What If Pain Could Be Made Optional? | The Future With Hannah Fry

Pain Research and a Pain-Free Future

• In the UK, there is a place where scientists are legally allowed to deliberately induce pain in participants to better understand and manage pain, with the goal of potentially mastering it one day (11s).
• Professor Hannah Fry, a mathematician and writer, is exploring how modern science is changing the fundamental understanding of pain and whether a pain-free future could be a reality (42s).

Amy's Journey with CRPS

• Amy Paul, a 30-year-old former primary school teacher, became a TikTok star after creating videos about her life with complex regional pain syndrome (CRPS), a poorly understood neurological condition that causes severe and debilitating pain (1m19s).
• Amy developed CRPS after a medical complication led to a severe infection in her hand, which was diagnosed by her doctor and required surgery (2m2s).
• Amy was prescribed various pain-killing medications, including opioids, but found it difficult to come off them and experienced withdrawal symptoms (2m43s).
• Chronic pain not only affects the individual but also their loved ones, as seen in Amy's case, where her daughter's life was impacted by her mother's constant pain (3m11s).
• Amy uses treatments like hot wax therapy and a neurostimulator machine to cope with her chronic pain, but there is currently no cure (3m57s).
• Amy found solace in creating TikTok videos, which became a form of therapy for her, and she credits her mindset as the biggest factor in making a difference in her life (4m42s).
• Despite being in constant excruciating pain, Amy has found ways to keep going and live her life, with the help of her mindset and the support of her loved ones (4m58s).

The Science of Pain

• Scientists are researching the fundamental mechanisms of pain to understand how it works inside the body, with the goal of finding ways to stop chronic pain that completely ruins a person's life (5m23s).
• When something hurts, it activates pain signaling nerves called nociceptors, which are found all around the body, including in muscles, joints, and just beneath the surface of the skin (5m55s).
• When nociceptors are triggered, a message is sent to the brain, which compiles the signal and creates the perception of pain, taking into account factors such as memories of pain, expectations, attention, and beliefs (6m16s).

The Case of Steve: A Person Who Cannot Feel Pain

• Steve, a person with a rare genetic condition, was found to be unable to feel pain after his parents discovered that he didn't react to a flame being held under his foot as an infant (7m31s).
• Steve's condition is caused by a faulty protein in his neurons, which prevents pain signals from being triggered and sent to the brain (8m20s).
• The discovery of this mutation has opened up possibilities for new treatments for chronic pain, and researchers hope to learn more about pain and how to reproduce the effects of Steve's condition using medicine (8m29s).

Controlling Pain Signals

• Professor David Bennet and his team at the University of Oxford are working towards controlling the protein responsible for pain signaling, with the goal of developing a new approach to managing pain (9m11s).
• However, researchers don't want to eliminate all pain, as some pain perception is necessary to prevent injuries and tissue damage (9m24s).
• A single protein can have a fundamental effect on pain perception, and understanding this can help develop drugs to block that protein and control pain signals (9m47s).
• Researchers can alter the genetic code of a single neuron to stop pain signals, but only when a specific drug is added, essentially allowing them to control the pain signal at will (10m19s).
• This process involves precise microsurgery to insert an electrode into the neuron and record its electrical activity (10m55s).
• When the drug is added, the neuron ceases to fire, and the pain signal is turned off, which can be seen in real-time (11m43s).
• This technique has the potential to be trialed in patients and could lead to the development of a new drug to control the sensation of pain (12m22s).

Mapping Pain in the Brain

• The brain constructs a feeling about a sensation, and there is a whole other section of the pain message getting into the brain that is not being looked at in this research (13m5s).
• Professor Irene Tracy, also known as the "Queen of Pain," has pioneered new ways to study pain perception and has used high-powered MRI scanners to study the brain's response to pain (13m34s).
• Research has shown that the brain's response to pain can be seen in the sensory cortex, with red blobs indicating where the brain has become active in response to a painful stimulus (13m49s).
• Researchers can now map pain as a unique, objective experience by analyzing brain activity, allowing them to understand why people experience pain differently (14m1s).
• The way people rate pain is influenced by a combination of their genetics, upbringing, and the chemical response to a stimulus (14m29s).
• The brain's response to pain can be complex and malleable, as shown by an experiment where a person's brain activity increased when poked in an area outside of where a pain-relieving cream was applied (14m42s).
• The brain has the ability to give more importance to incoming sensory signals, making pain feel worse, and this can be influenced by emotions such as anxiety and depression (15m12s).
• Experiments have shown that changing a person's emotional state, such as making them anxious or happy, can alter their brain's physiology and perception of pain (15m32s).
• A depressed brain can amplify pain signals more than a non-depressed brain, and anxiety can also increase the perception of pain (15m38s).

The Brain's Role in Pain Perception

• Chronic pain patients may benefit from treatments that address the brain's mechanisms, in addition to treating the underlying injury or problem (15m58s).
• A patient with CRPS, a chronic pain condition, has learned to manage her pain by doing things she enjoys and maintaining social connections, which has a mechanistic effect on her brain (16m19s).
• The brain's power to influence pain perception means that patients can work with their brain to reduce pain by harnessing positive networks and emotions (17m3s).
• Western medicine may have been missing something by focusing heavily on pain medication alone, as pain is a complex experience that involves the brain's volume dial, rather than an on/off switch (17m21s).
• Chronic pain is characterized by an overactive brain response that no longer serves the person, and finding ways to turn it down may be key to managing it (17m37s).

Integrating Eastern and Western Approaches to Pain Management

• The practice of using the body's power to master pain has been done for centuries, and many countries today combine modern pain medicine with traditional practices to combat pain (18m10s).
• Singapore's health system uses both eastern and western treatments to combat pain, and Rheumatology Professor Lao Tzu Ching advocates for using both approaches (18m35s).
• In Singapore, some Western doctors are trained in both Western medicine and traditional Chinese medicine, especially in acupuncture, and patients can choose to seek either Western medicine or traditional Chinese medicine (19m11s).
• Traditional Chinese medicine can be beneficial for conditions where Western medicine may not have a diagnosis, and it can help balance the body's different elements (19m35s).
• The placebo effect can play a role in the effectiveness of traditional Chinese medicine, and having faith in the treatment can increase its chances of working (19m59s).
• Professor Lao tries to tailor pain treatments to a patient's individual beliefs and is a firm believer in an open-minded approach to care (20m32s).
• Chronic pain can become emotionally and spiritually intertwined, and an open-minded approach to care can take into account the individual's overall well-being (20m46s).

A Holistic Approach to Pain Management

• Western medicine is moving back towards a holistic approach, but it may need to be systematized in a different way, and it's essential to reflect on what works and what doesn't (21m2s).
• Western medicine may have gotten sidetracked in the past, focusing on physical and pharmaceutical interventions, but it's essential to remember to look at a person as a whole (21m21s).
• The traditional approach to medicine emphasizes the importance of comforting the patient, and many doctors still firmly believe in this approach, but it can get lost in the busyness of modern medicine (21m41s).
• Comfort should be a crucial part of the approach to managing pain, rather than an afterthought, and it is actually possible to relieve and sometimes even cure chronic pain through comfort (22m1s).
• There are alternative methods of coping with chronic pain that have existed for centuries, beyond those typically offered by Western doctors (22m17s).
• The power of the mind can be harnessed to change the perception of pain in the body and improve feelings of well-being, as seen in various approaches such as finding a sense of purpose or alternative medicine (23m2s).
• Nurses, rather than just doctors, can play a significant role in making patients feel better, as they often provide comfort and care that goes beyond medical treatment (22m37s).
• Pharmaceutical interventions are important, but science may have been too skeptical about the powerful idea of harnessing the mind to control pain (23m26s).
• Different people may find different approaches to managing pain effective, such as Amy finding a sense of purpose, highlighting the importance of individualized approaches to pain management (22m49s).