How the brain interprets pain — and new ways to manage it

Thirty years into the opioid crisis, we still struggle to find other options for pain relief. This hour, TED speakers explain new understandings of how the brain interprets pain and new ideas to cope. Guests include equestrian Kat Naud, physician and researcher Amy Baxter and opioid reform advocate Cammie Wolf Rice. Original broadcast date: June 7, 2024. TED Radio Hour+ subscribers now get access to bonus episodes, with more ideas from TED speakers and a behind the scenes look with our producers. A Plus subscription also lets you listen to regular episodes (like this one!) without sponsors. Sign-up at plus.npr.org/ted http://plus.npr.org/ted. See pcm.adswizz.com https://pcm.adswizz.com for information about our collection and use of personal data for sponsorship and to manage your podcast sponsorship preferences. NPR Privacy Policy https://www.npr.org/about-npr/179878450/privacy-policy

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

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• 0:54Manoush Zomorodi?

  I'm Manoush Zomorodi. Some kids are obsessed with trains, others love cooking. And then there are the ones who are really into horses.

• 1:07Speaker 06

  I was kind of born into it.

• 1:09Manoush Zomorodi?

  This is Kat Nod.

• 1:10Speaker 06

  When I was two years old, I actually learned how to canter on a horse for the first time.

• 1:16Manoush Zomorodi?

  By the age of six, Kat knew what she wanted to be when she grew up.

• 1:20Speaker 06

  I decided I want to go to the Olympics for horseback riding and represent Canada. And my entire life has kind of been centered around that goal of being an Olympic horseback rider.

• 1:31Manoush Zomorodi?

  How much of your life, your daily life, did it take up? Like, what was the whole regimen?

• 1:38Speaker 06

  Is there a percent higher than 100?

• 1:42Manoush Zomorodi?

  In her 20s, Kat was on track to make it to the 2016 Olympics in a sport called three-day eventing.

• 1:49Speaker 06

  So it's got three phases. Over three days. So the dressage is kind of like dancing on horses. You have like a routine you do at certain places in a test. The second phase is called show jumping. That's what you see on TV where they jump the big jumps with the rails that fall down. And then the third phase is cross country. It's where you're going over big, solid jumps that if you hit the jumps, you fall down, not the jump. They'll have like a six foot wide ditch with a wall in the back and you have to jump all of it at the same time. Or like a seven, eight foot drop into water. And if you make a mistake, the jumps, there's no forgiving.

• 2:29Manoush Zomorodi?

  So there she was at the Olympic qualifiers. She and her horse sailed through the first two events, no problem.

• 2:37Speaker 06

  I was actually in first place heading into cross country, which was my strongest phase. And it was my 25th birthday and I was super excited. We headed to the start box to do our two minute countdown. There's nothing that gets me more excited than the last 10 seconds before you get to go. And we set out on course, my horse, Jackson and I. The entire course flew by in perfect jumps. There was not even a misstep to a single fence. And we headed to home to our very last jump. When my horse, Jackson, and I saw a completely different distance from each other to the fence.

• 3:18Speaker 06

  And he's enormous, so he's 17, three hands, which is just under six feet where his back is. And the last fence was a big upright table. And he caught the front edge of it with his knees. And we had what's called a rotational fall. What I can equate this to a somersault in the air. And he landed on top of me on the other side and slid 10 feet with him on top of me. He weighs about 1,500 pounds.

• 3:49Speaker 06

  I lost consciousness for a very brief amount of time. I remember kind of coming back to and he'd jumped off of me and ran off and people rushed over and they're trained to hold you down so you don't get up just in case you have very severe injuries. And all I could do was try to flail and figure out where my horse was and that was my main concern is where is he, is he okay?

• 4:16Speaker 06

  Shock kind of takes over and adrenaline. And then I was actually airlifted to the hospital in Seattle. And from there, it was a definitely whirlwind few days.

• 4:29Manoush Zomorodi?

  What in the end did they figure out had had happened to you? What was damaged in your body?

• 4:35Speaker 06

  So I had broken the transverse processes, the wings off both sides of my L2, 3 and 4 vertebrae in my back. I was told if you're gonna break your back, that the way that I broke it was the best way possible. So that's like, good news.

• 4:53Manoush Zomorodi?

  Some comfort. What, when you were leaving the hospital, what did your doctors tell you to expect?

• 5:00Speaker 06

  Yeah, so they said that it was gonna be about four months till I felt more normalized, like I was going to be able to do more activity, more walking, even think about getting back on a horse. It was tough. The pain level was something I'd never really experienced before. I would hit like an unmanageable level of pain every single day. When they give you the pain scale, like I would hit a 10 out of 10 at some point every day.

• 5:29Manoush Zomorodi?

  So, so what kept you going? Cause you, you thought, okay, well, this is just temporary. I need to get through this, you know, initial period and then I'm gonna feel better. Is that what you were thinking?

• 5:39Speaker 06

  Yeah, so being four months, like four months in hindsight is not that long. Like in the moment, four months in that level of pain feels really long. But four months, I was just trying to grind it out to get back to training. I knew there were still some qualifiers left in the season, so if I could recover and get back quick enough, I could try to still make a run for the, you know, being an Olympic athlete. And I had really just expected my body to bounce back.

• 6:06Manoush Zomorodi?

  When did you start to realize that things were not going back to quote unquote "normal" or before times?

• 6:15Speaker 06

  Yeah, so about the four month mark, I was really not feeling any better. But they said four months, so four months to the day I got on my horse. And the first step he took, like I was instantly 10 out of 10 pain. I was nauseous from pain and I almost fell off just because I couldn't even breathe. And I knew that there was more going on. I knew that something had been missed. I knew that whatever was happening had not healed the way that they were kind of expecting it to. And I had to get instantly off and I was crushed. They actually found out that my pelvis was dislocated and I was having stability issues.

• 7:00Speaker 06

  And that's actually why I had so much pain. And I got to the hospital in Vancouver and waited for over four hours in a waiting room on a hard chair with a back that you're thinking any moment, like what if I sneeze? And now I'm paralyzed. So it was quite a scary wait, not knowing what level of stability would happen. Um, if I shifted the wrong way, am I gonna make it worse? When they finally called me in to do the check with the doctor, I handed him my requisition and he didn't even look at it. He put it down. He didn't examine me.

• 7:46Speaker 06

  He didn't ask me a single question about my pain, about what I was experiencing, about what my doctor had said. He looked at me and he said, "What drugs do you want?" And I was like, "No, no, I need help." He said, "I'm busy, so you can take the drugs or you can leave."

• 8:03Manoush Zomorodi?

  Yikes. And what did you say?

• 8:06Speaker 06

  I left. I wasn't there for narcotics. I was there for help and support and I got none of that. And it was a really disappointing experience. And for me, I'd been kind of holding out hope that I was gonna heal physically. And to be that dismissed, I'd lost hope that day. That day was actually the first day of the downward spiral for me mentally. And a couple of months after that experience, I kind of hit my rock bottom of where I just couldn't fight through this anymore.

• 8:40Manoush Zomorodi?

  When you say you hit rock bottom, what do you mean?

• 8:43Speaker 06

  I slid into like depression quite quickly and I've actually never had experienced anything like depression before. And until you know, you don't know. And the pain was intolerable. I would dislocate my pelvis and fall and be kind of stranded. I limped every single day. Some days my leg almost felt like a peg leg, like I had to drag it behind me.

• 9:10Manoush Zomorodi?

  Were you getting treatment at that point?

• 9:13Speaker 06

  I had stopped. I had kind of given up hope because I had tried so many things previous. And nothing had really caused any significant relief or progression of my symptoms. And I'd been told by several doctors that like, there's a real chance that this is just physically your life and you'll have to acclimate to it. You won't be able to walk normally. You will limp. You will be in high degrees of pain. You will have instability in your pelvis or life. This is your life now. And yeah, it's like at 25, when you have so much of your life ahead of you, it's really hard to justify spending the rest of your life that way.

• 9:59Speaker 06

  When you're in that kind of depth of the darkness, you can't see past the darkness. You can't see little light at the end of the tunnel. You're not looking for hope. You are just alone in the dark.

• 10:15Manoush Zomorodi?

  In a single moment, Kat Nod's life was taken over by pain. First acute, then chronic. She felt alone, confused, and hopeless. Like most of us, she'd heard about the dangers of opioids. Roughly 80,000 Americans a year are dying from opioid overdoses. And the opioid epidemic has morphed over the years well beyond a pain pill problem.

• 10:46Manoush Zomorodi?

  But we don't hear much about other options for coping with pain. So what do we need to know about the next chapter in pain relief? Today on the show, new understandings about how the brain interprets pain, and what we can do to manage pain in the short and long term. Later in the show, we'll hear more from Kat Nod. But first, please meet pain expert Dr. Amy Baxter.

• 11:14Speaker 07

  When you live with chronic pain, it is really easy for it to take over and define who you are.

• 11:21Manoush Zomorodi?

  Amy says that in the 30 years she's been studying and developing methods to treat pain, she has heard all sorts of preconceived notions related to it.

• 11:31Speaker 07

  Talking about pain is so nuanced and loaded in our society, because we're supposed to be tough and we're supposed to deal with pain. And also because we are a society that fears aging, and pain means decrepitude, never doing the things that make you you. And even a little bit of pain carries extra meaning, because it means that both you're weak and you may not get over being weak.

• 11:59Manoush Zomorodi?

  Amy suggests we put all those judgments aside, because pain affects everyone differently. And as we'll explain later, how the brain processes pain can be confusing. But, she says, we need to remember one key thing about it.

• 12:16Speaker 07

  Pain is a survival system that serves us. And when it ceases to serve us, then we can choose to ignore it. We don't have to let it rule us. That is the most important paradigm shift for dealing with both acute pain and chronic pain. But the thing about pain is there isn't one answer. It is a giant, different, complex beast to every different person. And so we in the medical profession are used to one right answer, and treating it is one thing. It just isn't.

• 12:57Manoush Zomorodi?

  In a minute, Amy talks us through the past, present, and future of pain management. On the show today, rethinking ideas about pain. I'm Manoush Zamirodi, and you're listening to the TED Radio Hour from NPR. We'll be right back.

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• 14:53Manoush Zomorodi?

  Hey, before we get back to the show, I want to tell you about our next bonus episode for TED Radio Hour Plus. We are catching up with Ryan Phelan, head of Revive and Restore. This is a nonprofit that uses the latest technology in gene editing and cloning to try and save species from extinction. Ryan tells us about their new project, which is working with the U.S. Fish and Wildlife Service to build a genomic library preserving DNA from all of the country's endangered species. It's pretty wild. That conversation is coming on Thursday. Not a Plus supporter yet? Please join your fellow listeners for

• 15:34Manoush Zomorodi?

  bonus content and all our episodes sponsor-free. Go to plus.npr.org/ted or give it a try right in the Apple Podcasts app. And thanks. It's the TED Radio Hour from NPR. I'm Manoush Zomorodi. On the show today, pain relief: how to rethink and deal with physical pain. And a warning, some of this episode touches on addiction and a drug overdose. We were just talking to physician and pain expert Amy Baxter. Amy says our ideas about how to treat pain often start at a young age.

• 16:15Speaker 07

  We start early with children saying, oh, you bumped or this. Oh, you have a fever. Let me give you a pill. We really are telling each other that a pill is the way to solve a problem. And that isn't going to work when that is part of your survival system. You can't shut it down with a pill.

• 16:33Manoush Zomorodi?

  Amy believes that we need to teach, or be taught, to see pain as a messenger and listen closely to what it tells us, rather than fear it. But this is not what Amy learned back in medical school 30 years ago.

• 16:48Speaker 07

  In medical school, pain was a lot less important than diagnosing and treating whatever was causing it. We didn't actually talk much about what the nature of pain was. It was this amorphous, bad thing. But as a doctor, it's kind of like pain happens.

• 17:06Manoush Zomorodi?

  Amy did her residency and she specialized in pediatric medicine. And as a young budding physician, she found this approach hard to swallow.

• 17:16Speaker 07

  So, one of the hardest things about being a doctor is quelling down your empathy because it can get in the way of the diagnosis or the management that you need to be responsible for making sure happens.

• 17:30Manoush Zomorodi?

  But then, the theory of putting aside pain to get a diagnosis faded away. It was the mid 90s and a new approach was being offered by pharmaceutical companies. Doctors could be pain advocates for their patients, thanks to a new line of pain relief medications.

• 17:47Speaker 07

  That was when I first heard the concept of pain-free. At the time, it sounds great, you know? Why wouldn't you want that for your patients? We even had buttons that said "pain-free" on them, and all of us who were pain advocates wore them on our white coats. You know, it's like, "Pain-free, that's, I am going to get you to pain-free." And what's not to love about being pain-free?

• 18:11Manoush Zomorodi?

  Amy remembers the first time she got the opioid pitch. Here she is on the TED stage.

• 18:18Speaker 07

  The only pain lecture I remember from the 90s was in a dark room like this, after being awake for 30 hours and hungry, and finding out our noon lecture was sponsored by OxyContin. We got pens, we got great lasagna, and they had very cool slides that showed pain stopped by opioids. And we learned that home opioids aren't addictive, and if you stay ahead of pain, you can keep your patients pain-free.

• 18:50Manoush Zomorodi?

  But we've all heard how the story of opioids and addiction has gone.

• 18:56Speaker 07

  Patients became customers, and so you were supposed to respond to what a patient wanted, and if they had pain, you needed to both measure it and address it. And I realized that part of what Purdue did was suborn the message of care and make it a message of a prescription. You know, "I care about you, I'm going to give you the good stuff. I care about you, I am going to make it so you don't hurt at all." And beyond the obviously egregious marketing, I think it was framing "pain-free" as the goal that has destroyed countless lives. My friend's son, Christopher, started having severe abdominal pain during this no pain era.

• 19:39Speaker 07

  Eventually, he was diagnosed with a colon disease and had surgery his senior year. They sent Christopher home with 90 OxyContin, and then 90 more. And then, as the pain started getting faster and faster, uncontrolled pain is terrifying. So when his ran out and his friend's medicine cabinets ran out, Christopher tried heroin. And Christopher Wolf lost his battle with substance use at age 32. Christopher got 90 OxyContin for a stomach surgery. We would never do that now. But I was in the generation that if I had taken care of Christopher, I would have written for that.

• 20:24Speaker 07

  It's just what you did. Doctors, trained when I was in the 90s, believed that there was no amount of pills you could give someone that would cause a problem if they had, quote, "real pain."

• 20:39Manoush Zomorodi?

  Mm-hmm. So it turned out that the promise that OxyContin was less addictive wasn't true. Purdue Pharma pleaded guilty to federal crimes for false marketing.

• 20:51Speaker 07

  Yeah.

• 20:52Manoush Zomorodi?

  But here we are with researchers saying that more than 2 million Americans now have some degree of opioid addiction. Can you just explain what these drugs do? What is it that happens in our brain that makes us feel better?

• 21:06Speaker 07

  Yeah.

• 21:07Manoush Zomorodi?

  At least at first?

• 21:08Speaker 07

  Yeah. What we didn't know is that taking opioids actually increases your sensitivity to pain because you're used to feeling so rewarded that you don't notice it.

• 21:18Manoush Zomorodi?

  Hmm.

• 21:19Speaker 07

  So dopamine, which is what opioids address, dopamine makes you feel like you're winning and you're so rewarded that you don't care if you're feeling pain because you just feel great. And if it's a really excruciating pain, opioids are the best thing we've found to hardcore trigger the dopamine response that makes you feel rewarded. So it's great for the first couple of days and the first 24 hours after a burn or trauma, the more opioids, the less post-traumatic stress, et cetera. But because your brain is constantly adapting, what ends up happening is after about 72 hours, your mu receptors, your dopamine, I feel great receptors have actually hidden inside cells.

• 22:03Speaker 07

  And that's about when you go home and you're taking an oral pill that is not nearly as potent as what you were getting through your IV. And now you're just getting the risk and the side effects.

• 22:14Manoush Zomorodi?

  What is actually happening that some of us feel awful on Percocet or other narcotic drugs and other people can't get enough of them?

• 22:28Speaker 07

  If you've ever been at a Mexican restaurant and somebody at your table says, I cannot abide cilantro, it tastes like soap. And you're like, are you kidding me? Cilantro is great. That's what's going on with opioids. A percentage of the population get opioids and their taste of it is completely different. So they don't process dopamine in the same way. They don't get as much great taste from the kind of dopamine mastery or novelty or, you know, excitement or winning. They're not getting that as much. When they get an opioid, oh yeah, they get it.

• 23:02Manoush Zomorodi?

  Huh.

• 23:03Speaker 07

  And that can be exacerbated by a bad situation.

• 23:07Manoush Zomorodi?

  So the right circumstances with the wrong genes is a dangerous combo?

• 23:12Speaker 07

  Yes, even the, even the good circumstance with the wrong genes. Three days or more is when the risk starts increasing of being dependent.

• 23:21Manoush Zomorodi?

  So it's not necessarily the, no matter how it makes you feel, whether you love it or hate it, regarding pain, it doesn't actually necessarily do the job that we've thought it does?

• 23:35Speaker 07

  Yeah, I think this really gets to the nature of pain. What is the job that we want opioids to do and what exactly is pain? As I started unpacking the nature of what Purdue Pharma had taught me, I realized I believed, and I think many believed, that pain was a switch, on off, and you don't want to have it. But. Pain isn't a switch. It's not as magical as if you are in pain and then all of a sudden the pain goes away.

• 24:05Manoush Zomorodi?

  Amy now believes that the best definition of pain comes from the International Association of the Study of Pain.

• 24:12Speaker 07

  They say it's an unpleasant sensory and emotional experience that is associated with actual or potential tissue damage.

• 24:22Manoush Zomorodi?

  This idea of pain as a sensory and emotional experience got Amy thinking about where she could begin to try different tactics to mitigate pain. She decided to go back to a place she knew well, a place where many of us first experience acute pain, the pediatrician's office.

• 24:42Speaker 07

  I noticed that other doctors weren't addressing needle pain for kids.

• 24:46Manoush Zomorodi?

  Like getting a vaccine? Like, my daughter still screams and she's a teenager.

• 24:50Speaker 07

  Yeah, well, here's the deal. You and I got six injections and we got them before we were two and we don't remember. And we think we were really cool because we don't mind needles. But-

• 25:03Manoush Zomorodi?

  Yes.

• 25:03Speaker 07

  Starting-

• 25:04Manoush Zomorodi?

  That's so true.

• 25:05Speaker 07

  I know. Well, so, ah, so here's the thing. I started looking back at the history of vaccines and I was like, whoa, I had no idea. We have 36 separate shots now. And I realized this when my four-year-old had his vaccines and he had such an awful experience that afterwards he threw up. And I was like, if he-

• 25:26Manoush Zomorodi?

  Oh, my God.

• 25:27Speaker 07

  -gets old enough to drive himself to the doctor, he won't.

• 25:33Manoush Zomorodi?

  A shot punctures the soft tissue of the arm. The sensation goes to the spine, then the brain. And the brain remembers that feeling. So if we anticipate fear feeling that sensation again, that memory can make every future shot seem so much worse.

• 25:52Speaker 07

  Pain is this contextual response to whether you're safe or not. When you're afraid, your neurotransmitters that say danger are elevated and your memories of fear are elevated. And that fear increases your perception of pain. And certainly, when you're in pain and you're afraid of not being able to get relief, that fear lays down tracks in your brain. I mean, all of these things happen that increases your perception of pain.

• 26:26Speaker 07

  So Amy wanted to stop kids from associating shots with extreme pain. How to do that? Lessen the initial sensation.

• 26:36Speaker 07

  20 years ago, I just wanted to have a fast cure for needle pain for IV access and my kids' shots. I was driving home one night after a graveyard shift and my hands were vibrating on the steering wheel because we needed to get the tires balanced. I was ignoring that to think about pain. And when I got home and reached for the door of my house, my hand was numb.

• 27:01Speaker 07

  Vibration. So I burst in, my Boy Scout husband grabbed some frozen peas, and we had ourselves a genuine eureka moment where cold and vibration blocked pain. Over the next decade, I found the right frequency to block pain. I got a grant and I created Buzzi, which is vibration plus ice in a B shape. And you put it on your arm when you're getting an injection. And to date, 45 million needle procedures have decreased pain and over 80 randomized controlled trials independently all around the world have been published.

• 27:44Speaker 07

  So the reason that vibration decreases pain is because the physiology of the nerves of light touch, pressure, stretching, and motion all race pain to the spine. We now know that motion is what's most effective at shutting the gate on sharp pain. This is called gate control. And the exact right frequency of vibration triggers the nerves that decrease pain.

• 28:12Speaker 07

  So if you burn your finger and you stick it under cold water, instantly the burn feels better. If you've ever tried putting it just in ice water but not moving it, you will find the cold itself doesn't do it. You have to actually stir your finger around to make it work. The movement's the critical part. The cold helps. Well, to manufacture this sensation of movement, I stumbled upon vibration. The physiology of ice is different. So the cold goes up to the brain where the conductor goes obnoxious but not dangerous. I will decrease sensations coming from everywhere. And it decreases pain everywhere.

• 28:54Speaker 07

  If a child was so freaked out from previous experiences that even the swab hurt,

• 29:02Speaker 07

  physiology wasn't as helpful. So we added distraction, like a monkey poster. And what we discovered was combining counting plus making a decision, cut pain in half. So for example, how many monkeys are actually touching the bed activates the decision switchboard? I know what you guys are doing. It's five.

• 29:27Speaker 07

  The biggest hack, though, is understanding why distraction works. And now, through functional MRI, we can actually see pain happen. And it's not one place. Pain is a symphony of connections from the sensation area to the conductor to the decision switchboard, and then to fear, memory, meaning, control. So if the decision switchboard is occupied sorting monkeys, it can't notify fear and meaning, and you feel less pain.

• 30:02Speaker 07

  What you feel is mostly what you expect to feel.

• 30:07Manoush Zomorodi?

  So there are so many different things you can try: cold, vibration, distraction, mind games.

• 30:14Speaker 07

  Yeah, you've always got one other thing to try, so it keeps you from being afraid. A big part of my pain reeducation came when I was asked to do a talk in Wisconsin for a child life conference. I'd been invited to talk about different medications for sedation, because that was my specialty, and how to deal with pain. And an amazing woman who invited me, Regina Yocum, told me afterwards, from her wheelchair, where she had been since she was young from juvenile arthritis, she said, "You know, I appreciate knowing about these medicines, but the thing is, there's only a finite number of medicines. There are a much larger number of physical interventions,

• 30:57Speaker 07

  and there are so many different ways to activate your brain so that you just don't mind pain, that really, what pain management is for us, and for her personally, is knowing there's always another option." That changed everything for me.

• 31:16Speaker 07

  Choosing physiologic options that you can layer, that work for you, decrease pain. Like heat, cold, vibration, deep relaxation, acupuncture, capsaicin, exercise, meditation. There's more. Christopher probably had 10 of these around his house and just didn't know it. Having control over your options decreases pain. Deep breathing increases control. Choosing what to focus on increases control. Fear and control are the volume knobs for pain. Fear controls so many of our sensations. This shouldn't be unusual, but we don't practice it for pain.

• 32:00Speaker 07

  So if you're home alone and you hear a clunk, your hearing becomes hypersensitive. But when you remember your kids home from college, your fear dials down and your brain overrides it and says, "Don't worry about it." St. Augustine called pain "the greatest of evil." But if it is a survival system, it cannot be all evil. So instead, think of pain as your nagging, safety-obsessed, exaggerating friend who's sometimes wrong. And it's okay to ignore or override your friend if you know that you're safe. This takes practice.

• 32:44Speaker 07

  On a flight that was turbulent, I had an entire cup of scalding hot coffee dumped straight on my ankle. Electric jolt through my scalp. I ripped off my sock. It was already red. It was going to blister. There was no way I could get my foot into that little sink to get cold water on it. And then I remembered, "Physiology hack." I had an unopened cold beer. Medical-grade cold beer went on my ankle, stat. I had a vibrator in my carry-on because I would on my ankle. And then, the pain kind.

• 33:28Speaker 07

  And pain MacGyver, I was no longer that concerned.

• 33:39Speaker 07

  Although then I realized I'm that guy with my bare foot sticking out in the aisle on a plane with a beer on it.

• 33:50Manoush Zomorodi?

  So that's dealing with acute pain. But in a minute, physician and pain expert Amy Baxter explains more about how all of these methods can also help with chronic pain. On the show today, pain relief. I'm Manoush Zamirodi, and you're listening to the TED Radio Hour from NPR. Stay with us.

• 34:21Speaker 00

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• 35:34Manoush Zomorodi?

  It's the TED Radio Hour from NPR. I'm Manoush Zamirodi. Today on the show, we're looking into the past, present, and future of how we treat pain. We've been talking to physician and pain expert Amy Baxter. And as we heard, Amy decided to research different ways to relieve pain after working as a physician throughout the opioid crisis and seeing the lack of options given to patients. Living pain-free, she says, was a false promise made by the pharmaceutical industry. But dealing with chronic pain requires multiple strategies, especially as we better understand what long-term pain actually is.

• 36:17Speaker 07

  It's something of a moving target as we get better information from functional MRI. It used to be that pain was defined as acute until three months, and then magically it became chronic. My own personal opinion, based on the way the brain changes, is that probably it's more of a 72-hour thing. The thing is that the body adapts really, really quickly to what's going on and starts making different coping mechanisms. Those are probably the better definition of acute versus chronic pain. And we've moved the goalpost from three months to one month. But I think that probably the scientific literature is going to move it even closer to the event of the tissue damage in the next decade or so.

• 37:02Manoush Zomorodi?

  If someone is listening and they're thinking, okay, just tell me what to do if I am going in for a procedure and I want to deal with acute post-op pain, and then what I can do for chronic pain?

• 37:17Speaker 07

  One thing that's important, and I even this morning got a letter from somebody who is outraged that I wanted to take people's opioids away. I do not mind if people who are chronically managed with opioids have the same dose from now until the rest of their lives, because they rarely overdose and they rarely increase the doses. That is not where the problem is. My real mission is to stop giving pills out after surgery. By not having other pain options, we leave doctors with no choice but to give opioids at home after a surgery because they want to help. But it's about 6% of every surgery

• 37:59Speaker 07

  have people who are still on opioids 90 days later who weren't before. It is so clearly consistent despite the caliber of the surgery, and we should make people aware of this before they take a medicine, that they may be better off with ibuprofen, or an ice pack, or vibration, or having a whole bunch of friends over.

• 38:21Speaker 07

  Power of our pain isn't always pretty, but it is possible, and it is absolutely critical. So what do we do? Well, in my dream world, we have healthcare systems pay for options and coaching, and we quit giving double-digit prescriptions for opioids for home recovery. In the real world, 80,000 people died in the US last year from opioid overdoses, and 80% of substance use disorder starts with a pill prescribed for pain, usually taken from your friend's medicine cabinet. You all now know to throw away the opioids in your medicine cabinet. You now know that there are options you can use to decrease pain,

• 39:06Speaker 07

  and you know that pain-free should be ditched for more comfortable. And whether you dump scalding coffee or pain wakes you and exhausts you every day, options that are in your control can allow you to reframe pain.

• 39:29Manoush Zomorodi?

  So one of the options for dealing with acute pain is a tool that you created called Buzzi. It's for kids. It both cools and vibrates. It looks like a little bee, and it has FDA approval. But what about, say, a grown-up with chronic back pain? Do you have tools for that, Amy?

• 39:50Speaker 07

  So I will say that low back pain is the number-one source of disability worldwide. It is the number-one reason people go from acute opioids to chronic. And what we know about low back pain now is the same with a lot of injuries that go on to become chronic. The problem is not the original insult. The problem is that the small muscles that are holding you still so you don't increase pain, those muscles aren't designed to have that much load. They try to rise to the challenge and they don't have the plumbing. So they lose the blood supply. They have lactic acid and hurt like you've worked out too hard. And over time, they get fatty changes that further decrease the

• 40:31Speaker 07

  blood supply and then they start getting shrunken. And so I started reading and I started playing around with different frequencies. What we do now is we have three different frequencies that decreases fatty changes. And then we've played around with amplitude so you can get it to penetrate different depths of tissue. And the, the final pivotal trial will be done with the chronic patients on June 30. What we are hoping is that we will have not just a reduction in pain, but actually reduction in opioid use.

• 41:02Manoush Zomorodi?

  Hmm.

• 41:03Speaker 07

  But it's not ever going to be enough to have one thing. People need to realize that a little bit of magnesium is perhaps going to shave 10%, maybe 30% off of how much pain they perceive, but it's going to take a few days to kick in. A little bit of exercise, just bending over and lifting up 10 times a day and then gradually getting to 20 times a day and then doing it with a tiny weight. That I have heard from people who have overcome their back pain and they're doing the same thing we're trying to do. They're rehabilitating those little muscles, but it's very slow. I wish people with chronic pain knew it was okay not to think that they're going to find one thing that's going to fix their pain.

• 41:43Manoush Zomorodi?

  Hmm. Oh, but Amy, it's would be so nice if there was like this one magic thing that just took care of it. What you're describing, that's like taking on a part-time job.

• 41:53Speaker 07

  Yeah, it is. It's a part-time job. It's a, it's a remodel of your brain and nobody in it wants to hear that if they did a whole bunch of things every day for six months, they would feel a lot better because it's really hard to get up the energy to even do two.

• 42:11Manoush Zomorodi?

  You are reminding me of the story you told in your talk about your friend's son, Christopher, who ended up addicted to opioids after major surgery and later overdosed. What would you have done for Christopher now?

• 42:26Speaker 07

  Oh, wow. Well.

• 42:30Speaker 07

  If you ask what I would do for Christopher now, Kami Wolf, Christopher's mom, is actually doing it for people at Grady Hospital in Atlanta who have trauma. They're teaching them about how to go home without opioids.

• 42:45Speaker 06

  And I thought, how can I warn people? How can we stop this in hospitals? I didn't even think one second to ask the doctor about the medication he was being given. But when you're on OxyContin, you know, you can become addicted with one prescription. And of course, I had no idea. None.

• 43:03Manoush Zomorodi?

  This is Christopher's mom and Amy Baxter's friend, Kami Wolf Rice. She vividly remembers bringing Christopher home from the hospital.

• 43:12Speaker 06

  He was going home with a hole in his stomach and a bag. And he needed psychological counseling, right, to deal with that for a 17-year-old boy, right, a senior year in high school. They didn't prep us for what we were going home with. And not one single solitary word about any risk involved at all. Zero.

• 43:39Speaker 06

  Christopher, you know, his dream was to be a Navy SEAL. He was very disciplined. He was an AP student, just super book smart is the way I would describe, but a hugger.

• 43:52Manoush Zomorodi?

  Years passed, and he didn't stop taking the pills.

• 43:57Speaker 06

  So he was just constantly on the opioids and still managed to go to college, graduated college. But then he's the one that came to me and said, Mom, I have got a problem. I need this medicine, just like you need air to breathe. He fought it for 14-plus years. I'm talking multiple rehabs. But when it hijacks your brain, you trigger, things happen, and you relapse. And he kept thinking he was failing us, he was failing himself, which of course, depression sets in. And you could have never in a million years would I ever thought that Christopher would have done heroin.

• 44:39Speaker 06

  But he couldn't get the pills, and so he had to go to the street.

• 44:47Manoush Zomorodi?

  He overdosed in 2016.

• 44:52Speaker 06

  And it literally took me two years to even talk to my family because of The stigma that we have in this country, as sadly as it sounds, I didn't want him to have a disrespectful death. I didn't want people to think of him horribly because he was such a wonderful person. So I think there was enormous guilt that I was feeling that I failed as a parent. I failed as a mother, you know? I failed as a mother. But then I realized that silence is deadly and we need to be able to speak out because if everybody was honest about it, everyone knows somebody that's suffering with addiction. Everybody.

• 45:33Manoush Zomorodi?

  That's when Kami came up with an idea to give patients someone to guide them through the shock of dealing with pain, a kind of pain coach that she called a life care specialist.

• 45:46Speaker 06

  We use coaches for everything in our society, except for when you're in a health crisis. I felt like there was a missing person on the healthcare team. So the job of a life care specialist, number one, is to educate you on the pain medication that you've been prescribed. Then we provide non-narcotic pain management techniques, things to distract your brain. So all of our life care specialists are certified, also in techniques to deal with the mental side of the patient when you're in the hospital. If you're in the hospital, you probably have anxiety, stress, depression, and PTSD. Sometimes they need

• 46:28Speaker 06

  somebody to validate their pain, to validate their frustrations. Why did this happen to me? Why am I here? And they don't have that listening ear. And then follow up once you leave the hospital. Are you off your pain medicine? How to properly dispose of your opioids? And we found that patients, 70% of patients didn't even know they were taking

• 46:51Speaker 06

  Taking an opioid. The gentleman said, oh, my God, I did not know I was taking an opioid and my wife is in recovery. So I'm so glad you told me. So we were able to provide a lockbox so he could lock up his medicine. You know, there's a lot of little stories like that.

• 47:09Manoush Zomorodi?

  At first, Kami was very strategic with where she placed life care specialists. But now she's hoping to expand.

• 47:16Speaker 06

  We started in orthopedic trauma because that's where young people have their first introduction to opioids typically. It's a football injury, a car accident, a gymnastics injury, whatever the case may be, they go home with a big bottle of opioids and that's where the problem starts. So we started in orthopedic trauma, but we've expanded into multiple departments. And now at the rural hospital, we're really, we're on the floor across the board. If Christopher would have had a life care specialist, if I would have had somebody telling me about the dangers of the medication he was going home with, he would be here today. And so I really feel like we're saving lives one patient at a time.

• 47:58Speaker 06

  And it's definitely a preventative role that needs to be in every hospital across the country.

• 48:08Manoush Zomorodi?

  That was Kami Wolf Rice. She is founder of the CWC Alliance, the Christopher Wolf Crusade. She's also the author of The Flight: My Opioid Journey. Many thanks to her. And of course, Dr. Amy Baxter. She is a pain specialist physician and also the founder of Pain Care Labs. You can see her full talk at ted.com. Before we go, we wanted to give you a quick update on Kat Nod, the equestrian whose horse fell on her and who was trying to live with her chronic pain drug-free. Kat went through a period of complete despair, but she read a lot of self-help. And?

• 48:49Speaker 06

  Finally, I just... Decided that it was enough, that I'd had enough of the pity party and that I was going to fight for my life because that is at that point what I was fighting for. And I decided to challenge myself to move and get out and just five minutes a day of moving my body. And those five minutes were torture. They were not easy or fun. That five minute walk felt like it took an hour and a half every single time. But then slowly that five minutes became a little easier and a little longer. And the thing that I was torturing myself to do every day became the thing that was

• 49:34Speaker 06

  actually getting me out of bed every day.

• 49:38Manoush Zomorodi?

  How are you today? Are you living with chronic pain?

• 49:41Speaker 06

  Yes, and I will live in chronic pain very likely forever. Um, and that's okay. I have a way better mental control over my pain. And although, yes, I still am at like a five or six out of 10 almost every single day, it's more like background noise now when it's so constant. You kind of learn to tune it out and you learn to focus on the good things in your life. You learn to focus on other things that are stimulating because when all you have in your life is pain, that's really dark. But if you can bring other things into your life that bring you joy, bring you happiness,

• 50:21Speaker 06

  keep you moving, keeping you working, distracted, it does make it easier to kind of let that pain level fall into the background. I know it's there, but it's something I have a way better mental control over now.

• 50:36Speaker 06

  Pain is very complex, especially the chronic pain. And because there is a brain aspect to it because your brain is so used to being in pain. And there is the physical aspect of it because obviously most of the time it stems from some sort of injury or something happening, nerve pain, like all of these things. And so you kind of have to break it apart and treat. All of the pieces instead of just treating one as a whole and break that cycle. So for me, I found the chronic pain clinic and I did what they call an ablation. So they cauterized a bunch of nerves in my, from basically my neck to my tailbone. Very unpleasant experience, but it did help break a little bit of the cycle I was in pain wise, because the nerves couldn't communicate to my

• 51:21Speaker 06

  brain the same. And that really helped as a reset. And then I used that time to really strengthen and train my body around the injuries to have better support. And then I do also, I've seen natural pass and lots of people like that to help find some natural supplements to help with inflammation and pain as well, that aren't opioids.

• 51:43Manoush Zomorodi?

  It's a full time job.

• 51:45Speaker 06

  Oh, it's a commitment for sure. But you know, when your choice is, do I commit to not being here anymore? Or do I commit to finding a way through this and coming out the other side stronger, more knowledgeable and to be honest, I think healthier right now than I was before my injury. I'm gonna choose that route all day long.

• 52:04Manoush Zomorodi?

  Are you still involved with horses?

• 52:06Speaker 06

  Yes, actually. So I am training and back to competing and have really high hopes for where that journey could take us and whether that means all the way to the Olympics, that's definitely a goal.

• 52:20Manoush Zomorodi?

  Wow.

• 52:20Speaker 06

  It does hurt to ride, but do I notice it when I'm riding? No. Riding is the thing that is my therapy and a little extra physical pain that I can work through from a stable and healthy mental place is definitely worth it for me.

• 52:34Manoush Zomorodi?

  That's Kat Nod. Her book is called The Other Side, and you can see her TED Talk at ted.com. Many, many thanks to all the people we had on this show about pain relief. This episode was produced by Rachel Faulkner White, Matthew Cloutier, Fiona Giren, and Chloe Weiner. It was edited by Sanaz Meshkhanpour and me. Our production staff at NPR also includes James Delahoussaye, Katie Monteleone, Harsha Nahada, and Irene Noguchi is our executive producer. Our audio engineers were Ko Takasugi Chernovin and Robert Rodriguez. Our theme music was written by Ramtin Arablouei. Our partners at TED are Chris Anderson, Helen Walters, Alejandra Salazar, and Daniela Balarezzo.

• 53:20Manoush Zomorodi?

  I'm Manoush Zamirodi, and you've been listening to the TED Radio Hour from NPR.

• 53:24Speaker 02

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