IT SHOWED THAT IT WAS

3066
01:59:24,320 --> 01:59:27,040
SAFE TO ADMINISTER, INCLUDING IN

3067
01:59:27,040 --> 01:59:29,560
CONJUNCTION WITH OPIATES AND

3068
01:59:29,560 --> 01:59:31,160
THIS STUDY SUGGESTED THERE WAS

3069
01:59:31,160 --> 01:59:33,160
RAPIDLY ACTING ANALGESIA FROM

3070
01:59:33,160 --> 01:59:34,560
SINGLE DOSE THAT LASTED SEVERAL

3071
01:59:34,560 --> 01:59:37,440
WEEKS, BUT INTERESTINGLY, CAST

3072
01:59:37,440 --> 01:59:38,680
ALSO NOTED HIS PATIENTS SAID YOU

3073
01:59:38,680 --> 01:59:40,400
KNOW, I FEEL LESS DEPRESSED, I

3074
01:59:40,400 --> 01:59:42,240
FEEL LESS ANXIOUS, AND ALSO I

3075
01:59:42,240 --> 01:59:45,360
HAVE A DECREASED FEAR OF DEATH.

3076
01:59:45,360 --> 01:59:46,760
THEY FOUND SOME TRENDS TOWARDS

3077
01:59:46,760 --> 01:59:49,240
REDUCTION IN OPIATE USE, AND THE

3078
01:59:49,240 --> 01:59:50,320
INTENSITY OF THE SUBJECTIVE

3079
01:59:50,320 --> 01:59:51,800
EXPERIENCE SEEMED TO CORRELATE

3080
01:59:51,800 --> 01:59:54,800
WITH POSITIVE OUTCOMES BUT THERE

3081
01:59:54,800 --> 01:59:56,480
WERE SUBSTANTIAL SHORTCOMINGS,

3082
01:59:56,480 --> 01:59:59,920
NO PLACEBO GROUP AND OPEN LABEL

3083
01:59:59,920 --> 02:00:02,000
ADMINISTRATION.

3084
02:00:02,000 --> 02:00:03,920
SO IN THE MODERN ERA WE LOOKED

3085
02:00:03,920 --> 02:00:05,400
AT THIS DATA, THERE'S BEEN A

3086
02:00:05,400 --> 02:00:06,560
GROUP OF INDIVIDUALS THAT HAVE

3087
02:00:06,560 --> 02:00:07,360
GONE BACK AND DONE RESEARCH IN

3088
02:00:07,360 --> 02:00:09,880
THIS AREA, BOTH LSD AND

3089
02:00:09,880 --> 02:00:10,440
PSILOCYBIN.

3090
02:00:10,440 --> 02:00:11,840
THE L.

3091
02:00:11,840 --> 02:00:13,080
IS D RESEARCH HAS BEEN

3092
02:00:13,080 --> 02:00:13,680
INTERESTING.

3093
02:00:13,680 --> 02:00:15,080
THIS IS A RECENTLY PUBLISHED

3094
02:00:15,080 --> 02:00:19,240
STUDY IN 42 INDIVIDUALS THAT HAD

3095
02:00:19,240 --> 02:00:22,240
BOT ADVANCED ILLNESS AND ALSO

3096
02:00:22,240 --> 02:00:24,280
NOT HAVING ADVANCED ILLNESS AND

3097
02:00:24,280 --> 02:00:25,160
CLINICALLY SIGNIFICANT ANXIETY.

3098
02:00:25,160 --> 02:00:30,280
THIS WAS A TWO-DOSE SESSION, 20S

3099
02:00:30,280 --> 02:00:31,520
PLACEBO, IT WAS A CROSSOVER AT

3100
02:00:31,520 --> 02:00:35,840
16 WEEKS.

3101
02:00:35,840 --> 02:00:37,720
AND THE DATA WAS INTERESTING.

3102
02:00:37,720 --> 02:00:39,640
IT SUGGESTED THAT LSD ASSISTED

3103
02:00:39,640 --> 02:00:41,920
PSYCHOTHERAPY WAS A RAPIDLY

3104
02:00:41,920 --> 02:00:44,880
ACTING ANXIOLYTIC AND

3105
02:00:44,880 --> 02:00:53,640
ANTIDEPRESSANT AND EFFECT

3106
02:00:53,640 --> 02:00:54,680
CHANGES WERE SUBSTANTIAL BOTH

3107
02:00:54,680 --> 02:00:56,320
FOR ANXIETY AND DEPRESSION.

3108
02:00:56,320 --> 02:00:58,000
SO THERE'S BEEN A CONCERTED

3109
02:00:58,000 --> 02:01:00,880
EFFORT BETWEEN NYU, JOHNS

3110
02:01:00,880 --> 02:01:03,080
HOPKINS AND UCLA TO STUDY

3111
02:01:03,080 --> 02:01:06,000
PSILOCYBIN IN ADVANCED CANCER.

3112
02:01:06,000 --> 02:01:07,000
CHARLIE GROVE WAS THE FIRST TO

3113
02:01:07,000 --> 02:01:08,400
PUBLISH ON THIS AT UCLA.

3114
02:01:08,400 --> 02:01:10,480
THESE ARE ALL SINGLE DOSE

3115
02:01:10,480 --> 02:01:11,720
STUDIES IN CONJUNCTION WITH

3116
02:01:11,720 --> 02:01:12,040
PSYCHOTHERAPY.

3117
02:01:12,040 --> 02:01:14,040
THIS STUDY SUGGESTED TRENDS

3118
02:01:14,040 --> 02:01:15,720
TOWARDS REDUCTION IN DEPRESSION

3119
02:01:15,720 --> 02:01:17,640
AND ANXIETY.

3120
02:01:17,640 --> 02:01:18,840
ROLAND GRIFFITHS, A COLLEAGUE

3121
02:01:18,840 --> 02:01:20,560
AND FRIEND AT JOHNS HOPKINS, DID

3122
02:01:20,560 --> 02:01:24,520
A STUDY IN 51 INDIVIDUALS WITH

3123
02:01:24,520 --> 02:01:25,760
ADVANCED AND EARLY STAGE CANCER.

3124
02:01:25,760 --> 02:01:27,840
VERY SIMILAR DESIGN TO OUR

3125
02:01:27,840 --> 02:01:30,080
STUDY, AND FOUND SUSTAINED

3126
02:01:30,080 --> 02:01:31,760
REDUCTIONS IN DEPRESSION,

3127
02:01:31,760 --> 02:01:33,600
ANXIETY AND EXISTENTIAL

3128
02:01:33,600 --> 02:01:34,040
DISTRESS.

3129
02:01:34,040 --> 02:01:36,640
WE DID A STUDY, SINGLE DOSE

3130
02:01:36,640 --> 02:01:39,280
PSILOCYBIN, IT WAS A CROSSOVER

3131
02:01:39,280 --> 02:01:41,120
DESIGN, AND WE ALSO FOUND, AND

3132
02:01:41,120 --> 02:01:45,080
YOU CAN SEE HERE, THIS IS THE

3133
02:01:45,080 --> 02:01:52,920
SILL SI BIN GPSILOCYBIN GROUP, D

3134
02:01:52,920 --> 02:01:55,240
DECREASES, THE PLACEBO GROUP,

3135
02:01:55,240 --> 02:01:57,320
ONCE THEY RECEIVE PSILOCYBIN,

3136
02:01:57,320 --> 02:02:00,000
THEY START TO APPROACH THE OTHER

3137
02:02:00,000 --> 02:02:00,640
GROUP.

3138
02:02:00,640 --> 02:02:02,360
WE DID A LONG TERM FOLLOW-UP

3139
02:02:02,360 --> 02:02:05,200
STUDY AT 4 1/2 YEARS, AND

3140
02:02:05,200 --> 02:02:06,040
PARTICIPANTS CONTINUE TO SAY

3141
02:02:06,040 --> 02:02:07,040
THIS IS ONE OF THE MOST

3142
02:02:07,040 --> 02:02:09,280
SIGNIFICANT EXPERIENCES OF THEIR

3143
02:02:09,280 --> 02:02:09,600
LIVES.

3144
02:02:09,600 --> 02:02:10,600
THEY CONTINUED TO REPORT

3145
02:02:10,600 --> 02:02:12,040
SUSTAINED REDUCTIONS IN

3146
02:02:12,040 --> 02:02:14,600
DEPRESSION, ANXIETY AND

3147
02:02:14,600 --> 02:02:15,080
EXISTENTIAL DISTRESS.

3148
02:02:15,080 --> 02:02:16,160
AND WHEN WE ASKED THEM TO RATE

3149
02:02:16,160 --> 02:02:17,600
THE MEANINGFULNESS AND THE

3150
02:02:17,600 --> 02:02:21,160
SPIRITUAL SIG CAPS OF THESE SIGE

3151
02:02:21,160 --> 02:02:22,040
EXPERIENCES, MANY INDIVIDUALS

3152
02:02:22,040 --> 02:02:23,440
RATE THEM AMONG THE MOST

3153
02:02:23,440 --> 02:02:26,400
MEMORABLE, MOST MEANINGFUL, MOST

3154
02:02:26,400 --> 02:02:27,280
IMPACTFUL EXPERIENCES OF THEIR

3155
02:02:27,280 --> 02:02:27,480
LIVES.

3156
02:02:27,480 --> 02:02:29,560
THE WE WOULD HAVE PEOPLE THAT

3157
02:02:29,560 --> 02:02:31,720
WERE HIGHLY DISTRESSED WITH

3158
02:02:31,720 --> 02:02:32,920
THEIR CANCER FELT THAT LIFE WAS

3159
02:02:32,920 --> 02:02:34,280
NOT WORTH LIVING, AND BY THE END

3160
02:02:34,280 --> 02:02:36,560
OF THE DOSING SESSION, IT WAS

3161
02:02:36,560 --> 02:02:38,360
QUITE REMARKABLE TO SEE THESE

3162
02:02:38,360 --> 02:02:39,800
TRANSFORMATIONS IN PEOPLE'S

3163
02:02:39,800 --> 02:02:43,480
ORIENTATION TO THEIR DISEASE AND

3164
02:02:43,480 --> 02:02:45,040
TO LIFE AND DEATH, SO MUCH SO

3165
02:02:45,040 --> 02:02:46,320
THAT IT WAS HARD TO BELIEVE THE

3166
02:02:46,320 --> 02:02:47,560
DATA, AND THAT'S WHY WE NEED TO

3167
02:02:47,560 --> 02:02:48,400
DO MORE STUDIES.

3168
02:02:48,400 --> 02:02:50,560
WE DID A QUALITATIVE STUDY AND

3169
02:02:50,560 --> 02:02:53,160
WE FOUND VERY INTERESTING

3170
02:02:53,160 --> 02:02:53,760
THEMES.

3171
02:02:53,760 --> 02:02:54,960
ONE OF THE THEMES HERE WAS

3172
02:02:54,960 --> 02:02:56,320
GREATER CONFIDENCE IN THE FACE

3173
02:02:56,320 --> 02:02:58,200
OF CANCER RECURRENCE.

3174
02:02:58,200 --> 02:02:59,480
THIS HAS LED OUR GROUP, WE'RE

3175
02:02:59,480 --> 02:03:01,800
ABOUT TO SUBMIT ANOTHER R01 TO

3176
02:03:01,800 --> 02:03:03,800
NCI TO STUDY PSILOCYBIN PLUS

3177
02:03:03,800 --> 02:03:05,440
PSYCHOTHERAPY TO TREAT FEAR OF

3178
02:03:05,440 --> 02:03:08,640
RECURRENCE IN EARLY STAGE BREAST

3179
02:03:08,640 --> 02:03:09,720
CANCER TACKING TO EARLIER

3180
02:03:09,720 --> 02:03:10,040
ILLNESS.

3181
02:03:10,040 --> 02:03:14,080
WE DID A SECONDARY ANALYSIS AND

3182
02:03:14,080 --> 02:03:15,600
FOUND SUGGESTIONS OF REDUCTIONS

3183
02:03:15,600 --> 02:03:17,520
IN SUICIDAL IDEATION.

3184
02:03:17,520 --> 02:03:20,920
SO IN SUM, BETWEEN THE THREE

3185
02:03:20,920 --> 02:03:22,880
SITES, THERE WERE CLOSE TO 90

3186
02:03:22,880 --> 02:03:25,960
PARTICIPANTS TREATED, THAT WE

3187
02:03:25,960 --> 02:03:27,560
FOUND THAT SIEB SI LIN WAS A

3188
02:03:27,560 --> 02:03:30,640
RAPIDLY ACTING ANXIOLYTIC AND

3189
02:03:30,640 --> 02:03:31,520
ANTIDEPRESSANT, AND EFFECTS WERE

3190
02:03:31,520 --> 02:03:34,440
SUSTAINED PERHAPS FOR MONTHS TO

3191
02:03:34,440 --> 02:03:36,960
YEARS, WE FOUND REDUCTIONS IN

3192
02:03:36,960 --> 02:03:38,200
EXISTENTIAL DISTRESS, IMPROVED

3193
02:03:38,200 --> 02:03:39,600
QUALITY OF LIFE, AND THESE WERE

3194
02:03:39,600 --> 02:03:41,800
HIGHLY MEMORABLE, MEANINGFUL

3195
02:03:41,800 --> 02:03:42,320
EXPERIENCES.

3196
02:03:42,320 --> 02:03:44,080
I WAS VERY INTERESTED TO SEE

3197
02:03:44,080 --> 02:03:46,120
THAT NIH PUT ON A PSILOCYBIN

3198
02:03:46,120 --> 02:03:47,240
SERIES, INCLUDING NCI.

3199
02:03:47,240 --> 02:03:49,080
I WAS INVITED TO SPEAK.

3200
02:03:49,080 --> 02:03:51,720
AND THAT REALLY EMBOLDENED ME.

3201
02:03:51,720 --> 02:03:52,800
I WANTED TO MAKE SURE WE TOOK

3202
02:03:52,800 --> 02:03:55,200
THIS RESEARCH TO THE NEXT LEVEL,

3203
02:03:55,200 --> 02:03:59,360
AND SO KEPT APPLYING TO NCI, AND

3204
02:03:59,360 --> 02:04:00,760
WAS VERY GRATEFUL TO BE AWARDED

3205
02:04:00,760 --> 02:04:02,280
AN R01.

3206
02:04:02,280 --> 02:04:03,040
THIS WAS BACK IN JULY.

3207
02:04:03,040 --> 02:04:05,680
THIS IS GOING TO BE A TWO-SITE

3208
02:04:05,680 --> 02:04:08,400
STUDY BETWEEN NYU AND UC DENVER.

3209
02:04:08,400 --> 02:04:10,040
THIS WAS THE FIRST GRANT EVER

3210
02:04:10,040 --> 02:04:12,240
GIVEN BY NCI FOR PSYCHEDELIC

3211
02:04:12,240 --> 02:04:13,240
RESEARCH, THE THIRD IN THE LAST

3212
02:04:13,240 --> 02:04:15,480
IF YEARS, AND IS ENCOURAGING

3213
02:04:15,480 --> 02:04:19,520
THAT NIH APPEARS OPEN TO FUNDING

3214
02:04:19,520 --> 02:04:20,800
THIS TYPE OF RESEARCH.

3215
02:04:20,800 --> 02:04:22,440
SO THIS IS GOING TO BE 200

3216
02:04:22,440 --> 02:04:23,120
INDIVIDUALS WITH ADVANCED

3217
02:04:23,120 --> 02:04:24,520
CANCER, AND WE JUST STARTED

3218
02:04:24,520 --> 02:04:27,360
RECRUITING AT BOTH NYU AND

3219
02:04:27,360 --> 02:04:28,560
DENVER SO WE'RE REALLY EXCITED

3220
02:04:28,560 --> 02:04:31,320
FOR THIS TRIAL.

3221
02:04:31,320 --> 02:04:32,800
SO I'M GOING TO END BY TALKING

3222
02:04:32,800 --> 02:04:34,160
ABOUT PAIN.

3223
02:04:34,160 --> 02:04:35,920
ONE OF MY RESEARCH INTERESTS IS

3224
02:04:35,920 --> 02:04:37,000
THE INTERSECTION BETWEEN

3225
02:04:37,000 --> 02:04:38,200
ADDICTION AND PAIN AND WE'VE

3226
02:04:38,200 --> 02:04:40,480
HEARD A LOT IN THIS CONSORTIUM

3227
02:04:40,480 --> 02:04:44,800
SO FAR ABOUT THE MULTIFACETED

3228
02:04:44,800 --> 02:04:45,800
COMPONENTS OF PAIN.

3229
02:04:45,800 --> 02:04:47,360
NOT ONLY IS THERE PHYSICAL BUT

3230
02:04:47,360 --> 02:04:48,160
THERE'S A PSYCHOLOGICAL

3231
02:04:48,160 --> 02:04:50,560
COMPONENT TO PAIN AND A

3232
02:04:50,560 --> 02:04:52,960
SPIRITUAL COMPONENT AS WELL.

3233
02:04:52,960 --> 02:04:54,920
AND IN THINKING ABOUT THIS, THE

3234
02:04:54,920 --> 02:04:56,960
EVIDENCE BASE FOR CLASSIC

3235
02:04:56,960 --> 02:04:58,320
PSYCHEDELICS TO TREAT CHRONIC

3236
02:04:58,320 --> 02:05:00,720
PAIN HAS BEEN IN A RANGE OF PAIN

3237
02:05:00,720 --> 02:05:02,400
CONDITIONS RANGING FROM CANCER

3238
02:05:02,400 --> 02:05:07,640
PAIN, CLUSTER HAAK HEADACHES, PM

3239
02:05:07,640 --> 02:05:09,320
LIMB PAIN, BUT MOST OF THE DATA

3240
02:05:09,320 --> 02:05:11,440
HAS BEEN FROM CASE REPORTS,

3241
02:05:11,440 --> 02:05:12,320
RETROSPECTIVE SURVEYS, OPEN

3242
02:05:12,320 --> 02:05:15,840
LABEL TRIALS.

3243
02:05:15,840 --> 02:05:20,680
AND SO LSD, PSILOCYBIN AND

3244
02:05:20,680 --> 02:05:24,280
BROMAL LSD, LIKELY GOING TO BE

3245
02:05:24,280 --> 02:05:25,080
NEUROBIOLOGICAL.

3246
02:05:25,080 --> 02:05:27,040
PHANTOM LIMB PAIN, THERE'S SOME

3247
02:05:27,040 --> 02:05:28,680
CASE REPORTS AND THERE'S SOME

3248
02:05:28,680 --> 02:05:29,640
CASE REPORTS WITH MIGRAINES AND

3249
02:05:29,640 --> 02:05:30,840
HERE THE MECHANISM IS LIKELY

3250
02:05:30,840 --> 02:05:32,600
GOING TO BE A NEUROVASCULAR

3251
02:05:32,600 --> 02:05:34,320
RATHER THAN A PSYCHOSPIRITUAL.

3252
02:05:34,320 --> 02:05:37,360
IF WE WERE TO THINK OF DIFFERENT

3253
02:05:37,360 --> 02:05:38,760
MODELS, YOU COULD IMAGINE THE

3254
02:05:38,760 --> 02:05:40,960
SORT OF LIKE DAILY MICRO DOSING

3255
02:05:40,960 --> 02:05:45,200
MODEL THAT COULD BE USED, HERE

3256
02:05:45,200 --> 02:05:47,600
WE MIGHT BE THINKING OF

3257
02:05:47,600 --> 02:05:48,320
INFLAMMATION, ANTI-INFLAMMATORY

3258
02:05:48,320 --> 02:05:49,680
EFFECTS AS POTENTIAL MECHANISM,

3259
02:05:49,680 --> 02:05:50,800
AND THEN THIS OTHER MODEL WHERE

3260
02:05:50,800 --> 02:05:54,360
WE USE SINGLE HIGH DOSE OF

3261
02:05:54,360 --> 02:05:56,040
PSYCHEDELIC DRUGS AS A WAY TO

3262
02:05:56,040 --> 02:05:57,880
INDUCE THESE SORT OF SUBJECTIVE

3263
02:05:57,880 --> 02:06:01,040
STATES WHICH MAY HELP CHANGE

3264
02:06:01,040 --> 02:06:01,800
ORIENTATION TO ILLNESS.

3265
02:06:01,800 --> 02:06:03,600
AND IF WE WERE TO THINK OF

3266
02:06:03,600 --> 02:06:04,520
MECHANISMS, THERE'S BEEN ALMOST

3267
02:06:04,520 --> 02:06:05,840
NO PRE-CLINICAL WORK WITH

3268
02:06:05,840 --> 02:06:07,040
PSYCHEDELICS AND PAIN.

3269
02:06:07,040 --> 02:06:08,000
THERE'S SOME GROUPS WORKING ON

3270
02:06:08,000 --> 02:06:08,320
IT.

3271
02:06:08,320 --> 02:06:10,640
AND IF WE WERE TO THINK OF NEWER

3272
02:06:10,640 --> 02:06:12,800
BIOLOGIC MECHANISMS, WE WOULD

3273
02:06:12,800 --> 02:06:13,880
LOOK AT INFLAMMATION.

3274
02:06:13,880 --> 02:06:15,760
IT APPEARS THAT A WHOLE HOST OF

3275
02:06:15,760 --> 02:06:17,160
PSYCHEDELICS HAVE

3276
02:06:17,160 --> 02:06:19,040
ANTI-INFLAMMATORY EFFECTS BY

3277
02:06:19,040 --> 02:06:23,200
INHIBITING TNF ALPHA.

3278
02:06:23,200 --> 02:06:24,280
SEROTONERGIC EFFECT, WE KNOW

3279
02:06:24,280 --> 02:06:26,840
THAT 2A SYSTEM IS INVOLVED IN

3280
02:06:26,840 --> 02:06:28,760
PAIN REGULATION AND PSYCHEDELICS

3281
02:06:28,760 --> 02:06:30,040
LEADED DOWN REGULATION OF THAT

3282
02:06:30,040 --> 02:06:32,120
SYSTEM, SO THERE MAY BE, LET'S

3283
02:06:32,120 --> 02:06:33,720
SAY, REVERSAL OF PERIPHERAL

3284
02:06:33,720 --> 02:06:34,880
SENSITIZATION OCCURRING AT THE

3285
02:06:34,880 --> 02:06:35,400
SPINAL CORD LEVEL.

3286
02:06:35,400 --> 02:06:37,920
THERE MAY BE DOPAMINERGIC

3287
02:06:37,920 --> 02:06:40,160
PROCESSES, WE KNOW THAT

3288
02:06:40,160 --> 02:06:42,480
PSYCHEDELICS INDUCE

3289
02:06:42,480 --> 02:06:44,000
NEUROPLASTICITY, FUNCTIONAL AND

3290
02:06:44,000 --> 02:06:45,280
STRUCTURAL NEUROPLASTICITY, AND

3291
02:06:45,280 --> 02:06:45,960
THIS MAY PLAY A ROLE.

3292
02:06:45,960 --> 02:06:47,560
WE KNOW THAT THEY RECONFIGURE

3293
02:06:47,560 --> 02:06:49,280
BRAINNET WORKS, WE KNOW THAT THE

3294
02:06:49,280 --> 02:06:50,760
DEFAULT MODE NETWORK IN

3295
02:06:50,760 --> 02:06:53,320
PARTICULAR IS INVOLVED IN PAIN

3296
02:06:53,320 --> 02:06:54,400
CONDITIONS, AND SO IT MAY BE A

3297
02:06:54,400 --> 02:06:56,400
SORT OF REBOOTING OF THE SYSTEMS

3298
02:06:56,400 --> 02:06:57,760
THAT HELPS.

3299
02:06:57,760 --> 02:06:59,600
BUT WHAT I REALLY THINK IF I

3300
02:06:59,600 --> 02:07:01,560
WERE TO GUESS IS GOING ON, THAT

3301
02:07:01,560 --> 02:07:03,440
WE KNOW THAT A LOT OF PAIN IS

3302
02:07:03,440 --> 02:07:05,640
AMPLIFIED BY DEPRESSION, ANXIETY

3303
02:07:05,640 --> 02:07:07,280
AND EXISTENTIAL DISTRESS, SO IF

3304
02:07:07,280 --> 02:07:08,880
WE CAN MAKE SOME OF THOSE

3305
02:07:08,880 --> 02:07:10,440
COMPONENTS OF PAIN BETTER, CAN

3306
02:07:10,440 --> 02:07:14,920
WE IMPROVE OVERALL PAIN

3307
02:07:14,920 --> 02:07:16,680
EXPERIENCE?

3308
02:07:16,680 --> 02:07:22,560
SO THERE ARE SEVERAL -- TO TREAT

3309
02:07:22,560 --> 02:07:24,880
CHRONIC PAIN IN LOW BACK PAIN,

3310
02:07:24,880 --> 02:07:26,400
FIBROMYALGIA, PHANTOM LIMB PAIN,

3311
02:07:26,400 --> 02:07:28,480
AND IN CANCER PAIN, AND I WANT

3312
02:07:28,480 --> 02:07:30,000
TO JUST BRIEFLY END BY TALKING

3313
02:07:30,000 --> 02:07:30,800
ABOUT THAT.

3314
02:07:30,800 --> 02:07:34,440
SO CANCER INDUCED BONE PAIN IS

3315
02:07:34,440 --> 02:07:36,120
VERY COMMON, BONES ARE THE THIRD

3316
02:07:36,120 --> 02:07:37,760
MOST FREQUENT TARGET OF

3317
02:07:37,760 --> 02:07:38,640
METASTATIC CANCER, AND THEY

3318
02:07:38,640 --> 02:07:40,880
OCCUR RANGING FROM BREAST TO

3319
02:07:40,880 --> 02:07:42,080
KIDNEY.

3320
02:07:42,080 --> 02:07:44,640
HUGE PUBLIC HEALTH BURDEN.

3321
02:07:44,640 --> 02:07:48,440
AND HIGHLY PREVALENT, AND IT'S

3322
02:07:48,440 --> 02:07:51,160
MARKED BY SEVERE PAIN, DECREASED

3323
02:07:51,160 --> 02:07:52,160
SURVIVAL.

3324
02:07:52,160 --> 02:07:54,200
THERE'S ENORMOUS ANXIETY AND

3325
02:07:54,200 --> 02:07:56,400
DEPRESSION ASSOCIATED, THERE'S

3326
02:07:56,400 --> 02:07:57,800
EXISTENTIAL DISTRESS ASSOCIATED

3327
02:07:57,800 --> 02:08:00,920
WITH THIS ILLNESS.

3328
02:08:00,920 --> 02:08:05,280
AND THE -- INTERACTIONS BETWEEN

3329
02:08:05,280 --> 02:08:06,880
TUMOR CELLS, BONE CELLS AND

3330
02:08:06,880 --> 02:08:08,080
ACTIVATED INFLAMMATORY CELLS.

3331
02:08:08,080 --> 02:08:11,080
THERE'S INCREASED OSTEOCLAST

3332
02:08:11,080 --> 02:08:12,480
ACTIVITY, THERE'S -- YOU END UP

3333
02:08:12,480 --> 02:08:13,320
GETTING MASS EFFECT.

3334
02:08:13,320 --> 02:08:16,280
BUT THERE'S ALSO INFLAMMATORY

3335
02:08:16,280 --> 02:08:17,360
MEDIATOR RELEASE AND THERE'S

3336
02:08:17,360 --> 02:08:19,360
SOME THINKING THAT PERIPHERAL

3337
02:08:19,360 --> 02:08:21,400
AND CENTRAL SENSITIZATION PLAY A

3338
02:08:21,400 --> 02:08:22,720
ROLE HERE.

3339
02:08:22,720 --> 02:08:26,320
THERE ARE TREATMENTS FOR CANCER

3340
02:08:26,320 --> 02:08:28,960
INDUCED BONE PAIN RANGING FROM

3341
02:08:28,960 --> 02:08:30,440
SURGERY TO A VARIETY OF

3342
02:08:30,440 --> 02:08:33,760
MEDICATIONS.

3343
02:08:33,760 --> 02:08:34,960
OPIATES ARE USED IN THIS

3344
02:08:34,960 --> 02:08:37,560
POPULATION.

3345
02:08:37,560 --> 02:08:39,760
BUT THERE ARE LIMITATIONS,

3346
02:08:39,760 --> 02:08:41,040
THERE'S SIGNIFICANT GAPS, THE

3347
02:08:41,040 --> 02:08:42,800
PAIN EFFICACY TENDS TO BE

3348
02:08:42,800 --> 02:08:43,880
LIMITED, THE QUALITY OF LIFE

3349
02:08:43,880 --> 02:08:47,280
TENDS TO NOT GET IMPROVED.

3350
02:08:47,280 --> 02:08:52,720
THERE ARE POTENTIAL FOR A SAEs.

3351
02:08:52,720 --> 02:08:53,600
OPIATES, EVEN THOUGH THEY ARE

3352
02:08:53,600 --> 02:08:55,040
GIVEN TO CANCER PATIENTS,

3353
02:08:55,040 --> 02:08:56,720
THEY'RE NOT WITHOUT RISK THAT

3354
02:08:56,720 --> 02:08:58,480
PEOPLE CAN STILL HAVE

3355
02:08:58,480 --> 02:09:00,200
RESPIRATORY SUPPRESSION AND

3356
02:09:00,200 --> 02:09:01,560
POTENTIALLY GET ADDICTED TO

3357
02:09:01,560 --> 02:09:04,000
THEM.

3358
02:09:04,000 --> 02:09:06,880
SO LOOKING AT THIS, WE SHOULD

3359
02:09:06,880 --> 02:09:08,520
THINK OF INTERVENTIONS THAT ARE

3360
02:09:08,520 --> 02:09:09,880
NON-ADDICTIVE, CAN HAVE RAPID

3361
02:09:09,880 --> 02:09:12,880
AND SUSTAINED ANALGESIA, CAN

3362
02:09:12,880 --> 02:09:14,440
AFFECT PSYCHIATRIC AND

3363
02:09:14,440 --> 02:09:15,640
EXISTENTIAL DISTRESS, AND HAVE

3364
02:09:15,640 --> 02:09:17,560
THE POTENTIAL FOR OPIATE

3365
02:09:17,560 --> 02:09:17,880
SPARING.

3366
02:09:17,880 --> 02:09:21,400
SO I MET BOB DORKIN ABOUT A YEAR

3367
02:09:21,400 --> 02:09:22,480
AND A HALF AGO.

3368
02:09:22,480 --> 02:09:23,880
HE TOLD ME ABOUT HE PICK NET, I

3369
02:09:23,880 --> 02:09:24,800
KNEW NOTHING ABOUT IT.

3370
02:09:24,800 --> 02:09:26,320
HE ENCOURAGED ME TO APPLY.

3371
02:09:26,320 --> 02:09:31,360
SO I DID, AND THE PROPOSED STUDY

3372
02:09:31,360 --> 02:09:32,960
IS A RANDOMIZED CONTROL TRIAL,

3373
02:09:32,960 --> 02:09:34,960
THIS IS PICKING UP ON THE CAST

3374
02:09:34,960 --> 02:09:37,120
WORK, AND THE IDEA IS TO USE LSD

3375
02:09:37,120 --> 02:09:38,320
ASSISTED PSYCHOTHERAPY TO TARGET

3376
02:09:38,320 --> 02:09:39,800
CANCER INDUCED BONE PAIN TO LOOK

3377
02:09:39,800 --> 02:09:41,600
AT BOTH BREAST AND LUNG.

3378
02:09:41,600 --> 02:09:44,000
THIS WOULD BE A PHASE TWO STUDY,

3379
02:09:44,000 --> 02:09:46,040
N OF 100 MULTICENTER THAT COULD

3380
02:09:46,040 --> 02:09:50,640
BE UP TO 10 SITES INVOLVED.

3381
02:09:50,640 --> 02:09:54,880
THE DESIGN IS SINGLE DOSE LSD15S

3382
02:09:54,880 --> 02:09:55,880
PLACEBO, EVERYTHING DONE IN

3383
02:09:55,880 --> 02:09:57,080
CONJUNCTION WITH PSYCHOTHERAPY,

3384
02:09:57,080 --> 02:09:59,920
AND THERE'S AN OPEN LABEL

3385
02:09:59,920 --> 02:10:02,000
EXTENSION COMPONENT AT THE END.

3386
02:10:02,000 --> 02:10:04,280
PRIMARY OUTCOME IS GOING TO BE

3387
02:10:04,280 --> 02:10:05,360
PAIN, SUBJECTIVE PAIN, BUT WE'RE

3388
02:10:05,360 --> 02:10:07,640
ALSO GOING TO BE LOOKING AT

3389
02:10:07,640 --> 02:10:10,160
PSYCHIATRIC DISTRESS,

3390
02:10:10,160 --> 02:10:11,240
EXISTENTIAL DISTRESS, OPIATE

3391
02:10:11,240 --> 02:10:12,640
USE, QUALITY OF LIFE.

3392
02:10:12,640 --> 02:10:15,160
AND THERE'S GOING TO BE A

3393
02:10:15,160 --> 02:10:19,040
MECHANISTIC COMPONENT,

3394
02:10:19,040 --> 02:10:20,000
NEUROLOGIC, PSYCHOSPIRITUAL

3395
02:10:20,000 --> 02:10:21,640
MECHANISMS OF ACTIONS.

3396
02:10:21,640 --> 02:10:23,320
SO WE'VE MADE IT THROUGH TWO

3397
02:10:23,320 --> 02:10:24,480
ROUNDS, WE'RE WORKING NOW WITH

3398
02:10:24,480 --> 02:10:27,120
THE CLINICAL COORDINATING CENTER

3399
02:10:27,120 --> 02:10:28,520
ON THE CLINICAL SYNOPSIS WHICH

3400
02:10:28,520 --> 02:10:30,000
IS ABOUT TO GO IN AND WE'LL SEE

3401
02:10:30,000 --> 02:10:30,600
WHAT HAPPENS.

3402
02:10:30,600 --> 02:10:33,120
BUT IF IT HAPPENS, IT WILL BE

3403
02:10:33,120 --> 02:10:34,320
REALLY INTERESTING AND EXCITING.

3404
02:10:34,320 --> 02:10:37,920
IN TERMS OF THE FUTURE FOR

3405
02:10:37,920 --> 02:10:39,000
PSYCHEDELICS AND PAIN, I THINK

3406
02:10:39,000 --> 02:10:40,760
THESE ARE ALL THE AREAS THAT WE

3407
02:10:40,760 --> 02:10:43,960
NEED TO LOOK AT, AND WE NEED

3408
02:10:43,960 --> 02:10:45,480
RESEARCH IN A VARIETY OF

3409
02:10:45,480 --> 02:10:46,920
DIFFERENT PAIN CONDITIONS, WE

3410
02:10:46,920 --> 02:10:48,080
NEED MORE PRE-CLINICAL WORK AND

3411
02:10:48,080 --> 02:10:50,160
WE NEED TO DESIGN STUDIES TO

3412
02:10:50,160 --> 02:10:51,920
LOOK AT MECHANISMS OF ACTION.

3413
02:10:51,920 --> 02:10:53,440
AND FINALLY, IF ALL OF THIS

3414
02:10:53,440 --> 02:10:55,000
WORKS OUT AND THE DRUGS SHOW

3415
02:10:55,000 --> 02:10:56,120
THAT THEY WORK, THEY WOULD NEED

3416
02:10:56,120 --> 02:10:57,760
TO BE RESCHEDULED.

3417
02:10:57,760 --> 02:10:59,520
THE FDA WOULD MOST CERTAINLY

3418
02:10:59,520 --> 02:11:01,680
CREATE A REMS PROGRAM.

3419
02:11:01,680 --> 02:11:02,800
THERE'S A BIG DIFFERENCE BETWEEN

3420
02:11:02,800 --> 02:11:04,200
JUST TAKING THESE DRUGS AND

3421
02:11:04,200 --> 02:11:05,400
TAKING THEM IN A CONTROLLED

3422
02:11:05,400 --> 02:11:07,240
SETTING WITH PSYCHOTHERAPISTS.

3423
02:11:07,240 --> 02:11:09,320
AND ISSUES RELATED TO

3424
02:11:09,320 --> 02:11:10,320
REIMBURSEMENT AND EQUITY OF

3425
02:11:10,320 --> 02:11:11,760
DISTRIBUTION WOULD NEED TO BE

3426
02:11:11,760 --> 02:11:12,920
WORKED OUT.

3427
02:11:12,920 --> 02:11:15,560
AND ONE DAY IF THEY WERE TO BE

3428
02:11:15,560 --> 02:11:17,280
TRANSLATED, YOU WOULD THINK OF

3429
02:11:17,280 --> 02:11:19,040
PAIN PROGRAMS, HOSPICES, AND

3430
02:11:19,040 --> 02:11:21,240
CANCER CENTERS.

3431
02:11:21,240 --> 02:11:21,920
SO THANK YOU VERY MUCH FOR YOUR

3432
02:11:21,920 --> 02:11:22,120
TIME.

3433
02:11:22,120 --> 02:11:32,280
[APPLAUSE]

3434
02:11:33,400 --> 02:11:35,480
>>OUR FINAL SPEAKER FOR
THE

3435
02:11:35,480 --> 02:11:37,320
SESSION IS DR. KIP LUDWIG,

3436
02:11:37,320 --> 02:11:38,680
CO-DIRECTOR OF THE WISCONSIN

3437
02:11:38,680 --> 02:11:43,680
INSTITUTE FOR TRANSLATIONAL

3438
02:11:43,680 --> 02:11:46,320
NEUROENGINEERING, WITNE FOR

3439
02:11:46,320 --> 02:11:48,160
SHORT, AT THE UNIVERSITY OF

3440
02:11:48,160 --> 02:11:49,040
WISCONSIN, WHERE HIS LAB IS

3441
02:11:49,040 --> 02:11:51,000
DEVELOPING NEXT GENERATION

3442
02:11:51,000 --> 02:11:52,880
NEUROMODULATION THERAPIES USING

3443
02:11:52,880 --> 02:11:54,600
MINIMALLY INVASIVE STRATEGIES TO

3444
02:11:54,600 --> 02:11:56,800
HACK THE NERVOUS SYSTEM TO TREAT

3445
02:11:56,800 --> 02:11:59,680
CIRCUIT DYSFUNCTION AND DELIVER

3446
02:11:59,680 --> 02:12:00,640
BIOMOLECULES TO TARGET AREAS

3447
02:12:00,640 --> 02:12:05,680
WITH UNPRECEDENTED PRECISION.

3448
02:12:05,680 --> 02:12:07,760
DR. LUDWIG IS A CONCEPT TO

3449
02:12:07,760 --> 02:12:09,280
CLINIC INNOVATOR.

3450
02:12:09,280 --> 02:12:10,680
I WAS IMPRESSED WITH THE NUMBER

3451
02:12:10,680 --> 02:12:13,880
OF COLLABORATIONS IN ACADEMIA

3452
02:12:13,880 --> 02:12:15,720
AND IN INDUSTRY AND SO FORTH

3453
02:12:15,720 --> 02:12:16,920
THAT YOU'VE ENGAGED IN.

3454
02:12:16,920 --> 02:12:19,560
AND THIS IS ALSO A HOMECOMING

3455
02:12:19,560 --> 02:12:20,120
FOR KIP.

3456
02:12:20,120 --> 02:12:22,720
HE WAS A PROGRAM DIRECTOR AT THE

3457
02:12:22,720 --> 02:12:23,800
NATIONAL INSTITUTE FOR

3458
02:12:23,800 --> 02:12:26,800
NEUROLOGICAL DISEASES AND

3459
02:12:26,800 --> 02:12:30,680
STROKE, NINDS WAS RE WELL

3460
02:12:30,680 --> 02:12:31,640
REPRESENTED AT THIS MEETING,

3461
02:12:31,640 --> 02:12:34,960
WHERE HE SPE SPEARHEADED EFFORTS

3462
02:12:34,960 --> 02:12:36,360
THROUGH NINDS, THE BRAIN

3463
02:12:36,360 --> 02:12:38,560
INITIATIVE AND OTHER CROSS

3464
02:12:38,560 --> 02:12:39,760
COLLABORATIONS WITH IMPLANTABLE

3465
02:12:39,760 --> 02:12:41,840
DEVICES TO STIMULATE AND RECORD

3466
02:12:41,840 --> 02:12:44,080
FROM THE CNS AS WELL AS

3467
02:12:44,080 --> 02:12:44,800
NEUROMODULATION THERAPIES FOR

3468
02:12:44,800 --> 02:12:45,800
ORGAN SYSTEMS.

3469
02:12:45,800 --> 02:12:47,960
HIS INDUSTRY EXPERIENCE INCLUDES

3470
02:12:47,960 --> 02:12:50,920
DEVELOPING AN INNOVATIVE

3471
02:12:50,920 --> 02:12:52,120
NEUROSTIMULATION ELECTRODE FOR

3472
02:12:52,120 --> 02:12:54,320
REDUCING BLOOD PRESSURE AND

3473
02:12:54,320 --> 02:12:55,920
TODAY KIP WILL SHARE INSIGHTS ON

3474
02:12:55,920 --> 02:12:57,360
THE CHALLENGES OF IMPLANTABLE

3475
02:12:57,360 --> 02:12:59,720
SPINAL CORD STIMULATORS FOR

3476
02:12:59,720 --> 02:13:04,200
CHRONIC PAIN THROUGH AN

3477
02:13:04,200 --> 02:13:06,320
INNOVATIVE SOLUTION CALL WOULD

3478
02:13:06,320 --> 02:13:07,320
THE ELECTRODE.

3479
02:13:07,320 --> 02:13:08,440
SO WE LOOK FORWARD TO HEARING

3480
02:13:08,440 --> 02:13:15,480
MORE ABOUT THAT.

3481
02:13:15,480 --> 02:13:18,280
>>I HAD MONTE PYTHON
GOING

3482
02:13:18,280 --> 02:13:20,800
THROUGH MY HEAD RIGHT NOW, FOR

3483
02:13:20,800 --> 02:13:23,080
SOMETHING COMPLETELY DIFFERENT.

3484
02:13:23,080 --> 02:13:24,080
INTERESTINGLY, I COME FROM A

3485
02:13:24,080 --> 02:13:25,720
BACKGROUND BEFORE I WAS AN

3486
02:13:25,720 --> 02:13:28,480
ENGINEER OF BIOCELLULAR AND

3487
02:13:28,480 --> 02:13:29,120
MOLECULAR, AND IT'S INTERESTING

3488
02:13:29,120 --> 02:13:30,640
IN TERMS OF PEOPLE USING

3489
02:13:30,640 --> 02:13:31,600
ELECTRICAL STIMULATION TO

3490
02:13:31,600 --> 02:13:34,720
PERTURB THE NERVOUS SYSTEM, THEY

3491
02:13:34,720 --> 02:13:36,240
TEND TO LOOK AT THINGS IN TERMS

3492
02:13:36,240 --> 02:13:38,840
OF ELECTRICAL ENGINEERING AND

3493
02:13:38,840 --> 02:13:40,600
ACUTE CIRCLE DYSFUNCTIONS WHERE

3494
02:13:40,600 --> 02:13:42,040
THERE'S OVERLAP WITH EACH OF

3495
02:13:42,040 --> 02:13:44,120
THESE TALKS IN WAYS THAT AREN'T

3496
02:13:44,120 --> 02:13:45,120
BEING CONSIDERED.

3497
02:13:45,120 --> 02:13:46,480
IT'S ACTUALLY GREAT TO BE HERE

3498
02:13:46,480 --> 02:13:48,200
FOR THE LAST 36 HOURS, AS PART

3499
02:13:48,200 --> 02:13:49,200
OF THESE TALKS AND A COUPLE OF

3500
02:13:49,200 --> 02:13:50,840
OTHER TALKS, I'VE PROBABLY COME

3501
02:13:50,840 --> 02:13:52,120
UP WITH FOUR DIFFERENT

3502
02:13:52,120 --> 02:13:53,680
HYPOTHESES ABOUT HOW ELECTRICAL

3503
02:13:53,680 --> 02:13:55,080
STIMULATION MIGHT BE WORKING AT

3504
02:13:55,080 --> 02:13:59,560
A BIOMOLECULAR AND BIOCELLULAR

3505
02:13:59,560 --> 02:14:00,960
LEVEL, BIOPLAUSIBLE HYPOTHESES

3506
02:14:00,960 --> 02:14:02,440
BUT IT REALLY KIND OF TELLS YOU

3507
02:14:02,440 --> 02:14:03,720
WHERE THIS FIELD IS AT RIGHT

3508
02:14:03,720 --> 02:14:04,920
NOW.

3509
02:14:04,920 --> 02:14:06,440
SO THERE HAS ACTUALLY BEEN A LOT

3510
02:14:06,440 --> 02:14:08,080
OF RECENT NEWS IN SPINAL CORD

3511
02:14:08,080 --> 02:14:10,040
STIMULATION FOR PAIN.

3512
02:14:10,040 --> 02:14:11,600
I'M GOING TO TALK A LITTLE ABOUT

3513
02:14:11,600 --> 02:14:12,800
THAT FIRST JUST TO KIND OF

3514
02:14:12,800 --> 02:14:13,800
ORIENT EVERYBODY ESPECIALLY AS

3515
02:14:13,800 --> 02:14:16,280
THIS IS NOT A VERY BIG DEVISED

3516
02:14:16,280 --> 02:14:18,040
BASED CROWD AND IT REALLY KIND

3517
02:14:18,040 --> 02:14:19,240
OF IMPORTANT TO UNDERSTAND WHERE

3518
02:14:19,240 --> 02:14:21,080
THE EVIDENCE IS RIGHT NOW.

3519
02:14:21,080 --> 02:14:22,880
I HAVE A LOT OF DISCLOSURES.

3520
02:14:22,880 --> 02:14:23,640
I'M GOING TO SPECIFICALLY

3521
02:14:23,640 --> 02:14:24,520
MENTION THAT I'M GOING TO BE

3522
02:14:24,520 --> 02:14:26,800
TALKING ABOUT THE INJECTRODE.

3523
02:14:26,800 --> 02:14:28,640
WE HAVE SPUB OUT A COMPANY OF

3524
02:14:28,640 --> 02:14:30,560
WHICH I'M CO-FOUNDER SO PLEASE

3525
02:14:30,560 --> 02:14:31,800
ADJUST YOUR BS METERS

3526
02:14:31,800 --> 02:14:32,760
ACCORDINGLY WHEN I SPEAK ABOUT

3527
02:14:32,760 --> 02:14:35,080
IT. I OBVIOUSLY HAVE SOME BIAS

3528
02:14:35,080 --> 02:14:36,840
THERE BUT I ALSO WORK FOR

3529
02:14:36,840 --> 02:14:37,840
MOST -- I AM ASSOCIATES WITH

3530
02:14:37,840 --> 02:14:39,800
MANY OF THE MAJOR COMPANIES AND

3531
02:14:39,800 --> 02:14:41,120
THE DEVICE COMPANIES EITHER ON

3532
02:14:41,120 --> 02:14:42,520
THEIR SCIENTIFIC ADVISORY BOARD

3533
02:14:42,520 --> 02:14:46,040
AS THEY'RE CONSULTED AS WELL.

3534
02:14:46,040 --> 02:14:47,720
MOTIVATION RECENT HISTORY FOR

3535
02:14:47,720 --> 02:14:48,320
SPINAL CORD STIMULATION.

3536
02:14:48,320 --> 02:14:49,640
I ALWAYS LIKE USING THIS AND I

3537
02:14:49,640 --> 02:14:52,280
HAVEN'T SEEN THIS COME UP IN THE

3538
02:14:52,280 --> 02:14:52,560
TALKS.

3539
02:14:52,560 --> 02:14:54,240
IN TERMS OF WE HAVEN'T HAD A LOT

3540
02:14:54,240 --> 02:14:55,680
OF EVOLUTIONARY DRIVERS FOR AS

3541
02:14:55,680 --> 02:14:57,400
WE AGE TO NOT HAVE THINGS LIKE

3542
02:14:57,400 --> 02:14:59,040
CHRONIC BACK PAIN.

3543
02:14:59,040 --> 02:15:00,120
TRUTH OF THE MATTER IS, IF YOU

3544
02:15:00,120 --> 02:15:01,760
GO BACK 200 YEARS, WE WEREN'T

3545
02:15:01,760 --> 02:15:02,720
MAKING IT PAST 40.

3546
02:15:02,720 --> 02:15:04,960
SO OUR BODY, OUR BACKS, OUR

3547
02:15:04,960 --> 02:15:07,680
KNEES, ET CETERA, REALLY DIDN'T

3548
02:15:07,680 --> 02:15:09,560
EVOLVE TO NOT HAVE THAT BE A

3549
02:15:09,560 --> 02:15:10,600
PROBLEM, AND SO IT'S REALLY

3550
02:15:10,600 --> 02:15:12,400
USEFUL TO KIND OF THINK ABOUT

3551
02:15:12,400 --> 02:15:13,600
ITS CONTEXT IN TERMS OF WHY WE

3552
02:15:13,600 --> 02:15:15,640
HAVE SOME OF THESE CHRONIC PAIN

3553
02:15:15,640 --> 02:15:16,760
SYNDROMES AS WE AGE.

3554
02:15:16,760 --> 02:15:18,400
BACK PAIN IS INCREDIBLY

3555
02:15:18,400 --> 02:15:18,880
PREVALENT.

3556
02:15:18,880 --> 02:15:20,800
I'M GOING TO GUESS 40 TO 50% OF

3557
02:15:20,800 --> 02:15:22,120
THE PEOPLE IN THIS ROOM HAVE HAD

3558
02:15:22,120 --> 02:15:24,240
BACK PAIN AT SOME POINT IN THEIR

3559
02:15:24,240 --> 02:15:24,560
LIFE.

3560
02:15:24,560 --> 02:15:26,240
IF YOU'RE LIKE MYSELF, I'VE HAD

3561
02:15:26,240 --> 02:15:27,080
CHRONIC BACK PAIN SINCE I

3562
02:15:27,080 --> 02:15:29,040
STARTED WORKING AT THE NIH.

3563
02:15:29,040 --> 02:15:31,800
BACK IN THE DAY, I GIVE THAT AS

3564
02:15:31,800 --> 02:15:33,120
CORRELATION, NOT CAUSATION, I

3565
02:15:33,120 --> 02:15:35,280
ENJOYED MY TIME AT THE NIH.

3566
02:15:35,280 --> 02:15:37,560
BUT SO THIS IS A HUGE MARKET AND

3567
02:15:37,560 --> 02:15:38,920
THE TRUTH OF THE MATTER IS RIGHT

3568
02:15:38,920 --> 02:15:40,120
NOW IF YOU HAVE CHRONIC BACK

3569
02:15:40,120 --> 02:15:43,560
PAIN, YOU GO GET SOME DRUGS, YOU

3570
02:15:43,560 --> 02:15:45,000
DO PHYSICAL THERAPY, WHEN THOSE

3571
02:15:45,000 --> 02:15:46,320
FAIL, THEN YOU COME TO SPINAL

3572
02:15:46,320 --> 02:15:47,800
CORD STIMULATORS FOR PAIN.

3573
02:15:47,800 --> 02:15:49,040
SPINAL CORD STIMULATORS FOR PAIN

3574
02:15:49,040 --> 02:15:52,680
ARE ACTUALLY AN ENORMOUS MARKET.

3575
02:15:52,680 --> 02:15:53,960
SO PEOPLE DON'T REALIZE HOW BIG

3576
02:15:53,960 --> 02:15:58,360
IT IS, BUT RIGHT NOW THE ENTIRE

3577
02:15:58,360 --> 02:16:00,320
NEUROMODULATION MARKET IS ABOUT

3578
02:16:00,320 --> 02:16:02,520
$6 BILLION A YEAR, SO WE DO

3579
02:16:02,520 --> 02:16:03,520
ABOUT $1 TRILLION IN ECONOMIC

3580
02:16:03,520 --> 02:16:05,280
ACTIVITY FOR PHARMA FOR MEDICAL

3581
02:16:05,280 --> 02:16:07,240
DEVICES, WE DO ABOUT

3582
02:16:07,240 --> 02:16:09,120
$300 BILLION PER YEAR.

3583
02:16:09,120 --> 02:16:10,840
SOMEWHERE AROUND 3 TO $6 BILLION

3584
02:16:10,840 --> 02:16:11,960
IS SPINAL CORD STIMULATORS FOR

3585
02:16:11,960 --> 02:16:13,160
PAIN, WHICH IS AN ENORMOUS

3586
02:16:13,160 --> 02:16:14,240
MARKET AND IT GROWING.

3587
02:16:14,240 --> 02:16:16,120
NOW, THE INTERESTING THING,

3588
02:16:16,120 --> 02:16:21,800
ACTUALLY I NEED TO GO BACK.

3589
02:16:21,800 --> 02:16:23,800
SO THE INTERESTING THING IS

3590
02:16:23,800 --> 02:16:25,040
SPINAL CORD STIMULATION FOR PAIN

3591
02:16:25,040 --> 02:16:25,480
IS NOT NEW.

3592
02:16:25,480 --> 02:16:27,840
IT ACTUALLY ONE OF THE FIRST

3593
02:16:27,840 --> 02:16:29,800
IMPLANTS FOR SPINAL CORD STIM

3594
02:16:29,800 --> 02:16:32,440
FOR PAIN WAS TOM MORTIMER AS

3595
02:16:32,440 --> 02:16:34,280
PH.D. THESIS BACK IN 1967.

3596
02:16:34,280 --> 02:16:35,600
THE INTERESTING THING IS

3597
02:16:35,600 --> 02:16:37,000
TECHNOLOGY GETTING TO BE ALL

3598
02:16:37,000 --> 02:16:38,120
WIRELESS AND THINGS LIKE THAT.

3599
02:16:38,120 --> 02:16:40,080
WHAT PEOPLE DON'T REALIZE IS THE

3600
02:16:40,080 --> 02:16:40,920
ORIGINAL SPINAL CORD STIMULATOR

3601
02:16:40,920 --> 02:16:44,320
FOR PAIN WAS ACTUALLY ALSO

3602
02:16:44,320 --> 02:16:45,760
WIRELESS, IT HAD A HUGE COIL

3603
02:16:45,760 --> 02:16:47,120
THAT SUPPLIED POWER BECAUSE WE

3604
02:16:47,120 --> 02:16:48,400
DIDN'T HAVE GOOD BATTERIES THAT

3605
02:16:48,400 --> 02:16:50,480
COULD LAST IN THE BODY AS WELL.

3606
02:16:50,480 --> 02:16:51,480
SO UNFORTUNATELY EVEN THOUGH

3607
02:16:51,480 --> 02:16:55,720
IT'S BEEN AROUND SINCE 1967,

3608
02:16:55,720 --> 02:16:57,160
THESE ARE THE THEORIES OF

3609
02:16:57,160 --> 02:17:01,040
MECHANISM OF A ACTION FOR SPINAL

3610
02:17:01,040 --> 02:17:02,320
CORD STIMULATION FOR PAIN AND I

3611
02:17:02,320 --> 02:17:03,720
JUST TOLD YOU I CAME UP WITH

3612
02:17:03,720 --> 02:17:04,840
THREE TO FOUR NEW ONES.

3613
02:17:04,840 --> 02:17:06,280
I'M GOING TO TALK ABOUT GAIT

3614
02:17:06,280 --> 02:17:07,560
THEORY BUT THIS REALLY GETS INTO

3615
02:17:07,560 --> 02:17:08,320
MANY DIFFERENT THINGS THAT MIGHT

3616
02:17:08,320 --> 02:17:10,200
BE HAPPENING WITH MANY DIFFERENT

3617
02:17:10,200 --> 02:17:11,160
BIOMOLECULAR PLAYERS.

3618
02:17:11,160 --> 02:17:12,400
SO THE TRUTH OF THE MATTER IS,

3619
02:17:12,400 --> 02:17:14,840
WE DON'T KNOW REALLY WHAT WE'RE

3620
02:17:14,840 --> 02:17:16,320
STIMULATING FOR EFFECT, AND IN

3621
02:17:16,320 --> 02:17:17,720
MANY CASES, ALL OF THESE

3622
02:17:17,720 --> 02:17:18,760
THERAPIES THAT ARE ELECTRICAL

3623
02:17:18,760 --> 02:17:20,360
STIMULATION TURN IT UP TO A SIDE

3624
02:17:20,360 --> 02:17:22,680
EFFECT AND THEN TURN IT DOWN A

3625
02:17:22,680 --> 02:17:23,760
NOTCH AND HOPE THEY'RE

3626
02:17:23,760 --> 02:17:25,080
ACTIVATING THE PATHWAYS OR

3627
02:17:25,080 --> 02:17:26,560
CREATING BITE OWE MOLECULAR

3628
02:17:26,560 --> 02:17:30,120
CHANGES THEY NEEDED FOR EFFECT.

3629
02:17:30,120 --> 02:17:31,760
THIS IS WHY WE'VE RUN INTO THIS

3630
02:17:31,760 --> 02:17:32,960
PROBLEM, SO THIS IS A NICE STUDY

3631
02:17:32,960 --> 02:17:36,440
THAT WAS DONE BY GRILL, A 2014

3632
02:17:36,440 --> 02:17:37,680
PAPER AND THERE HAVE BEEN A LOT

3633
02:17:37,680 --> 02:17:39,520
OF INNOVATIONS IN SPINAL CORD

3634
02:17:39,520 --> 02:17:40,720
STIMULATION SINCE THEN BUT WHAT

3635
02:17:40,720 --> 02:17:42,640
I LOVE ABOUT THIS, THIS IS A

3636
02:17:42,640 --> 02:17:43,920
META-ANALYSIS OF RESPONDER RATES

3637
02:17:43,920 --> 02:17:45,360
IN DIFFERENT TRIALS ACROSS MANY,

3638
02:17:45,360 --> 02:17:48,240
MANY YEARS.

3639
02:17:48,240 --> 02:17:49,440
AND ONE OF THE PROBLEMS WITH

3640
02:17:49,440 --> 02:17:50,520
IMPLANTABLE DEVICES IS THEY'RE

3641
02:17:50,520 --> 02:17:51,160
REALLY EXPENSIVE.

3642
02:17:51,160 --> 02:17:52,560
THERE'S A HIGH TECHNOLOGY

3643
02:17:52,560 --> 02:17:52,760
BURDEN.

3644
02:17:52,760 --> 02:17:55,000
SO A LOT OF THE TRIALS TEND TO

3645
02:17:55,000 --> 02:17:56,280
BE SMALLER AND ASSOCIATED WITH

3646
02:17:56,280 --> 02:17:57,880
THEM AND THEY CAN'T RANDOMIZE

3647
02:17:57,880 --> 02:17:59,640
FOR NUISANCE VARIABLES VERY WELL

3648
02:17:59,640 --> 02:18:03,600
AND THEY DON'T DO A GREAT JOB OF

3649
02:18:03,600 --> 02:18:05,440
ASSESSING EXPECTANCY BIAS.

3650
02:18:05,440 --> 02:18:08,400
AT THE TIME YOU'RE GETTING A

3651
02:18:08,400 --> 02:18:10,040
STIMULATOR USUALLY YOU'RE AT THE

3652
02:18:10,040 --> 02:18:11,120
WORST OF YOUR CONDITION, ALSO

3653
02:18:11,120 --> 02:18:12,440
YOU HAVE WHEN YOU IMPLANT, WHAT

3654
02:18:12,440 --> 02:18:13,760
SEASON AND THAT BECAUSE THERE

3655
02:18:13,760 --> 02:18:14,960
ARE SEASONAL COMPONENTS, ET

3656
02:18:14,960 --> 02:18:15,640
CETERA, THAT CAN CREATE ALL

3657
02:18:15,640 --> 02:18:18,720
SORTS OF NUISANCE VARIABLES THAT

3658
02:18:18,720 --> 02:18:21,920
CAN CREATE A STRONG EFFECT.

3659
02:18:21,920 --> 02:18:24,440
THESE ARE RESPONDER RATES ACROSS

3660
02:18:24,440 --> 02:18:25,400
RANDOMIZED TRIALS AND THEY'RE

3661
02:18:25,400 --> 02:18:26,760
ALL OVER THE PLACE FOR SPINAL

3662
02:18:26,760 --> 02:18:28,960
CORD STIM.

3663
02:18:28,960 --> 02:18:30,120
WHAT MANY DO IS WE DRAW A

3664
02:18:30,120 --> 02:18:31,440
STRAIGHT LINE ACROSS AND GO

3665
02:18:31,440 --> 02:18:32,840
OKAY, IF YOU TAKE ALL OF THIS

3666
02:18:32,840 --> 02:18:34,800
DATA, YOU GET ROUGHLY 50% OF THE

3667
02:18:34,800 --> 02:18:36,720
PATIENTS GET A 50% REDUCTION IN

3668
02:18:36,720 --> 02:18:37,120
PAIN.

3669
02:18:37,120 --> 02:18:38,880
IF YOU LOOK AT ANY ONE OF THESE

3670
02:18:38,880 --> 02:18:41,920
TRIALS, USUALLY BETWEEN Ns OF

3671
02:18:41,920 --> 02:18:44,240
10 TO 80, YOU GET A WILDLY

3672
02:18:44,240 --> 02:18:45,160
MISLEADING PICTURE OF WHERE AND

3673
02:18:45,160 --> 02:18:46,880
THE RATE AT WHICH SPINAL CORD

3674
02:18:46,880 --> 02:18:47,760
STIMULATION FOR INPA WORKS.

3675
02:18:47,760 --> 02:18:50,640
SO THERE'S BEEN A LOT OF RECENT

3676
02:18:50,640 --> 02:18:52,280
BAD PRESS AND SOME OF IT IS VERY

3677
02:18:52,280 --> 02:18:52,520
DESERVED.

3678
02:18:52,520 --> 02:18:53,720
IT'S NOT SURPRISING WHEN YOU

3679
02:18:53,720 --> 02:18:55,320
DON'T UNDERSTAND THE MECHANISTIC

3680
02:18:55,320 --> 02:18:56,320
HYPOTHESIS, IT'S REALLY HARD TO

3681
02:18:56,320 --> 02:18:58,560
NOT RUN INTO ISSUES.

3682
02:18:58,560 --> 02:19:01,800
SO THERE HAVE BEEN SEVERAL

3683
02:19:01,800 --> 02:19:05,640
SYSTEMATIC REVIEWS, TWO IN THE

3684
02:19:05,640 --> 02:19:07,280
LAST YEAR, THAT SUGGESTED SPINAL

3685
02:19:07,280 --> 02:19:08,800
CORD STIMULATION FOR PAIN HAS A

3686
02:19:08,800 --> 02:19:10,800
LIMITED EFFECT AND THAT EFFECT

3687
02:19:10,800 --> 02:19:12,120
OFTEN DOESN'T LAST SIX MONTH, A

3688
02:19:12,120 --> 02:19:14,040
YEAR, TWO YEARS AFTER THE STUDY

3689
02:19:14,040 --> 02:19:16,040
AS WE. THERE'S TWO META ANALYSES

3690
02:19:16,040 --> 02:19:16,920
THAT CAME UP.

3691
02:19:16,920 --> 02:19:18,480
THIS WAS ONE, THIS WAS ANOTHER

3692
02:19:18,480 --> 02:19:21,880
ONE LOOKING AT THE MORE

3693
02:19:21,880 --> 02:19:23,480
ECONOMIC -- BUT IT GETS A LITTLE

3694
02:19:23,480 --> 02:19:24,160
BIT WORSE THAN THAT.

3695
02:19:24,160 --> 02:19:26,040
SO THESE ARE EXPENSIVE AND

3696
02:19:26,040 --> 02:19:29,200
COMPLICATED DEVICES.

3697
02:19:29,200 --> 02:19:31,160
IN 2020, THE FDA DID A REVIEW OF

3698
02:19:31,160 --> 02:19:32,480
THE SPINAL CORD STIM FOR PAIN

3699
02:19:32,480 --> 02:19:34,160
DATA, AND THEY RELEASED A

3700
02:19:34,160 --> 02:19:36,760
GUIDANCE THAT SAID WELL, WE HAVE

3701
02:19:36,760 --> 02:19:38,160
50,000 SPINAL CORD STIMULATOR

3702
02:19:38,160 --> 02:19:40,320
DEVICES IMPLANTED ANNUALLY IN

3703
02:19:40,320 --> 02:19:41,160
THE UNITED STATES.

3704
02:19:41,160 --> 02:19:48,920
THERE WAS 107,000 MEDICAL DEVICE

3705
02:19:48,920 --> 02:19:49,600
REPORTS.

3706
02:19:49,600 --> 02:19:50,400
500 ASSOCIATED WITH A PATIENT

3707
02:19:50,400 --> 02:19:51,120
DEATH.

3708
02:19:51,120 --> 02:19:53,080
WHAT YOU DON'T REALIZE IS WHEN

3709
02:19:53,080 --> 02:19:54,400
YOU'RE ELECTRICALLY ACTIVATING

3710
02:19:54,400 --> 02:19:57,280
THE SPINAL CORD, IF YOU GET A --

3711
02:19:57,280 --> 02:19:58,000
POTENTIAL AND A LEG TWITCHES A

3712
02:19:58,000 --> 02:19:59,000
LITTLE BIT, THAT'S NOT A BIG

3713
02:19:59,000 --> 02:19:59,320
DEAL.

3714
02:19:59,320 --> 02:20:00,880
BUT WHEN YOU GO INTO HUMANS AND

3715
02:20:00,880 --> 02:20:02,400
YOU'RE DRIVING THE CAR OR YOU'RE

3716
02:20:02,400 --> 02:20:03,520
WALKING DOWN THE STAIRS AND YOU

3717
02:20:03,520 --> 02:20:04,720
CHANGE YOUR POSTURE, THERE HAVE

3718
02:20:04,720 --> 02:20:06,120
BEEN REPORTED INCIDENTS OF

3719
02:20:06,120 --> 02:20:08,360
PEOPLE DYING OR BEING PARALYZED

3720
02:20:08,360 --> 02:20:11,520
BECAUSE OF AN ACCIDENTAL MOTOR

3721
02:20:11,520 --> 02:20:15,560
EEVOKED POTENTIAL.

3722
02:20:15,560 --> 02:20:17,080
SOLACE THESE DEVICES ALSO HAVE

3723
02:20:17,080 --> 02:20:20,240
TO LAST 10 TO 15 YEARS, WE'VE

3724
02:20:20,240 --> 02:20:25,200
HAD ALMOST 50 RECALLS IN THE

3725
02:20:25,200 --> 02:20:26,280
LAST -- YEARS.

3726
02:20:26,280 --> 02:20:27,960
THE SUPPLY CHAIN IS CHANGING,

3727
02:20:27,960 --> 02:20:28,840
THINGS LIKE THAT, YOU RUN INTO

3728
02:20:28,840 --> 02:20:30,080
THINGS THAT CREATE PROBLEMS OVER

3729
02:20:30,080 --> 02:20:30,680
TIME AS WELL.

3730
02:20:30,680 --> 02:20:32,760
SO COMPLICATED EXPENSIVE

3731
02:20:32,760 --> 02:20:34,240
DEVICES, THERE'S A REASON WHY

3732
02:20:34,240 --> 02:20:35,320
IT'S ESSENTIALLY A TREATMENT OF

3733
02:20:35,320 --> 02:20:39,040
LAST RESORT FOR DRUGS AND

3734
02:20:39,040 --> 02:20:40,040
PHYSICAL THAIMPLET THERE'S ALSO

3735
02:20:40,040 --> 02:20:43,560
BEEN SOME CRITICISM FROM PUBLIC

3736
02:20:43,560 --> 02:20:45,320
CITIZENS REPORT ABOUT THE FDA'S

3737
02:20:45,320 --> 02:20:46,720
OVERSIGHT OF SPINAL CORD

3738
02:20:46,720 --> 02:20:47,920
STIMULATORS FOR PAIN.

3739
02:20:47,920 --> 02:20:48,840
THERE'S BEEN SEVERAL THAT HAVE

3740
02:20:48,840 --> 02:20:50,600
NOW BEEN IMPROVED OFF OF WHAT'S

3741
02:20:50,600 --> 02:20:53,000
CALLED THE 510K PATHWAY WITHOUT

3742
02:20:53,000 --> 02:20:54,880
ANY HUMAN DATA.

3743
02:20:54,880 --> 02:20:55,960
ESSENTIALLY THEY'RE SHOWING A

3744
02:20:55,960 --> 02:20:58,680
SUBSTANTIAL PREDICATE DEVICE AND

3745
02:20:58,680 --> 02:20:59,800
SAYING PLEASE APPROVE US BUT

3746
02:20:59,800 --> 02:21:01,680
WITHOUT ANY CLINICAL TRIALS OR

3747
02:21:01,680 --> 02:21:02,800
CLINICAL STUDIES OF THAT DEVICE.

3748
02:21:02,800 --> 02:21:04,280
THIS HAS ACTUALLY COME TO A HEAD

3749
02:21:04,280 --> 02:21:06,840
QUITE RECENTLY, A MAJOR COMPANY,

3750
02:21:06,840 --> 02:21:10,360
STIMWAVE, WHICH WAS A WIRELESS

3751
02:21:10,360 --> 02:21:12,440
SPINAL CORD STIMULATOR, THE CEO

3752
02:21:12,440 --> 02:21:14,040
WAS INDICTED AND THROWN IN JAIL

3753
02:21:14,040 --> 02:21:15,280
BECAUSE THEY HAD A COMPONENT OF

3754
02:21:15,280 --> 02:21:16,680
IT THAT WAS SUPPOSED TO BE A

3755
02:21:16,680 --> 02:21:19,640
WIRELESS RECEIVER FOR POWER THAT

3756
02:21:19,640 --> 02:21:21,040
DIDN'T WORK SO THEY STARTED

3757
02:21:21,040 --> 02:21:22,280
IMPLANTING AN EMPTY PIECE OF

3758
02:21:22,280 --> 02:21:24,040
PLASTIC AND CHARGING $16,000 FOR

3759
02:21:24,040 --> 02:21:29,480
THAT ADDITIONAL MODULE AS WELL.

3760
02:21:29,480 --> 02:21:33,880
SO WITH A LOT OF THINGS IN THE

3761
02:21:33,880 --> 02:21:35,840
NIH, THERE ARE THINGS THAT WORK

3762
02:21:35,840 --> 02:21:37,480
WELL IN RODENT MODELS THAT WHEN

3763
02:21:37,480 --> 02:21:40,240
WE WENT TO HUMANS DIDN'T WORK.

3764
02:21:40,240 --> 02:21:41,520
SPINAL CORD STIMULATION FOR PAIN

3765
02:21:41,520 --> 02:21:44,320
IN RODENTS HAS SHOWN LOTS OF

3766
02:21:44,320 --> 02:21:45,720
DIFFERENT LABS CONSISTENTLY GET

3767
02:21:45,720 --> 02:21:47,360
EFFECT FOR SPINAL CORD

3768
02:21:47,360 --> 02:21:48,760
STIMULATION FOR PAIN.

3769
02:21:48,760 --> 02:21:50,000
THEY'RE MUCH HARDER TO SHOW IN

3770
02:21:50,000 --> 02:21:50,360
HUMANS.

3771
02:21:50,360 --> 02:21:52,120
I'M GOING TO TALK ABOUT SOME OF

3772
02:21:52,120 --> 02:21:53,840
THE REASONS REALLY QUICK.

3773
02:21:53,840 --> 02:21:55,640
THE FIRST HAS TO DO WITH HOW THE

3774
02:21:55,640 --> 02:21:56,800
SPINAL CORD IS SET UP.

3775
02:21:56,800 --> 02:21:58,880
SO IN THE RODENT, YOU IMPLANT

3776
02:21:58,880 --> 02:22:00,760
THESE IN THE EPIDURAL SPACE AND

3777
02:22:00,760 --> 02:22:01,960
YOU'RE TRYING TO STIMULATE

3778
02:22:01,960 --> 02:22:03,840
DORSAL COLUMN AND ACTIVATE

3779
02:22:03,840 --> 02:22:05,160
PREDOMINANTLY WHAT ARE CALLED A

3780
02:22:05,160 --> 02:22:06,360
BETA FIBERS.

3781
02:22:06,360 --> 02:22:08,440
A BETA SENSORY FIBERS FOR GAIT

3782
02:22:08,440 --> 02:22:10,520
THEORY ESSENTIALLY PREDOMINANTLY

3783
02:22:10,520 --> 02:22:11,840
COME FROM MUSCLE SPINDLES AND

3784
02:22:11,840 --> 02:22:12,520
THINGS LIKE THAT.

3785
02:22:12,520 --> 02:22:14,120
YOU'RE TRYING TO AVOID

3786
02:22:14,120 --> 02:22:15,280
STIMULATING THINGS LIKE A DELTAS

3787
02:22:15,280 --> 02:22:19,520
WHICH WOULD CAUSE ACUTE PAIN, C

3788
02:22:19,520 --> 02:22:20,840
FIBERS, SOME VERSUS CHRONIC PAIN

3789
02:22:20,840 --> 02:22:22,560
BUT YOU'RE ALSO TRYING TO NOT

3790
02:22:22,560 --> 02:22:25,560
ACTIVATE A ALPHA FIBERS THAT

3791
02:22:25,560 --> 02:22:26,760
INNERVATE MOTOR NERVES AND

3792
02:22:26,760 --> 02:22:27,640
CREATE MUSCLE ACTIVATION AND

3793
02:22:27,640 --> 02:22:28,480
THINGS LIKE THAT AS WELL.

3794
02:22:28,480 --> 02:22:30,200
SO IN A RODENT, THE EPIDURAL

3795
02:22:30,200 --> 02:22:31,480
SPACE IS RIGHT NEXT TO THE

3796
02:22:31,480 --> 02:22:32,040
DORSAL COLUMN.

3797
02:22:32,040 --> 02:22:34,240
THERE'S NOT A LOT OF CSF IN

3798
02:22:34,240 --> 02:22:35,000
BETWEEN.

3799
02:22:35,000 --> 02:22:36,480
ELECTRICAL STIMULATION, THE

3800
02:22:36,480 --> 02:22:38,040
FALLOFF OF AN ELECTRIC FIELD IS

3801
02:22:38,040 --> 02:22:40,120
# OVER R SCARED, R IS THE

3802
02:22:40,120 --> 02:22:41,720
DISTANCE FROM THE ELECTRODE, IT

3803
02:22:41,720 --> 02:22:42,560
FALLS OFF REALLY, REALLY FAST.

3804
02:22:42,560 --> 02:22:46,200
IN A HUMAN, YOU'VE GOT A TON OF

3805
02:22:46,200 --> 02:22:50,320
CSF IN BETWEEN AND THAT CHANGES

3806
02:22:50,320 --> 02:22:52,160
EVERY TIME YOU MOVE IN DIFFERENT

3807
02:22:52,160 --> 02:22:52,600
POSTURE, ET CETERA.

3808
02:22:52,600 --> 02:22:54,680
SO THE DISTANCE YOUR ELECTRICAL

3809
02:22:54,680 --> 02:22:56,160
STIMULATOR IS FROM THE CORD

3810
02:22:56,160 --> 02:22:57,600
YOU'RE TRYING TO STIMULATE

3811
02:22:57,600 --> 02:22:59,080
CHANGES IN HUMANS IN WAY IT DOES

3812
02:22:59,080 --> 02:23:00,320
NOT IN RODENTS.

3813
02:23:00,320 --> 02:23:01,520
WHEN YOU'RE TRYING TO DO THINGS

3814
02:23:01,520 --> 02:23:04,240
LIKE I WANT TO STIMULATE ONLY A

3815
02:23:04,240 --> 02:23:06,240
BETAS FOR EFFECT AND I WANT TO

3816
02:23:06,240 --> 02:23:07,320
AVOID STIMULATING ALL THESE

3817
02:23:07,320 --> 02:23:09,720
PATHWAYS FOR SIDE EFFECTS, AS

3818
02:23:09,720 --> 02:23:11,880
THESE MOVE, THE THERAPEUTIC

3819
02:23:11,880 --> 02:23:13,120
WINDOW FROM SIDE EFFECT TO

3820
02:23:13,120 --> 02:23:14,320
EFFECT CHANGES DRAMATICALLY.

3821
02:23:14,320 --> 02:23:19,080
SO THE OTHER THING IS WE MOVE A

3822
02:23:19,080 --> 02:23:20,120
LOT MORE RELATIVELY THAN THE

3823
02:23:20,120 --> 02:23:22,080
RODENTS IN TERMS OF HOW MUCH OUR

3824
02:23:22,080 --> 02:23:24,000
SPINAL CORD MOVES.

3825
02:23:24,000 --> 02:23:28,640
SO THIS IS A STUDY WITH 91 CAS 

3826
02:23:28,640 --> 02:23:31,520
CASES, THEY DID THE IMPLANTED

3827
02:23:31,520 --> 02:23:32,480
LEADS, VISUALIZATION OF IT, THIS

3828
02:23:32,480 --> 02:23:34,840
IS OUR DATA IN PIGS SHOWING YOU

3829
02:23:34,840 --> 02:23:41,080
AN X-RAY OF TWO OCTRODES, 16

3830
02:23:41,080 --> 02:23:42,880
CHANNEL LEADS, AND THEY FOUND

3831
02:23:42,880 --> 02:23:47,880
85% OF THE LEADS MIGRATED OVER A

3832
02:23:47,880 --> 02:23:48,640
CENTIMETER IN TWO MONTHS.

3833
02:23:48,640 --> 02:23:50,440
SO WHEREVER THEY IMPLANTED THESE

3834
02:23:50,440 --> 02:23:51,600
TO GET THE SIDE EFFECT, THEY'RE

3835
02:23:51,600 --> 02:23:52,600
NOT IN THE SAME PLACE

3836
02:23:52,600 --> 02:23:53,560
AFTERWARDS.

3837
02:23:53,560 --> 02:23:54,520
THEY'RE STIMULATING AN

3838
02:23:54,520 --> 02:23:55,240
ADDITIONAL PORTION OF THE CORD.

3839
02:23:55,240 --> 02:23:57,760
AND THE REASON WE HAVE THESE 16

3840
02:23:57,760 --> 02:24:03,280
ELECTRODES OR 3 IT DEPEN 32 IS T

3841
02:24:03,280 --> 02:24:03,680
REDUNDANCY.

3842
02:24:03,680 --> 02:24:05,160
FOR EFFECT, WE ONLY STIMULATE

3843
02:24:05,160 --> 02:24:05,840
THROUGH TWO OF THESE.

3844
02:24:05,840 --> 02:24:07,480
THE REST IS JUST OKAY, IF THIS

3845
02:24:07,480 --> 02:24:09,440
MIGRATES, I HOPE ONE OF THESE

3846
02:24:09,440 --> 02:24:10,520
ELECTRODES WINDS UP IN THE RIGHT

3847
02:24:10,520 --> 02:24:11,600
PLACE WHERE IT WAS WHEN IT

3848
02:24:11,600 --> 02:24:11,880
STARTED.

3849
02:24:11,880 --> 02:24:12,880
SO IT'S KIND OF INTERESTING WHEN

3850
02:24:12,880 --> 02:24:16,920
YOU START LOOKING AT THESE HUGE

3851
02:24:16,920 --> 02:24:18,240
REVARIABLE RESULTS IN THINGS

3852
02:24:18,240 --> 02:24:18,920
LIKE THAT, AND REALIZE THAT

3853
02:24:18,920 --> 02:24:20,480
EVERYBODY IS GETTING DIFFERENT

3854
02:24:20,480 --> 02:24:21,000
DOSES.

3855
02:24:21,000 --> 02:24:22,200
AS IT MIGRATES, ET CETERA,

3856
02:24:22,200 --> 02:24:23,840
YOU'RE IN SLIGHTLY DIFFERENT

3857
02:24:23,840 --> 02:24:24,280
LOCATIONS.

3858
02:24:24,280 --> 02:24:26,240
IMAGINE DOING A DRUG TRIAL WITH

3859
02:24:26,240 --> 02:24:29,280
50 PATIENTS WI BUT I IS A WE'RE

3860
02:24:29,280 --> 02:24:31,160
GOING TO RANDOMIZE THE DOSES AND

3861
02:24:31,160 --> 02:24:32,800
WE DON'T KNOW WHAT'S WHAT.

3862
02:24:32,800 --> 02:24:34,720
IT'S NOT SURPRISING YOU JUST GET

3863
02:24:34,720 --> 02:24:35,480
HIGHLY VARIABLE RESULTS.

3864
02:24:35,480 --> 02:24:36,960
SO WHAT'S THE IMPACT OF

3865
02:24:36,960 --> 02:24:38,080
MIGRATION?

3866
02:24:38,080 --> 02:24:39,560
WELL, YOU ALWAYS STIMULATE

3867
02:24:39,560 --> 02:24:41,680
WHAT'S CLOSEST TO AN ELECTRODE

3868
02:24:41,680 --> 02:24:44,440
FIRST SO IT'S GOOD TO UNDERSTAND

3869
02:24:44,440 --> 02:24:45,000
THE ANATOMY.

3870
02:24:45,000 --> 02:24:47,480
THIS IS SOME WORK WE'RE DOING AS

3871
02:24:47,480 --> 02:24:47,960
PART.

3872
02:24:47,960 --> 02:24:53,440
SPARK PROGRAM THAT  ALLOWS US TO

3873
02:24:53,440 --> 02:24:55,240
TRACE THE AXONAL PATHWAYS.

3874
02:24:55,240 --> 02:24:57,920
WHAT WE HAVE A S. A PICTURE OF A

3875
02:24:57,920 --> 02:24:59,280
MICRO CT.

3876
02:24:59,280 --> 02:25:01,360
ELECTRODES ARE ESSENTIALLY

3877
02:25:01,360 --> 02:25:06,640
PLACED MIDLINE -- THE ROUTE LET

3878
02:25:06,640 --> 02:25:07,440
SPACING.

3879
02:25:07,440 --> 02:25:08,200
SO WHAT'S IMPORTANT ABOUT THIS

3880
02:25:08,200 --> 02:25:10,320
IS I WANT TO STIMULATE DORSAL

3881
02:25:10,320 --> 02:25:11,720
COLUMN, I DON'T WANT TO

3882
02:25:11,720 --> 02:25:19,840
STIMULATE THE ROOTS AND ROOTL 

3883
02:25:19,840 --> 02:25:20,600
ROOTLETTES, THEN THERE'S A TON

3884
02:25:20,600 --> 02:25:22,680
OF CSF SHUNTING.

3885
02:25:22,680 --> 02:25:24,320
THE ELECTRIC FIELD IN HUMANS AND

3886
02:25:24,320 --> 02:25:25,800
LARGE ANIMAL MODELS JUST SPREADS

3887
02:25:25,800 --> 02:25:27,680
OUT IN THE CSF AND TENDS TO

3888
02:25:27,680 --> 02:25:29,240
ACTUALLY START ACTIVATING EASY

3889
02:25:29,240 --> 02:25:30,600
TO ACTIVATE LARGE DIAMETER

3890
02:25:30,600 --> 02:25:32,160
FIBERS NOT JUST IN DORSAL COLUMN

3891
02:25:32,160 --> 02:25:34,480
BUT AT THE ROOTS AND ROOTLETTES

3892
02:25:34,480 --> 02:25:35,720
AND TO SOME EXTENT ON THE

3893
02:25:35,720 --> 02:25:36,400
VENTRAL SIDE AS WELL.

3894
02:25:36,400 --> 02:25:38,120
SO THIS IS DATA TO REALLY JUST

3895
02:25:38,120 --> 02:25:38,680
SHOW THIS.

3896
02:25:38,680 --> 02:25:41,160
SO WHAT WE DO IS WE DO SOME

3897
02:25:41,160 --> 02:25:42,560
LARGE ANIMAL EXPERIMENTS WHERE

3898
02:25:42,560 --> 02:25:43,720
WE WILL RECORD FROM THE SPINAL

3899
02:25:43,720 --> 02:25:45,160
CORD AND GET THE EVOKED ACTIVITY

3900
02:25:45,160 --> 02:25:48,440
AND THEN RECORD FROM MUSCLE

3901
02:25:48,440 --> 02:25:49,520
GROUPS.

3902
02:25:49,520 --> 02:25:55,200
THE VENTRAL EFFERENTS -- THEY

3903
02:25:55,200 --> 02:25:56,840
INNERVATE THE LONG MUSCLES OF

3904
02:25:56,840 --> 02:25:57,400
THE BACK.

3905
02:25:57,400 --> 02:25:59,360
SO WE DO EMG RECORDINGS AND TRY

3906
02:25:59,360 --> 02:26:01,760
TO FIGURE OUT WITH DIFFERENT

3907
02:26:01,760 --> 02:26:03,080
ELECTRODE DESIGNS, SPACING,

3908
02:26:03,080 --> 02:26:04,400
SLIGHT MOVEMENT, DO WE GET THE

3909
02:26:04,400 --> 02:26:06,200
SIDE EFFECT, WHICH IS EMG

3910
02:26:06,200 --> 02:26:07,440
ACTIVATION, OR DO WE GET ACT

3911
02:26:07,440 --> 02:26:09,160
VASE WITH A BETAS IN DORSAL

3912
02:26:09,160 --> 02:26:09,480
COLUMN.

3913
02:26:09,480 --> 02:26:10,920
SO THIS IS WHAT IT LOOKS LIKE

3914
02:26:10,920 --> 02:26:12,560
WHEN YOU GET THE RECORDINGS, YOU

3915
02:26:12,560 --> 02:26:14,760
ACTUALLY EU YOU MEASURE, THE

3916
02:26:14,760 --> 02:26:17,160
ACTION POTENTIAL IS CREATED,

3917
02:26:17,160 --> 02:26:17,960
PROPAGATES DOWN THESE

3918
02:26:17,960 --> 02:26:18,760
ELECTRODES, YOU CAN SEE THERE'S

3919
02:26:18,760 --> 02:26:20,840
A LITTLE FEATURE CALLED A BETAS

3920
02:26:20,840 --> 02:26:22,560
THAT ACTUALLY HAS A PROPAGATING

3921
02:26:22,560 --> 02:26:23,560
DELAY AS YOU GO FURTHER AND

3922
02:26:23,560 --> 02:26:24,600
FURTHER FROM IT, AND THEN YOU

3923
02:26:24,600 --> 02:26:27,120
CAN USE THIS TO DIFFERENTIATE IT

3924
02:26:27,120 --> 02:26:31,480
FROM EMG SIGNAL.

3925
02:26:31,480 --> 02:26:38,920
THEY'RE NOR T NOR T -- WE DO A F

3926
02:26:38,920 --> 02:26:40,440
CONTROLS SUCH AS MUSCLE BLOCKS

3927
02:26:40,440 --> 02:26:42,160
TO SAY THIS IS DEFINITELY

3928
02:26:42,160 --> 02:26:42,520
NEURAL.

3929
02:26:42,520 --> 02:26:44,040
THE IMPORTANT POINT, THOUGH, IS

3930
02:26:44,040 --> 02:26:46,160
HOW SENSITIVE THE ELECTRIC

3931
02:26:46,160 --> 02:26:48,520
PLACEMENT IS WITH RESPECT TO THE

3932
02:26:48,520 --> 02:26:52,200
ROOTS AND ROOTLETTES, EMG

3933
02:26:52,200 --> 02:26:52,640
ACTIVATION.

3934
02:26:52,640 --> 02:26:54,080
SO WHAT I'M SHOW YOU GO HERE IS

3935
02:26:54,080 --> 02:26:55,720
ESSENTIALLY FLIPPING THE

3936
02:26:55,720 --> 02:26:56,880
ELECTRODE CONTACTS WHICH ARE

3937
02:26:56,880 --> 02:26:58,400
LESS THAN A CENTIMETER APART

3938
02:26:58,400 --> 02:27:00,840
WHERE ONE IS OFF THE ROOTLETTES

3939
02:27:00,840 --> 02:27:02,080
AND ONE IS OFF AND WHAT YOU'RE

3940
02:27:02,080 --> 02:27:05,160
SEEING IS A VERY DIFFERENT EMG

3941
02:27:05,160 --> 02:27:05,440
RESPONSE.

3942
02:27:05,440 --> 02:27:06,760
WE'VE DONE THIS IN A COHORT OF

3943
02:27:06,760 --> 02:27:07,680
EIGHT ANIMALS.

3944
02:27:07,680 --> 02:27:09,000
VERY SMALL DIFFERENCES

3945
02:27:09,000 --> 02:27:12,000
COMPLETELY CHANGES YOUR

3946
02:27:12,000 --> 02:27:13,880
THERAPEUTIC WINDOW BETWEEN

3947
02:27:13,880 --> 02:27:14,760
ACTIVATING A BETAS VERSUS

3948
02:27:14,760 --> 02:27:15,880
GETTING THIS UNWANTED E.

3949
02:27:15,880 --> 02:27:16,880
IN G RESPONSE.

3950
02:27:16,880 --> 02:27:18,600
SO THAT MIGRATION OVER A

3951
02:27:18,600 --> 02:27:19,840
CENTIMETER IS A VERY LARGE

3952
02:27:19,840 --> 02:27:20,840
DIFFERENCE AND THERE YOU'RE

3953
02:27:20,840 --> 02:27:22,000
GOING TO WIND UP IN THIS RATIO

3954
02:27:22,000 --> 02:27:24,720
OF ON OR OFF TARGET EFFECTS.

3955
02:27:24,720 --> 02:27:27,840
SO THIS IS ACTUALLY SHOWING THE

3956
02:27:27,840 --> 02:27:28,840
DOSE-RESPONSE CURVES, THIS IS

3957
02:27:28,840 --> 02:27:30,520
SHOWING STIMULATING FROM TWO

3958
02:27:30,520 --> 02:27:32,200
DIFFERENT CONTACTS AND REALLY

3959
02:27:32,200 --> 02:27:34,600
SHOWING DOSE-RESPONSE FOR ENG

3960
02:27:34,600 --> 02:27:35,400
VERSUS EM DP.

3961
02:27:35,400 --> 02:27:37,080
THE OTHER THING O.A.R. GOING TO

3962
02:27:37,080 --> 02:27:39,200
REALIZE VERY QUICKLY, THE ENG

3963
02:27:39,200 --> 02:27:41,320
AND EMG DEPENDING WHERE YOU'RE

3964
02:27:41,320 --> 02:27:43,120
STIMULATING, THOSE DOSE-RESPONSE

3965
02:27:43,120 --> 02:27:44,480
CURVES LOOK VERY SIMILAR.

3966
02:27:44,480 --> 02:27:45,840
IT'S VERY HARD TO GET WHAT YOU

3967
02:27:45,840 --> 02:27:48,040
WANT, WHICH IS THE ENG, YOU HAVE

3968
02:27:48,040 --> 02:27:49,880
TO BE LIKE IN THE RIGHT LOCATION

3969
02:27:49,880 --> 02:27:51,320
TO BE ABLE TO SEPARATE THESE

3970
02:27:51,320 --> 02:27:52,600
WHICH IS WHAT YOU WANT TO DO FOR

3971
02:27:52,600 --> 02:27:55,240
A THERAPY.

3972
02:27:55,240 --> 02:27:58,000
THE INTERESTING THING FOR THE

3973
02:27:58,000 --> 02:27:58,680
LONG MUSCLES OF THE BACK,

3974
02:27:58,680 --> 02:28:00,680
BECAUSE YOU HAVE TO INNERVATE

3975
02:28:00,680 --> 02:28:03,840
THE LUNG MUSCLES VERY QUICKLY,

3976
02:28:03,840 --> 02:28:06,600
THOSE TEND TO BE THE MOST DORSAL

3977
02:28:06,600 --> 02:28:09,640
VENTRAL EFFERENTS EASY TO

3978
02:28:09,640 --> 02:28:11,440
ACTIVATE AND CLOSEST TO THE

3979
02:28:11,440 --> 02:28:12,040
DORSAL STIMULATOR.

3980
02:28:12,040 --> 02:28:13,920
SO WE WERE INTERESTED IN TO SOME

3981
02:28:13,920 --> 02:28:16,000
EXTENT CAN WE SOLVE THIS PROBLEM

3982
02:28:16,000 --> 02:28:16,600
BY COMING UP WITH A SOLUTION

3983
02:28:16,600 --> 02:28:17,960
WHERE WE'RE NOT PLACING THIS ON

3984
02:28:17,960 --> 02:28:18,800
THE SPINAL CORD, WHERE THERE'S A

3985
02:28:18,800 --> 02:28:22,920
LOT OF MOVEMENT AND THAT THAT

3986
02:28:22,920 --> 02:28:24,640
THING MIGRATES, CAN WE STIMULATE

3987
02:28:24,640 --> 02:28:27,080
IN THE FORAMEN THE DORSAL

3988
02:28:27,080 --> 02:28:29,480
GANGLIA AND SENSORY ASPECT THAT

3989
02:28:29,480 --> 02:28:30,960
WILL THEN SEND AN ACTION

3990
02:28:30,960 --> 02:28:34,160
POTENTIAL TO THE ROOTS AND

3991
02:28:34,160 --> 02:28:35,720
ROOTLETS AND INTO THE DORSAL

3992
02:28:35,720 --> 02:28:36,600
COLUMN OR TO SOME EXTENT INTO

3993
02:28:36,600 --> 02:28:37,600
THE GREY MATTER AS WELL.

3994
02:28:37,600 --> 02:28:41,840
SO IT'S REALLY HARD TO GET AN

3995
02:28:41,840 --> 02:28:43,440
ELECTRODE INTO THE DORSAL ROOT

3996
02:28:43,440 --> 02:28:45,680
GANGLIA AND THE FORAMEN WITHOUT

3997
02:28:45,680 --> 02:28:47,680
PUTTING COMPRESSION ON TO SOME

3998
02:28:47,680 --> 02:28:47,920
EXTENT.

3999
02:28:47,920 --> 02:28:49,240
IT'S A COMPLEX PROCEDURE AND

4000
02:28:49,240 --> 02:28:50,400
RIGHT NOW IF THEY USE IT,

4001
02:28:50,400 --> 02:28:52,320
THEY'RE USING THESE $25,000

4002
02:28:52,320 --> 02:28:53,360
STIMULATORS THAT BREAK A LOT.

4003
02:28:53,360 --> 02:28:54,880
SO WE WERE INSPIRED BY

4004
02:28:54,880 --> 02:28:55,160
SIMPLICITY.

4005
02:28:55,160 --> 02:29:00,920
SO IF YOU'RE FAMILIAR WITH MICRO

4006
02:29:00,920 --> 02:29:02,160
ANNULISM COILS, YOU TAKE A BUNCH

4007
02:29:02,160 --> 02:29:04,120
OF COILS TO FILL A SPACE, A

4008
02:29:04,120 --> 02:29:08,400
LITTLE DEFECT IN THE ARTERY, TO

4009
02:29:08,400 --> 02:29:09,400
ESSENTIALLY PREVENT IT FROM

4010
02:29:09,400 --> 02:29:10,080
BALLOONING AND POPPING.

4011
02:29:10,080 --> 02:29:12,000
SO WE WERE INTERESTED TO SAY CAN

4012
02:29:12,000 --> 02:29:13,600
WE TAKE THAT SAME CONCEPT AND

4013
02:29:13,600 --> 02:29:16,520
TAKE AN ELECTRODE WITH TWO

4014
02:29:16,520 --> 02:29:19,240
COMPONENTS, JUST THESE COILED

4015
02:29:19,240 --> 02:29:22,080
PLATINUM WIRES AND LITERALLY

4016
02:29:22,080 --> 02:29:23,960
HEAT SHRINK WRAP FOR INSULATION

4017
02:29:23,960 --> 02:29:26,160
AND CAN WE INJECT TO FILL A

4018
02:29:26,160 --> 02:29:28,160
SPACE IN THE FORAMEN SOMETHING

4019
02:29:28,160 --> 02:29:29,520
LIKE LIDOCAINE INJECTIONS, VERY

4020
02:29:29,520 --> 02:29:31,040
COMPATIBLE WITH EXISTING

4021
02:29:31,040 --> 02:29:31,920
PROCEDURES, THEN IT WOULD FORM

4022
02:29:31,920 --> 02:29:34,920
AROUND THE DRG TO CREATE A NICE

4023
02:29:34,920 --> 02:29:36,680
TIGHT INSULATED INTERFACE WHERE

4024
02:29:36,680 --> 02:29:37,760
BECAUSE IT'S IN THE FORAMEN,

4025
02:29:37,760 --> 02:29:39,000
THERE'S NOT RELATIVE MOVEMENT AS

4026
02:29:39,000 --> 02:29:42,000
WELL SO YOU SOLVE THE MY MIGRATN

4027
02:29:42,000 --> 02:29:42,360
ISSUE.

4028
02:29:42,360 --> 02:29:44,960
BUT THEN WE WENT ONE STEP

4029
02:29:44,960 --> 02:29:47,160
FURTHER, CAN WE GET THIS

4030
02:29:47,160 --> 02:29:48,360
IMPLANTABLE -- CAN WE JUST ROUTE

4031
02:29:48,360 --> 02:29:50,720
BACK UP TO THE SURFACE OF THE

4032
02:29:50,720 --> 02:29:53,080
SKIN, PUT A PARALLEL PLATE,

4033
02:29:53,080 --> 02:29:54,160
ESSENTIALLY INJECT MORE MATERIAL

4034
02:29:54,160 --> 02:29:56,440
THAT'S CONDUCTIVE AND DO A

4035
02:29:56,440 --> 02:29:57,480
BYPASS OF THE SURFACE OF THE

4036
02:29:57,480 --> 02:29:58,960
SKIN TO THE DEEP NERVE.

4037
02:29:58,960 --> 02:30:00,120
BECAUSE YOU CAN STIMULATE ALL

4038
02:30:00,120 --> 02:30:01,360
YOUR NERVES THAT ARE DEEP FROM

4039
02:30:01,360 --> 02:30:02,040
THE SURFACE OF THE SKIN.

4040
02:30:02,040 --> 02:30:03,520
THE PROBLEM IS YOU CAN'T DO IT

4041
02:30:03,520 --> 02:30:05,120
WITHOUT ACTIVATING SIDE EFFECTS,

4042
02:30:05,120 --> 02:30:06,760
ALL THE NERVES THAT ARE

4043
02:30:06,760 --> 02:30:07,280
SUPERFICIAL.

4044
02:30:07,280 --> 02:30:08,120
IN THE SAME WAY YOU CAN

4045
02:30:08,120 --> 02:30:09,160
DEFIBRILLATE THE HEART FROM THE

4046
02:30:09,160 --> 02:30:10,280
SURFACE OF THE SKIN, YOU CAN

4047
02:30:10,280 --> 02:30:11,240
ACTIVATE ALL THOSE NERVES BUT

4048
02:30:11,240 --> 02:30:14,240
YOU CAN'T DEFIB RATE THE HEART

4049
02:30:14,240 --> 02:30:15,280
WITHOUT DEFIBRILLATING EVERY

4050
02:30:15,280 --> 02:30:15,920
NEVER IF BETWEEN.

4051
02:30:15,920 --> 02:30:18,800
SO WE CREATED A CONDUCTIVE

4052
02:30:18,800 --> 02:30:20,240
BYPASS FROM THE DRG TO THE SKIN,

4053
02:30:20,240 --> 02:30:22,240
COULD WE GET THOSE SIDE EFFECT

4054
02:30:22,240 --> 02:30:23,080
NEURONS AND ONLY ACTIVATE WHAT

4055
02:30:23,080 --> 02:30:24,840
WE WANT TO ACTIVATE?

4056
02:30:24,840 --> 02:30:26,080
THE COOL THING ABOUT THIS COIL

4057
02:30:26,080 --> 02:30:27,240
DESIGN, I'LL SHOW YOU SOME DATA

4058
02:30:27,240 --> 02:30:29,480
IN A SECOND, THE FIRST THING IS,

4059
02:30:29,480 --> 02:30:30,960
WE PUBLISHED THIS STUDY

4060
02:30:30,960 --> 02:30:31,880
ESSENTIALLY SHOWING THAT THIS

4061
02:30:31,880 --> 02:30:34,000
WORKS, THAT YOU CAN STIMULATE

4062
02:30:34,000 --> 02:30:36,960
FROM TSH WITH A TENS UNIT FROM

4063
02:30:36,960 --> 02:30:38,600
WAL-MART FOR 50 BUCKS THAT YOU

4064
02:30:38,600 --> 02:30:39,640
CAN GET FOR MUSCLE PAIN AND THAT

4065
02:30:39,640 --> 02:30:41,560
YOU CAN ACTIVATE A DEEP NEVER

4066
02:30:41,560 --> 02:30:43,600
WITHOUT ACTIVATING THE

4067
02:30:43,600 --> 02:30:45,160
SUPERFICIAL NEVER BUT ALSO THE

4068
02:30:45,160 --> 02:30:46,480
TRADITIONAL ELECTRODES -- THIS

4069
02:30:46,480 --> 02:30:49,000
IS ADVANCING ITSELF -- WORK LIKE

4070
02:30:49,000 --> 02:30:50,000
A POINT SOURCE.

4071
02:30:50,000 --> 02:30:51,120
SO IDEALLY WHAT YOU WANT TO DO

4072
02:30:51,120 --> 02:30:53,640
IS ACTIVATE ALL THE A BETAS

4073
02:30:53,640 --> 02:30:54,840
WITHOUT GETTING TO A DELTAS

4074
02:30:54,840 --> 02:30:57,040
WHICH WOULD CAUSE YOU ACUTE

4075
02:30:57,040 --> 02:30:59,000
PAIN, A SIDE EFFECT YOU CAN'T

4076
02:30:59,000 --> 02:31:00,280
TOLERATE.

4077
02:31:00,280 --> 02:31:02,360
IF YOU'RE GOING TO GET ALL THE A

4078
02:31:02,360 --> 02:31:03,280
BETAS AT A DISTANCE, YOU'RE

4079
02:31:03,280 --> 02:31:04,360
GOING TO HAVE TO GET TO LEVELS

4080
02:31:04,360 --> 02:31:05,920
WHERE YOU START ACTIVATING A

4081
02:31:05,920 --> 02:31:06,320
DELTAS.

4082
02:31:06,320 --> 02:31:07,320
IF YOU ACTUALLY HAVE SOMETHING

4083
02:31:07,320 --> 02:31:08,920
THAT SPANS OUT AND FILLS THE

4084
02:31:08,920 --> 02:31:10,920
SPACE IN THE FORAMEN, YOU CAN

4085
02:31:10,920 --> 02:31:12,560
EQUALLY ACTIVATE A BETAS IN ALL

4086
02:31:12,560 --> 02:31:15,120
OF THEM WITHIN THE DORSAL ROOT

4087
02:31:15,120 --> 02:31:16,640
GANGLIA WITHOUT GETTING TO A

4088
02:31:16,640 --> 02:31:17,760
DELTAS WHICH ARE SIDE EFFECTS SO

4089
02:31:17,760 --> 02:31:19,720
YOU'RE KIND OF EXPANDING THE

4090
02:31:19,720 --> 02:31:20,440
THERAPEUTIC WINDOW AS WELL.

4091
02:31:20,440 --> 02:31:21,600
SO THIS IS WHAT IT LOOKS LIKE TO

4092
02:31:21,600 --> 02:31:22,000
INJECT.

4093
02:31:22,000 --> 02:31:23,760
WE HAVE UNDERGRADUATES WHO CAN

4094
02:31:23,760 --> 02:31:24,840
LEARN TO INJECT THIS IN FIVE

4095
02:31:24,840 --> 02:31:25,320
MINUTES.

4096
02:31:25,320 --> 02:31:30,440
THIS SIN JECTING IS INJECTING IT

4097
02:31:30,440 --> 02:31:30,800
THE DRG.

4098
02:31:30,800 --> 02:31:31,880
YOU SEE IT'S FILLING THE SPACE

4099
02:31:31,880 --> 02:31:33,400
IN THE FORAMEN, AND THEN YOU

4100
02:31:33,400 --> 02:31:34,680
JUST PULL IT BACK OUT TO THE

4101
02:31:34,680 --> 02:31:36,520
SURFACE OF THE SKIN TO BE ABLE

4102
02:31:36,520 --> 02:31:38,480
TO STIMULATE TRANS CUTANEOUS --

4103
02:31:38,480 --> 02:31:41,800
WITH A TEN TENS UNIT WITH NO WIE

4104
02:31:41,800 --> 02:31:42,280
SPANNING THE SKIN.

4105
02:31:42,280 --> 02:31:43,760
BUT THE REALLY COOL THING ABOUT

4106
02:31:43,760 --> 02:31:45,200
THE DESIGN S EVEN AFTER IT'S

4107
02:31:45,200 --> 02:31:46,760
BEEN HEALED IN FOR A YEAR, EACH

4108
02:31:46,760 --> 02:31:48,320
ONE OF THOSE COILS WHEN YOU PULL

4109
02:31:48,320 --> 02:31:50,600
IT FROM THE SURFACE OF THE SKIN

4110
02:31:50,600 --> 02:31:51,080
UNWINDS.

4111
02:31:51,080 --> 02:31:52,160
SO ACTUALLY THE STRUCTURE

4112
02:31:52,160 --> 02:31:53,000
UNWINDS SEQUENTIALLY AND YOU'LL

4113
02:31:53,000 --> 02:31:54,320
SEE THAT, AND IT CAN ACTUALLY

4114
02:31:54,320 --> 02:31:57,280
PULL OUT, EVEN THOUGH IT HAS A

4115
02:31:57,280 --> 02:32:01,040
COMPLEX STRUCTURE AROUND THE

4116
02:32:01,040 --> 02:32:03,200
DRG, IT WILL PULL OUT SMOOTHLY

4117
02:32:03,200 --> 02:32:05,120
AFTER A YEAR IN 30 SECONDS.

4118
02:32:05,120 --> 02:32:07,600
SORROW DENT AND PIG STUDIES,

4119
02:32:07,600 --> 02:32:09,840
THIS IS ESSENTIALLY ONE BEING

4120
02:32:09,840 --> 02:32:11,080
REMOVED AND YOU'LL SEE IT

4121
02:32:11,080 --> 02:32:12,320
UNWINDING COIL BY COIL AND THEN

4122
02:32:12,320 --> 02:32:15,600
IT JUST KIND OF PULLS OUT.

4123
02:32:15,600 --> 02:32:16,680
SO WE'VE DONE DIRECT COMPARISONS

4124
02:32:16,680 --> 02:32:19,560
TO THE DRG IN PIGS BOTH ACUTELY

4125
02:32:19,560 --> 02:32:20,560
AND CHRONICALLY NOW AND SHOW

4126
02:32:20,560 --> 02:32:22,320
THAT WE CAN GET THE SAME EVOKED

4127
02:32:22,320 --> 02:32:25,640
POTENTIALS BUT ACTUALLY BECAUSE

4128
02:32:25,640 --> 02:32:27,840
IT'S -- IT CONFORMS BETTER THAN

4129
02:32:27,840 --> 02:32:29,760
DRG, WE USE ONE FOURTH THE

4130
02:32:29,760 --> 02:32:31,000
CURRENT TO GET THE SAME

4131
02:32:31,000 --> 02:32:31,640
ACTIVATION.

4132
02:32:31,640 --> 02:32:33,200
AND THEN BECAUSE THIS IS A

4133
02:32:33,200 --> 02:32:34,360
TWO-COMPONENT SYSTEM AND FOR

4134
02:32:34,360 --> 02:32:35,880
THOSE WHO DO TRANSLATIONAL STUFF

4135
02:32:35,880 --> 02:32:40,960
AND IT'S JUST LITERALLY PLAT

4136
02:32:40,960 --> 02:32:42,600
ELECTRODES AND HEAT SHRINK

4137
02:32:42,600 --> 02:32:43,720
WRAP -- FROM CURRENT BEING LOST

4138
02:32:43,720 --> 02:32:46,160
ACROSS THE CON DK TORE, WE HAD

4139
02:32:46,160 --> 02:32:47,760
THE CONCEPT IDEA IN 2018, WE

4140
02:32:47,760 --> 02:32:49,200
WERE ABLE TO DO THE FIRST HUMAN

4141
02:32:49,200 --> 02:32:51,440
TRIALS IN 2020 FOR A BRAND NEW

4142
02:32:51,440 --> 02:32:54,920
DEVICE.

4143
02:32:54,920 --> 02:32:57,560
SO THIS IS GENERALLY CONSIDERED

4144
02:32:57,560 --> 02:33:01,080
IRB NON-SIGNIFICANT RIS BE, AN

4145
02:33:01,080 --> 02:33:01,720
INJECTABLE TWO COMPONENT

4146
02:33:01,720 --> 02:33:02,920
SOLUTION VERY SIMILAR TO THE

4147
02:33:02,920 --> 02:33:05,200
DEPLOYMENT OF GETTING AN

4148
02:33:05,200 --> 02:33:06,040
EPIDURAL DURING PREGNANCY.

4149
02:33:06,040 --> 02:33:07,840
SO THIS TAKES A LOT.

4150
02:33:07,840 --> 02:33:10,440
SO I HAVE LOTS OF COLLABORATORS,

4151
02:33:10,440 --> 02:33:11,640
I WOULD VERY MUCH LIKE TO -- THE

4152
02:33:11,640 --> 02:33:13,480
HEAL PROGRAM FUNDED A LOT OF

4153
02:33:13,480 --> 02:33:14,920
THIS WORK TO ATTEMPT TO CONVERT

4154
02:33:14,920 --> 02:33:17,040
THIS TO STIMULATING THE DRG.

4155
02:33:17,040 --> 02:33:18,280
WHICH HAS BEEN HUGELY VALUABLE

4156
02:33:18,280 --> 02:33:18,880
FOR US.

4157
02:33:18,880 --> 02:33:22,160
AND WE'VE NOW GOTTEN SOMEWHERE

4158
02:33:22,160 --> 02:33:23,360
AROUND $6 MILLION IN VC

4159
02:33:23,360 --> 02:33:26,400
INVESTMENT TO DO THE FIRST HUMAN

4160
02:33:26,400 --> 02:33:27,160
CLINICAL TRIALS FOR THE DRG STIM

4161
02:33:27,160 --> 02:33:27,600
AS WELL.

4162
02:33:27,600 --> 02:33:28,160
SO THANK YOU VERY MUCH.

4163
02:33:28,160 --> 02:33:31,680
[APPLAUSE]

4164
02:33:31,680 --> 02:33:35,280
I SHOULD NOTE -- OH, THERE'S A

4165
02:33:35,280 --> 02:33:36,480
PICTURE OF ME IN THE PENALTY BOX

4166
02:33:36,480 --> 02:33:39,120
WITH MY SON FOR HOCKEY.

4167
02:33:39,120 --> 02:33:41,160
THE REFS -- THERE IT IS.

4168
02:33:41,160 --> 02:33:43,640
THE REFS DECIDED HE SHOULD COME

4169
02:33:43,640 --> 02:33:45,440
VISIT ME WHILE I WAS MANNING THE

4170
02:33:45,440 --> 02:33:55,640
PENALTY BOX.

4171
02:33:59,880 --> 02:34:02,360
>>WE CAN TAKE A FEW
QUESTIONS.

4172
02:34:02,360 --> 02:34:04,280
I COULD SPEND THE NEXT FOUR

4173
02:34:04,280 --> 02:34:05,600
HOURS TALK BEING TO THESE GUYS.

4174
02:34:05,600 --> 02:34:07,400
THIS WAS FANTASTIC.

4175
02:34:07,400 --> 02:34:11,520
WHILE WE'RE LINING UP, I HAVE A

4176
02:34:11,520 --> 02:34:13,720
PSYCH DEGREE SO I GET TO ASK

4177
02:34:13,720 --> 02:34:14,640
SUSMITA OR GET TO MAKE A

4178
02:34:14,640 --> 02:34:15,120
COMMENT.

4179
02:34:15,120 --> 02:34:16,040
I'M ALWAYS LOOKING FOR THINGS

4180
02:34:16,040 --> 02:34:16,600
LIKE THIS.

4181
02:34:16,600 --> 02:34:18,640
ONE OF THE KIND OF OVERARCHING

4182
02:34:18,640 --> 02:34:19,680
PRINCIPLE OF BEHAVIORAL

4183
02:34:19,680 --> 02:34:21,680
INTERVENTIONS IS TO HAVE

4184
02:34:21,680 --> 02:34:22,800
SUCCESSFUL SUCCESSIVE

4185
02:34:22,800 --> 02:34:23,840
APPROXIMATION TOWARD A DESIRED

4186
02:34:23,840 --> 02:34:24,640
GOAL.

4187
02:34:24,640 --> 02:34:26,560
SO IN YOUR EX-SIERS PROGRAM, I

4188
02:34:26,560 --> 02:34:28,000
THINK THERE'S A LITTLE BIT MORE

4189
02:34:28,000 --> 02:34:30,640
TO IT THAN JUST THE PHYSICAL

4190
02:34:30,640 --> 02:34:31,960
EXERCISE, THERE'S A STRONG

4191
02:34:31,960 --> 02:34:32,600
PSYCHOLOGICAL COMPONENT BECAUSE

4192
02:34:32,600 --> 02:34:34,000
YOU'RE GOING FROM A SITUATION

4193
02:34:34,000 --> 02:34:35,960
WHERE IF YOU DROP PEOPLE INTO A

4194
02:34:35,960 --> 02:34:37,560
BOOT CAMP-LIKE SITUATION,

4195
02:34:37,560 --> 02:34:38,400
ESPECIALLY WITH THE PAIN

4196
02:34:38,400 --> 02:34:39,920
CONDITIONS AND SO FORTH, IT'S A

4197
02:34:39,920 --> 02:34:43,640
VERY AVERSIVE SITUATION, INSTEAD

4198
02:34:43,640 --> 02:34:45,520
PROGRAMMING FOR SUCCESS, YOU

4199
02:34:45,520 --> 02:34:47,680
KNOW, SUCCESSES REINFORCEMENT

4200
02:34:47,680 --> 02:34:48,880
AND SO FORTH, SO IT'S KIND OF

4201
02:34:48,880 --> 02:34:52,240
LIKE A PSYCHOLOGICAL

4202
02:34:52,240 --> 02:34:53,240
INTERVENTION BAKED INTO THE

4203
02:34:53,240 --> 02:34:53,960
EXERCISE PROGRAM.

4204
02:34:53,960 --> 02:34:54,920
HAVE YOU THOUGHT ABOUT IT THAT

4205
02:34:54,920 --> 02:34:56,520
WAY, AND HOW THE INTERACTION

4206
02:34:56,520 --> 02:34:57,560
BETWEEN YOUR TWO PRONGS MIGHT

4207
02:34:57,560 --> 02:35:00,160
HAVE A BIT OF SYNERGY ON THE

4208
02:35:00,160 --> 02:35:08,840
PSYCHOLOGICAL LEVEL?

4209
02:35:08,840 --> 02:35:10,440
>>YES, EXCELLENT
OBSERVATION.

4210
02:35:10,440 --> 02:35:15,440
THERE DEFINITELY IS THAT

4211
02:35:15,440 --> 02:35:16,600
COMPONENT OF GRADUALLY BUILDING

4212
02:35:16,600 --> 02:35:18,080
THEM UP TO SOMETHING THAT IS A

4213
02:35:18,080 --> 02:35:24,200
FEARED ACTIVITY, SO FOR EXAMPLE,

4214
02:35:24,200 --> 02:35:26,000
THERE ARE TIMES WE USE TRICKS,

4215
02:35:26,000 --> 02:35:26,760
ONE OF THE COMPONENTS OF FEAR IS

4216
02:35:26,760 --> 02:35:27,920
THAT THEY HAVE A FEAR OF

4217
02:35:27,920 --> 02:35:30,120
FALLING, FOR INSTANCE, SO WHEN

4218
02:35:30,120 --> 02:35:33,480
WE DO, LET'S SAY, A SQUAT

4219
02:35:33,480 --> 02:35:35,400
MOVEMENT, WHAT WE DID WITH ONE

4220
02:35:35,400 --> 02:35:36,920
PATIENT WHO WAS PARTICULARLY

4221
02:35:36,920 --> 02:35:40,760
ANXIOUS ABOUT IT IS, THEY WANTED

4222
02:35:40,760 --> 02:35:41,720
TO HAVE A CHAIR, SO WE STARTED

4223
02:35:41,720 --> 02:35:43,160
WITH LIKE A BENCH BEHIND THEM,

4224
02:35:43,160 --> 02:35:44,640
SO THAT THEY WOULD FEEL LIKE IF

4225
02:35:44,640 --> 02:35:46,160
THEY FELL, THEY WOULD FALL ON

4226
02:35:46,160 --> 02:35:48,120
THE BENCH.

4227
02:35:48,120 --> 02:35:50,000
AND AS SHE GOT MORE CONFIDENT,

4228
02:35:50,000 --> 02:35:52,560
WE REMOVED THE BENCH, AND WE HAD

4229
02:35:52,560 --> 02:35:54,360
HER PRACTICE IN FRONT OF -- IT

4230
02:35:54,360 --> 02:35:56,360
WAS JUST A DRAPE.

4231
02:35:56,360 --> 02:35:57,720
THE DRAPE IS NOT GOING TO HOLD

4232
02:35:57,720 --> 02:35:59,280
YOU IF YOU FALL, BUT THE FACT

4233
02:35:59,280 --> 02:36:01,040
THAT THERE WAS SOMETHING BEHIND

4234
02:36:01,040 --> 02:36:05,440
HER MADE HER ABLE TO DO THE

4235
02:36:05,440 --> 02:36:06,960
SQUAT IN A WAY THAT WAS JUST

4236
02:36:06,960 --> 02:36:08,320
SORT OF ABLE TO SLOWLY BUILD HER

4237
02:36:08,320 --> 02:36:08,680
CONFIDENCE.

4238
02:36:08,680 --> 02:36:11,320
SO WE HAVE THE PSYCHOLOGISTS, WE

4239
02:36:11,320 --> 02:36:13,200
CALL THEM PSYCHOLOGY TRAINERS

4240
02:36:13,200 --> 02:36:15,000
AND EXERCISE TRAINERS, THEY

4241
02:36:15,000 --> 02:36:18,760
REALLY WORK TOGETHER TO REALLY

4242
02:36:18,760 --> 02:36:20,160
MAKE THESE MOVEMENTS HAPPEN.

4243
02:36:20,160 --> 02:36:23,320
AND, YOU KNOW, FROM THE

4244
02:36:23,320 --> 02:36:26,280
PROGRESSION OF EXERCISES, WE DO

4245
02:36:26,280 --> 02:36:29,760
KNOW THAT HOLDING THE MOVEMENTS

4246
02:36:29,760 --> 02:36:31,800
AND THEN USING PROPS, WHETHER

4247
02:36:31,800 --> 02:36:40,480
IT'S THE TRX STRAPS OR THE BOSU,

4248
02:36:40,480 --> 02:36:43,320
WE DO IT IN A WAY THAT IT GIVES

4249
02:36:43,320 --> 02:36:44,160
THEM CONFIDENCE THEY'RE NOT

4250
02:36:44,160 --> 02:36:46,200
GOING TO FALL, THEY'LL SLOWLY

4251
02:36:46,200 --> 02:36:47,440
BUILD THEIR STRENGTH AND AS THE

4252
02:36:47,440 --> 02:36:48,440
MUSCLE MOVEMENTS BECOME MORE

4253
02:36:48,440 --> 02:36:49,160
DIFFICULT AND MORE COMPLEX, THEY

4254
02:36:49,160 --> 02:36:50,560
ALREADY HAVE THE STRENGTH

4255
02:36:50,560 --> 02:36:51,480
PHYSICALLY AND PSYCHOLOGICALLY

4256
02:36:51,480 --> 02:36:54,600
TO DEAL WITH THAT.

4257
02:36:54,600 --> 02:36:57,600
SO VERY MUCH -- THANK YOU.

4258
02:36:57,600 --> 02:36:58,320
>>OKAY.

4259
02:36:58,320 --> 02:37:01,600
THANK YOU.

4260
02:37:01,600 --> 02:37:03,160
I'LL START WITH A COMMENDATION

4261
02:37:03,160 --> 02:37:06,440
TO THE NIH FOR CREATING SPACE

4262
02:37:06,440 --> 02:37:07,880
FOR PRESENTATIONS ABOUT

4263
02:37:07,880 --> 02:37:08,240
PSYCHEDELICS.

4264
02:37:08,240 --> 02:37:10,440
THANK YOU, DR. ROSS, AND IT'S A

4265
02:37:10,440 --> 02:37:11,680
REALLY INTENTIONAL SHIFT THAT I

4266
02:37:11,680 --> 02:37:13,640
SEE FROM THE NIH, SO KUDOS

4267
02:37:13,640 --> 02:37:14,440
THERE.

4268
02:37:14,440 --> 02:37:16,120
BUT THIS COMES AFTER DECADES

4269
02:37:16,120 --> 02:37:18,520
WHERE THE NIH REFUSED TO FUND

4270
02:37:18,520 --> 02:37:20,280
ANY PSYCHEDELIC RESEARCH, AND SO

4271
02:37:20,280 --> 02:37:21,560
THERE'S A HUGE GAP TO MAKE UP

4272
02:37:21,560 --> 02:37:22,040
FOR.

4273
02:37:22,040 --> 02:37:23,440
SO IT'S REALLY A TWO-PART

4274
02:37:23,440 --> 02:37:24,680
QUESTION FOR DR. ROSS.

4275
02:37:24,680 --> 02:37:27,680
WHAT IS IT GOING TO TAKE TO

4276
02:37:27,680 --> 02:37:29,080
UNLOCK INCREASED FUNDING FROM

4277
02:37:29,080 --> 02:37:30,560
THE NIH FOR PSYCHEDELIC RESEARCH

4278
02:37:30,560 --> 02:37:33,160
IN A REALLY RAPID AND FULSOME

4279
02:37:33,160 --> 02:37:35,400
MANNER, AND THEN PART 2 IS, THE

4280
02:37:35,400 --> 02:37:36,680
NIH HAS SAID THAT THEY ARE

4281
02:37:36,680 --> 02:37:37,920
RESTRICTING RESEARCH ON

4282
02:37:37,920 --> 02:37:39,560
PSYCHEDELICS TO MECHANISMS OF

4283
02:37:39,560 --> 02:37:40,800
ACTION, WHICH ARE REALLY

4284
02:37:40,800 --> 02:37:42,680
IMPORTANT TO UNDERSTAND, BUT

4285
02:37:42,680 --> 02:37:44,880
IT'S ALSO IMPORTANT TO DO

4286
02:37:44,880 --> 02:37:47,160
RESEARCH ON WHICH PSYCHEDELICS

4287
02:37:47,160 --> 02:37:49,080
AT WIDOWS AND SCHEDULES WORK

4288
02:37:49,080 --> 02:37:51,520
BEST FOR WHICH CONDITIONS AND

4289
02:37:51,520 --> 02:37:52,000
WHICH PEOPLE.

4290
02:37:52,000 --> 02:37:53,760
HOW DO WE GET THE NIH TO FUND

4291
02:37:53,760 --> 02:38:04,280
THAT TYPE OF RESEARCH AS WELL?

4292
02:38:04,840 --> 02:38:07,440
>>THANK YOU FOR THOSE

4293
02:38:07,440 --> 02:38:07,880
QUESTIONS.

4294
02:38:07,880 --> 02:38:09,520
I'M NOT SURE HOW NIH THINKS

4295
02:38:09,520 --> 02:38:11,440
ABOUT THIS, SO I CAN'T COMMENT,

4296
02:38:11,440 --> 02:38:14,840
OTHER THAN TO KNOW THAT THEY'RE

4297
02:38:14,840 --> 02:38:15,680
INCREASINGLY OPEN THAT ABOUT TWO

4298
02:38:15,680 --> 02:38:19,240
YEARS AGO, NIMH GAVE THE FIRST

4299
02:38:19,240 --> 02:38:22,680
PSYCHEDELIC GRANT FOR CLINICAL

4300
02:38:22,680 --> 02:38:25,680
TRIAL PSILOCYBIN TO TREAT OCD AT

4301
02:38:25,680 --> 02:38:27,920
YALE AND THEN A RECENT HISTORIC

4302
02:38:27,920 --> 02:38:31,360
GRANT AT NIDA U01 FOR TOBACCO

4303
02:38:31,360 --> 02:38:32,200
ADDICTION.

4304
02:38:32,200 --> 02:38:33,920
AND THEN THE NCI AWARD.

4305
02:38:33,920 --> 02:38:38,800
SO I THINK NIH IS INCREASINGLY

4306
02:38:38,800 --> 02:38:39,000
OPEN.

4307
02:38:39,000 --> 02:38:40,120
YOU KNOW, PSYCHEDELICS, THERE'S

4308
02:38:40,120 --> 02:38:42,800
A KIND OF LIKE EXTREME NATURE TO

4309
02:38:42,800 --> 02:38:45,040
THAT SOME PEOPLE THINK THAT

4310
02:38:45,040 --> 02:38:46,160
THEY'RE HORRIBLE, TERRIBLE DRUGS

4311
02:38:46,160 --> 02:38:47,320
AND OTHER PEOPLE THINK THEY'RE

4312
02:38:47,320 --> 02:38:49,000
GOING TO CURE EVERYTHING, AND I

4313
02:38:49,000 --> 02:38:50,800
THINK IT'S REALLY IMPORTANT TO

4314
02:38:50,800 --> 02:38:52,400
DO MORE RESEARCH AND DO GOOD

4315
02:38:52,400 --> 02:38:54,520
SCIENCE AND THE TRUTH WILL

4316
02:38:54,520 --> 02:38:57,680
EMERGE FROM THAT.

4317
02:38:57,680 --> 02:38:59,160
I THINK YOU'RE REFERRING TO

4318
02:38:59,160 --> 02:39:00,880
MAYBE AN RFA THAT CAME OUT FROM

4319
02:39:00,880 --> 02:39:04,560
NIDA OR MAYBE IT WAS NIMH WHERE

4320
02:39:04,560 --> 02:39:06,160
SPECIFICALLY THEY'RE INTERESTED

4321
02:39:06,160 --> 02:39:07,480
IN INCLUDING MECHANISMS OF

4322
02:39:07,480 --> 02:39:10,320
ACTION, BUT THE NCI GRANT,

4323
02:39:10,320 --> 02:39:12,400
THEY'RE INTERESTED IN EFFICACY

4324
02:39:12,400 --> 02:39:15,480
AND IF EPIC NET FUNDS THIS LSD

4325
02:39:15,480 --> 02:39:17,240
CANCER PAIN STUDY, THAT WILL BE

4326
02:39:17,240 --> 02:39:19,520
AN EFFICACY TRIAL, AND A

4327
02:39:19,520 --> 02:39:20,960
MECHANISTIC COMPONENT.

4328
02:39:20,960 --> 02:39:23,880
SO I THINK CERTAIN PARTS OF NIH

4329
02:39:23,880 --> 02:39:25,120
ARE DEFINITELY INTERESTED IN

4330
02:39:25,120 --> 02:39:27,000
MECHANISMS AND OTHERS SEEM

4331
02:39:27,000 --> 02:39:28,640
INTERESTED IN FINDING NEW

4332
02:39:28,640 --> 02:39:29,880
TREATMENTS FOR PATIENTS.

4333
02:39:29,880 --> 02:39:31,680
SO I'M HEARTENED BY WHAT I'M

4334
02:39:31,680 --> 02:39:33,000
SEEING SO FAR, AND I'M GOING TO

4335
02:39:33,000 --> 02:39:39,800
KEEP SUBMITTING GRANTS TO NIH.

4336
02:39:39,800 --> 02:39:40,400
>>TESTING.

4337
02:39:40,400 --> 02:39:41,040
ALL RIGHT.

4338
02:39:41,040 --> 02:39:42,800
SO AS A FORMER NIH PROGRAM

4339
02:39:42,800 --> 02:39:47,480
DIRECTOR, I'M GOING TO GIVE YOU

4340
02:39:47,480 --> 02:39:49,480
A NON-GOVY ANSWER.

4341
02:39:49,480 --> 02:39:51,640
I USED TO CALL IT A GOVY ANSWER

4342
02:39:51,640 --> 02:39:52,480
IN TERMS OF ADDRESSING THAT

4343
02:39:52,480 --> 02:39:53,120
QUESTION.

4344
02:39:53,120 --> 02:39:54,080
ONE OF THE THINGS THAT ALWAYS

4345
02:39:54,080 --> 02:39:55,880
STRUCK ME AS ODD IS PEOPLE ARE

4346
02:39:55,880 --> 02:39:57,240
LIKE WHY DOESN'T THE NIH DO

4347
02:39:57,240 --> 02:39:59,680
THIS, SO THERE ARE PROGRAM

4348
02:39:59,680 --> 02:40:01,320
DIRECTORS ASHES LUTELY

4349
02:40:01,320 --> 02:40:02,160
SUPPORTIVE OF PSYCHEDELICS AND

4350
02:40:02,160 --> 02:40:03,000
RESEARCH TO IT.

4351
02:40:03,000 --> 02:40:03,760
BUT THEY DON'T HAVE CONTROL,

4352
02:40:03,760 --> 02:40:05,520
LIKE YOU CAN DO A SPECIALIZED

4353
02:40:05,520 --> 02:40:08,160
RFA FOR NON-MECHANISTIC RESEARCH

4354
02:40:08,160 --> 02:40:09,520
FOR PSYCHEDELICS, BUT THE

4355
02:40:09,520 --> 02:40:14,440
MAJORITY OF STUFF AT THE NIH IS

4356
02:40:14,440 --> 02:40:15,680
INVESTIGATOR INITIATED AND TO

4357
02:40:15,680 --> 02:40:17,800
SOME EXTENT IT'S ACADEMIC PEER

4358
02:40:17,800 --> 02:40:19,760
REVIEWERS -- IF IT SCORES WELL,

4359
02:40:19,760 --> 02:40:20,440
THOSE INSTITUTES WILL FUND IT,

4360
02:40:20,440 --> 02:40:21,800
BUT THE OTHER THING IS, WE DON'T

4361
02:40:21,800 --> 02:40:23,520
DO A GREAT JOB AS SCIENTISTS IN

4362
02:40:23,520 --> 02:40:24,560
TERMS OF ADVOCACY.

4363
02:40:24,560 --> 02:40:26,840
THE NIH HAS TO SOME EXTENT

4364
02:40:26,840 --> 02:40:28,880
CONGRESS LOOKING OVER THEM, AND

4365
02:40:28,880 --> 02:40:31,360
DEFINING WHAT THEY FUND AND

4366
02:40:31,360 --> 02:40:33,160
UNDERSTANDING WHAT SETASIDES GO

4367
02:40:33,160 --> 02:40:34,320
TO WHAT, AND THERE'S SOME

4368
02:40:34,320 --> 02:40:35,720
NEGATIVE FEEDBACK SOMETIMES TO

4369
02:40:35,720 --> 02:40:36,400
PERCEPTION OF FUNDING THINGS

4370
02:40:36,400 --> 02:40:38,000
THAT HAVE TO DO WITH

4371
02:40:38,000 --> 02:40:39,800
PSYCHEDELICS, HAVE TO DO WITH

4372
02:40:39,800 --> 02:40:40,960
OTHER SCHEDULE CLASS DRUGS AND

4373
02:40:40,960 --> 02:40:41,880
THINGS LIKE THAT.

4374
02:40:41,880 --> 02:40:43,160
IT'S A BIG PROBLEM FOR EPILEPSY,

4375
02:40:43,160 --> 02:40:45,320
FOR INSTANCE, AND MARIJUANA AND

4376
02:40:45,320 --> 02:40:46,400
OTHER THINGS LIKE THAT.

4377
02:40:46,400 --> 02:40:47,960
AND TO SOME EXTENT, YOU'RE GOING

4378
02:40:47,960 --> 02:40:50,360
TO HAVE TO, AS US, ON THE

4379
02:40:50,360 --> 02:40:51,480
OUTSIDE, NOT AT THE NIH, BECAUSE

4380
02:40:51,480 --> 02:40:53,040
THEY'RE NOT ALLOWED TO ADVOCATE

4381
02:40:53,040 --> 02:40:54,840
FOR THEMSELVES AS MUCH, IT'S AS

4382
02:40:54,840 --> 02:40:56,440
SCIENTISTS, WE NEED TO ADVOCATE

4383
02:40:56,440 --> 02:40:57,520
TO CONGRESS AND SAY HOW

4384
02:40:57,520 --> 02:40:59,000
IMPORTANT THIS IS AND WORK WITH

4385
02:40:59,000 --> 02:41:02,200
THE ADVOCACY GROUPS FOR EACH OF

4386
02:41:02,200 --> 02:41:04,880
OUR THERAPEUTIC INDICATIONS TO

4387
02:41:04,880 --> 02:41:06,080
CREATE MORE EFFECTIVE LOBBYING

4388
02:41:06,080 --> 02:41:07,320
OF CONGRESS TO UNDERSTAND THAT

4389
02:41:07,320 --> 02:41:08,880
THE NIH NEEDS TO SUPPORT THESE

4390
02:41:08,880 --> 02:41:10,760
STUDIES AS OPPOSED TO GETTING

4391
02:41:10,760 --> 02:41:12,080
BACKLASH FROM CONGRESS PEOPLE

4392
02:41:12,080 --> 02:41:16,480
FOR FUNDING THESE STUDIES.

4393
02:41:16,480 --> 02:41:18,320
>>SO THANKS SO MUCH FOR
THESE

4394
02:41:18,320 --> 02:41:19,920
REALLY EXCITING DIFFERENT KIND

4395
02:41:19,920 --> 02:41:25,000
OF AREAS FOR TREATMENTS.

4396
02:41:25,000 --> 02:41:25,800
SO BUILDING OFF OF KIND OF THE

4397
02:41:25,800 --> 02:41:27,520
QUESTION MARKED ASKED AT THE

4398
02:41:27,520 --> 02:41:29,440
BEGINNING IN THE CONTEXT OF THE

4399
02:41:29,440 --> 02:41:30,640
PSYCHOSOCIAL CONTEXT SURROUNDING

4400
02:41:30,640 --> 02:41:33,120
THE EXERCISE STUDY, I'M REALLY

4401
02:41:33,120 --> 02:41:34,840
INTERESTED IN THE PLACEBO

4402
02:41:34,840 --> 02:41:36,480
EFFECT, AND WE KNOW PLACEBO

4403
02:41:36,480 --> 02:41:37,280
EFFECTS ARE STRONGEST IN PAIN,

4404
02:41:37,280 --> 02:41:40,520
SO I GUESS FOR ALL OF THE

4405
02:41:40,520 --> 02:41:44,800
SPEAKERS, PARTICULARLY STEVE

4406
02:41:44,800 --> 02:41:45,920
AND -- BASICALLY I'M INTERESTED

4407
02:41:45,920 --> 02:41:47,160
IN THE CONTEXT OF PSYCHEDELICS,

4408
02:41:47,160 --> 02:41:49,440
WHAT DO YOU THINK ABOUT PLACEBO

4409
02:41:49,440 --> 02:41:51,000
CONTROL, HOW DO YOU THINK ABOUT

4410
02:41:51,000 --> 02:41:51,800
THEM, ARE THESE EFFECTS THAT

4411
02:41:51,800 --> 02:41:54,160
YOU'RE LOOKING AT SPECIFIC TO

4412
02:41:54,160 --> 02:41:56,000
THE DIFFERENT POPULATIONS OR ARE

4413
02:41:56,000 --> 02:41:57,400
WE LOOKING AT KIND OF

4414
02:41:57,400 --> 02:41:59,160
NONSPECIFIC EFFECTS RELATED TO

4415
02:41:59,160 --> 02:42:01,120
EXPECTANCY, WHICH IS GOING TO BE

4416
02:42:01,120 --> 02:42:02,600
LARGER WITH PSYCHEDELICS

4417
02:42:02,600 --> 02:42:03,280
TREATMENTS WE'VE BEEN EXCITED

4418
02:42:03,280 --> 02:42:05,240
ABOUT AND INTERVENTIONS LIKE

4419
02:42:05,240 --> 02:42:06,040
SURGERIES.

4420
02:42:06,040 --> 02:42:09,360
SO CAN YOU ESPECIALLY DR. ROSS

4421
02:42:09,360 --> 02:42:10,800
AND LUDWIG, CAN YOU SPEAK A

4422
02:42:10,800 --> 02:42:12,800
LITTLE BIT TO THE PLACEBO

4423
02:42:12,800 --> 02:42:14,520
COMPONENTS OR HOW WE MIGHT KIND

4424
02:42:14,520 --> 02:42:16,000
OF QUANTIFY THOSE OVER TIME IN

4425
02:42:16,000 --> 02:42:17,360
THESE TRIALS?

4426
02:42:17,360 --> 02:42:21,600
>>YEAH, IT'S BEEN VERY
HARD TO

4427
02:42:21,600 --> 02:42:24,360
FIND A GOOD ACTIVE PLACEBO THAT

4428
02:42:24,360 --> 02:42:25,520
CAN OBSCURE BOTH OF WHAT'S

4429
02:42:25,520 --> 02:42:27,000
HAPPENING TO THE PARTICIPANT AND

4430
02:42:27,000 --> 02:42:28,280
THE INVESTIGATOR.

4431
02:42:28,280 --> 02:42:29,760
WE'VE TRIED VARIOUS ONES AND

4432
02:42:29,760 --> 02:42:31,480
THEY'RE ALL RELATIVELY POOR.

4433
02:42:31,480 --> 02:42:32,920
AND THEATION LED PEOPLE TO

4434
02:42:32,920 --> 02:42:34,840
CRITICIZE THAT THERE'S HUGE

4435
02:42:34,840 --> 02:42:35,560
EXPECTANCY EFFECTS.

4436
02:42:35,560 --> 02:42:37,360
SO I THINK WE NEED TO DO A

4437
02:42:37,360 --> 02:42:41,960
BETTER JOB OF COMING UP WITH

4438
02:42:41,960 --> 02:42:43,080
BETTER CONTROLS SO AS AN

4439
02:42:43,080 --> 02:42:46,600
EXAMPLE, YOU COULD PICK KETAMINE

4440
02:42:46,600 --> 02:42:48,920
MIGHT OBSCURE MORE BUT YOU MIGHT

4441
02:42:48,920 --> 02:42:52,680
HAVE A -- E EFFICACY TRIAL THER.

4442
02:42:52,680 --> 02:42:54,720
IF YOUR PRIMARY OUT COME IS A

4443
02:42:54,720 --> 02:42:55,960
PRIMARY CLINICIAN RATED OUT COME

4444
02:42:55,960 --> 02:42:57,240
AND THERE'S A CENTRAL RATER

4445
02:42:57,240 --> 02:42:59,160
DOING IT, I THINK THAT HELPS TO

4446
02:42:59,160 --> 02:42:59,440
A DEGREE.

4447
02:42:59,440 --> 02:43:01,600
THE FDA INTERESTINGLY IS OKAY

4448
02:43:01,600 --> 02:43:03,040
WITH WHATEVER PLACEBO YOU WANT

4449
02:43:03,040 --> 02:43:04,520
FOR SOME OF THESE BIGGER TRIALS,

4450
02:43:04,520 --> 02:43:07,040
INCLUDING AN INERT PLACEBO.

4451
02:43:07,040 --> 02:43:10,520
I THINK IT'S IMPORTANT TO LOOK

4452
02:43:10,520 --> 02:43:11,880
AT EXPECT SEE AND TO BE ABLE TO

4453
02:43:11,880 --> 02:43:13,880
TEST FOR IT AND TO HAVE

4454
02:43:13,880 --> 02:43:15,840
VALIDATED MEASURES LIKE THE

4455
02:43:15,840 --> 02:43:17,360
STANFORD EXPECTANCY MEASURE THAT

4456
02:43:17,360 --> 02:43:18,520
YOU CAN ADMINISTER TO REALLY

4457
02:43:18,520 --> 02:43:23,200
TAKE A LOOK AT THAT.

4458
02:43:23,200 --> 02:43:24,600
WE FOUND IN OUR CANCER STUDY,

4459
02:43:24,600 --> 02:43:26,760
THERE ARE SOME PEOPLE THAT GOT

4460
02:43:26,760 --> 02:43:29,360
NIACIN THAT HAD FULL BLOWN

4461
02:43:29,360 --> 02:43:32,080
EXPERIENCES AND SOME ARE MORE

4462
02:43:32,080 --> 02:43:32,960
SUGGESTIBLE THAN OTHERS.

4463
02:43:32,960 --> 02:43:35,200
WE STILL NEED TO DO A BETTER JOB

4464
02:43:35,200 --> 02:43:36,400
OF MINIMIZING EXPECTANCY.

4465
02:43:36,400 --> 02:43:37,800
>>I WOULD AGREE WITH
THAT.

4466
02:43:37,800 --> 02:43:39,440
ANY TIME YOU ALSO GET -- YOU

4467
02:43:39,440 --> 02:43:40,640
HAVE TO DO AN EARLY STAGE

4468
02:43:40,640 --> 02:43:42,520
CLINICAL STUDY BEFORE YOU CAN DO

4469
02:43:42,520 --> 02:43:43,960
A LATER STAGE CLINICAL STUDY AND

4470
02:43:43,960 --> 02:43:45,280
YOU HAVE TO BE VERY CAREFUL

4471
02:43:45,280 --> 02:43:47,280
ABOUT UNDERSTANDING THE NUISANCE

4472
02:43:47,280 --> 02:43:48,680
VARIABLES AND THE PREVALENCE

4473
02:43:48,680 --> 02:43:50,640
THAT RANDOMIZATION CAN'T REALLY

4474
02:43:50,640 --> 02:43:52,040
TAKE ACCOUNT.

4475
02:43:52,040 --> 02:43:54,120
AND EVEN DOING A POSTDOC

4476
02:43:54,120 --> 02:43:54,840
EVALUATION OF THE RANDOMIZATION

4477
02:43:54,840 --> 02:43:56,360
WHEN YOU DON'T KNOW WHAT ALL THE

4478
02:43:56,360 --> 02:43:59,000
NUISANCE VARIABLES ARE, WHEN

4479
02:43:59,000 --> 02:44:00,600
YOU -- BECOMES LIKE A REAL

4480
02:44:00,600 --> 02:44:01,800
PROBLEM HERE, BUT IT ALSO

4481
02:44:01,800 --> 02:44:05,120
DOESN'T MEAN THAT SOME OF THESE

4482
02:44:05,120 --> 02:44:06,880
THINGS -- IF YOU LOOK AT THE

4483
02:44:06,880 --> 02:44:09,120
COCHRANE RISK OF BIAS, IF YOU

4484
02:44:09,120 --> 02:44:10,800
LOOK AT MY SPINAL CORD STIM

4485
02:44:10,800 --> 02:44:12,080
STUFF, THERE'S MEDIUM TO HIGH

4486
02:44:12,080 --> 02:44:16,440
HIGHRISK OF BIAS IN TERMS OF ALF

4487
02:44:16,440 --> 02:44:17,800
THAT BECAUSE THEY COULDN'T

4488
02:44:17,800 --> 02:44:18,640
EFFECTIVELY BLIND THESE PEOPLE,

4489
02:44:18,640 --> 02:44:21,080
THEY HAD ALL SORTS OF BIASES --

4490
02:44:21,080 --> 02:44:22,320
THAT THEY WEREN'T ASSESSING FOR

4491
02:44:22,320 --> 02:44:23,640
SO I THINK WE NEED TO KIND OF

4492
02:44:23,640 --> 02:44:25,080
PUSH FOR UNDERSTANDING THAT

4493
02:44:25,080 --> 02:44:27,120
BECAUSE OF THE WAY THE THERAPY

4494
02:44:27,120 --> 02:44:28,920
MAY WORK, WE'RE GOING TO BE --

4495
02:44:28,920 --> 02:44:30,240
IT'S GOING TO BE DIFFICULT TO

4496
02:44:30,240 --> 02:44:31,720
BLIND TO SOME EXTENT.

4497
02:44:31,720 --> 02:44:33,040
AND WE NEED TO START THINKING OF

4498
02:44:33,040 --> 02:44:34,560
HOW DO WE WORK WITH THE FDA TO

4499
02:44:34,560 --> 02:44:36,880
CREATE NON-TRADITIONAL ADAPTIVE

4500
02:44:36,880 --> 02:44:38,200
DESIGNS AND THINGS LOOK THAT

4501
02:44:38,200 --> 02:44:39,440
THAT ARE A LITTLE BIT OUTSIDE OF

4502
02:44:39,440 --> 02:44:41,920
THE BOX TO TRY TO SAY IF WE

4503
02:44:41,920 --> 02:44:43,040
ACCEPT THE FACT IT'S GOING TO BE

4504
02:44:43,040 --> 02:44:44,080
REALLY HARD TO BLIND WITH SOME

4505
02:44:44,080 --> 02:44:47,800
OF THESE THINGS, HOW DO WE STILL

4506
02:44:47,800 --> 02:44:48,440
CREATE SCIENTIFIC RIGOR?

4507
02:44:48,440 --> 02:44:52,440
>>JUST TO SAY, I THINK
THE

4508
02:44:52,440 --> 02:44:53,480
RECENT PRE-PRINT THAT CAME OUT

4509
02:44:53,480 --> 02:44:56,280
OF STANFORD WHERE THEY

4510
02:44:56,280 --> 02:44:57,160
ACTUALLY -- KETAMINE UNDER

4511
02:44:57,160 --> 02:44:58,480
ANESTHESIA WOULD BE REALLY

4512
02:44:58,480 --> 02:45:00,520
EXCITING FOR SOME OF THESE

4513
02:45:00,520 --> 02:45:02,560
TECHNIQUES TO TAKE OUT THAT --

4514
02:45:02,560 --> 02:45:03,520
OR UNDERSTAND WHETHER THAT'S AN

4515
02:45:03,520 --> 02:45:05,000
ESSENTIAL COMPONENT OF THE

4516
02:45:05,000 --> 02:45:06,280
ACTUAL THERAPEUTIC IMPACT.

4517
02:45:06,280 --> 02:45:07,760
SO COOL, THANKS.

4518
02:45:07,760 --> 02:45:09,400
>>I SHOULD MENTION REALLY

4519
02:45:09,400 --> 02:45:13,160
QUICKLY FOR DP DEVICES THE PLACO

4520
02:45:13,160 --> 02:45:14,080
EFFECT IS ACTUALLY MUCH HIGHER.

4521
02:45:14,080 --> 02:45:16,920
THERE'S A STUDY SHOWING HOW MUCH

4522
02:45:16,920 --> 02:45:18,920
ENGAGEMENT YOU HAVE WITH THE

4523
02:45:18,920 --> 02:45:22,120
PLACEBO MAKES IT MUCH LARGER,

4524
02:45:22,120 --> 02:45:25,360
THE -- CAN ALSO CREATE A LARGER

4525
02:45:25,360 --> 02:45:25,720
PLACEBO EFFECT.

4526
02:45:25,720 --> 02:45:30,560
>>THIS QUESTION IS ALSO
FOR DR.

4527
02:45:30,560 --> 02:45:31,960
PSYCHEDELIC TREATMENT DEFINITELY

4528
02:45:31,960 --> 02:45:36,520
IS AN EMERGING AREA OF RESEARCH,

4529
02:45:36,520 --> 02:45:38,320
AND IT'S RELATIVELY SAFE AND

4530
02:45:38,320 --> 02:45:42,680
THERE'S EVIDENCE OF EFFECT

4531
02:45:42,680 --> 02:45:43,480
EFFECTIVENESS.

4532
02:45:43,480 --> 02:45:44,200
THERE'S A LOT THAT NEEDS TO BE

4533
02:45:44,200 --> 02:45:47,400
DONE AND SHOULD BE DONE BECAUSE

4534
02:45:47,400 --> 02:45:53,640
MANY PATIENTS SELF MEDICATE --

4535
02:45:53,640 --> 02:45:56,280
MEDICATION, BUT IT'S HARD FOR ME

4536
02:45:56,280 --> 02:45:59,320
TO IMAGINE THAT CAN BE BUILT

4537
02:45:59,320 --> 02:46:00,320
INTO STANDARD OF CARE.

4538
02:46:00,320 --> 02:46:02,760
IT MAY BE THE LAST RESORT OR

4539
02:46:02,760 --> 02:46:07,680
LAST REGIMEN THAT A CLINICIAN

4540
02:46:07,680 --> 02:46:09,160
CAN CONSIDER BECAUSE WHEN WE

4541
02:46:09,160 --> 02:46:11,240
SELECT PATIENT OR SELECT

4542
02:46:11,240 --> 02:46:14,160
INDICATION, EVEN WE WANT TO

4543
02:46:14,160 --> 02:46:16,160
SPEND -- OF CLINICAL TRIALS, I

4544
02:46:16,160 --> 02:46:17,760
THINK MANY NEED TO BE CONSIDERED

4545
02:46:17,760 --> 02:46:21,040
WHAT PATIENT WE CAN TREAT, WHAT

4546
02:46:21,040 --> 02:46:23,280
INDICATION WE WANT DO -- THIS.

4547
02:46:23,280 --> 02:46:28,440
SO MY QUESTION FOR YOU, WI WHENU

4548
02:46:28,440 --> 02:46:29,840
DESIGN YOUR LARGE CLINICAL

4549
02:46:29,840 --> 02:46:31,000
TRIALS, WHAT TYPICALLY THE

4550
02:46:31,000 --> 02:46:33,800
EXCLUSION CRITERIA YOU WANT

4551
02:46:33,800 --> 02:46:35,640
CONSIDERED FOR PATIENTS -- EVEN

4552
02:46:35,640 --> 02:46:39,280
CANCER RELATED PAIN?

4553
02:46:39,280 --> 02:46:41,640
>>PSYCHEDELICS ARE
DEFINITELY

4554
02:46:41,640 --> 02:46:42,600
NOT FOR EVERYONE.

4555
02:46:42,600 --> 02:46:45,320
THEY CAN HAVE SOME PSYCHOLOGICAL

4556
02:46:45,320 --> 02:46:46,080
TOXICITY.

4557
02:46:46,080 --> 02:46:55,720
IN PARTICULAR THEY'RE PSYCHO --

4558
02:46:55,720 --> 02:46:56,600
PSYCHOSIS, BIPOLAR 1 DISORDER.

4559
02:46:56,600 --> 02:46:58,240
IN TERMS OF -- WE'RE DOING

4560
02:46:58,240 --> 02:46:59,920
STUDIES IN ADVANCED CANCER BUT

4561
02:46:59,920 --> 02:47:01,200
SOMEBODY CAN'T BE SO MEDICALLY

4562
02:47:01,200 --> 02:47:03,480
UNSTABLE THEY CAN'T PARTICIPATE.

4563
02:47:03,480 --> 02:47:05,880
SO THERE ARE CERTAIN DRUG-DRUG

4564
02:47:05,880 --> 02:47:06,240
INTERACTIONS.

4565
02:47:06,240 --> 02:47:08,160
YOU CAN'T BE ON ANTIDEPRESSANTS,

4566
02:47:08,160 --> 02:47:10,640
YOU CAN'T BE ON AMY YOE

4567
02:47:10,640 --> 02:47:13,160
INHIBITOR, YOU CAN GET -- SO

4568
02:47:13,160 --> 02:47:14,320
THROUGH APPROPRIATE EXCLUSION

4569
02:47:14,320 --> 02:47:15,280
CRITERIA, WE CAN MINIMIZE SOME

4570
02:47:15,280 --> 02:47:18,600
OF THESE KNOWN RISKS, AND WE

4571
02:47:18,600 --> 02:47:20,760
JUST NEED TO DO MUCH MORE

4572
02:47:20,760 --> 02:47:21,480
RESEARCH TO ESTABLISH WHETHER

4573
02:47:21,480 --> 02:47:23,120
IT'S A TREATMENT OR NOT.

4574
02:47:23,120 --> 02:47:24,800
BUT YOU KNOW, LET'S TAKE ALCOHOL

4575
02:47:24,800 --> 02:47:25,280
USE DISORDER.

4576
02:47:25,280 --> 02:47:26,600
I'M NOT SURE WE ACTUALLY NEED

4577
02:47:26,600 --> 02:47:28,320
ANY NEW TREATMENTS FOR THAT

4578
02:47:28,320 --> 02:47:28,600
DISORDER.

4579
02:47:28,600 --> 02:47:29,920
IF WE JUST USE THE ONES WE DID

4580
02:47:29,920 --> 02:47:31,640
AND CHANGE THE SYSTEM OF CARE,

4581
02:47:31,640 --> 02:47:33,640
WE COULD HAVE ENORMOUS BENEFIT.

4582
02:47:33,640 --> 02:47:34,800
SO I DON'T THINK THAT

4583
02:47:34,800 --> 02:47:38,040
PSYCHEDELICS ARE THE ANSWER TO

4584
02:47:38,040 --> 02:47:39,680
CURE THESE PROBLEMS, BUT THEY

4585
02:47:39,680 --> 02:47:41,280
ARE WORTH DOING MORE RESEARCH TO

4586
02:47:41,280 --> 02:47:43,520
SEE IF THEY CAN ADD TO THE

4587
02:47:43,520 --> 02:47:48,520
THERAPEUTIC ARMAMENTARIUM.

4588
02:47:48,520 --> 02:47:50,360
>>THIS IS ANOTHER
QUESTION FOR

4589
02:47:50,360 --> 02:47:50,640
DR. ROSS.

4590
02:47:50,640 --> 02:47:54,400
YOU'RE ON A ROLL.

4591
02:47:54,400 --> 02:47:56,480
SO YOU DESCRIBE THE EFFECTS OF

4592
02:47:56,480 --> 02:47:58,920
PSYCHEDELICS FOR ALCOHOL ABUSE

4593
02:47:58,920 --> 02:48:03,400
AND YOU ALSO ALLUDED TO THE

4594
02:48:03,400 --> 02:48:06,480
RECENT NIH-FUNDED STUDY ON

4595
02:48:06,480 --> 02:48:07,120
PSYCHEDELICS FOR TOBACCO

4596
02:48:07,120 --> 02:48:07,480
ADDICTION.

4597
02:48:07,480 --> 02:48:09,160
SO THESE ARE BEHAVIORS.

4598
02:48:09,160 --> 02:48:11,040
I WONDER IF YOU COULD SPECULATE

4599
02:48:11,040 --> 02:48:13,000
ABOUT THE USE OF PSYCHEDELICS

4600
02:48:13,000 --> 02:48:15,480
FOR OTHER BEHAVIORS, WHICH WE

4601
02:48:15,480 --> 02:48:17,240
KNOW PLAY A LARGE ROLE IN THE

4602
02:48:17,240 --> 02:48:19,880
GENESIS OF CHRONIC DISEASES, SO

4603
02:48:19,880 --> 02:48:25,120
THINGS LIKE DIET, LIFESTYLE,

4604
02:48:25,120 --> 02:48:27,240
SLEEP, ADHERENCE TO MEDICATIONS

4605
02:48:27,240 --> 02:48:30,760
AND SEEKING HEALTHCARE, ALL OF

4606
02:48:30,760 --> 02:48:32,000
THESE BEHAVIORS, DO YOU THINK

4607
02:48:32,000 --> 02:48:33,880
THAT PSYCHEDELICS MIGHT PLAY A

4608
02:48:33,880 --> 02:48:35,600
ROLE IN TARGETING THOSE

4609
02:48:35,600 --> 02:48:37,600
MECHANISMS AND THEREBY HAVE AN

4610
02:48:37,600 --> 02:48:39,720
EFFECT ON A VARIETY OF CHRONIC

4611
02:48:39,720 --> 02:48:41,200
DISEASES?

4612
02:48:41,200 --> 02:48:42,720
>>THAT'S INTERESTING TO

4613
02:48:42,720 --> 02:48:43,160
CONSIDER.

4614
02:48:43,160 --> 02:48:44,200
SOMETIMES I GET THE QUESTION

4615
02:48:44,200 --> 02:48:46,360
WHAT ABOUT USING PSYCHEDELICS IN

4616
02:48:46,360 --> 02:48:48,280
PEOPLE WHO ARE RELATIVELY WELL

4617
02:48:48,280 --> 02:48:51,400
TO IMPROVE SPIRITUAL WELL-BEING,

4618
02:48:51,400 --> 02:48:51,760
SELF-CARE.

4619
02:48:51,760 --> 02:48:53,760
YOU KNOW, OUR FOCUS AT OUR

4620
02:48:53,760 --> 02:48:55,800
CENTER IS TREATING VERY SICK

4621
02:48:55,800 --> 02:48:57,200
PEOPLE, ALTHOUGH WE DID DO A

4622
02:48:57,200 --> 02:48:58,720
STUDY ADMINISTERING PSILOCYBIN

4623
02:48:58,720 --> 02:49:00,160
TO RELIGIOUS PROFESSIONALS SO WE

4624
02:49:00,160 --> 02:49:02,520
WERE INTERESTED IN SOME BASIC

4625
02:49:02,520 --> 02:49:03,640
PROCESSES.

4626
02:49:03,640 --> 02:49:06,360
YOU KNOW, HOW COULD PSYCHEDELICS

4627
02:49:06,360 --> 02:49:09,080
IMPROVE YOUR RELATIONSHIP TO

4628
02:49:09,080 --> 02:49:10,000
YOURSELF OR YOUR ENVIRONMENT

4629
02:49:10,000 --> 02:49:12,560
THAT YOU COULD ENGAGE IN, LET'S

4630
02:49:12,560 --> 02:49:13,320
SAY, EXERCISE OR SLEEP OR DIET

4631
02:49:13,320 --> 02:49:15,080
OR SOME OF THESE THINGS THAT WE

4632
02:49:15,080 --> 02:49:15,920
KNOW AFFECT HEALTH, THAT WOULD

4633
02:49:15,920 --> 02:49:17,760
BE REALLY INTERESTING TO

4634
02:49:17,760 --> 02:49:18,040
CONSIDER.

4635
02:49:18,040 --> 02:49:20,000
YOU'D HAVE TO DESIGN IT IN A

4636
02:49:20,000 --> 02:49:20,320
SPECIFIC WAY.

4637
02:49:20,320 --> 02:49:22,280
I WOULD HAVE TO THINK ABOUT THAT

4638
02:49:22,280 --> 02:49:23,680
SOME MORE.

4639
02:49:23,680 --> 02:49:26,920
BUT YEAH, IN GENERAL, YOU KNOW,

4640
02:49:26,920 --> 02:49:29,760
THE IDEA OF IMPROVING HOW ONE

4641
02:49:29,760 --> 02:49:31,360
CARES FOR THEMSELVES, I THINK

4642
02:49:31,360 --> 02:49:37,920
WOULD BE IMPORTANT TO LOOK AT.

4643
02:49:37,920 --> 02:49:38,960
>>OKAY.

4644
02:49:38,960 --> 02:49:40,600
LET'S THANK OUR PANEL ONCE AGAIN

4645
02:49:40,600 --> 02:49:45,800
FOR THESE VERY INSPIRING HOPEFUL

4646
02:49:45,800 --> 02:49:46,680
TALKS.

4647
02:49:46,680 --> 02:49:50,520
AND NOW WE'RE GOING TO CONCLUDE

4648
02:49:50,520 --> 02:49:54,600
WITH MY LONG-TIME COLLEAGUE, DRE

4649
02:49:54,600 --> 02:49:56,720
DEPUTY DIRECTOR OF THE NATIONAL

4650
02:49:56,720 --> 02:49:57,720
CENTER FOR COMPLEMENTARY AND

4651
02:49:57,720 --> 02:50:08,080
INTEGRATIVE HEALTH.

4652
02:50:10,080 --> 02:50:10,400
>>OKAY.

4653
02:50:10,400 --> 02:50:11,600
WELL, THANK YOU, MARK.

4654
02:50:11,600 --> 02:50:13,000
IT'S NICE TO SEE YOU IN PERSON

4655
02:50:13,000 --> 02:50:13,600
RATHER THAN ON ZOOM.

4656
02:50:13,600 --> 02:50:15,840
YOU LOOK A LOT TALLER THAN I

4657
02:50:15,840 --> 02:50:16,480
REMEMBER.

4658
02:50:16,480 --> 02:50:18,920
BUT GOOD TO SEE YOU.

4659
02:50:18,920 --> 02:50:20,720
SO BEFORE I START, I'D JUST LIKE

4660
02:50:20,720 --> 02:50:23,320
TO MENTION AND PUT A PLUG IN FOR

4661
02:50:23,320 --> 02:50:25,040
A MEETING THAT'S RELATED TO WHAT

4662
02:50:25,040 --> 02:50:26,320
WE'VE JUST HEARD TODAY.

4663
02:50:26,320 --> 02:50:29,360
IT'S AN NCCIH INTEGRATIVE

4664
02:50:29,360 --> 02:50:30,520
MEDICINE INTEGRATIVE LECTURE

4665
02:50:30,520 --> 02:50:31,920
SERIES HELD ON JUNE 15TH.

4666
02:50:31,920 --> 02:50:36,720
OUR SPEAKER IS DR. TONYA

4667
02:50:36,720 --> 02:50:38,080
PALEMMO, VICE CHAIR OF RESEARCH,

4668
02:50:38,080 --> 02:50:38,760
DEPARTMENT OF ANESTHESIOLOGY AND

4669
02:50:38,760 --> 02:50:40,520
PAIN MEDICINE AT THE UNIVERSITY

4670
02:50:40,520 --> 02:50:40,840
OF WASHINGTON.

4671
02:50:40,840 --> 02:50:43,160
IT WILL BE ON JUNE 15TH AS I

4672
02:50:43,160 --> 02:50:46,080
SAID, NOON TO 1:15 EASTERN

4673
02:50:46,080 --> 02:50:48,200
DAYLIGHT TIME ON NIH VIDEOCAST.

4674
02:50:48,200 --> 02:50:50,160
AND THE TITLE OF HER TALK IS NEW

4675
02:50:50,160 --> 02:50:53,680
INSIGHTS INTO PREVENTION AND MAD

4676
02:50:53,680 --> 02:50:54,640
MANAGEMENT OF CHRONIC PAIN IN

4677
02:50:54,640 --> 02:50:55,880
CHILDREN AND ADOLESCENTS.

4678
02:50:55,880 --> 02:51:00,240
SO WITH THAT, I'LL JUST TURN TO

4679
02:51:00,240 --> 02:51:02,040
THE MEETING AND JUST SAY HOW

4680
02:51:02,040 --> 02:51:03,520
TRULY EXCITING IT WAS TO BE HERE

4681
02:51:03,520 --> 02:51:04,600
FOR THE LAST DAY AND A HALF.

4682
02:51:04,600 --> 02:51:06,080
I WANT TO THANK ALL THE

4683
02:51:06,080 --> 02:51:08,200
PRESENTERS, IN PARTICULAR THE

4684
02:51:08,200 --> 02:51:10,120
ORGANIZERS, LEA.

4685
02:51:10,120 --> 02:51:12,320
, OFFICE OF PAIN POLICY THE A

4686
02:51:12,320 --> 02:51:13,880
NINDS, MELISSA, NATIONAL

4687
02:51:13,880 --> 02:51:15,120
INSTITUTE ON DENTAL AND

4688
02:51:15,120 --> 02:51:18,160
CRANIOFACIAL RESEARCH, DEVON,

4689
02:51:18,160 --> 02:51:20,280
NATIONAL INSTITUTE ON AGING, AND

4690
02:51:20,280 --> 02:51:23,680
THANKS, TOO, TO INA, MARK, DAVE,

4691
02:51:23,680 --> 02:51:26,120
AND LINDA FOR THEIR HELP IN

4692
02:51:26,120 --> 02:51:26,800
SUPPORTING THIS SYMPOSIUM AS

4693
02:51:26,800 --> 02:51:27,720
WELL.

4694
02:51:27,720 --> 02:51:29,600
AND I WANT TO THANK YOU, THE

4695
02:51:29,600 --> 02:51:30,840
AUDIENCE, FOR ATTENDING THIS

4696
02:51:30,840 --> 02:51:33,880
WHAT IS NOW THE FIRST HYBRID AND

4697
02:51:33,880 --> 02:51:34,880
PERSON-PERSON MEETING WE'VE HAD

4698
02:51:34,880 --> 02:51:36,520
IN OVER THREE YEARS, SO IT'S

4699
02:51:36,520 --> 02:51:37,720
REALLY EXCITING TO BE COMING OUT

4700
02:51:37,720 --> 02:51:40,320
OF THIS PANDEMIC, AND I'M REALLY

4701
02:51:40,320 --> 02:51:41,400
GRATIFIED TO BE HERE IN PERSON

4702
02:51:41,400 --> 02:51:42,640
FOR THE FIRST TIME IN A VERY

4703
02:51:42,640 --> 02:51:43,040
LONG TIME.

4704
02:51:43,040 --> 02:51:44,880
I KIND OF FORGOT WHAT NATCHER

4705
02:51:44,880 --> 02:51:46,400
LOOKED LIKE.

4706
02:51:46,400 --> 02:51:48,800
BUT REALLY, THIS SYMPOSIUM

4707
02:51:48,800 --> 02:51:50,680
RAISED OUR AWARENESS OF THE

4708
02:51:50,680 --> 02:51:51,640
COMPLEXITY OF PAIN, AND I THINK

4709
02:51:51,640 --> 02:51:52,840
AS WE ALL APPRECIATE BEING IN

4710
02:51:52,840 --> 02:51:54,400
THE PAIN FIELD, PAIN IS MORE

4711
02:51:54,400 --> 02:51:55,640
THAN JUST NOCICEPTION, ALTHOUGH

4712
02:51:55,640 --> 02:51:59,000
THAT'S AN IMPORTANT COMPONENT.

4713
02:51:59,000 --> 02:52:00,240
WHAT CONTRIBUTES TO CHRONIC PAIN

4714
02:52:00,240 --> 02:52:02,080
AND PAIN INTENSITY AMONG

4715
02:52:02,080 --> 02:52:03,000
INDIVIDUALS IS QUITE VARIABLE

4716
02:52:03,000 --> 02:52:05,080
AND RELIES ON MANY FACTORS,

4717
02:52:05,080 --> 02:52:06,840
INCLUDING THE TOPIC OF THIS

4718
02:52:06,840 --> 02:52:08,960
SYMPOSIUM, RESILIENCE.

4719
02:52:08,960 --> 02:52:10,560
AS WE ALSO LEARNED OVER THE LAST

4720
02:52:10,560 --> 02:52:12,880
DAY AND A HALF, RESILIENCE IS A

4721
02:52:12,880 --> 02:52:14,000
DYNAMIC, MULTIDIMENSIONAL

4722
02:52:14,000 --> 02:52:15,040
CONCEPT THAT INCLUDES THE

4723
02:52:15,040 --> 02:52:18,520
ABILITY TO RESIST, ADAPT,

4724
02:52:18,520 --> 02:52:19,840
RECOVER, OR GROW, OR EVEN THRIVE

4725
02:52:19,840 --> 02:52:21,560
FROM A CHALLENGE.

4726
02:52:21,560 --> 02:52:23,000
SOMETHING WE AT NIH HAVE BEEN

4727
02:52:23,000 --> 02:52:24,840
THINKING ABOUT A LOT LATELY

4728
02:52:24,840 --> 02:52:27,480
THROUGH OUR WORKING GROUP

4729
02:52:27,480 --> 02:52:29,000
MULTIDISCIPLINARY NIH RESILIENCE

4730
02:52:29,000 --> 02:52:30,000
WORKING GROUP UNDER THE

4731
02:52:30,000 --> 02:52:31,800
LEADERSHIP OF DR. LAVERNE BROWN

4732
02:52:31,800 --> 02:52:33,200
IN THE OFFICE OF DIETARY

4733
02:52:33,200 --> 02:52:33,840
SUPPLEMENTS, AND I THINK YOU'LL

4734
02:52:33,840 --> 02:52:36,840
BE SEEING MORE PROMOTED RESEARCH

4735
02:52:36,840 --> 02:52:39,320
EFFORTS IN THIS DOMAIN IN THE

4736
02:52:39,320 --> 02:52:40,520
NEAR FUTURE.

4737
02:52:40,520 --> 02:52:42,280
BUT IMPORTANTLY, THE DIVERSITY

4738
02:52:42,280 --> 02:52:43,720
OF THE SPEAKERS, WE HAD THE

4739
02:52:43,720 --> 02:52:46,360
PLEASURE OF HEARING FROM HERE,

4740
02:52:46,360 --> 02:52:47,920
COLLECTIVELY THEY PRESENTED

4741
02:52:47,920 --> 02:52:50,480
REALLY A WHOLE PERSON

4742
02:52:50,480 --> 02:52:52,720
BIOPSYCHOSOCIAL MODEL OF HEALTH

4743
02:52:52,720 --> 02:52:53,400
AND PAIN.

4744
02:52:53,400 --> 02:52:55,360
A CONCEPTUAL MODEL THAT WE

4745
02:52:55,360 --> 02:52:58,160
CERTAINLY AT NCCIH EMBRACE AS A

4746
02:52:58,160 --> 02:53:00,440
WHOLE PERSON HEALTH RESEARCH

4747
02:53:00,440 --> 02:53:02,840
FOCUS, AND REALLY REFLECTS OUR

4748
02:53:02,840 --> 02:53:05,560
STRATEGIC PLAN AND VISION BY OUR

4749
02:53:05,560 --> 02:53:07,640
DIRECTOR, DR. HELENE LANGEVIN,

4750
02:53:07,640 --> 02:53:09,360
WHO YOU HEARD FROM THIS MORNING.

4751
02:53:09,360 --> 02:53:13,320
AS WE LEARNED HERE B ABOUT

4752
02:53:13,320 --> 02:53:14,280
RESILIENCE, AGAIN THE CAPACITY

4753
02:53:14,280 --> 02:53:23,240
TO HE AD ADAPT AND RECOVER,

4754
02:53:23,240 --> 02:53:24,240
ENCOMPASSING AN INDIVIDUAL'S

4755
02:53:24,240 --> 02:53:25,840
SOCIAL SUPPORT SYSTEM,

4756
02:53:25,840 --> 02:53:27,360
COMMUNITY, AND CONNECTION,

4757
02:53:27,360 --> 02:53:28,560
EMOTION AND BEHAVIORAL

4758
02:53:28,560 --> 02:53:30,800
FLEXIBILITY, AND THE ABILITY OF

4759
02:53:30,800 --> 02:53:33,160
PHYSIOLOGICAL SYSTEMS TO ADAPT,

4760
02:53:33,160 --> 02:53:35,680
COMPENSATE, EVEN BOUNCE BACK OR

4761
02:53:35,680 --> 02:53:39,200
GROW OR REGAIN FUNCTION TO

4762
02:53:39,200 --> 02:53:45,720
RESOLVE THE PAINFUL EVENT.

4763
02:53:45,720 --> 02:53:46,760
SO BECAUSE THERE ARE MULTIPLE

4764
02:53:46,760 --> 02:53:48,280
FACTORS THAT CONTRIBUTE TO

4765
02:53:48,280 --> 02:53:49,680
RESILIENCE, THIS WHOLE PERSON

4766
02:53:49,680 --> 02:53:52,320
HEALTH RESEARCH FRAMEWORK

4767
02:53:52,320 --> 02:53:57,720
SUGGESTS AND REALLY REQUIRES

4768
02:53:57,720 --> 02:53:58,680
MULTICOMPONENT INTERVENTIONS

4769
02:53:58,680 --> 02:53:59,880
ACTING AT MULTIPLE LEVELS AND

4770
02:53:59,880 --> 02:54:01,960
THAT ARE NEEDED TO ENHANCE AN

4771
02:54:01,960 --> 02:54:03,040
INDIVIDUAL'S RESILIENCE TO PAIN.

4772
02:54:03,040 --> 02:54:04,200
SOMETHING THAT WAS ECHOED

4773
02:54:04,200 --> 02:54:07,320
THROUGHOUT THIS MEETING.

4774
02:54:07,320 --> 02:54:09,400
AND IN FACT WE AT NCCIH PROMOTE

4775
02:54:09,400 --> 02:54:11,000
THE DEVELOPMENT AND STUDY OF

4776
02:54:11,000 --> 02:54:12,120
MULTICOMPONENT INTERVENTIONS

4777
02:54:12,120 --> 02:54:13,400
UNDER A WHOLE PERSON HEALTH

4778
02:54:13,400 --> 02:54:15,800
RESEARCH STRATEGY.

4779
02:54:15,800 --> 02:54:17,440
THE PRESENTERS IN THIS MEETING

4780
02:54:17,440 --> 02:54:19,200
ALSO EMPHASIZE THE

4781
02:54:19,200 --> 02:54:20,680
INTERCONNECTEDNESS AMONG

4782
02:54:20,680 --> 02:54:21,840
PSYCHOLOGICAL, SOCIAL,

4783
02:54:21,840 --> 02:54:23,720
BEHAVIORAL PROCESSES, GENETIC,

4784
02:54:23,720 --> 02:54:25,640
IMMUNE, MOLECULAR, CELLULAR

4785
02:54:25,640 --> 02:54:27,320
MECHANISMS, AND PHYSIOLOGICAL

4786
02:54:27,320 --> 02:54:29,080
SYSTEMS THAT REALLY AND TRULY

4787
02:54:29,080 --> 02:54:30,560
REPRESENT A WHOLE PERSON HEALTH

4788
02:54:30,560 --> 02:54:34,360
RESEARCH FRAMEWORK IN THE

4789
02:54:34,360 --> 02:54:36,040
SERVICE OF RESILIENCE RESEARCH

4790
02:54:36,040 --> 02:54:37,240
IN THE CONTEXT OF STUDYING

4791
02:54:37,240 --> 02:54:37,680
CHRONIC PAIN.

4792
02:54:37,680 --> 02:54:40,160
I REALLY -- REFLECTING BACK ON

4793
02:54:40,160 --> 02:54:40,960
YESTERDAY, I REALLY APPRECIATE

4794
02:54:40,960 --> 02:54:48,440
THE OPENING KEYNOTE SPEAKER, DRD

4795
02:54:48,440 --> 02:54:49,600
RESILIENCE IN THE CONTEXT OF

4796
02:54:49,600 --> 02:54:51,120
PAIN AND RIGHTFULLY POINTING OUT

4797
02:54:51,120 --> 02:54:54,880
THE NEED FOR POSITIVE ACTIVITY

4798
02:54:54,880 --> 02:54:56,280
INTERVENTIONS AIMED AT RAISING

4799
02:54:56,280 --> 02:54:58,240
POSITIVE FEELINGS IN AFFECT,

4800
02:54:58,240 --> 02:55:00,920
POSITIVE COGNITION OR POSITIVE

4801
02:55:00,920 --> 02:55:02,720
BEHAVIORS TO ENHANCE RESILIENCE.

4802
02:55:02,720 --> 02:55:05,000
IT REALLY IS DIFFERENT FROM HOW

4803
02:55:05,000 --> 02:55:08,160
WE TRADITIONALLY THINK ABOUT

4804
02:55:08,160 --> 02:55:13,480
TREAT M OF TREATMENT OF PAIN, TE

4805
02:55:13,480 --> 02:55:14,880
SYMPTOMS, HERE WE'RE TAKING INTO

4806
02:55:14,880 --> 02:55:16,320
ACCOUNT INDIVIDUAL -- THE

4807
02:55:16,320 --> 02:55:19,560
INDIVIDUAL POSITIVE PROMOTING

4808
02:55:19,560 --> 02:55:21,520
ASPECTS OF AFFECT TO PROTECT AND

4809
02:55:21,520 --> 02:55:25,120
PROMOTE AND INCREASE RESILIENCE.

4810
02:55:25,120 --> 02:55:26,480
INTERVENTIONS THAT FOCUSED ON

4811
02:55:26,480 --> 02:55:27,640
GRATITUDE, JOY, KINDNESS,

4812
02:55:27,640 --> 02:55:30,160
PURPOSE OF LIFE, SELF-EFFICACY,

4813
02:55:30,160 --> 02:55:31,680
CHARACTER AND SOCIAL SUPPORT

4814
02:55:31,680 --> 02:55:34,440
PROMOTE THIS POSITIVE AFFECT AND

4815
02:55:34,440 --> 02:55:35,520
BEHAVIORAL ACTIVATION THAT CAN

4816
02:55:35,520 --> 02:55:36,960
ONLY CHANGE ATTITUDE AND

4817
02:55:36,960 --> 02:55:37,960
PSYCHOLOGICAL PROCESSES BUT AS

4818
02:55:37,960 --> 02:55:39,720
WE LEARNED THROUGH THIS

4819
02:55:39,720 --> 02:55:43,120
SYMPOSIUM, ACTUALLY -- KEY

4820
02:55:43,120 --> 02:55:44,400
BIOLOGICAL MECHANISMS THAT ARE

4821
02:55:44,400 --> 02:55:45,760
INVOLVED IN THE DEVELOPMENT AND

4822
02:55:45,760 --> 02:55:47,280
MAINTENANCE OF CHRONIC PAIN.

4823
02:55:47,280 --> 02:55:48,880
THE PRESENTER IN THIS MEETING

4824
02:55:48,880 --> 02:55:50,840
ALSO EMPHASIZED THE

4825
02:55:50,840 --> 02:55:54,360
INTERCONNECTEDNESS AMONG THESE

4826
02:55:54,360 --> 02:55:57,240
DOMAINS, GENETIC, IMMUNE AND

4827
02:55:57,240 --> 02:55:59,640
REALLY SET THE STAGE FOR

4828
02:55:59,640 --> 02:56:00,880
THINKING ABOUT THIS

4829
02:56:00,880 --> 02:56:02,280
INTERCONNECTEDNESS, AGAIN, FOR

4830
02:56:02,280 --> 02:56:02,600
CHRONIC PAIN.

4831
02:56:02,600 --> 02:56:05,600
IN FACT, RESEARCH THAT WE AT

4832
02:56:05,600 --> 02:56:07,520
NCCIH HAVE SUPPORTED SHOWS THAT

4833
02:56:07,520 --> 02:56:08,520
PHYSICAL MEDITATIVE PRACTICE

4834
02:56:08,520 --> 02:56:10,720
SUCH AS YOGA CAN CHANGE BRAIN

4835
02:56:10,720 --> 02:56:12,120
CIRCUITRY THAT INCREASES

4836
02:56:12,120 --> 02:56:17,400
RESILIENCE TO PA PAINFUL STIMULI

4837
02:56:17,400 --> 02:56:19,040
AND RECENT RESEARCH JUST

4838
02:56:19,040 --> 02:56:23,160
SUPPORTED BY NCCIH ON

4839
02:56:23,160 --> 02:56:24,720
MINDFULNESS, STRESS REDUCTION

4840
02:56:24,720 --> 02:56:26,960
FOR LONELY OLDER ADULTS SHOWS

4841
02:56:26,960 --> 02:56:28,880
INCREASE IN IMMUNE SYSTEM

4842
02:56:28,880 --> 02:56:31,040
STIMULATION AND THE

4843
02:56:31,040 --> 02:56:32,840
ANTI-INFLAMMATORY CYTOKINE IL-6.

4844
02:56:32,840 --> 02:56:34,760
AND SPECIFICALLY, THE NEED TO

4845
02:56:34,760 --> 02:56:36,280
ADDRESS LONELINESS HAS BEEN

4846
02:56:36,280 --> 02:56:37,680
AMPLIFIED AT THE NATIONAL LEVEL

4847
02:56:37,680 --> 02:56:41,080
BY THE U.S. SURGEON GENERAL, DR.

4848
02:56:41,080 --> 02:56:42,360
HIS RECENT WARNING ABOUT

4849
02:56:42,360 --> 02:56:43,760
LONELINESS AND ISOLATION

4850
02:56:43,760 --> 02:56:45,920
INCREASES THE RISK FOR

4851
02:56:45,920 --> 02:56:47,120
INDIVIDUALS DEVELOPING MENTAL

4852
02:56:47,120 --> 02:56:49,960
HEALTH CHALLENGES ACROSS THEIR

4853
02:56:49,960 --> 02:56:50,840
LIFESPAN.

4854
02:56:50,840 --> 02:56:52,520
ONE OF OUR POSTER PRESENTERS

4855
02:56:52,520 --> 02:56:56,400
HERE ACTUALLY, DR. LOLA

4856
02:56:56,400 --> 02:56:59,200
AKINTOLA, ONE OF THE MEMBERS OF

4857
02:56:59,200 --> 02:57:01,240
OUR LAB UNDER THE LEADERSHIP OF

4858
02:57:01,240 --> 02:57:02,640
DR. LAUREN ATLAS REPORTED SURVEY

4859
02:57:02,640 --> 02:57:04,640
DATA TO SHOW THAT SOCIAL

4860
02:57:04,640 --> 02:57:05,440
CONNECTEDNESS DURING THE

4861
02:57:05,440 --> 02:57:07,240
PANDEMIC ACTUALLY REDUCED THE

4862
02:57:07,240 --> 02:57:07,720
IMPACT OF PAIN.

4863
02:57:07,720 --> 02:57:11,000
SO AGAIN SHOWING THE IMPORTANCE

4864
02:57:11,000 --> 02:57:13,520
OF THESE NON-PHARMACOLOGICAL

4865
02:57:13,520 --> 02:57:14,960
APPROACHES IN REDUCTION OF

4866
02:57:14,960 --> 02:57:16,920
LONELINESS AND HELPING US COPE

4867
02:57:16,920 --> 02:57:18,840
WITH A VARIETY OF CONDITIONS

4868
02:57:18,840 --> 02:57:19,440
INCLUDING PAIN.

4869
02:57:19,440 --> 02:57:20,920
BUT THE PANEL ON DISPARITIES

4870
02:57:20,920 --> 02:57:25,280
ACROSS DIVERSE POPULATIONS WITH

4871
02:57:25,280 --> 02:57:29,360
DRS. EDWARDS, GOODIN AND

4872
02:57:29,360 --> 02:57:32,400
RITCHIE, RESILIENCE TO CHRONIC

4873
02:57:32,400 --> 02:57:34,040
PAIN, INDIVIDUAL DIFFERENCES AND

4874
02:57:34,040 --> 02:57:35,040
PSYCHOLOGICAL FACTORS,

4875
02:57:35,040 --> 02:57:36,200
IMPORTANTLY STIGMA AND FALSE

4876
02:57:36,200 --> 02:57:37,680
BELIEFS AMONG HEALTH CARE

4877
02:57:37,680 --> 02:57:39,520
PROVIDER, AND SOCIAL CONTEXT

4878
02:57:39,520 --> 02:57:39,920
MATTERS TOO.

4879
02:57:39,920 --> 02:57:41,920
AS WE LEARNED FROM DR. EDWARDS,

4880
02:57:41,920 --> 02:57:45,280
THESE FACTORS CAN LEAD TO PAIN

4881
02:57:45,280 --> 02:57:45,800
CATASTROPHIZING, THAT IS

4882
02:57:45,800 --> 02:57:47,320
ASSOCIATED WITH CHANGES IN THE

4883
02:57:47,320 --> 02:57:49,680
BRAIN DEFAULT MODE NETWORK.

4884
02:57:49,680 --> 02:57:52,440
AND INTERVENTIONS SUCH AS CBT

4885
02:57:52,440 --> 02:57:56,160
MAY REDUCE PAIN KA T CATASTROPH,

4886
02:57:56,160 --> 02:57:57,720
ADOPT A PROBLEM SOLVING APPROACH

4887
02:57:57,720 --> 02:57:59,760
AND REDUCE HEALTH DISPARITIES.

4888
02:57:59,760 --> 02:58:01,520
THE PSYCHOLOGICAL ASPECT OF PAIN

4889
02:58:01,520 --> 02:58:03,400
RESILIENCE SUGGESTS PATIENTS

4890
02:58:03,400 --> 02:58:06,200
SUFFERING FROM CHRONIC PAIN ARE

4891
02:58:06,200 --> 02:58:07,880
STIGMATIZED, MARGINALIZED, AND

4892
02:58:07,880 --> 02:58:10,240
EXPERIENCE PSYCHOSOCIAL

4893
02:58:10,240 --> 02:58:11,160
PREJUDICE IN ADDITION TO THEIR

4894
02:58:11,160 --> 02:58:15,200
PAIN CONDITION, AND AS

4895
02:58:15,200 --> 02:58:16,760
DR. GOODIN EMPA SIZED, PEOPLE

4896
02:58:16,760 --> 02:58:21,720
FROM MARGINALIZED GROUPS --

4897
02:58:21,720 --> 02:58:22,320
FRAMED AS SOCIAL THREAT.

4898
02:58:22,320 --> 02:58:24,720
THE RESULTS IN CHRONIC PAIN

4899
02:58:24,720 --> 02:58:25,760
DISPARITIES EXPERIENCE RESULT IN

4900
02:58:25,760 --> 02:58:28,360
GREATER PAIN INTENSITY,

4901
02:58:28,360 --> 02:58:30,680
INCREASED BURDEN OF PAIN, AND

4902
02:58:30,680 --> 02:58:32,560
SADLY, I INADEQUATE PAIN TREATMT

4903
02:58:32,560 --> 02:58:33,560
DESPITE GREATER NEED.

4904
02:58:33,560 --> 02:58:36,000
THE BRIEF BEHAVIORAL TREATMENT

4905
02:58:36,000 --> 02:58:37,960
FOR INSOMNIA, BBTI, THAT

4906
02:58:37,960 --> 02:58:40,000
DR. GOOD D IN MENTIONED, MAY

4907
02:58:40,000 --> 02:58:44,120
HELP COPE WITH PAIN INTENSITY,

4908
02:58:44,120 --> 02:58:47,600
IMPROVE SLEEVE AND REDUCE HEALTH

4909
02:58:47,600 --> 02:58:47,880
DISPARITIES.

4910
02:58:47,880 --> 02:58:49,800
FINALLY, DR. RITCHIE POINTED OUT

4911
02:58:49,800 --> 02:58:51,080
AGEISM, EXPERIENCE AMONG OLDER

4912
02:58:51,080 --> 02:58:52,400
ADULTS ALSO LEADS TO

4913
02:58:52,400 --> 02:58:54,320
DISCRIMINATION AND BARRIERS TO

4914
02:58:54,320 --> 02:58:55,240
TREATMENT FOR CHRONIC PAIN AND

4915
02:58:55,240 --> 02:58:58,200
LEADS TO DEVASTATING DISABILITY

4916
02:58:58,200 --> 02:58:58,920
SPIRAL.

4917
02:58:58,920 --> 02:59:00,520
THE PANEL ON RESILIENCE OF

4918
02:59:00,520 --> 02:59:03,760
MECHANISMS OF PAIN RESOLUTION

4919
02:59:03,760 --> 02:59:07,320
WITH PRESENTATIONS BY

4920
02:59:07,320 --> 02:59:16,560
DR. BARTLEY, DIATCHENKO AND KIM

4921
02:59:16,560 --> 02:59:18,560
SIBILLE, DR. BARTLEY RAISED THE

4922
02:59:18,560 --> 02:59:20,440
IMPORTANT POINT THAT

4923
02:59:20,440 --> 02:59:22,480
UNDERSTANDING PAIN RESILIENCE

4924
02:59:22,480 --> 02:59:24,040
INTERVENTIONS CAN PROMOTE

4925
02:59:24,040 --> 02:59:25,000
ADAPTIVE PAIN OUTCOMES.

4926
02:59:25,000 --> 02:59:29,960
SHE EMPHASIZED THE IMPORTANCE OF

4927
02:59:29,960 --> 02:59:30,800
SOURCES OF RESILIENCE.

4928
02:59:30,800 --> 02:59:32,720
IN THIS CONTEXT, THE FOCUS

4929
02:59:32,720 --> 02:59:34,520
SHIFTS TO EMPHASIZING THE

4930
02:59:34,520 --> 02:59:36,800
STRENGTHS AND ASSETS OF AN

4931
02:59:36,800 --> 02:59:38,560
INDIVIDUAL RATHER THAN THEIR

4932
02:59:38,560 --> 02:59:38,800
DEFICITS.

4933
02:59:38,800 --> 02:59:41,120
AND THINKING ABOUT HIGHER

4934
02:59:41,120 --> 02:59:42,520
PSYCHOLOGICAL RESOURCES, HOW

4935
02:59:42,520 --> 02:59:45,600
THEY CAN LEAD TO BETTER PAIN

4936
02:59:45,600 --> 02:59:48,760
OUTCOME AND HOW THERAPIES CAN BE

4937
02:59:48,760 --> 02:59:51,120
RESILIENCE-ENHANCING.

4938
02:59:51,120 --> 02:59:58,680
AND DR. DIATCHENKO, BASED ON

4939
02:59:58,680 --> 03:00:01,920
GENE EXPRESSION, SHE HIGHLIGHTED

4940
03:00:01,920 --> 03:00:02,720
EXCITING INFORMATION -- FROM

4941
03:00:02,720 --> 03:00:03,520
ACUTE TO CHRONIC PAIN IS REALLY

4942
03:00:03,520 --> 03:00:06,400
PART OF A NATURAL HEALING

4943
03:00:06,400 --> 03:00:09,240
PROCESS AND A MECHANISM OF

4944
03:00:09,240 --> 03:00:09,880
RESILIENCE, AND THE FINDING

4945
03:00:09,880 --> 03:00:11,640
RAISES AN INTRIGUING NOTION THAT

4946
03:00:11,640 --> 03:00:13,120
MAYBE WE'VE BEEN ALL WRONG ABOUT

4947
03:00:13,120 --> 03:00:14,480
HOW WE TREAT PAIN.

4948
03:00:14,480 --> 03:00:16,680
MAYBE WE NEED TO THINK ABOUT

4949
03:00:16,680 --> 03:00:18,400
ACTIVATION OR REACTIVATION OF

4950
03:00:18,400 --> 03:00:19,680
THE IMMUNE RESPONSE INSTEAD OF

4951
03:00:19,680 --> 03:00:21,280
TRYING TO INHIBIT TO TREAT PAIN.

4952
03:00:21,280 --> 03:00:22,520
REALLY A FASCINATING IDEA THAT

4953
03:00:22,520 --> 03:00:24,440
CAME FROM THIS MEETING.

4954
03:00:24,440 --> 03:00:27,280
AND DR. SIBILLE EXPLAINED THAT

4955
03:00:27,280 --> 03:00:29,120
AL STATIC LOAD MODEL REALLY

4956
03:00:29,120 --> 03:00:31,800
PRESENTS ITSELF AS AN

4957
03:00:31,800 --> 03:00:32,360
EVIDENCE-BASED THEORY BACKED

4958
03:00:32,360 --> 03:00:33,680
CANDIDATE FOR A WAY TO MODEL

4959
03:00:33,680 --> 03:00:35,640
CHRONIC PAIN AND RESILIENCE.

4960
03:00:35,640 --> 03:00:37,240
AND THE LAST PANEL WE JUST HEARD

4961
03:00:37,240 --> 03:00:41,320
FROM REALLY WAS IMROWND BREAK G,

4962
03:00:41,320 --> 03:00:42,760
EXCITING AND JUST UNBELIEVABLE

4963
03:00:42,760 --> 03:00:44,160
NEW, CUTTING EDGE TECHNOLOGIES

4964
03:00:44,160 --> 03:00:45,160
FOR THINKING ABOUT THE TREATMENT

4965
03:00:45,160 --> 03:00:49,520
OF PAIN FROM NANOPARTICLES THAT

4966
03:00:49,520 --> 03:00:55,880
DR. BUNNETT PRESENTED TO

4967
03:00:55,880 --> 03:00:56,880
DR. KASHIKAR-ZUCK, FIBROMYALGIA

4968
03:00:56,880 --> 03:00:57,840
INTEGRATIVE TRAINING PROGRAM

4969
03:00:57,840 --> 03:00:59,200
THAT REALLY EMPHASIZES THE NEED

4970
03:00:59,200 --> 03:01:00,080
TO ADDRESS THESE CONDITIONS

4971
03:01:00,080 --> 03:01:03,320
EARLY IN LIFE, ACROSS

4972
03:01:03,320 --> 03:01:04,000
PSYCHOLOGICAL, SOCIAL AND

4973
03:01:04,000 --> 03:01:06,960
PHYSICAL DOMAINS, AGAIN THINKING

4974
03:01:06,960 --> 03:01:08,720
OF A MULTICOMPONENT APPROACH TO

4975
03:01:08,720 --> 03:01:11,080
TREATING AND ENHANCING

4976
03:01:11,080 --> 03:01:13,000
RESILIENCE FOR CHRONIC PAIN.

4977
03:01:13,000 --> 03:01:15,200
I WAS STRUCK BY HER REACHING OUT

4978
03:01:15,200 --> 03:01:16,560
TO SPORTS MEDICINE TO REALLY NOT

4979
03:01:16,560 --> 03:01:19,680
THINK ABOUT JUST IMPLEMENTING A

4980
03:01:19,680 --> 03:01:21,120
BEHAVIORAL EXERCISE REGIMEN, BUT

4981
03:01:21,120 --> 03:01:24,280
ACTUALLY THINKING ABOUT THE

4982
03:01:24,280 --> 03:01:26,200
MOVEMENT PATTERNS AND THE KIN

4983
03:01:26,200 --> 03:01:28,240
ESTHETICS OF EXERCISE THAT WOULD

4984
03:01:28,240 --> 03:01:30,000
BE MOST RELEVANT TO OPTIMIZE

4985
03:01:30,000 --> 03:01:31,680
MOVEMENT AND PROMOTE RESILIENCE.

4986
03:01:31,680 --> 03:01:34,240
I THOUGHT THAT WAS BRILLIANT.

4987
03:01:34,240 --> 03:01:37,280
AND OF COURSE DR. ROSS' HIGHLY

4988
03:01:37,280 --> 03:01:39,480
EXCITING WORK ON PSYCHEDELIC

4989
03:01:39,480 --> 03:01:40,720
ASSISTED PSYCHOTHERAPY.

4990
03:01:40,720 --> 03:01:43,240
I THINK YOU SHOULD KNOW,

4991
03:01:43,240 --> 03:01:45,720
DR. ROSS, THAT IN ADDITION TO

4992
03:01:45,720 --> 03:01:50,360
NCI, NCCIH IS SUPPORTING EFFECTS

4993
03:01:50,360 --> 03:01:54,360
OF PSILOCYBIN THERAPY FOR THE

4994
03:01:54,360 --> 03:01:57,680
TREATMENT OF CHRONIC PAIN

4995
03:01:57,680 --> 03:01:58,880
PATIENTS WITH CHRONIC

4996
03:01:58,880 --> 03:01:59,920
DEPRESSION, AN AWARD WE JUST

4997
03:01:59,920 --> 03:02:01,080
AWARDED THIS FISCAL YEAR.

4998
03:02:01,080 --> 03:02:03,120
AND OF COURSE WELCOME BACK

4999
03:02:03,120 --> 03:02:04,160
DR. LUDWIG.

5000
03:02:04,160 --> 03:02:06,040
REALLY INTRIGUED BY YOUR WORK ON

5001
03:02:06,040 --> 03:02:08,880
THIS -- I THINK I HAVE THIS

5002
03:02:08,880 --> 03:02:10,200
RIGHT -- INJECTRODE.

5003
03:02:10,200 --> 03:02:12,160
I THINK YOU'RE HITTING A REALLY

5004
03:02:12,160 --> 03:02:13,640
IMPORTANT ASPECT OF PAIN

5005
03:02:13,640 --> 03:02:14,880
MANAGEMENT WHEN YOU'RE TARGETING

5006
03:02:14,880 --> 03:02:16,920
A SPECIFIC MECHANISM, HERE THE

5007
03:02:16,920 --> 03:02:18,920
DORSAL ROOT GANGLIA AND THE A

5008
03:02:18,920 --> 03:02:21,200
BETA NEURONS, IN A WAY THAT WILL

5009
03:02:21,200 --> 03:02:23,840
ENHANCE OUR NATURAL RESPONSE TO

5010
03:02:23,840 --> 03:02:26,440
PAIN, WITHOUT THE ADVERSE SIDE

5011
03:02:26,440 --> 03:02:27,560
EFFECTS.

5012
03:02:27,560 --> 03:02:29,760
AND I WANT TO ESPECIALLY THANK

5013
03:02:29,760 --> 03:02:33,000
MISS NICOLE HEMMENWAY FOR

5014
03:02:33,000 --> 03:02:33,800
BRINGING THE PATIENT PERSPECTIVE

5015
03:02:33,800 --> 03:02:34,880
TO THIS MEETING.

5016
03:02:34,880 --> 03:02:36,440
SHE SHARED HER LIVED EXPERIENCE

5017
03:02:36,440 --> 03:02:37,960
THAT BRINGS A STORY OF COURAGE

5018
03:02:37,960 --> 03:02:41,120
AND TRIUMPH, BUT IMPORTANTLY, IT

5019
03:02:41,120 --> 03:02:43,680
REMINDS US THAT ALL PAIN

5020
03:02:43,680 --> 03:02:45,480
PATIENTS HAVE AN IMPORTANT STORY

5021
03:02:45,480 --> 03:02:46,880
TO TELL US.

5022
03:02:46,880 --> 03:02:50,560
WE AS RESEARCHERS AND AS PART OF

5023
03:02:50,560 --> 03:02:52,440
THE CLINICAL CARE COMMUNITY, AND

5024
03:02:52,440 --> 03:02:53,920
WE NEED TO LISTEN.

5025
03:02:53,920 --> 03:02:55,480
SHE ALSO EMPHASIZED THAT

5026
03:02:55,480 --> 03:02:57,240
PATIENTS ARE OUR TEACHERS IN SO

5027
03:02:57,240 --> 03:02:58,800
MANY WAYS, AND THAT THEY SERVE

5028
03:02:58,800 --> 03:03:00,560
AS VOLUNTEERS TO HELP ADVANCE

5029
03:03:00,560 --> 03:03:01,800
THE RESEARCH WE DO.

5030
03:03:01,800 --> 03:03:03,800
SO CRITICALLY IMPORTANT THAT

5031
03:03:03,800 --> 03:03:05,600
THEY ARE PART OF OUR THINKING

5032
03:03:05,600 --> 03:03:07,840
AND OUR RESEARCH AND CLINICAL

5033
03:03:07,840 --> 03:03:10,400
CARE TEAM.

5034
03:03:10,400 --> 03:03:11,480
NOW, JUST TO END, I KNOW I'M

5035
03:03:11,480 --> 03:03:14,160
HERE BETWEEN YOU AND LUNCH AND

5036
03:03:14,160 --> 03:03:15,920
GETTING ON THE ROAD, BUT JUST A

5037
03:03:15,920 --> 03:03:17,560
FEW FINAL CLOSING THOUGHTS.

5038
03:03:17,560 --> 03:03:19,480
FOR ME, THE MEETING EMPHASIZED

5039
03:03:19,480 --> 03:03:20,600
THE IMPORTANCE AND THE NEED TO

5040
03:03:20,600 --> 03:03:22,680
UNDERSTAND THE MECHANISMS OF

5041
03:03:22,680 --> 03:03:24,320
RESILIENCE IN THE CONTEXT OF

5042
03:03:24,320 --> 03:03:26,040
PAIN, AND IT'S AN IMPERATIVE

5043
03:03:26,040 --> 03:03:27,480
RESEARCH QUESTION THAT WE NEED

5044
03:03:27,480 --> 03:03:30,960
TO HELP RESOLVE SO THAT ACUTE

5045
03:03:30,960 --> 03:03:34,000
PAIN DOES NOT BECOME CHRONIC,

5046
03:03:34,000 --> 03:03:36,680
DEBILITATING PAIN CONDITION.

5047
03:03:36,680 --> 03:03:37,920
WHICH FURTHER UNDERSCORES THE

5048
03:03:37,920 --> 03:03:39,640
NEED, AGAIN, FOR

5049
03:03:39,640 --> 03:03:41,640
MULTIDISCIPLINARY APPROACHES AND

5050
03:03:41,640 --> 03:03:43,640
COLLABORATIONS TO THE MANAGEMENT

5051
03:03:43,640 --> 03:03:46,560
OF PAIN THAT INTEGRATES

5052
03:03:46,560 --> 03:03:47,240
BIOLOGICAL, PSYCHOLOGICAL AND

5053
03:03:47,240 --> 03:03:49,280
SOCIAL ASPECTS UNDER A WHOLE

5054
03:03:49,280 --> 03:03:51,160
PERSON RESEARCH FRAMEWORK.

5055
03:03:51,160 --> 03:03:53,760
THE IMPORTANCE OF ENGAGING IN

5056
03:03:53,760 --> 03:03:54,760
INDIVIDUAL TREATMENT FOR CHRONIC

5057
03:03:54,760 --> 03:03:58,520
PAIN RECOGNIZES THE ROLE OF

5058
03:03:58,520 --> 03:03:59,200
INDIVIDUAL BIOPSYCHOSOCIAL

5059
03:03:59,200 --> 03:04:01,160
FACTORS PLAY IN PROMOTING

5060
03:04:01,160 --> 03:04:02,840
RESILIENCE, REPORTING NOT IN

5061
03:04:02,840 --> 03:04:05,440
ACUTE YOU INTERVENTIONS BUT A

5062
03:04:05,440 --> 03:04:06,200
LONG-TERM BEHAVIORAL CHANGE, I

5063
03:04:06,200 --> 03:04:10,440
THINK THIS IS REALLY SOMETHING

5064
03:04:10,440 --> 03:04:11,440
WE NEED TO THINK ABOUT.

5065
03:04:11,440 --> 03:04:13,320
WE TEND TO THINK PAIN IN AN

5066
03:04:13,320 --> 03:04:14,720
ACUTE MANNER BY GIVING AN

5067
03:04:14,720 --> 03:04:16,240
INTERVENTION THAT MAY BE LESS

5068
03:04:16,240 --> 03:04:21,200
HOURS OR MAYBE A DAY OR TWO.

5069
03:04:21,200 --> 03:04:22,200
THESE INTERVENTIONS CAN LAST A

5070
03:04:22,200 --> 03:04:23,800
LIFETIME AND REALLY INCREASE

5071
03:04:23,800 --> 03:04:25,760
RESILIENCE TO NOT ONLY PAIN, BUT

5072
03:04:25,760 --> 03:04:27,640
OTHER HEALTH CONDITIONS.

5073
03:04:27,640 --> 03:04:29,360
CLINICAL PROVIDERS NEED MORE

5074
03:04:29,360 --> 03:04:31,800
TIME FOR INDIVIDUALIZED

5075
03:04:31,800 --> 03:04:34,040
TREATMENT, APPROPRIATE MEASURES,

5076
03:04:34,040 --> 03:04:36,560
ASSESSMENTS, TOOLS NEED TO BE

5077
03:04:36,560 --> 03:04:39,960
DEVELOPED, MORE INFORMATION

5078
03:04:39,960 --> 03:04:41,280
ABOUT CHRONIC PAIN ARE NEEDED

5079
03:04:41,280 --> 03:04:43,040
AND MORE IS NEEDED TO DEVELOP

5080
03:04:43,040 --> 03:04:45,240
PREVENTIVE APPROACHES TO PAIN.

5081
03:04:45,240 --> 03:04:46,800
BUT THIS IS THE SORT OF

5082
03:04:46,800 --> 03:04:49,600
CHALLENGE HERE, THE CHASM

5083
03:04:49,600 --> 03:04:53,440
BETWEEN RESEARCH ON RESILIENCE

5084
03:04:53,440 --> 03:04:54,960
AND CURRENT CLINICAL CARE IS

5085
03:04:54,960 --> 03:04:56,520
QUITE VAST, AS WE ALL KNOW.

5086
03:04:56,520 --> 03:04:58,440
THESE APPROACHES ARE NOT BEING

5087
03:04:58,440 --> 03:05:01,640
USED IN CLINICAL CARE FOR PAIN.

5088
03:05:01,640 --> 03:05:04,640
THIS PUTS THE NEED IN

5089
03:05:04,640 --> 03:05:04,920
PERSPECTIVE.

5090
03:05:04,920 --> 03:05:08,120
ONE STUDY THAT I'LL HIGHLIGHT

5091
03:05:08,120 --> 03:05:13,720
FROM MY COLLEAGUE AT NCCIH JUST

5092
03:05:13,720 --> 03:05:16,680
PUBLISHED IN JAMA NETWORK,

5093
03:05:16,680 --> 03:05:17,840
INTERVIEW SURVEY IN THE YEARS OF

5094
03:05:17,840 --> 03:05:21,320
2019 AND 2020 OF A LONGITUDAL

5095
03:05:21,320 --> 03:05:22,320
COHORT AND REPORTED THAT CHRONIC

5096
03:05:22,320 --> 03:05:28,680
PAIN IN 2019 WAS ALMOST TWO

5097
03:05:28,680 --> 03:05:31,320
THIRDS -- ALMOST TWO THIRDS OF

5098
03:05:31,320 --> 03:05:32,880
PATIENTS WHO REPORTED CHRONIC

5099
03:05:32,880 --> 03:05:35,480
PAIN IN 2019 ALSO REPORTED

5100
03:05:35,480 --> 03:05:36,800
CHRONIC PAIN IN 2020, MEANING

5101
03:05:36,800 --> 03:05:37,960
THESE PATIENTS DID NOT GET

5102
03:05:37,960 --> 03:05:39,600
BETTER, SUGGESTING THE TREATMENT

5103
03:05:39,600 --> 03:05:40,440
THEY'RE RECEIVING IS NOT

5104
03:05:40,440 --> 03:05:41,760
ADEQUATE.

5105
03:05:41,760 --> 03:05:44,760
SO WE NEED TO DO BETTER, FASTER,

5106
03:05:44,760 --> 03:05:46,760
TO ADDRESS CHRONIC PAIN AS A

5107
03:05:46,760 --> 03:05:49,000
SERIOUS PUBLIC HEALTH CRISIS,

5108
03:05:49,000 --> 03:05:50,560
AND ARE INCOURAGED BY THE

5109
03:05:50,560 --> 03:05:51,280
INNOVATION AND THE RESEARCH AND

5110
03:05:51,280 --> 03:05:52,960
THE COMMITMENT EXPRESSED IN THIS

5111
03:05:52,960 --> 03:05:54,040
MEETING, AND I LOOK FORWARD TO

5112
03:05:54,040 --> 03:05:55,240
NEW DEVELOPMENTS AS MOVING

5113
03:05:55,240 --> 03:05:55,680
FORWARD.

5114
03:05:55,680 --> 03:05:59,120
SO AGAIN, THANK YOU, EVERYONE,

5115
03:05:59,120 --> 03:06:00,760
FOR YOUR PARTICIPATION IN THIS

5116
03:06:00,760 --> 03:06:01,080
MEETING.

5117
03:06:01,080 --> 03:06:02,320
IT WAS A WONDERFUL OPPORTUNITY

5118
03:06:02,320 --> 03:06:04,080
FOR ME TO GET OUT FROM MY ZOOM

5119
03:06:04,080 --> 03:06:04,800
WORLD, SO THANK YOU.

5120
03:06:04,800 --> 03:06:14,960
[APPLAUSE]