back to indexControl Pain & Heal Faster with Your Brain | Huberman Lab Podcast #9
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Welcome to the Huberman Lab Podcast,
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where we discuss science and science-based tools
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for everyday life.
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I'm Andrew Huberman, and I'm a professor of neurobiology
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and ophthalmology at Stanford School of Medicine.
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This podcast is separate from my teaching
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and research roles at Stanford.
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It is, however, part of my desire and effort
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to bring zero cost to consumer information
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about science and science-related tools
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to the general public.
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In keeping with that theme,
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I'd like to thank the sponsors of today's podcast.
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Our first sponsor is ExpressVPN.
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ExpressVPN is a virtual private network
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that keeps your data secure by routing your data
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and online activities through their servers
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and keeping your data safe and secure,
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but also not selling your data to third parties.
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I started using ExpressVPN because unfortunately,
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I had my bank accounts hacked.
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I was traveling a lot,
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and I typically go on hotel or airline
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or other public wifi from time to time.
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And I don't know how it happened,
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but somehow my information got out there.
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And as I learned more from my friends
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and people that work in the tech community,
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turns out that many networks are not secure.
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So with ExpressVPN, it keeps all your information secure.
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It keeps information about your password secure.
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It keeps information about the websites that you visit
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secure, and as I mentioned earlier,
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they never give away or sell your data.
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The nice thing is you can use ExpressVPN.
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It runs in the background,
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and you don't even really realize that it's on.
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It works on your phone.
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It works on your laptop.
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It even works on your smart TV.
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If you'd like to try ExpressVPN,
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you can go to expressvpn.com slash Huberman
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to get three months free on their one-year program.
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I love ExpressVPN.
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I use it even when I'm at home.
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And so if you wanna try it,
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you can go to expressvpn.com slash Huberman,
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and you'll get three months free on their one-year program.
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The second sponsor of today's podcast is Athletic Greens.
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Athletic Greens is a vitamin mineral probiotic drink.
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I started taking Athletic Greens in 2012
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because I wanted to cover my vitamin and mineral bases.
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I didn't know which things to take.
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I found it really dizzying to know which vitamins
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and minerals to purchase.
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And Athletic Greens allowed me to get all the things
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I needed to cover my bases in one easy-to-consume formula
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that also happens to taste really good.
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I mix mine with water and a little bit of lemon juice.
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The probiotics in Athletic Greens
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are also really important to me
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because now there's an abundance of data
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showing that the gut microbiome,
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which is supported by probiotics,
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is important for gut-brain axis,
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mood, metabolic function, hormone function,
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just a huge number of biological functions
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and health parameters.
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If you wanna try Athletic Greens,
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you can go to athleticgreens.com slash Huberman.
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And if you do that,
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they'll give you a year's supply of vitamin D3K2.
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Vitamin D3 also has a lot of support
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from the scientific literature
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showing that it's important for immune function.
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So if you go to athleticgreens.com slash Huberman,
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you'll get Athletic Greens
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plus the year's supply of vitamin D3K2.
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And they'll give you five free travel packets.
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Mixing up powders is a little bit messy sometimes
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when you're on the road.
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You're in the car, you're on the plane,
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or you're on the move.
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These travel packets make everything really clean
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Once again, that's athleticgreens.com slash Huberman
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for Athletic Greens, the five free travel packets,
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and the year's supply of vitamin D3K2.
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Many of you have graciously asked
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how you can help support the Huberman Lab Podcast.
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There are several ways that you can do that.
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One is to check out our sponsors.
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The other is we've set up a Patreon account.
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You can go to patreon.com slash Andrew Huberman.
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And that allows you to donate to the podcast
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at a variety of different levels.
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In addition, if you could subscribe
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to the podcast on YouTube, that's terrific.
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If you haven't done that already, please do so.
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And please leave a comment.
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If you want to make suggestions about future episodes,
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please also put that in the comment section.
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If you subscribe on Apple or Spotify or both,
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And as well, Apple gives you the opportunity
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to leave a review and give us a five-star rating
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if you feel we deserve a five-star rating.
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And of course, please recommend the podcast
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to your friends, to your family members,
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anyone that you think would benefit from the information.
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So really the answer to your question
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of how you can support the podcast is
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you don't have to buy products,
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although checking all the sponsors does help.
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You don't have to donate to Patreon.
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We, of course, can't require you to subscribe
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and fill out reviews and things of that sort.
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But we like to think that we're providing
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a number of different ways to support the podcast,
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some of which are zero cost, some of which, if you like,
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gives you the opportunity to contribute financially.
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That's terrific as well.
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So thank you so much.
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We really appreciate your interest
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in helping us keep this coming your way.
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Let's continue our discussion about neuroplasticity,
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this incredible feature of our nervous system
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that allows it to change itself
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in response to experience and even in ways
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that we consciously and deliberately decide to change it.
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That's an incredible feature.
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No other organ in our body has that capability.
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Our nervous system, which governs everything
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about who we are, how we feel, and what we do,
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does have that capability.
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The issue is most people don't know
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how to access neuroplasticity.
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Children readily access neuroplasticity
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and they don't even realize that they're doing it.
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Adults want neuroplasticity.
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And so that's what this entire month
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of the Huberman Lab podcast has been about.
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We've explored neuroplasticity
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from a variety of different perspectives.
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We talked about representational plasticity.
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We talked about the importance of focus and reward.
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We talked about this amazing and somewhat surprising aspect
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of the vestibular system,
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how altering our relationship to gravity.
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And in addition to that, making errors as we try and learn
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can open up windows to plasticity.
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But we have not really talked so much
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about directing the plasticity toward particular outcomes.
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And thus far, we really haven't talked yet
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about how to undo things that we don't want.
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I've talked about learning and I say learn a language,
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learn free throws, learn a particular motor skill, et cetera.
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But what about what we would call unlearning
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or about removing some aspect of our experience
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that we don't want?
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And so today we are going to explore
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that aspect of neuroplasticity
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and we are going to do that in the context
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of a very important and somewhat sensitive topic,
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which is pain regeneration,
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and in some cases injury to the nervous system.
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Now, for those of you that are fortunate enough
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to not have or had a concussion or not have
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or know someone who's experiencing chronic or acute pain,
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I encourage you to stay in here with us
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because a lot of the information that we are going to cover
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has direct relevance to neuroplasticity for other purposes.
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We, as always here on this podcast,
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are going to discuss some of the science,
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we get into mechanism,
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but we also really get at principles.
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Principles are far more important than any one experiment
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or one description of mechanism,
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and certainly far more important than any one protocol
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because principles allow you to think
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about your nervous system and work with it
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in ways that best serve you.
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They are very flexible batches of information.
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So we are going to talk about the principles
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of neuroplasticity for removing pain
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and wound healing and injury.
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We're going to talk about acupuncture of all things.
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We are going to talk about modern medicine's attempt
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to try and restore youth to the aging
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or injured or demented brain.
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And we are going to definitely talk about tools.
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Got a lot of tools.
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I consulted a number of fantastic colleagues at Stanford,
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at Harvard Medical School,
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and in the greater community of tissue rehabilitation,
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injury and pain management in preparation for this podcast.
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I do want to be very clear and just remind you
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that I'm not a medical doctor.
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I'm a professor, so I don't prescribe anything.
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I have my beliefs,
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but the podcast is for information purposes.
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I do hope that the tools that we discuss
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will be of benefit to you.
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But as always, you should talk to your doctor
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or healthcare provider about any tools
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that you plan to add or are looking to explore,
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as well as anything that you might look to remove
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from your daily protocols.
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In other words, don't change anything
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without consulting an expert first.
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You're responsible for your health, not me.
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And I say this not just to protect me,
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but also to protect you.
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So please keep that in mind as we move forward.
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And I'm very excited to share with you this information
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because I do feel that it can be of great benefit
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to a number of people.
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So let's start our discussion about pain and sensation
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and regeneration and wound healing
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with a discussion about a very important system
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in the nervous system,
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which is the somatosensory system.
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The somatosensory system is, as the name implies,
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involved in understanding touch,
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physical feeling on our body.
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And the simplest way to think about
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the somatosensory system is that we have little sensors,
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and those sensors come in the form of neurons,
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nerve cells, that reside in our skin
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and in the deeper layers below the skin.
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We have some that correspond to,
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and we should say respond to mechanical touch.
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So, you know, pressure on the top of my hand
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or a pinpoint or other sensors, for instance,
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respond to heat, to cold.
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Some respond to vibration.
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We have a huge number of different receptors in our skin
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and they take that information
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and send it down these wires that we call axons
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in the form of electrical signals
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to our spinal cord and then up to the brain.
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And within the spinal cord and brain,
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we have centers that interpret that information,
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that actually makes sense of those electrical signals.
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And this is amazing because none of those sensors
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has a different unique form of information that it uses.
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It just sends electrical potentials into the nervous system.
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So the nervous system, you somehow decode
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what a given stimulus on your skin is.
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So maybe it's the wind blowing gently
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and deflecting some of the hairs on your arm,
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or maybe it's a sharp pinprick or a hot stove
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or the warmth of a glowing fire.
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That all arrives in your nervous system
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in the form of these electrical things
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we call action potentials, which is just amazing.
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And then the brain computes them and makes sense of them.
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So we have peripheral sensors
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and we've got stations up in our brain
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and within our spinal cord
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that makes sense of all the stuff coming in.
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Pain and the sensation of pain is, believe it or not,
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a controversial word in the neuroscience field.
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People prefer to use the word nociception.
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Nociceptors are the sensors in the skin
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that detect particular types of stimuli.
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It actually comes from the Latin word nocera,
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which means to harm.
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And why would neuroscientists not want to talk about pain?
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Well, it's very subjective.
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It has a mental component and a physical component.
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We cannot say that pain is simply an attempt
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to avoid physical harm to the body.
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They actually can be dissociated from one another.
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A good example would be if, God forbid,
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you were exposed to high levels of radiation,
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such as working with some sort of material
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that was radioactive or, you know,
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you were near a former radioactive plant
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or some radiation, excessive x-rays, et cetera,
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you wouldn't feel any pain during the x-rays.
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In fact, you don't.
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If you've ever had x-rays, as I have,
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you don't feel anything.
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They put you under that lead blanket,
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they run behind a wall, and then they,
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in my case, they take these pictures of your teeth
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and it's really scary because you go,
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something really terrible must be happening here,
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but you don't feel anything.
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But there can be a lot of tissue damage.
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There can be mutations introduced to cells, et cetera.
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I'm not saying people shouldn't have x-rays,
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but excessive x-rays certainly are not good
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Likewise, with excessive exposure to any radiation.
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So there can be tissue damage
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without the physical perception
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or mental perception of pain at all.
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As well, there can be the belief of pain
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or the feeling of pain without there being tissue damage.
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And there's a famous case that was published
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in the British Journal of Medicine
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where a construction worker,
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I think he fell is how the story went,
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and a 14 inch nail went through his boot
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and up through the boot.
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And he was in excruciating pain,
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just beyond anything he'd experienced.
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He reported that he couldn't even move in any dimension,
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even a tiny bit without feeling excruciating pain.
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They brought him into the clinic, into the hospital.
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They were able to cut away the boot
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and they realized that the nail had gone between two toes
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and it had actually not impaled the skin at all.
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His visual image of the nail going through his boot
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gave him the feeling, the legitimate feeling,
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that he was experiencing the pain of a nail
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going through his foot,
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which is incredible because it speaks to the power
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of the mind in this pain scenario.
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And it also speaks to the power of the specificity.
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It's not like he thought that his foot was on fire.
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He thought because he saw a nail going through his foot,
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what it was going through his boot,
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but he thought it was going through his foot,
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that it was sharp pain of the sort
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that a nail would produce.
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And there are thousands of these kinds
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of case reports out there.
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Now that is not to say that all pain that we experience
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but it really speaks to the incredible capacity
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that these top-down,
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these higher level cognitive functions have
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in interpreting what we're experiencing
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out in the periphery,
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even just on the basis of what we see.
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And the example of radiation speaks to the fact
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that pain and tissue damage are dissociable
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from one another, okay?
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So why are we talking about pain
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during a month on neuroplasticity?
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Well, it turns out that the pain system offers us
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a number of different principles that we can leverage
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to A, ensure that if we are ever injured,
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we are able to understand the difference
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between injury and pain, because there is a difference,
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that if we're ever in pain,
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that we can understand the difference
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between injury and pain,
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that we will be able to interpret our pain.
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And during the course of today's podcast,
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I'm going to cover protocols that help eliminate pain
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from both ends of the spectrum,
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from the periphery at the level of the injury,
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and through these top-down mental mechanisms.
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A lot of times on this podcast,
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in fact, mostly I tend to center on the physiology,
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on the really objective things that you can describe
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and talk about diaphragmatic movement or sunlight
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of a particular number of photons, et cetera.
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But today's a really exciting opportunity
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for us to discuss some of the more subjective things.
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Believe it or not, we're going to talk about love.
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A colleague of mine at Stanford,
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who runs a major pain clinic,
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is working on and has published quality peer review data
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on the role of love in modulating the pain response.
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Only there's a twist to it,
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and I'm not going to reveal it just yet,
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but it turns out that the specific type of connection
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one has to a romantic partner actually dictates
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whether or not their love for them
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will alleviate physical pain.
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And the effects are really robust.
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It's an amazing literature.
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And so what we're talking about today
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is plasticity of perception,
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which has direct bearing on emotional pain
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and has direct bearing on trauma.
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And other things that we've discussed in previous episodes
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a little bit, but that we're going to explore even more
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in an entire month about those topics.
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So let's get started in thinking about
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what happens with pain.
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And I will describe some examples
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of some kind of extreme cases.
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For instance, I will tell you just now
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that there is a mutation, a genetic mutation,
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in a particular sodium channel.
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A sodium channel is one of these little holes in neurons
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that allows them to fire action potentials.
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It's important to the function of the neuron.
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It's also important for the development of certain neurons.
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And there's a particular mutation.
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There are kids that are born without this sodium channel 1.7
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if you want to look it up.
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Those kids experience no pain, no pain whatsoever.
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And it is a terrible situation.
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They burn themselves.
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They tend to rest on their limbs too long.
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They don't make the micro adjustments.
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You might see me swiveling around in my chair,
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moving around a lot.
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Those micro adjustments are actually normal,
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healthy micro adjustments that prevent us
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from going into pain.
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They don't make those adjustments.
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They don't get the feedback
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that they're in a particular position.
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And so they never make those adjustments
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and their joints get destroyed essentially.
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They don't tend to live very long due to accidents.
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It's a really terrible and unfortunate circumstance.
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Some people have a mutation in the same channel
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where they make too much of this channel
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so they feel too much pain.
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In fact, it's reasonable to speculate
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that one of the reasons, not all,
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but one of the reasons why people might differ
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in their sensitivity to pain is by way of genetic variation
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in how many of these sorts of receptors that they express.
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People who make too much of this receptor
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experience extreme pain from even subtle stimuli.
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Now, the good news is there are good drug treatments
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that can block specifically this sodium channel 1.7.
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And so those people get a lot of relief
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from taking such drugs.
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So pain and how much pain we are sensitive to
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or insensitive to probably has some genetic basis.
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And then of course, there are things that we can do
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to make sure that we experience less pain,
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although pain has this adaptive role.
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So let's talk about some of the features
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of how we're built physically and how that relates to pain
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and how we can recover from injury.
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So first of all, we have maps of our body surface
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It's called a homunculus.
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In a rat, believe it or not, I'm not making this up,
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it's called a ratunculus.
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In Costello, my dog is snoring behind me.
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It's a dogunculus.
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I could get into the nomenclature and why it's called this,
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but it's basically a representation of the body surface.
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That representation is scaled
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in a way that matches sensitivity.
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So the areas of your body that are most sensitive
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have a lot more brain real estate devoted to them.
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Your back is an enormous piece of tissue
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compared to your fingertip,
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but your back has fewer receptors devoted to it
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and the representation of your back in your brain
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is actually pretty small,
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whereas the representation of your finger is enormous.
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So how big a brain area is devoted to a given body part
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is directly related to the density of receptors
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in that body part, not the size of the body part.
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And that's why if we were to draw your homunculus
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or Costello's dogunculus,
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what we would find is that certain areas like the lips,
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like the fingertips, like the genitalia,
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like the eyes and the area around the face
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would have a huge representation.
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Whereas the back, the torso and areas of the body
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that are less sensitive
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are going to have smaller representation.
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So it'd be a very distorted map.
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You can actually know how sensitive a given body part is
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and how much brain area is devoted to it
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through what's called two-point discrimination.
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You can do this experiment if you want.
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I think I've described this once or twice before,
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but basically if you have someone put,
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maybe take two pens and put them maybe six inches apart
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on your back and touch while you're facing away
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and they'll ask you how many points they're touching you
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but if they move those closer together, say three inches,
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you're likely to experience it as one point of contact.
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Whereas on your finger,
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you could play that game all day
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and as long as there's a millimeter or so spacing,
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you will know that it's two points as opposed to one
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and that's because there's more pixels,
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more density of receptors.
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This has direct bearing to pain
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because it says that areas of the body
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that have denser receptors
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are going to be more sensitive to pain than to others.
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And where we have more receptors,
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we tend to have more blood vessels and glia,
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which are these support cells
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and other cells that lend to the inflammation response
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and that's really important.
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So just as a rule of thumb,
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areas of your body that are injured that are large areas
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that have low sensitivity before injury
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likely are going to experience less pain
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and the literature shows will heal more slowly
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because they don't have as many cells around
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to produce inflammation.
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And you might say, wait, I thought inflammation is bad.
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Well, one of the things I really want to get across today
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is that inflammation is not bad.
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Inflammation out of control is bad,
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but inflammation is wonderful.
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Inflammation is the tissue repair response
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and we are going to talk about subjective and objective ways
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to modulate inflammation after tissue injury,
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even after just exercise that's been too intense.
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Okay, so you have this map of your body surface,
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it's sensitive in different ways, now you know why.
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So you've got your neurobiology of somatic sensation 101
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under your belt now.
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We didn't cover everything,
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but we'll touch on some of the other details
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I thought it might be a nice time to just think about
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the relationship between the periphery and the central maps
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in a way that many of you have probably heard about before,
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which will frame the discussion a little bit better,
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which is phantom limb pain.
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Now, some of you are probably familiar with this,
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but for people that have an arm or a leg or a finger
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or some other portion of their body amputated,
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it's not uncommon for those people to feel
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as if they still have that limb or appendage
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or piece of their body intact.
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And typically, unfortunately, the sensation of that limb
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is not one of the limb being nice and relaxed
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The sensation is that the limb is experiencing pain
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or is contorted in the specific orientation that it was
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around the time of the injury.
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So if someone has a blunt force to the hand
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and they end up having their hand amputated,
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typically they will continue to feel pain
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in their phantom hand, which is pretty wild.
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And that's because the representation of that hand
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is still intact in the cortex, in the brain,
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and it's trying to balance its levels of activity.
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Normally, it's getting what's called
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proprioceptive feedback.
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Proprioception is just our knowledge
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of where our limbs are in space.
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It's an extremely important aspect
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of our somatosensory system.
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And there's no proprioceptive feedback.
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And so a lot of the circuits start to ramp up
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their levels of activity and they become very conscious
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of the phantom limb.
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Now, before my lab was at Stanford, I was at UC San Diego.
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And one of my colleagues was a guy,
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everyone just calls him by his last name, Ramachandran,
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who is famous for understanding this phantom limb phenomenon
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and developing a very simple,
link |
but very powerful solution to it
link |
that speaks to the incredible capacity
link |
of top-down modulation.
link |
And top-down modulation, the ability to use one's brain,
link |
cognition, and senses to control pain in the body
link |
is something that everyone,
link |
not just people missing limbs or in chronic pain
link |
can learn to benefit from because it is a way
link |
to tap into our ability to use our mind
link |
to control perceptions of what's happening in our body.
link |
And this is not a mystical statement.
link |
This is not about mind, I guess, as much as his brain
link |
to control our perceptions of our body.
link |
So what did Ramachandran do?
link |
Ramachandran had people who were missing a limb
link |
put their intact limb into a box that had mirrors in it
link |
such that when they looked in the box
link |
and they moved their intact limb,
link |
the opposite limb, which was a reflection of the intact limb
link |
because they're missing the opposite limb,
link |
they would see it as if it was intact.
link |
And as they would move their intact limb,
link |
they would visualize with their eyes
link |
the limb that's in the place of the absent limb,
link |
so this is all by mirrors,
link |
moving around and they would feel immediate relief
link |
from the phantom pain.
link |
And he would tell them and they would direct their hand
link |
toward a orientation that felt comfortable to them.
link |
Then they would exit the mirror box,
link |
they would take their hand out
link |
and they would feel as if the hand was now
link |
in its relaxed normal position.
link |
So you could get real time in moments
link |
remapping of the representation of the hand.
link |
Now that's amazing.
link |
This is the kind of thing that all of us
link |
would like to be able to do if we are in pain.
link |
If you stub your toe, if you break your ankle,
link |
if you take a hard fall on your bike,
link |
or if you're in chronic pain,
link |
wouldn't it be amazing to be able to use a mind trick,
link |
but it's not a trick, right?
link |
Because it's real visual imagery
link |
to remap your representation of your body surface
link |
and where your body is.
link |
That is something that we could all benefit from
link |
because if you do anything for long enough, including live,
link |
you're going to experience pain of some sort.
link |
And this, again, I just want to remind you,
link |
isn't just about physical injuries and pain,
link |
this has direct relevance to emotional pain as well,
link |
which we, of course, we'll talk about.
link |
So the Ramachandran studies were really profound
link |
because they said a couple of things.
link |
One, plasticity can be very fast,
link |
that it can be driven by the experience of something,
link |
just the visual experience.
link |
He had people do this mirror box thing,
link |
but not look into the mirror box
link |
and they didn't get the remapping.
link |
So it required visual imagery coming in.
link |
We also know, for instance,
link |
that in cases like where people are congenitally deaf,
link |
the cochlear implant, which is simply a way of putting,
link |
it's not simple, but it's a way of putting in a device
link |
that replaces the cochlea,
link |
the device that we're normally born with,
link |
in the ear that has these little,
link |
what are called hair cells
link |
that deflect according to sound waves
link |
and allow us to hear
link |
by replacing the normal hearing apparatus
link |
that's deficient in deaf people
link |
with this cochlear implant,
link |
the brain can make sense of this artificial ear, basically.
link |
It's not the outside ear, not the pinna,
link |
but the inner ear, and they can start to hear sounds.
link |
Now, some people really like the artificial cochlea.
link |
They really benefit from it.
link |
It restores their ability to hear and they like it.
link |
Other people don't.
link |
Some deaf people would prefer not to hear anything,
link |
can be very disruptive to them.
link |
And some of that might have to do with
link |
the need for further,
link |
better engineering of these artificial cochleas.
link |
But all this really speaks to the fact
link |
that the brain is an adaptive device.
link |
It will respond to what you give it.
link |
It is not a device that is fixed.
link |
In fact, the essence of the brain,
link |
especially the human brain,
link |
is to take sensory inputs and to make sense of those,
link |
meaning cognitive sense,
link |
and then to interpret those signals.
link |
And so this may come as a shock to some of you,
link |
and by no means am I trying to be insensitive,
link |
but pain is a perceptual thing
link |
as much as it's a physical thing.
link |
It's a belief system
link |
about what you're experiencing in your body.
link |
And that has important relevance
link |
for healing different types of injury
link |
and the pain associated with that injury.
link |
In people's pursuit for neuroplasticity,
link |
a question that comes up every once in a while
link |
is people will say,
link |
if I just brush my teeth with the opposite hand
link |
for a couple nights in a row, will I get neuroplasticity?
link |
And the answer is probably yes.
link |
I mean, it's a deliberate action.
link |
You're focusing on it.
link |
There's an end goal.
link |
You're very likely to make errors
link |
like dropping an anterior lip and gums at first
link |
and then getting better at it.
link |
And as you heard in last episode,
link |
making errors is really important
link |
because those errors are the signal
link |
that plasticity needs to happen.
link |
And then when you get the actions correct,
link |
then those correct actions are programmed in.
link |
I'm not sure that brushing one's teeth
link |
with the opposite hand is the most effective use
link |
of this incredible thing that we have,
link |
which is plasticity.
link |
It's not going to open up plasticity for many other things.
link |
So if that were really important to you for whatever reason,
link |
maybe you have a crowded bathroom
link |
and it's easier to do on one side or the other, then fine.
link |
But it's kind of hard to imagine
link |
why this would be a highly adaptive behavior,
link |
unless of course you have an injured limb
link |
or you're missing a limb.
link |
And that gets me to some really exciting
link |
and important studies that were performed
link |
mostly in the 90s, as well as in the 2000s.
link |
And that for now there is really a solid base of data.
link |
There's really a center of mass
link |
around a particular set of experiments
link |
that point to particular protocols
link |
for how to overcome motor injury.
link |
And this may resonate with some of you
link |
who've ever been injured to the point
link |
where you couldn't walk well temporarily,
link |
I hope, or even longer.
link |
So think about a sprained ankle scenario
link |
or a broken arm scenario.
link |
We're all familiar with the stories
link |
of people having a cast on and then getting the cast off.
link |
And that the particular limb that wasn't being used
link |
that was casted is much smaller and atrophied.
link |
Most of that atrophy, you might be surprised to learn,
link |
is not because the muscles aren't being used.
link |
It's because the nerves sending signals to those muscles
link |
And therefore the muscles aren't contracting.
link |
Work done by a guy named Timothy Schallert
link |
and his graduate students and postdocs,
link |
Teresa Jones and others, in the 90s and 2000s,
link |
showed something really wonderful
link |
that I think we can all benefit from
link |
should we have an injury,
link |
and even if we simply want to balance out imbalances
link |
in our motor activity.
link |
And I think all of us tend to be stronger
link |
on one side or the other side.
link |
Usually a right-handed person
link |
will be stronger in their left arm,
link |
not always, for compensatory reasons.
link |
Some other time we can talk about handwriting.
link |
The lefties likely will be stronger in their right arm,
link |
although it kind of depends on whether or not
link |
people are hook righties.
link |
That's when you kind of hook around and right from the top
link |
There are all sorts of theories about this
link |
that we can talk about,
link |
right brain, left brain, math proficiency, et cetera.
link |
In any event, what Schallert and colleagues showed
link |
was that if we have damage to our brain
link |
in the sensory motor pathways,
link |
any number of different sensory motor pathways,
link |
or we have damage to a limb,
link |
could be a leg, could be an arm, could be a hand,
link |
there's great benefit
link |
to restricting the use of the opposite,
link |
better performing uninjured limb or hand
link |
or other part of the body.
link |
They had about a dozen papers showing
link |
that if there was damage centrally in the brain,
link |
or there was damage to a limb,
link |
so unilateral damage, as we say, one side,
link |
the thing to do is not to cast up the damaged side,
link |
although you need to do that to protect the limb,
link |
of course, from further damage.
link |
So if it's a broken arm, you need to cast the arm
link |
or you need to brace the arm,
link |
but that the key thing was to restrict movement
link |
of the intact uninjured opposite limb.
link |
And when they did that,
link |
it forced some movement in the injured limb
link |
and remarkably through connections
link |
from the two sides of the brain,
link |
through the corpus callosum,
link |
this huge fiber pathway
link |
that links the two sides of the brain,
link |
they saw plasticity on both sides of the brain.
link |
So this makes sense when you hear it.
link |
Let's say I injure my left ankle
link |
and I'm limping along or I'm using crutches.
link |
You would think, well, the last thing you want to do
link |
is injure your opposite limb
link |
or not use your opposite limb,
link |
my right ankle is perfectly fine.
link |
But if I lean too hard on my right limb
link |
and I take all the work out of the left limb,
link |
that's actually setting up a situation
link |
where there's going to be runaway asymmetry
link |
in the central pathways
link |
and the nerve to muscle pathways on my left side.
link |
And so what they suggested
link |
and what they showed in a variety of experiments
link |
was that by encouraging activity of the injured limb
link |
provided it could be done without pain
link |
and importantly, not just exercising that limb
link |
or part of the body,
link |
but restricting the opposite healthy part of the body
link |
that the speed of recovery was significantly faster.
link |
Now I want to repeat,
link |
you don't want to go injuring something further.
link |
That's probably the worst thing you could do.
link |
But in some cases where people have damage in their brain,
link |
the limbs are perfectly fine,
link |
but the motor signals aren't getting down to the limbs.
link |
And in that case, the limb is fine.
link |
So you actually are free
link |
to use either limb as much as you want.
link |
you don't want to rely on the uninjured pathway too much.
link |
In fact, you want to restrict the uninjured pathway.
link |
So I find these studies remarkable
link |
and they've been followed up on at the molecular level,
link |
at the cellular level many times.
link |
And I think the physiotherapists out there
link |
and the rest of you who are involved in sports medicine
link |
and some of the physicians will say,
link |
well, of course that makes perfect sense.
link |
But oftentimes this is not what happens.
link |
Oftentimes what happens is it's all about resting
link |
and limiting inflammation, et cetera,
link |
of the injured limb
link |
or the limbs corresponding to the injured part of the brain.
link |
And these experiments and the collection of them
link |
point to the fact that the balance between the right
link |
and left side of our body is always dynamic.
link |
It's always being updated at the level of neural circuitry.
link |
The Ramachandran studies with the mirror box
link |
And that even slight imbalances
link |
in the two sides of the body can get amplified.
link |
And so when you're in a situation where one side is injured
link |
or the brain is injured representing one side of the body,
link |
the key thing to do is to really overwork
link |
the side that needs the work
link |
and to restrict the activity of the side
link |
that doesn't need the work because it's healthy.
link |
And this has great semblance to ocular dominance plasticity
link |
which I talked about a couple episodes ago.
link |
I won't go into it in detail,
link |
but where the Nobel prize winning neurobiologists
link |
Torrance Wiesel and David Hubel showed
link |
that if one eye is closed early in development,
link |
that the representation of the opposite eye in the brain
link |
is completely overtaken by the intact eye.
link |
So this is important.
link |
It means that all of our senses and our movements
link |
are competing for space in our brain.
link |
And so the way to think about the principle
link |
is anytime you're injured and you're hobbling along,
link |
you don't want to injure yourself further,
link |
but you want to try and compensate
link |
in the ways that respect this competition
link |
for neural real estate.
link |
And what that usually means is not relying
link |
on where you're still strong
link |
because that's just going to create runaway plasticity
link |
that's going to make it very hard
link |
for you to recover the motor function
link |
and in some cases the sensory function of the damaged limb.
link |
Some of you may be wondering how long
link |
and how often one should restrict the activity
link |
of the intact or healthy limb or limbs in some cases.
link |
And the answer is you don't have to do that
link |
all day every day.
link |
These experiments centered on doing one or two hours
link |
of dedicated work, sensory motor work,
link |
or so for instance, if you had a sprained ankle on the left,
link |
you might spend part of the day where your left leg,
link |
provided it's not too painful, can be exercised,
link |
again, in a way that's not damaging to the injury,
link |
and the right limb can't contribute to that exercise.
link |
So this might be pedaling unilaterally on a stationary bike.
link |
If you can do that for a different type of limb injury,
link |
like an arm injury, this might be reaching
link |
provided the shoulder is mobile, doing reaching.
link |
It might be even writing with the damaged side
link |
and then intentionally not writing
link |
with the preferred or undamaged side.
link |
This has been shown to accelerate the central plasticity
link |
and the recovery of function,
link |
which I think is what most people want.
link |
When people are injured, they want to get back
link |
to doing what they were doing previously
link |
and they want to be able to do that without pain.
link |
Now, this brings up another topic,
link |
which is definitely related to neuroplasticity and injury,
link |
but is a more general one that I hear about a lot,
link |
which is traumatic brain injury.
link |
Many injuries are not just about the limb
link |
and the lack of use of the limb,
link |
but concussion and head injury.
link |
And I want to emphasize, I'm not a neurologist.
link |
I have many colleagues that are.
link |
At some point, we will do a whole month on TBI
link |
because it's such a serious issue
link |
and it's such a huge discussion.
link |
But I want to talk a little bit about what is known
link |
about recovery from concussion.
link |
And this is very important because it has implications
link |
for just normal aging as well
link |
and offset setting some of the cognitive decline
link |
and physical decline that occurs with normal aging.
link |
So we shouldn't think of TBI
link |
as just for the football players
link |
or just for the kids that had an injury
link |
or just for the person that was in the car accident.
link |
We want to learn about TBI
link |
and understand TBI for those folks.
link |
But we're also going to talk about TBI
link |
as it relates to general degradation of brain function
link |
because there's a certain semblance there
link |
of TBI to general brain aging.
link |
Typically after TBI,
link |
there are a number of different things that happen
link |
and there are a huge range of things that can create TBI.
link |
Neurologists and the emergency room physicians
link |
are going to want to know,
link |
was the skull itself injured
link |
or did the brain rattle around in the skull?
link |
Was there actually a breach through the skull?
link |
Is there a physical object in there?
link |
How many concussions has the person had?
link |
I mean, everyone's situation with TBI
link |
is incredibly different,
link |
but there's a constellation of symptoms that many people,
link |
if not all people with TBI report,
link |
which is headache, photophobia,
link |
that lights become kind of aversive,
link |
sleep disruption, trouble concentrating,
link |
sometimes mood issues.
link |
There's a huge range
link |
and of course the severity will vary, et cetera.
link |
In a previous episode, I mentioned the Kennard principle.
link |
The Kennard principle, named after the famous neurologist,
link |
named by and after the famous neurologist, Margaret Kennard,
link |
said that if you're going to get a brain injury,
link |
better to get it early in life than later in life
link |
and that's because the brain has a much greater
link |
or heightened capacity for repairing itself
link |
early in life than later.
link |
But of course, none of us want TBI
link |
and you can't pick when you get your TBI.
link |
You can avoid certain activities that would give you TBI,
link |
but really when it comes to TBI,
link |
there are a couple of things
link |
that are agreed upon across the board.
link |
The first one is as much as possible,
link |
you want to avoid a second traumatic brain injury
link |
Now that's going to be a tough one for some of the athletes
link |
and even recreational athletes to swallow
link |
because they want to continue in their sport
link |
and I'm not here to tell you that you should or you shouldn't
link |
but that's simply the way that it is.
link |
For folks that are in military
link |
or that are in certain professions,
link |
construction is a place where we see a lot of TBI.
link |
It's not always just football.
link |
A lot of construction workers are dealing
link |
with heavy objects swinging around in space.
link |
They wear those hard hat helmets,
link |
which unfortunately don't protect much
link |
against a lot of those blunt forces
link |
and certainly not against falls and things of that sort.
link |
So many people in order to survive and feed their families
link |
have to go back to work.
link |
It's very clear that regardless of whether or not
link |
there was a skull break
link |
and regardless of when the TBI happened
link |
or how many times it's happened,
link |
that the system that repairs the brain, the adult brain,
link |
is mainly centered around this lymphatic system
link |
that we call for the brain, the glymphatic system.
link |
Now the brain wasn't thought to have a lymphatic system.
link |
It wasn't thought to have circulating immune cells
link |
but about 10 years ago, it was sort of rediscovered
link |
because if you look in the literature,
link |
you realize this stuff was around longer,
link |
that there's a glymphatic system.
link |
It's sort of like a sewer system that clears out
link |
the debris that surrounds neurons,
link |
especially injured neurons.
link |
And the glymphatic system is very active during sleep.
link |
It's been imaged in functional
link |
and magnetic resonance imaging.
link |
And the glymphatic system is something
link |
that you want very active
link |
because it's going to clear away the debris
link |
that sits between the neurons
link |
and the cells that surround the connections
link |
between the neurons called the glia,
link |
those cells are actively involved
link |
in repairing the connections between neurons when damaged.
link |
So the glymphatic system is so important that many people,
link |
if not all people who get TBI,
link |
are told get adequate rest, you need to sleep.
link |
And that's kind of twofold advice.
link |
On the one hand, it's telling you to get sleep
link |
because all these good things happen in sleep.
link |
It's also about getting those people
link |
to not continue to engage in their activity full-time
link |
or really try and hammer through it.
link |
You might say, well, if you have trouble sleeping,
link |
how are you supposed to get deep sleep?
link |
Most of the activity of the glymphatic system,
link |
this washout of the debris
link |
is occurring during slow wave sleep.
link |
Slow wave sleep, as I mentioned in a previous episode,
link |
is something that happens typically
link |
in the early part of the evening.
link |
So even for those of you that are falling
link |
or early part of the night, rather,
link |
if you're falling asleep
link |
and then waking up three, four hours later,
link |
it's important that you continue to get sleep,
link |
but know that the slow wave sleep
link |
is mainly packed toward the early part of the night.
link |
So that hopefully will alleviate some of the anxiety
link |
of the three and 4 a.m. wake up,
link |
although you really should follow some of the protocols
link |
that I've suggested in your physicians' protocols
link |
in order to try and get regular,
link |
longer sleep of seven, eight hours.
link |
Later, we're going to talk about the eight-hour mark
link |
as a prerequisite for repair.
link |
The glymphatic system has been shown
link |
to be activated further in two ways.
link |
One is that sleeping on one side, not on back or stomach,
link |
seems to increase the amount of washout,
link |
or wash through, I should say, of the glymphatic system.
link |
There aren't a ton of data on this,
link |
but the data that exist are pretty solid.
link |
Again, sleeping on one side
link |
or with feet slightly elevated as well
link |
has been shown to increase the rate of clearance
link |
of some of the debris,
link |
and that's because the way that the glymphatic system works
link |
is it has a physical pressure fluid dynamic to it
link |
that allow it to work more efficiently
link |
when one is sleeping on their side
link |
or with feet slightly elevated.
link |
So this means not falling asleep
link |
in a chair while watching TV.
link |
This means, if possible, not falling asleep on one's back
link |
or on one's stomach, sleeping on one's side,
link |
and if you can't do that,
link |
I don't really like to sleep on my side.
link |
I sleep with my feet slightly elevated.
link |
I put out the kind of thin pillow under my ankles.
link |
but I have had a few concussions before,
link |
but right now I feel fine,
link |
but I find that putting the pillow under my ankles
link |
helps me sleep much more deeply,
link |
and I wake up feeling much more refreshed.
link |
The other thing that has been shown
link |
to improve the function of the glymphatic system,
link |
and this is, again, is for sake of TBI
link |
as well as for everyone, even without brain injury,
link |
is a certain form of exercise,
link |
and I want to be very, very clear here.
link |
I will never, and I am not suggesting
link |
that people exercise in any way
link |
that aggravates their injury
link |
or that goes against their physician's advice.
link |
Take your physician's advice
link |
as to whether or not you should be exercising at all
link |
and how much and into what intensity.
link |
However, there's some interesting data,
link |
and we can provide a link to the review on this.
link |
It shows that exercise of what,
link |
I guess people would nowadays call it zone two cardio,
link |
which is kind of low-level cardio
link |
that one could do while talking to somebody else.
link |
You could maintain a conversation,
link |
although you don't have to talk to somebody else.
link |
It just gives you a sense of the intensity of the exercise.
link |
That zone two cardio for 30 to 45 minutes
link |
three times a week seems to improve the rates of clearance
link |
of some of the debris after injury,
link |
and in general, injury or no,
link |
to accelerate and improve the rates of flow
link |
for the glymphatic system.
link |
I find this really interesting
link |
because I think nowadays there's such an obsession
link |
with high-intensity interval training
link |
and people trying to pack in as much as they can
link |
into a short workout, which is great
link |
if it brings people to the table
link |
who haven't been exercising before,
link |
but I think it's really important that we know
link |
that the data on exercise
link |
and its relationship to brain health
link |
speak to doing 30 to 45 minutes
link |
of this kind of what we call low-level cardio.
link |
It could be fast walking.
link |
It could be jogging.
link |
If you can do that with your injury safely,
link |
it could be cycling.
link |
This is not the kind of workout
link |
that's designed to get your heart rate up
link |
to the point where you're improving your fitness levels
link |
at some sort of massive rate
link |
or taking huge jumps in your VO2 max or anything like that.
link |
I do this, and I know a number of other people,
link |
especially people in communities
link |
where there is a lot of TBI
link |
are now starting to adopt this,
link |
that the 30 to 45 minutes, three times a week or so,
link |
could be more, of this zone two type cardio
link |
can be very beneficial for washout of debris from the brain.
link |
And this is really interesting outside of TBI
link |
because what we know from aging
link |
is that aging is a nonlinear process.
link |
It's not like with every year of life,
link |
your brain gets a little older.
link |
It has, sometimes it follows
link |
what's more like a step function.
link |
Like you get these big jumps in markers of aging.
link |
I guess that we could think of them as jumps down
link |
because it's a negative thing for most everybody
link |
would like to live longer
link |
and be healthier in brain and body.
link |
And so the types of exercise I'm referring to now
link |
are really more about brain longevity
link |
and about keeping the brain healthy
link |
than they are about physical fitness.
link |
There's no reason why you couldn't do this
link |
and also provided again, it's safe for you
link |
given your brain state and injury state, et cetera.
link |
There's no reason why you couldn't also combine it
link |
with weight training and other forms of cardio.
link |
So I think this is really interesting.
link |
And if some of you would like to know the mechanism
link |
or at least the hypothesized mechanism,
link |
there's a molecule called aquaporin-4.
link |
It almost sounds like the fourth in a sequel of movies
link |
or something like that.
link |
But aquaporin-4 is a molecule
link |
that is related to the glial system.
link |
So glia, it means glue in Latin,
link |
are these cells in the brain,
link |
the most numerous cells in the brain, in fact,
link |
that in sheath synapses, but they're very dynamic cells.
link |
They're like little ambulance cells.
link |
The microglia will run in and will gather up debris
link |
and soak it up and then run out after an injury.
link |
Aquaporin-4 is mainly expressed by the glial cell
link |
called the astrocyte.
link |
Astro, it looks like a little star.
link |
Incredibly interesting cells.
link |
And the thing to remember is that the astrocytes
link |
bridge the connection between the neurons,
link |
the synapse, the connections between them
link |
and the vasculature, the blood system
link |
and the glymphatic system.
link |
So they kind of sit at the interface
link |
and they kind of imagine somebody on an emergency site,
link |
car crash site, who's directing everybody around
link |
Get that person on a stretcher, bandage them up,
link |
call their mother, et cetera, et cetera,
link |
get this out of the road, put down some flares.
link |
The astrocytes kind of work in that capacity
link |
as well as doing some things more directly.
link |
So this glymphatic system and the glial astrocyte system
link |
is a system that we want chronically active
link |
throughout the day as much as possible.
link |
So low level walking, zone two cardio,
link |
and then at night during slow wave sleep
link |
is then really when this glymphatic system kicks in.
link |
So that should hopefully be an actionable takeaway
link |
provided that you can do that kind of cardio safely
link |
that I believe everybody should be doing
link |
who cares about brain longevity,
link |
not just people who are trying to get over TBI.
link |
Now I'd like to return a little bit
link |
to some of the subjective aspects of pain modulation
link |
because I think it's so interesting and so actionable
link |
that everyone should know about this.
link |
And in this case, we can also say that regardless
link |
of whether or not you're experiencing pain,
link |
acute or chronic, what I'm about to tell you
link |
is as close as anything is to proof,
link |
in science we rarely talk about proof,
link |
we talk about evidence in favor or against a hypothesis,
link |
but as close as possible to proof that our interpretation,
link |
our subjective interpretation of a sensory event
link |
is immensely powerful for dictating
link |
our experience of the event, here are a couple examples.
link |
First of all, anyone who's ever done combat sports
link |
or martial arts knows that it's incredible
link |
how little a punch hurts during a fight
link |
and it's incredible how much it hurts after a fight.
link |
The molecule adrenaline when it's liberated into our body
link |
truly blunts our experience of pain.
link |
We all know the stories of people walking miles
link |
on stumped legs, people doing all sorts of things
link |
that were incredible feats that allowed them
link |
to move through what would otherwise be pain
link |
and afterward they do experience extreme pain,
link |
but during the event oftentimes
link |
they are not experiencing pain
link |
and that's because of the pain blunting effects
link |
I'll tell you exactly how this works in a few minutes
link |
when we talk about acupuncture,
link |
but norepinephrine binding to particular receptors,
link |
adrenaline binding to particular receptors
link |
actually shuts down pain pathways.
link |
People who anticipate an injection of morphine
link |
immediately report the feeling of loss of pain.
link |
Their pain starts to diminish
link |
because they know they're going to get pain relief
link |
and it's a powerful effect.
link |
Now, all of you are probably saying placebo effect.
link |
Placebo effects are very real.
link |
Placebo effects and belief effects as they're called
link |
have a profound effect on our experience
link |
of noxious stimuli like pain
link |
and they can also have a profound effect
link |
on positive stimuli and things
link |
that we're looking forward to.
link |
One study that I think is particularly interesting here
link |
is from my colleague at Stanford, Sean Mackey.
link |
They did a neuroimaging study.
link |
They subjected people to pain.
link |
In this case, it was a heat pain.
link |
People have very specific thresholds to heat
link |
at which they cannot tolerate any more heat,
link |
but they explored the extent
link |
to which looking at an image of somebody,
link |
in this case, a romantic partner that the person loved,
link |
would allow them to adjust their pain response.
link |
And it turns out it does.
link |
If people are looking at an image
link |
or thinking about a person that they love
link |
or even a thing that they love, a pet that they love,
link |
studies previous to the one that Mackey and colleagues did
link |
showed that their experience of pain was reduced.
link |
Their threshold for pain was higher.
link |
They could tolerate more pain
link |
and they reported it as not as painful.
link |
But there's a twist there,
link |
which is it turns out that the extent
link |
to which love will modulate pain has everything to do
link |
with how infatuated and obsessed somebody is
link |
with the object of their love.
link |
People that report thinking about somebody or a pet
link |
for many hours of the day,
link |
kind of having an obsessive nature,
link |
like almost like kind of what people might call,
link |
quote, unquote, codependency.
link |
For those of you that are listening,
link |
I'm just providing air quotes
link |
because codependency is kind of a clinical thing now,
link |
although it's thrown around a lot all the time.
link |
It's sort of like gaslighting.
link |
People talk about gaslighting all the time.
link |
Now, gaslighting is a real thing,
link |
but then people talk about gaslighting
link |
for many things outside the clinical description.
link |
If people are very obsessed with somebody,
link |
they have a kind of obsessive love of somebody's face,
link |
even if the other person doesn't know them,
link |
which is a little weird,
link |
that response, that feeling of love internally
link |
can blunt the pain experience to a significant degree.
link |
These are not small effects.
link |
So it's not just that love can protect us from pain.
link |
It's that infatuation and obsession
link |
can protect us from pain.
link |
And not surprisingly, how early a relationship is,
link |
how new a relationship is,
link |
directly correlates with people's ability, they showed,
link |
to use this love, this internal representation of love
link |
to blunt the pain response.
link |
So for those of you that have been with your partners
link |
for many years and you love them very much
link |
and you're obsessed with them, terrific.
link |
You have a pre-installed,
link |
well, I suppose it's not pre-installed.
link |
You had to do the work because relationships are work,
link |
but you've got a installed mechanism for blunting pain.
link |
And again, these are not minor effects.
link |
These are major effects.
link |
And it's all going to be through that top-down modulation
link |
that we talked about,
link |
not unlike the mirror box experiments with phantom limb
link |
that relieve phantom pain
link |
or some other top-down modulation.
link |
And the opposite example is the nail through the boot,
link |
which is a visual image that made the person
link |
think it was painful when in fact it was painful,
link |
even though there was no tissue damage.
link |
It was all perceptual.
link |
So the pain system is really subject
link |
to these perceptual influences,
link |
which is remarkable because really,
link |
when we think about the somatosensory system,
link |
it has this cognitive component,
link |
it's got this peripheral component,
link |
but there's another component,
link |
which is the way in which our sensation,
link |
our somatosensory system is woven in
link |
with our autonomic nervous system.
link |
And we're going to get to that next,
link |
but I want to just raise the idea
link |
that the reason that this kind of infatuation
link |
and obsessive love can blunt the pain response
link |
and increase one's threshold for pain
link |
may have to do, I would say almost certainly has to do,
link |
but it hasn't been measured yet with dopamine release,
link |
because dopamine is absolutely the molecule
link |
that's liberated in our brain and body
link |
when there's a new kind of obsession or infatuation,
link |
it's very distinct from the kind of love chemicals,
link |
if you will, I don't even like calling them love chemicals,
link |
that just feels weird,
link |
if this were text, I would delete that line,
link |
but from the chemicals associated with warmth and connection
link |
such as serotonin and oxytocin,
link |
which tend to be for more stable,
link |
long lasting relationships,
link |
dopamine is what dilates the pupils,
link |
which gets people really excited,
link |
they can't stop thinking about somebody,
link |
the text messages are even exciting,
link |
they write to them and they can't wait
link |
for the text message to come back,
link |
the dot, dot, dot on the screen,
link |
the text message is excruciating,
link |
they don't respond for two minutes
link |
and people are getting flipped out,
link |
I'm not here to support that kind of whatever,
link |
what I'm saying is that that obsessive type of love,
link |
which without question is going to be associated
link |
with the dopamine pathway,
link |
does seem to have a utility in the context
link |
of reducing the unpleasantness of physical pain
link |
and probably has a lot to do with reducing
link |
the unpleasantness of a lot of life,
link |
like sitting in traffic, et cetera,
link |
because when we talk about pain,
link |
emotional pain and physical pain
link |
start to become one in the same,
link |
they are so closely intertwined
link |
that the lines between them neurally become very blurry,
link |
what do I mean by that?
link |
Well, if love and infatuation can reduce pain,
link |
presumably through the release of dopamine,
link |
well then does dopamine release itself, blunt pain,
link |
should we be chasing dopamine release
link |
as a way to treat chronic and acute pain?
link |
And that's exactly what we're going to talk about now,
link |
independent of love,
link |
we're going to talk about something quite different,
link |
which is putting needles and electricity
link |
in different parts of the body,
link |
so-called acupuncture,
link |
something that for many people,
link |
it's been viewed as a kind of alternative medicine,
link |
but now there are excellent laboratories
link |
exploring what's called electroacupuncture and acupuncture,
link |
these are big university centers,
link |
in fact, my source for everything I'm about to tell you next
link |
is Professor Chufu Ma at Harvard Medical School
link |
I stand behind the information
link |
that I'm going to provide today,
link |
but it's extracted largely from the Ma lab's papers,
link |
which are very rigorous, variable isolating experiments
link |
to address just how does something like acupuncture work?
link |
And I think what you'll be interested in
link |
and surprised to learn is that it does work,
link |
but sometimes it can exacerbate pain
link |
and sometimes it can relieve pain
link |
and it all does that through very discrete pathways
link |
for which we can really say,
link |
this neuron connects to that neuron,
link |
connects to the adrenals
link |
and we can tie this all back to dopamine
link |
because in the end,
link |
it's the chemicals and neural circuits
link |
that are giving rise to these perceptions
link |
or these experiences rather
link |
of things that we call pain, love, et cetera.
link |
In a previous podcast episode,
link |
I mentioned my experience of visiting an acupuncturist
link |
and getting acupuncture,
link |
the acupuncture itself didn't really do that much for me,
link |
but I wasn't there for any specific reason.
link |
It was gifted to me by somebody and I wanted to try it.
link |
I'm not passing judgment on acupuncture.
link |
In fact, I know a number of people
link |
that really derive tremendous benefit
link |
from acupuncture for pain and for gastrointestinal issues.
link |
There are actually a lot of really good peer reviewed studies
link |
supporting the use of acupuncture
link |
for in particular GI tract issues.
link |
In recent years, there's been an emphasis
link |
on trying to understand the mechanism
link |
of things like acupuncture and acupuncture itself,
link |
not to support acupuncture
link |
or to try to get everybody to do acupuncture,
link |
but as a way to try and understand
link |
how these sorts of practices might actually benefit people
link |
who are experiencing pain or for changing the nervous system
link |
or brain-body relationship in general.
link |
And actually the National Institutes of Health
link |
in the United States now has a entire subdivision,
link |
an institute within the National Institutes of Health,
link |
which is complimentary health.
link |
And that institute is interested in things like acupuncture
link |
and a variety of other practices
link |
that I think 10, 15 years ago,
link |
people probably thought were really alternative
link |
and maybe even counterculture, at least in the States.
link |
And it's exciting.
link |
I think people are starting to really take a look
link |
at what's going on under the hood
link |
for certain types of treatments that are very useful.
link |
And I think it's very likely to lead
link |
to an expanded number of treatments
link |
for a number of different conditions.
link |
What I want to talk about in terms of acupuncture
link |
is the incredible way in which acupuncture illuminates
link |
the crosstalk between the somatosensory system,
link |
our ability to feel stuff externally,
link |
exteroception, internally, interoception,
link |
and how that somatosensory system is wired in with
link |
and communicating with our autonomic nervous system
link |
that regulates our levels of alertness or calmness.
link |
After that, I'm going to talk about how the acupuncture
link |
that's being done right now also points to relief
link |
for what's called referred pain.
link |
So this takes us all back to the homunculus.
link |
Let's start there.
link |
We have this representation of our body surface
link |
That representation is what we call somatotopic.
link |
And what somatotopy is is it just means
link |
that areas of your body that are near one another,
link |
so your thumb and your forefinger, for instance,
link |
are represented by neurons
link |
that are nearby each other in the brain.
link |
Now you might say, well, duh,
link |
but actually it didn't have to be that way.
link |
The neurons that represent the tip of my forefinger
link |
and the neurons that represent my thumb on the same hand
link |
could have been distantly located.
link |
And therefore the map of my body surface,
link |
the homunculus would be really disordered,
link |
but it's not that way.
link |
It's very ordered, it's very smooth.
link |
As let's say you were to image my brain,
link |
if you were to stimulate my finger, my forefinger,
link |
and then march that stimulation across my finger,
link |
across the palm into the nearby thumb,
link |
you would see that neurons in the brain
link |
would also make a sort of J shape
link |
in their pattern of activation.
link |
So that means they're so-called somatotopy,
link |
but the connections from those brain neurons
link |
are sent into the body
link |
and they are synchronized with,
link |
meaning they cross wire with and form synapses
link |
with some of the input from the viscera,
link |
from our guts, from our diaphragm, from our stomach,
link |
from our spleen, from our heart.
link |
Our internal organs are sending information
link |
up to this map in our brain of the body surface,
link |
but it's about internal information,
link |
what we call interoception,
link |
our ability to look inside or imagine inside
link |
and feel what we're feeling inside.
link |
So the way to think about this accurately
link |
is that our representation of ourself
link |
is a representation of our internal workings,
link |
our viscera, our guts, everything inside our skin
link |
and the surface of our skin
link |
and the external world, what we're seeing.
link |
Those three things are always being combined
link |
in a very interesting, complex, but very seamless way.
link |
Acupuncture involves taking needles
link |
and sometimes electricity and or heat as well
link |
and stimulating particular locations on the body.
link |
And through these maps of stimulation
link |
that have been developed over thousands of years,
link |
but now this is a practice that's being done
link |
many places throughout the world,
link |
they have these maps that speak to,
link |
oh, well, if you stimulate this part of the body,
link |
you get this response.
link |
And if somebody has a gastrointestinal issue,
link |
like their guts are moving too quick, they have diarrhea,
link |
you stimulate this area
link |
and it'll slow their gut motility down.
link |
Or if their gut motility is too slow, they're constipated,
link |
you stimulate someplace else and it accelerates it.
link |
And hearing about this, it sounds kind of to a Westerner
link |
who's not thinking about the underlying neural circuitry,
link |
it could sound kind of wacky.
link |
It really sounds like alternative
link |
or even kind of really out there kind of stuff.
link |
But when you look at the neural circuitry, the neuroanatomy,
link |
it really starts to make sense.
link |
And Chufu Ma's lab at Harvard Medical School
link |
is an excellent laboratory,
link |
has been exploring how stimulation of different types,
link |
intense or weak, with heat or without heat
link |
on different parts of the body
link |
can modulate pain and inflammation.
link |
And what they've shown in a particularly exciting study
link |
is that stimulation of the abdomen
link |
anywhere on the midsection weekly does nothing.
link |
That's not very interesting, you might say.
link |
Intense stimulation of the abdomen, however,
link |
with this electroacupuncture has a very strong effect
link |
of increasing inflammation in the body.
link |
And this is important to understand
link |
because it's not just that stimulating the gut does this
link |
because you're activating the gut area,
link |
it activates a particular nerve pathway.
link |
For the aficionados, it's the splenic spinal sympathetic axis
link |
if you really want to know, and it's pro-inflammatory
link |
under most conditions.
link |
However, there are other conditions where if, for instance,
link |
the person is dealing with a particular bacterial infection
link |
that can be beneficial.
link |
And this goes back to a much earlier discussion
link |
that we had on a previous podcast
link |
that we'll revisit again and again,
link |
which is that the stress response
link |
was designed to combat infection.
link |
So it turns out that there are certain patterns
link |
of stimulation on the abdomen
link |
that can actually liberate immune cells
link |
from our immune organs, like our spleen,
link |
and counter infection
link |
through the release of things like adrenaline.
link |
Chufu's lab also showed that stimulation
link |
of the feet and hands can reduce inflammation.
link |
And again, this was done mechanistically.
link |
This was done by blocking certain pathways
link |
with the appropriate control experiments.
link |
This was done not in any kind of subjective way.
link |
This was also done by measuring particular molecules,
link |
IL-6 and cytokines,
link |
and things that are related to the inflammation response.
link |
And what they showed is that the stimulation of the,
link |
in particular, the hind limbs at low intensity
link |
led to increases in the activity of this vagal pathway,
link |
the vagus nerve being this 10th cranial nerve
link |
that serves the kind of rest and digest and parasympathetic,
link |
in other words, calming response.
link |
So what this means is that we are now at the front edge
link |
of this research field that's just,
link |
it's early days still,
link |
but it's discovering that depending on whether or not
link |
the stimulation is intense or mild,
link |
and depending on where the stimulation is done on the body,
link |
you can get very different effects.
link |
So this points to the idea that
link |
you can't say acupuncture good or acupuncture bad.
link |
There has to be a systematic understanding
link |
of what exactly the effect is that you're trying to achieve.
link |
And the underlying basis for this is really relevant
link |
to the thing about adrenaline that I said before,
link |
that in a fight, it's rare that you ever feel pain
link |
I've experienced that, but later it hurts a lot.
link |
It turns out that when you stimulate these pathways
link |
that activate, in particular, the adrenals,
link |
the adrenal gland liberates norepinephrine and epinephrine,
link |
and the brain does as well,
link |
it binds to what are called
link |
the beta-noreadrenergic receptors.
link |
Okay, so this is really getting kind of down into the weeds,
link |
but the beta-noreadrenergic receptors activate the spleen,
link |
which liberates cells that combat infection,
link |
and it's anti-inflammatory.
link |
That's the short-term quick response.
link |
The more intense stimulation of the abdomen and other areas
link |
can be pro-inflammatory
link |
because of the ways that they trigger certain loops
link |
that go back to the brain
link |
and trigger the sort of anxiety pathways,
link |
and that place people into a state of anxiety
link |
that exacerbates pain.
link |
So one pathway stimulates norepinephrine and blunts pain.
link |
The other one doesn't.
link |
What does all this mean?
link |
How are we supposed to put all of this together?
link |
Well, there's a paper
link |
that was published in Nature Medicine in 2014,
link |
this is an excellent journal,
link |
that describes how dopamine
link |
can activate the vagus peripherally,
link |
not dopamine in the brain, peripherally,
link |
and norepinephrine can activate the vagus peripherally
link |
and reduce inflammation.
link |
And I'm not trying to throw a ton of facts at you and say,
link |
well, what am I supposed to do with all this information?
link |
What this means is that there are real maps
link |
of our body surface that when stimulated
link |
communicate with our autonomic nervous system,
link |
the system that controls alertness or calmness,
link |
and thereby releases either molecules
link |
like norepinephrine and dopamine,
link |
which make us more alert as we would be in a fight
link |
and blunt our response to pain,
link |
and they reduce inflammation.
link |
But there are yet other pathways that when stimulated
link |
are pro-inflammatory, and that brings us to the question
link |
of what is all this inflammation stuff
link |
that people are talking about?
link |
One of the things that bothers me so much these days,
link |
and I'm not easily irritated,
link |
but what really bothers me is when people
link |
are talking about inflammation, like inflammation is bad,
link |
inflammation is terrific,
link |
inflammation is the reason why cells
link |
are called to the site of injury to clear it out.
link |
Inflammation is what's going to allow you
link |
to heal from any injury.
link |
Chronic inflammation is bad,
link |
but acute inflammation is absolutely essential.
link |
Remember those kids that we talked about earlier
link |
that have mutations in these receptors for sensing pain,
link |
they never get inflammation,
link |
and that's why their joints literally disintegrate.
link |
It's really horrible
link |
because they don't actually have the inflammation response
link |
because it was never triggered by the pain response.
link |
So inflammation can be very beneficial.
link |
There's a lot of interest nowadays in taking things
link |
and doing things to limit inflammation.
link |
One of the ones that comes up a lot is turmeric.
link |
I'm sure the moment anyone starts talking about inflammation
link |
the question is, what about turmeric?
link |
I have talked before about turmeric elsewhere.
link |
I am very skeptical of turmeric
link |
and I might lose a few friends,
link |
although that'd be weird if my friend,
link |
that would say something about my friendships
link |
if I lost friends over a discussion about turmeric.
link |
turmeric does have anti-inflammatory properties.
link |
There's no question about that.
link |
But as we've just described,
link |
inflammation can be a very good thing,
link |
at least in the short term.
link |
The other thing about turmeric
link |
is there was a study published out of Stanford
link |
in collection with some work from other universities
link |
showing that a lot of turmeric
link |
is heavily contaminated with lead.
link |
The lead is used to get that really rich, dense,
link |
you know, orange coloring to it that everyone wants to see.
link |
So you have to check your sources of turmeric.
link |
The other thing is for men in particular,
link |
turmeric can be very antagonistic to dihydrotestosterone.
link |
Dihydrotestosterone is the more dominant form of androgen
link |
And it's involved in things like aggression and libido
link |
and things of that sort.
link |
Many people that I've talked to who have taken turmeric
link |
get a severe blunting of affect and libido.
link |
So for some people, that might be a serious negative.
link |
I certainly avoid turmeric.
link |
I don't like turmeric for that reason.
link |
I also think that the inflammation response
link |
is a healthy response.
link |
You have to keep it in check.
link |
And we're going to talk about specific practices
link |
for wound, healing, and injury in a moment.
link |
But this idea that just inflammation is bad
link |
and you want to reduce inflammation across the board,
link |
nothing could be further from the truth.
link |
We have pathways that exist in our body
link |
specifically to increase inflammation.
link |
It's the inflammation that goes unchecked,
link |
just like stress, which is problematic
link |
for repair from brain injury
link |
and that can exacerbate certain forms of dementia, et cetera.
link |
But I'd like to create a little bit more nuance
link |
or a lot more nuance if possible
link |
in the conversation around inflammation
link |
because people have just taken this discussion
link |
around inflammation to be this idea
link |
that just inflammation is bad
link |
and nothing could be further from the truth.
link |
Before I continue, I just thought I'd answer a question
link |
that I get a lot, which is what about Wim Hof breathing?
link |
I get asked about this a lot.
link |
Wim Hof, also called AKA the Iceman,
link |
has this breathing that's similar to Tummo breathing
link |
as it was originally called,
link |
involves basically hyperventilating
link |
and then doing some exhales and some breath holds.
link |
A couple of things about that,
link |
it should never be done near water.
link |
People who have done it near water,
link |
unfortunately, have drowned.
link |
It's certainly not for everybody
link |
and I'm not here to either promote it
link |
nor discourage people from doing it.
link |
But I think we should ask ourselves,
link |
what is the net effect of that?
link |
Because a number of people have asked me about it
link |
in relation to pain management.
link |
The effect of doing that kind of breathing,
link |
it's not a mysterious effect,
link |
it liberates adrenaline from the adrenals.
link |
There is a paper published in the proceeds
link |
of the National Academy of Sciences,
link |
which is a very fine journal,
link |
showing that that breathing pattern
link |
can counter infection from endotoxin.
link |
And that's because when you have adrenaline in your system
link |
and when the spleen is very active,
link |
that response is used to counter infection
link |
and stress counters infection.
link |
We'll talk about this more going forward,
link |
but the idea that stress lends itself to infection is false.
link |
Stress counters infection by liberating killer cells
link |
You don't want the stress response
link |
to stay on indefinitely, however.
link |
Things like Wim Hof breathing, like ice baths,
link |
anything that releases adrenaline
link |
will counter the infection.
link |
But you want to regulate the duration
link |
of that adrenaline response.
link |
This should make perfect sense.
link |
We, as a species, had to evolve
link |
under conditions of famine and cold.
link |
Actually, Texas right now is an extreme case
link |
of cold and power outage.
link |
I've seen the pictures and there are a lot of people
link |
out there really suffering.
link |
Their systems are releasing a ton of adrenaline.
link |
Some of them are likely to be hungry.
link |
They're probably stressed.
link |
They're releasing a lot of adrenaline,
link |
which is keeping them safe from infection.
link |
After they get their heat back on and they relax
link |
and they can finally warm up again,
link |
which we would like for them very soon.
link |
Hopefully by the time this podcast comes out,
link |
that will have already happened.
link |
That's typically when people get sick
link |
because the immune response is blunted
link |
as the stress response starts to subside.
link |
So stress, inflammation, countering infection
link |
that comes from endotoxin,
link |
that comes from any number of things,
link |
can be from cold, it can be from hyperventilation,
link |
it can be from a physical threat,
link |
it can be from the stress of an exam or an upcoming surgery.
link |
This adrenaline thing and the inflammation associated
link |
with it is adaptive, it's highly adaptive.
link |
It is a short-term plasticity that is designed
link |
to make us better for what we're experiencing
link |
and challenged with, not worse.
link |
And so hopefully that will add an additional layer
link |
to this whole idea that stress is bad,
link |
inflammation is bad, et cetera.
link |
Again, I'm not suggesting people do
link |
or don't do something like Wim Hof Tummo breathing.
link |
I just want to point to the utility.
link |
It's very similar to the utility from cold showers,
link |
ice baths, and other forms of anything
link |
that increase adrenaline.
link |
Every episode, I want to make sure
link |
that every listener comes away
link |
with as much knowledge as possible,
link |
but also actionable tools.
link |
And today we've talked about a variety of tools,
link |
but I want to center in on a particular sequence of tools
link |
that hopefully you won't need,
link |
but presumably if you're a human being and you're active,
link |
you will need at some point.
link |
It's about managing injury and recovering and healing fast,
link |
or at least as fast as possible.
link |
It includes removing the pain,
link |
it includes getting mobility back
link |
and getting back to a normal life,
link |
whatever that means for you.
link |
I want to emphasize that what I'm about to talk about next
link |
was developed in close consultation with Kelly Starrett,
link |
who many of you probably have heard of before.
link |
Kelly can be found at The Ready State.
link |
He's a formally trained,
link |
so degreed and educated exercise physiologist.
link |
He's a world expert in movement
link |
and tissue rehabilitation, et cetera.
link |
They're not sponsors of the podcast.
link |
Kelly is a friend and a colleague.
link |
He's somebody that I personally trust
link |
and his views on tissue rehabilitation and injury,
link |
I think are really grounded extremely well
link |
in both medicine, physiology,
link |
and the real cutting edge of what's new
link |
and what you might not get in terms of advice
link |
from the typical person.
link |
All that said, you always, always, always
link |
should consult with your physician
link |
before adopting any protocols or removing any protocols.
link |
So I asked Kelly, I made it really simple.
link |
I said, okay, let's say I were to sprain my ankle
link |
or break my arm or injure my knee or ACL tear
link |
or something like that, or shoulder injury.
link |
What are the absolute necessary things to do
link |
regardless of situation?
link |
And what science is this grounded in?
link |
And then I made it a point to go find the studies
link |
that either supported or refuted what he was telling me
link |
because that's why I'm here.
link |
So the first one is a very basic one
link |
that now you have a lot of information to act on,
link |
which is in terms of what we know about tissue rehabilitation
link |
both brain and body, we know that sleep is essential.
link |
And so we both agreed that eight hours minimum
link |
in bed per night is critical.
link |
Now, what was interesting, however,
link |
is that it doesn't have to be eight hours of sleep.
link |
We acknowledge that some of that time
link |
might be challenging to get to sleep,
link |
especially if one is in pain or mobility is limited.
link |
We forget how often we roll over in bed
link |
or how the conditions of our sleeping
link |
can impact those injuries too.
link |
So Kelly acknowledged and I agree
link |
that eight hours of sleep would be ideal,
link |
but if not at least eight hours immobile,
link |
and that speaks to the power
link |
of these non-sleep deep rest protocols too.
link |
If you can't sleep doing non-sleep deep rest protocols,
link |
we've provided links to them before,
link |
we're going to continue to provide links
link |
to the previous ones and new ones are coming soon,
link |
that is extremely beneficial.
link |
So that's a non-negotiable in terms of getting
link |
the foundation for allowing for glymphatic clearance
link |
and tissue clearance, et cetera.
link |
The other is, if possible,
link |
unless it's absolutely excruciating
link |
or you just can't do it, a 10 minute walk per day,
link |
of course, you don't want to exacerbate the injury,
link |
at least a 10 minute walk per day and probably longer.
link |
This is where it gets interesting.
link |
I was taught, I learned that when you injure yourself,
link |
you're supposed to ice something,
link |
you're supposed to put ice on it,
link |
but I didn't realize this,
link |
but when speaking to exercise physiologists
link |
and some physicians,
link |
they said that the ice is really more of a placebo.
link |
It numbs the environment of the injury,
link |
which is not surprising,
link |
and will eliminate the pain for a short while,
link |
but it has some negative effects
link |
that perhaps offset its use.
link |
One, it sludges, it creates sludging within the blood
link |
and other lymphatic tissue.
link |
So it actually can create some like clotting and sludging
link |
of the tissue and fluids, the fascial interface with muscle,
link |
and a number of the stuff
link |
that's supposed to be flowing through there can slow up
link |
and increase inflammation in the wrong way,
link |
can actually restrict movement out of the injury site,
link |
which is bad because you want the macrophages
link |
and the other cell types, phagocytosing,
link |
eating up the debris and injury
link |
and moving it out of there so that it can repair.
link |
So that was surprising to me,
link |
which made me ask, well, then what about heat?
link |
Well, it turns out heat is actually quite beneficial.
link |
A lot of people talk about heat shock proteins
link |
and all these genetic pathways and protein pathways
link |
that can be activated by heat.
link |
Very little data to support the idea
link |
that heat shock proteins are part
link |
of the wound healing process,
link |
at least in terms of the sorts of conventional heat
link |
that one could use like a hot water bottle
link |
or a hot bath or a hot compress.
link |
The major effects seem to be explained
link |
by heat improving the viscosity of the tissues
link |
and the clearance and the perfusion of fluid,
link |
blood, lymph, and other fluids out of the injury area.
link |
So that's really interesting.
link |
I didn't know this.
link |
I thought, well, you're supposed to ice something.
link |
I said, well, whenever I would like see a kid get injured
link |
in soccer, never me, of course, no, of course,
link |
I got injured in soccer from time to time,
link |
they give you an ice pack.
link |
And the ice pack removes some of the pain.
link |
I think the consensus now,
link |
which was surprising to me is that the ice pack
link |
is actually more of the top-down modulation.
link |
You think you're doing something for the pain.
link |
There's some interesting studies
link |
that actually showed the placebo effect of the ice pack.
link |
So ice packs are placebo, perhaps.
link |
That's interesting.
link |
I'll underline perhaps because who knows,
link |
maybe there's some people out there
link |
that are gonna say this is totally crazy
link |
and the ice is actually very beneficial,
link |
but it seems like heat, mobility, sleep, keeping movement.
link |
And it turns out that the movement itself
link |
can act as a bit of an analgesic.
link |
It can actually reduce the pain.
link |
Whereas the ice reduces the pain,
link |
but sludges the tissue and keeps the cells
link |
that need to be removed from leaving the area.
link |
Now, what's also interesting is in neuroscience,
link |
we know that if we wanna kill neurons or silence neurons,
link |
This is a well-known tool in the laboratory.
link |
Some of the early and most important studies in neuroscience
link |
that form the basis for the textbooks
link |
were lowering a cooling probe
link |
into a particular area of the brain or a peripheral nerve
link |
in order to shut down that nerve.
link |
So the cooling will shut down the nerve.
link |
But another very well-known fact
link |
in neuroscience textbooks is that when the activity
link |
of the nerve pathway or neurons comes back,
link |
there's what's called homeostatic plasticity
link |
that it rebounds with greater pain
link |
with a higher level of intensity,
link |
which in the pain system would equate to greater pain.
link |
So regardless of where these neurons are in the body,
link |
if you stimulate a neuron, it's active.
link |
If you cool it, it becomes inactive.
link |
And when the neuron heats back up after being cooled,
link |
it becomes hyperactive.
link |
And so this makes really good sense as to why heat,
link |
provided it's not damaging levels of heat,
link |
would be more beneficial for wound healing
link |
and for reducing pain in the short and long run
link |
than would be cold or ice, which I find very interesting.
link |
Now, in terms of chronic pain, the manuscripts on this,
link |
my discussion with Kelly and with others point to the fact
link |
that chronic pain is basically plasticity gone wrong.
link |
It's sort of like PTSD for the emotional system
link |
and the stress system.
link |
And chronic pain is going to involve a number
link |
of different protocols to rewire both the brain centers
link |
and the peripheral centers associated with chronic pain.
link |
Certain things like fibromyalgia, for instance,
link |
which is whole body pain, relate to too little inhibition.
link |
In the brain, you have excitation and inhibition.
link |
They come from different sources of neurons.
link |
The inhibition is mainly from GABA and glycine
link |
and things like that.
link |
In fibromyalgia, there's too little central
link |
within the brain modulation of the pain responses
link |
so that people experience whole body pain.
link |
So in that case, the emerging therapies
link |
are really interesting.
link |
I have a friend who works
link |
for the National Institutes of Health
link |
who unfortunately suffers from fibromyalgia
link |
who asked me about this a lot.
link |
And his question and what he's now actually exploring
link |
is red light therapy.
link |
Something that I've talked about on various Instagram posts,
link |
red light therapy typically is talked about
link |
in terms of mitochondria.
link |
And the data on that are not so terrific,
link |
at least not really published in blue ribbon journals
link |
in most cases, except for one study that I'm aware of
link |
from Glenn Jeffrey's lab at University College London
link |
showing that red light stimulation to the eyes
link |
in people 40 or older can offset some of the effects
link |
of macular degeneration by improving the health
link |
of the photoreceptors.
link |
People with fibromyalgia, which is this whole body pain
link |
are now starting to use red light therapies.
link |
And I asked Kelly and others and some experts in pain,
link |
what are your thoughts on this red light therapy
link |
for things like fibromyalgia and pain,
link |
especially red light local therapy?
link |
Their idea, and I don't think this is a field
link |
that's progressed far enough now
link |
to really place any firm conclusions on,
link |
but the idea is that red light therapy locally
link |
may have some effect, but the systemic red light therapy,
link |
this is like wearing protection to the eyes in some cases,
link |
so not from the treatment of macular degeneration,
link |
but wearing protection to the eyes
link |
and getting very bright red light therapy,
link |
in many ways may be, to use Kelly's words,
link |
approximating the effects of nature.
link |
These are like surrogate technologies
link |
for getting outside in the sunshine.
link |
When you're in the sun, it might not look red,
link |
but there are a lot of red wavelengths coming toward you.
link |
So the red light therapies may have some utility,
link |
but getting into sunlight
link |
may actually have as much or more effect.
link |
Of course, if these wounds are on a part of the body
link |
that you can't expose,
link |
then you could imagine why the red light therapy
link |
might be good, I don't know,
link |
depending on the neighborhood you live in,
link |
that may or may not be a weird thing to go outside
link |
and expose your body to sunlight.
link |
Probably a number of factors that dictate
link |
whether or not that'd be weird or not,
link |
but that's up to you, not me.
link |
And it seems that, so movement, heat, not ice, light, sleep,
link |
and in some cases, the use,
link |
and I'll talk about this in a moment,
link |
some cases, the use of restricting above and below the injury
link |
to then release and then increase perfusion
link |
through the site, so may actually accelerate
link |
the wound healing.
link |
So all of this might sound just like common sense knowledge,
link |
but to me, at least as a 45-year-old,
link |
I always just thought it's ice, it's non-steroid,
link |
anti-inflammatory drugs,
link |
it's things that block prostaglandin,
link |
so things like aspirin, ibuprofen, acetaminophen,
link |
those things generally work by blocking things
link |
like they're called cox prostaglandin blockers
link |
and things of that sort, things in that pathway.
link |
Those sorts of treatments which reduce inflammation
link |
may not be so great at the beginning
link |
when you want inflammation,
link |
they may be important for limiting pain
link |
so people can be functional at all,
link |
but the things that I talked about today
link |
really are anchored in three principles.
link |
One is that the inflammation response is a good one.
link |
This is what we're learning
link |
from Chufu Ma's lab's work on acupuncture.
link |
The immediate acute inflammation response is good.
link |
It calls to the site of injury,
link |
things that are going to clean up the injury in bad cells.
link |
Then there are going to be things
link |
that are going to improve perfusion
link |
like the glymphatic system, getting deep sleep,
link |
feet elevated, sleeping on one side,
link |
low level zone two cardio three times a week.
link |
Red light perhaps is going to be useful
link |
although sunlight might be just as good
link |
depending on who you talk to.
link |
And we talk about that probably more at length
link |
in a future episode.
link |
A number of people will ask me I'm sure about stem cells
link |
and I don't want to take more of your time
link |
by going into an hour long discussion about stem cells.
link |
Stem cells exist in all of us during development.
link |
We were created from stem cells
link |
which are cells that can become essentially anything.
link |
Later cells get what's called restricted in their lineage.
link |
unless you do some fancy molecular gymnastics to it,
link |
you can't actually turn that cell into a neuron.
link |
Yamanaka won the Nobel Prize
link |
for finding these Yamanaka factors
link |
which you could give a skin cell to turn into a neuron
link |
but that's not an approved therapy at this time.
link |
But many people ask me about platelet rich plasma,
link |
They take blood, they enrich for platelets
link |
and then they re-inject it back into people.
link |
This deserves an entire episode.
link |
It has never been shown whether or not the injection itself
link |
is what's actually creating the effect.
link |
This is something that the acupuncture literature
link |
suffered from for a long time
link |
that the sham control as it's called,
link |
sham we don't mean it's a sham
link |
but in science you say a sham control
link |
meaning you do everything
link |
that exactly the same way you would like.
link |
So for acupuncture,
link |
you would bring the needle right up to the skin
link |
but you wouldn't actually poke it into the skin.
link |
For instance, that would be a sham control.
link |
With a drug treatment,
link |
you would inject a drug into a person
link |
and then the control, the sham control
link |
would be that you would bring the injection over.
link |
You might do the injection or not do the injection
link |
because you imagine that the injection itself
link |
could have an effect.
link |
It's never really been shown whether or not PRP
link |
has effects that are separate
link |
from injecting a volume of fluid into a tissue.
link |
The claims that PRP actually contains stem cells
link |
are very, very feeble.
link |
And when you look at the literature
link |
and you talk to anyone expert in the stem cell field,
link |
they will tell you that the number of stem cells in PRP
link |
is infinitesimally small.
link |
In fact, so much so that these places that inject PRP
link |
for injuries are not allowed to advertise
link |
through the use of the words stem cells.
link |
It's actually illegal at this point.
link |
At least as far as I know,
link |
it was through the end of last year
link |
and I'm guessing it still is now.
link |
Stem cells are an exciting area of technology.
link |
However, there's a clinic down in Florida
link |
that was shut down a couple of years ago
link |
for injecting stem cells harvested from patients
link |
into the eye for macular degeneration.
link |
These were people that were suffering from poor vision
link |
and very shortly after injecting these stem cells
link |
into the eyes, they went completely blind.
link |
So I'm somebody who is very skeptical
link |
of the stem cell treatment work that's out there.
link |
It's actually very hard to get in the United States
link |
for this reason, it's not approved.
link |
The PRP treatments are very complicated.
link |
The marketing around them is shaky at best.
link |
I'm sure a number of people will say that they had PRP
link |
and benefited from it tremendously and I don't doubt that.
link |
Whether or not it was placebo,
link |
today we talked a lot about top-down control.
link |
That's just a variant on the word placebo, belief effects.
link |
Whether or not it was placebo or not, I don't know.
link |
I wasn't there, that's for you to decide.
link |
And I'm not here to tell you
link |
that you should or shouldn't do something,
link |
but I do think that anything involving stem cells,
link |
one should be very cautious of.
link |
You should also be very cautious of anyone
link |
that tells you that PRP is injecting a lot of stem cells.
link |
This is an evolving area
link |
that really needs a lot more work and attention.
link |
The major issue with stem cells that I think is concerning
link |
is that stem cells are cells
link |
that want to become lots of different things,
link |
not just the tissue that you're interested in.
link |
So if you damage your knee
link |
and you inject stem cells into your knee,
link |
you need to molecularly restrict those stem cells
link |
so that they don't become tumor cells, right?
link |
A tumor is a collection of stem cells, right?
link |
So when you get something horrible
link |
like glioblastoma in the brain,
link |
which is a terrible thing to have,
link |
it's glial cells that returned to stemness,
link |
excessive stemness, they've started to produce
link |
too many of themselves.
link |
And glioblastoma is often deadly, not always.
link |
So injecting stem cells, it sounds great,
link |
and it sounds like something that one would want to do,
link |
but one needs to approach this with extreme caution,
link |
even if it's your own blood or stem cells
link |
that you're re-injecting.
link |
I think those technologies are coming, they're on the way.
link |
If any of you are devotees of PRP,
link |
tell me your experiences with them.
link |
I'm curious, I want to see the papers,
link |
I want to know the evidence.
link |
And of course, there are always folks out there that say,
link |
I don't care what the scientists
link |
and the physicians and the FDA say, I just want to do this.
link |
And if that's your stance, that's your stance.
link |
I'm not here to govern that.
link |
But I do think that people should be informed.
link |
And in thinking about tissue recovery and injury,
link |
that's what I was able to glean.
link |
Again, check out what Kelly and his coworkers are doing
link |
at the ReadyState, it's phenomenal.
link |
And they've worked with all the top people in
link |
just about every domain of life it seems,
link |
very high integrity folks.
link |
Some of you are probably saying, well, I'm not injured,
link |
I'm not an athlete, I don't want stem cell injections.
link |
I don't have, again, I think you shouldn't get
link |
stem cell injections for now.
link |
Please hold off until the field learns more
link |
about how to do that safely.
link |
But I want to talk about and end with a really interesting
link |
and somewhat weird technology, which is baby blood.
link |
I have a colleague at Stanford, his name is Tony Weiss Corey.
link |
And in 2014, his laboratory published a study showing
link |
that the blood of young rodents, mice and rats,
link |
when transfused into old demented rodents, mice and rats,
link |
made those old demented rodents recover much of their memory
link |
and seem much more vital and energetic,
link |
better recall of different spatial learning tasks,
link |
tissue and wound healing, they've since shown
link |
can be improved in these older animals.
link |
It's pretty incredible.
link |
They went on to show several years later
link |
that blood from umbilical cords, I'm not making this up,
link |
blood from umbilical cords can do the same.
link |
And this is the basis of a biotech company,
link |
actually one of my former postdocs
link |
is now an employee there.
link |
They've isolated the molecules from young blood
link |
that seems to vitalize or revitalize the old brain
link |
and body and one of those molecules
link |
goes by the name TIMP2, T-I-M-P, two.
link |
Where's all this going?
link |
Well, I don't know how long it's going to be
link |
before there are treatments based
link |
on these blood transfusions.
link |
I doubt that blood transfusions themselves
link |
from young people into old people
link |
is going to be used for the treatment of dementia.
link |
Although it might, as weird as it seems,
link |
we know that transfusions of all sorts of stuff,
link |
for instance, fecal transplants
link |
are being used to treat obesity.
link |
The gut microbiome of thin people
link |
is being not transfused but is being transplanted
link |
into the colons and guts of obese people
link |
and leading to weight loss,
link |
which sounds really wild and is not a topic
link |
I particularly enjoy talking about.
link |
But nonetheless, it points to the importance
link |
of the gut microbiome in regulating things
link |
like blood sugar and health as it relates to obesity
link |
and diabetes and all sorts of things.
link |
So it does appear that there are things,
link |
factors in the blood of young members of a given species
link |
that are lost over time in the older members of that species.
link |
I am not going to give you a tool
link |
on the basis of these findings today.
link |
I am not going to tell you to consume any fluid
link |
from any other member of your species, our species,
link |
But I do think that it's important to mention
link |
that the science is asking questions
link |
such as what are the factors within the brain
link |
that allow the young brain to recover so much better
link |
than the older brain from injury,
link |
from all sorts of things, events, et cetera.
link |
And what are the factors in the older brain
link |
that are limiting?
link |
And thinking about identifying which factors
link |
are going to allow people to restore cognitive function,
link |
physical function, wound healing, and so forth.
link |
It's a really exciting area.
link |
I mention it not to be sensationalist,
link |
but because it's happening
link |
and because there's a lot of excitement about it.
link |
And because I think it's clear
link |
that the young brain and body and blood
link |
are very different from the old brain, body, and blood.
link |
And the goal of science is to identify
link |
and isolate those factors that make that so
link |
such that people who would otherwise get dementia
link |
or perhaps even have dementia will be allowed to recover.
link |
Again, not an actionable item at this point,
link |
but one to think about, perhaps not too long,
link |
but one to think about.
link |
So I'm going to close there.
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I've talked about a lot of tools today.
link |
I've talked a lot about somatosensation,
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about plasticity, about pain, about acupuncture,
link |
some of the nuance of acupuncture, inflammation, stress.
link |
We even talked a little bit about high intensity breathing.
link |
I've talked about restricting limb movement
link |
to get compensatory regrowth of pathways,
link |
or I should say reactivation of pathways
link |
that have been injured or damaged.
link |
So as always, we take kind of a whirlwind tour
link |
through a given topic, lay down some tools as we go.
link |
Hopefully the principles that relate to pain and injury,
link |
but also neuroplasticity in general today
link |
in the context of the somatosensory system
link |
will be of use to all of you.
link |
I don't wish injury on any of you,
link |
but I do hope that you'll take this information to mind
link |
and that you will think about it
link |
if ever you find yourself in a situation
link |
where you have to ask,
link |
what's the difference between my perception
link |
and the actual tissue damage?
link |
Is it injury and pain?
link |
Do I have some control over my experience of pain?
link |
Does all of that involve taking drugs
link |
or doing certain therapeutics?
link |
No, not necessarily.
link |
There's an incredible subjective component.
link |
There also is a need sometimes to treat the injury
link |
at the level of the pain receptors
link |
at the site of the wound.
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So please take the information, do with it what you will.
link |
And in the meantime,
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thank you so much for your time and attention.
link |
Before we go, I just want to remind you
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to please subscribe to the YouTube channel,
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Apple and or Spotify,
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leave us comments and feedback,
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five-star review on Apple.
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If you think we deserve that, please check out our sponsors,
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check out our Patreon, patreon.com slash Andrew Huberman.
link |
if you're interested in the supplements that I take
link |
and you want to try any of those,
link |
you can go to Thorne, T-H-O-R-N-E.com slash U slash Huberman
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and you'll get 20% off any of the supplements listed there
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as well as any others on the Thorne site.
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Once again, thanks so much for your time and attention today
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and as always, thank you for your interest in science.
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I'll see you in the next one.