In Your Pants with Dr. Susie G - The brain, immune system, and chronic pain

Starting point is 00:00:00 Hi friends, it's Dr. Susie G here and welcome to another In Your Pants podcast. On today's show, we are diving deep into the depths of our biology. The more that we learn about the true complexity of our physiology, the better equipped we are to transform our world from the inside out. So sit back, relax, and get ready to have your mind blown. So here's an appetizer of some of the topics that my guests and I cover on today's show. How the brain changes our immunology and how our immunology changes our brain. The role that inflammation plays in chronic pain. How memories, thoughts, our faith and beliefs influence pain and physiology in real time.

Starting point is 00:01:11 The impact of profound emotional responses on our immune response. you know, that mind-body connection, and how a modern society in our modern world, how this hyper lifestyle negatively impacts our health. My guest coins this term molecular surgical techniques, talking about strategies like meditation, mindfulness, talking about life and our experiences, such as in talk therapy, how this resets shapes and forms our immune cells so that they are not so super reactive. We are actually changing things on a nanomolecular scale. Folks, that is really, really, really, really, really tiny. Really tiny. Super deep. Amazing. We touch on why medications are just not cutting it. There are hundreds of molecular on-off switches

Starting point is 00:02:13 and there is no one single drug or combination of drugs that can cover them all. We chat about how deep meaningful conversations are transformative for our physiology, actually changing the structure of our central nervous system. How to embrace complexity of our biology with simple strategies to reset a hypersensitive biological state such as the chronic pain state and we touch on this concept of trust how to build hope and connection because without trust transformation is really really hard and that is evident on our biology and lastly we talk about how professor mark hutchinson became a sheep farmer and his advances in his research of pain neuroscience so if you ask me professor mark is one of the most genius

Starting point is 00:03:25 sheep farmers there is but i guess i'm a little biased but don't just take my word for it let's have a peek into his bio, shall we? Okay, so Professor Hutchinson is the director of the ARC Center of Excellence for Nanoscale Biophotonics, an Australian Research Council future fellow and a professor within the Adelaide Medical School at the University of Adelaide. Mark is also the President of Science and Technology Australia, the peak body in Australia that represents 90,000 scientists. Professor Hutchinson's research explores the other brain or the other 90% of cells in the brain and the spinal cord. These immune-like cells are termed glia. Mark's research has implicated the brain immune-like cells in the action of drugs, of dependence, and the negative

Starting point is 00:04:22 side effects of pain treatments. He has pioneered research which has led to the discovery of novel drug activity at innate immune receptors. His work has enabled the translation of compounds at the lab bench to clinical agents used at the bedside. In his role as the director of the CNBP, he is responsible for the research program of the ARC Center of Excellence with $50 million of funding headquartered at the University of Adelaide with nodes at Macquarie University and UNSW Sydney, the RMIT, Melbourne, and Griffith University. The CNBP is partnered with universities and companies in Europe, the US, and China, as well as other Australian institutions. Professor Hutchinson's work with the CNBP is to discover new approaches to measure

Starting point is 00:05:18 nanoscale dynamic phenomenon in living systems and allow the first minimally invasive real-time visualizations of the other brain in inverted quotes. So, who is ready to get their mind blown? Let's go. Three, two, one. Hi, Mark. Thank you so much for being on the show today with me. Thanks, Susie. Well, we're going to dive right in into neuromunology and chronic pain. And the first question that I have for you is how does the brain change our immunology? And then how does our immunology change our brain? And why is this important? How long have we got? So brain and body are connected. Who knew, right? But yet in reductionist Western Descartes approaches to understand how we work, we like to isolate these parts of our

Starting point is 00:06:23 bodies. We like to investigate just the brain in isolation or just the immunology in isolation. And that's not right. We can't learn about the true complexity of our physiology, the connected mind and body, by doing that. So how does the brain modify the immunology? Well, there's a series of ways that it does that. We have the classic hormonal pathways, neurohormonal pathways that allow for immune control, and those can be things like the HPA axis or our fight and flight response. That's a classic mechanism that was understood for some time that, yes, a stressed or responding individual, an alert individual, will have a modified immune response. But it goes much deeper than that now. We understand that there are discrete neuronal pathways, descending

Starting point is 00:07:14 pathways that are actually innovating our primary and secondary lymphoid organs to actually change how the cells leave those organs and then respond. And so there may be that phrase that some of the listeners might know, venting your spleen, literally that occurs. There is a descending sympathetic parasympathetic drive to the spleen to cause contraction of the splenic muscles that then leads to squeezing out of immune cells, just as an example. But then it goes the other way as well. So our immune system then talks to our brain, and it does that in several ways,

Starting point is 00:07:51 three key ways that are really important to understand. One is the release of inflammatory molecules that we know classically that lead to that classic inflammation of swelling, increased blood vessels, increasing in the leakiness of blood vessels, and of course heat but that doesn't occur in the brain all the time so we're not talking about neuroinflammation here we're just simply talking about changes in immune signaling and that then changes how the immune cells within the brain the glial cells respond and function that then they

Starting point is 00:08:25 talk to and translate that immune signal into the neuronal signal we also have the direct immune to neuronal communication and that's those primary afferents those neuronal bodies in our in our ascending pathways like the vagal nerve for example which is actually sensitive to the peripheral immune system and that communicates up into the brain and probably the most exciting new development in neuroscience in recent times is the acknowledgement that immune cells from our periphery circulate specifically into the brain to change brain function now that's not a breakdown of the blood-brain barrier. That's not a neurodegenerative state. That's a normal brain receiving and accepting cells from the periphery to go in and do stuff. And I'm using stuff in

Starting point is 00:09:10 inverted commas there because we don't understand what they're doing there yet. We don't know really where they're going, who they're talking to, what they're functioning, but they're clearly doing something because if we stop those cells going there, then we fundamentally change the brain states. So we're dealing with an extraordinarily complex scenario here where the brain and body are far more complicated in their relationship between one another than we've ever appreciated. And that brings me to ask you the question about our thoughts and beliefs and the influence on these neurobiological processes. Particularly, there was a paper that you had referenced on religion and beliefs this was the the noi groups master sessions 2021 where

Starting point is 00:09:54 you had brought this paper um to my light here the fmri study measuring analgesia influenced by religion as a belief system uh yeah could you could you enlighten us about that thoughts beliefs and pain and neurobiology so there's a range of papers out there that demonstrate that um you know The most prominent one that I think tells this story best is the work by Alan Prozen. Alan shows a study where the remembrance of a death of a loved one whilst somebody is being imaged in an fMRI study leads to an activation of central nervous system regions as measured by a bold signal from the fMRI. And then within 20 minutes after that event in the magnet, the blood samples are taken

Starting point is 00:10:44 from the individuals and how well the brain responded oh sorry i shouldn't say how well the magnitude with which the brain responded to that recall of the death of a loved one was proportional to the change of the immune system response in the periphery and that demonstrates to us that even within a 20 minute window of a profound emotional response we can then change how our immune systems respond now then you start layering in complex cognitive and mind-body experiences of faith and belief you really do start then having this opportunity for an externalization as it is as it were of of um of control perhaps of and some a belief in something bigger than oneself actually then changing the physiological connectivity and

Starting point is 00:11:37 signaling from the mind to the body to then enable immune system change to occur and some of that work yes there are some papers in and around religious belief there's also a really fascinating new literature around mindful thought and practices like yoga qigong right through to the breathing exercises of wim hof where we are seeing selective activation of discrete pathways which then controls the the immune system response and and the way that I try to get this across is Western society we are really good at exercising the on switches that is we really live a really hyper life we are we are always in that on state we do a terrible job at exercising the off yes and the off is

Starting point is 00:12:30 actually potentially exercisable and so when you think about the immunology we're dealing with a pro system and then let's call it anti but it's it's an anti inflammatory system but that often puts it in that negative connotation it's really a control system and in order to move from pro-inflammatory signaling to anti-inflammatory system the ante needs to be able to turn on and that turning on is not just in the immune cells itself it's also a mind-body connectivity signal that's a descending control pathway. And we don't usually in Western society exercise that off. And some of these practices appear to give the body space and time to

Starting point is 00:13:16 actually enable those offs to turn on to then gain control of the pro-inflammation. Okay. So this is where your quote from last year, you said, Talk therapy is like microsurgery for our nanomolecules. I'm paraphrasing. Yeah, totally. So talk-based therapy is one of the best ways, along with exercise and engaging with complex, diverse microbiological environments out there in the bush, out there in forests. is one of the best ways to intervene across hundreds of molecular signals to start changing our physiology.

Starting point is 00:13:59 So we've done a lot of work in the past and in some brilliant work more recently by Ted Price's group from Dallas. We and he and his group have shown that there are hundreds of molecular switches which are changing to create the exaggerated hyponose-susceptive state. So that is, it's not just a single switch that then suddenly says, oh, you will now have exaggerated pain experience. It's hundreds of switches. If we want to undo those, if we want to reset those switches, a single medicine, a single drug, which targets a single receptor, ain't ever going to touch those 600 switches. So we need to come in with complex solutions for a complex problem.

Starting point is 00:14:46 And it's quite clear now from the evidence in the scientific base is that these practices of talk-based therapies, mindfulness, exercise, through to the complex relationship we have with the microbes in us and in our environment are switching these switches, multitudes of them, in very complex ways. And truly, we are seeing not only molecular changes, but three-dimensional structural changes. And those three-dimensional structural changes we can think of, like our bodies undertaking its own molecular neurosurgery, to rejig the connections, to delete the ones that aren't helpful, and to strengthen the ones that are. to reset the shape, the form of our immune cells within our brain and spinal column so that they aren't super reactive, that they are quiescent and they regain a helpful form rather than a hindering form. And that takes a lot to understand

Starting point is 00:15:49 because we don't understand it yet. For pain consumers, it's really hard for them to expect to be able to understand it if the scientists who are undertaking the work don't understand it. But fundamentally, I think it is helpful to think that talking about life, talking about one's experience and how that benefits the painful responses, behaviors that the body has, it's not just talking about it. It's actually structurally changing things at the nanoscale to a systems level. and you know really therefore I as a white male I encourage my community of white males to say

Starting point is 00:16:34 talking about it is a good thing to encourage people to actually go and have really deep meaningful conversations with professionals about problems and this of course then means encourage women in the community who are experiencing chronic pain as well to do this not just talking about your problem. It's actually changing the structures and functions of the central nervous system. Well, and it's such an interesting point that you're bringing up and very profound because in the field that I work in, which is pelvic pain for men, particularly as my specialty, imagining the stigma, the taboo, the social cultural aspects of even just having the courage to speak a word of what is happening in one's pants you know uh it's it's a scary place

Starting point is 00:17:29 it's very vulnerable for a lot of uh again from speaking from a i i recognize very gender-centric language here but men that i that i work with you know it's i'm glad that you're bringing this up because it is important for people to have the courage to step into these spaces which is literally going to help with your recovery and transformation of these neurobiological processes? Yeah, and from the Australian context, Australian men are not as even forthcoming with discussions about these types of challenges as other countries, and using multiple schemas here and broad brushing it but classically we go down to the pub and have a drink with our mates and talk about our problems there rather than actually speaking to a professional now is there benefit in

Starting point is 00:18:26 that sharing in the pub setting absolutely not saying not do that but i can guarantee that the mates over but beer are not going to be providing the specialist care like yourself suzy to to actually alleviate to to alleviate challenges but also to give additional skill sets to start really in a skilled fashion not over a beer the molecular neurosurgical techniques to actually take regain control of these systems and I think it's so important that we do talk about this and we talk about the talk and we talk about the talk from the perspective of these are real changes that can be enabled in the molecular underpinnings of the hyponosusceptive state it's not just an inverted commas here talk right right and and that definitely takes the edge off

Starting point is 00:19:18 of the traditional i guess concept of well it's if if there isn't something on a scan or something that is physically visible uh with my pain then are you saying it's all in my head and and what you're saying mark is like no well your brain is in your head but there are so many complex parts That's right. And so let's unpack that a bit. So there are no scans today that are able to image what we are dealing with. Now, we need to remember, we've got brilliant scans today, but even an fMRI, that is only looking at the oxygen use within the brain in response to brain activity.

Starting point is 00:20:02 Now, just let me unpack that for a second a bit further, because oxygen concentration changes in the brain will occur when the brain is active in its on sense and when the brain is trying to turn things off, which means the on and the off switch on a bold signal will look identical and we're only getting resolution down to about the millimeter scale and the events that we're talking about are occurring at the millionth of a millimeter. So we need to get a million times better with our brain imaging to actually start to see these molecular consequences. So when we start realizing that, well, of course we can't see these exaggerated states in a brain scan. But then beyond that, we focus on the brain and spinal column where we think a lot of the

Starting point is 00:20:52 hyponosis-ception information, as it were, is getting processed. And yet what we now understand is, that is not the whole story. The mind and body is connected. So if we have a hyponosusceptive peripheral immune system state, then those peripheral immune cells are as important as what's happening at a cellular and molecular level within the brain and spinal column, as is happening out in our peripheral lymphoid organs, which means it is not all in your head. And yet, and yet the key part is, unless we get the molecular and cellular signals within our mind and our body aligned, we will not be able to overcome the hyponosusceptive state. So by talking about things, yes, we are doing things within the neurochemistry and structural activities within our brain, but that is then controlling the descending activation and inhibitory pathways within our peripheral immune system, which then circulates back into our brain in a better state and supports that adaptive change. Right. And you're updating the internal, you know, your internal model, your internal systems, basically.

Starting point is 00:22:01 Totally. And so that goes sort of to what Laura Mimosley talks about with that Bayesian feed forward feedback predictive model. Yes, you can reframe the prediction and error in predictions. And the body does that as well through, let's say you have a hyponose-susceptive central nervous system and the peripheral immune system coming in is more in a lesser hyponose-susceptive state. well the immune system finds a central nervous system that it shouldn't be in and so it's like i've got to fix stuff here and then of course it doesn't necessarily fix it the right way because the central nervous system is in a hyponoseceptive state so you end up with immune cells that leave the central nervous system saying to the rest of the immunology guys we've got a problem here girls come on in we've got to fix this and of course they don't come in in the right fashion and so we think that we unless we set up the appropriate central and peripheral states in the right molecular switched capacity, that prediction at a molecular and cellular level

Starting point is 00:23:02 won't occur properly. And so we end up with this misfiring of our intervention approaches. And for the listeners and viewers there who might not be familiar with the term hypergnosis section that you're using, would you be able to expand on that a little bit? Yeah, sure. So what we experience at a cellular and molecular level when a signal of danger or potential danger from our periphery gets communicated by mechanical or chemical signals into the neuronal systems of our body, these neuronal systems respond with what's termed an action potential, which on the TV you'd see as an electrical impulse through the body. it's not really electrical it's an ionic signal but we'll let cv have a creative license there that is not pain that is only nociception it's only an information at a molecular and an atomic level that the body has not interpreted as painful yet we only experience the painful experience and

Starting point is 00:24:11 emotional and physical response once it's actually computed within our brain it would be kind of like saying that you know in our hard drive of our computers is a brilliant picture right and you look at the usb or the hard drive and go i don't see that picture here because the information hasn't been processed by the the video card and and the the colors of the monitor to give us that information it's only in digital form until the brain interprets that information until the video card and screen interprets that information for us to see that on the screen it means nothing to our physiology it's only nociception when we talk about hyper nociception we're talking about that elevated state so it is possible for information to be processed within our ascending tracks our

Starting point is 00:25:02 ascending neuronal wiring system so that the dimmer switches are turned right up the volumes turned right up so they are they are set on a trigger edge so they respond much more than perhaps they did before and that's where we start to experience the clinical terms of aledinia touch becomes pain that that touch from sunscreen from from sunburn where you just have the cloth touching your skin and oh that hurts um or the hyper the um hyperalgesia where once what was painful really is painful now. And so we try and use those terms to delineate hyponosusception from pain, because when we talk about pain, of course, that's a sensory and an emotional experience. And so when we talk about hyponosusception, we're really only, or I'm only

Starting point is 00:25:56 talking about that sensory component. Until we get to the brain and integrate this information to the expression of pain, we haven't integrated hyponosusception into the sensory component, into the emotional component of the state that we are in. Now, just thinking about this now, Susie, I don't know what the term would be for a hyper-emotional state and those inputs from limbic structures into the sensory experience. I'm going to have to go away and do some homework on that. But again, it's a hyper-emotional state will occur into that computation as well to lead to the exaggerated painful experience. Right, right. Which is why when you have pain in your genitals, it's exponentially heightened from all angles.

Starting point is 00:26:52 All angles, dimensions, and timeframes. And it's so, it's fascinating that we speak of it this way from from the genitals and i would i'd also say the facial area is also quite um critical as well genitals with emotional and highly sensory um innovated region facial region and as well where we have huge amounts of sensory information and distance from face to the the nuclei within our brain is so short. We have slightly longer distances for genital innervation to get to those key sensory regions, but the degree with which the brain dedicates key information to these regions demonstrates how important they are, but also how much processing information is actually undertaken dedicated to those regions. Right, right. And I have a personal story as far

Starting point is 00:27:53 is segueing to just context, but also how our cells remember. Uh, and, and there was a time where I had some really wicked poison Ivy, uh, here in the States. I don't know if you have that in Australia, but, um, silly me did not prepare enough for this landscaping task that, uh, I was about to go on and I got it all over my, on my arm, actually all over. And it, it, it's so bad and it healed and everything was fine but what happens now and this is so interesting and this might not be maybe so interesting for you mark but when i when my my offs um when my ons are on and i'm not able to turn off uh turn off the ons and turn on the offs i itch i get red little um bumps that pop up in the same areas that I had that initial, um, insult with this poison

Starting point is 00:28:55 IV, uh, what, and that could be psychological stress. That could be me not sleeping well. And it's the, the load or you had mentioned this, um, a couple of days ago over the weekend in the master sessions, allostatic load. And I would like for you to, yeah, talk to me about that experience. Yeah. So let me give you my own personal experience. So when I was doing my PhD, I fell off my bike. My pannier bags got caught in the rear wheel and I just literally went over the handlebars. That gave me a back injury. And it took about three years of PT and exercise and

Starting point is 00:29:34 training to get over it. But my lower back, within two days prior to me feeling a cold or flu coming on it seizes up i i can set my clock by it you know it is just so exquisitely loaded up um a few years ago i got um shingles just on the back of the neck uh and again just recently when i got covered the first thing that i noticed that was changing was that the shingles started to um sort of resensitize i didn't get the actual presentation of the shingles it was just the hyponoception sensitivity of that region. Now that's allostatic load. So what I mean by that is our physiology has feedback and feed forward loops. So when we turn our system on, there are natural systems within our physiology which say, oh, we've got something turning on here. I need to now start

Starting point is 00:30:31 turning on the off and the off then turns on and so that then the pro and anti actions then start challenging one another and eventually the anti wins out and turns the pro off and that's that's a normal feed forward feedback system however if we do lots of on switches repeatedly the off gets exhausted and we start to or we start to see multiple other off systems having to come in to work in concert to actually control the on the pro side and so one and one is still equaling two but if we start to look at the number of 0.1 0.2 0.3s that are having to come together to equal that one of the off that's really complicated complicated and so from a molecular standpoint point what we then see is whilst the phenotype of the person the experience of the cellular system

Starting point is 00:31:33 may seem the same from the outside at a macro level when we look at the nano level we see hundreds of systems trying to maintain control now you can imagine if you've got hundreds of systems trying to maintain homeostasis maintain control that's exhausting and of course you're to have what we call molecular non-versation things that shouldn't have had a conversation that should never have occurred right happening because you've got hundreds of systems trying to keep control this increase in the number of systems and the complexity of the control can be thought of as allostasis allostatic load the accumulation of the systems that need to be in place to maintain control. And of course, what happens when you start to have all of these

Starting point is 00:32:23 systems that don't usually work together, their ground truths do not all line up. And so where once upon a time the floor was the baseline, now the tabletop is the baseline. And that's where we see this allostatic load reach. So rather than the response going from the floor up a bit and then back down to the floor now the table is the starting point and we go up to the top of my computer screen monitor and back down to the tabletop and we never the biology never hits the floor again now in some people that then goes right up to the fan ceiling level and we start at the fan ceiling level and we go through the roof and then back down again that's that's where we start to see the complexities of the systems coming in and all of these hundreds of molecular

Starting point is 00:33:13 are switches around which are changing the pain experience of the physiology. A single drug will never undo all of those switches from the ceiling, the fan or the table back down to the floor again and in fact one of the challenges we have in chronic pain, persistent pain individuals is that the expectation that we will ever get back to and here in inverted commas normal or ground zero is really, really hard because the physiological structures have changed. Rather, what we need to do

Starting point is 00:33:52 is we need to simplify for our physiology the systems that are in place to maintain control so that maybe we do now have to expect that our baseline is the tabletop. But what we need to be able to do is with confidence to say, I'm okay with tabletop. I'm not at floor anymore. Aging is a good thing. I'm comfortable with these few wrinkles, but I'm confident that my training, my experience, my talking skills, my thought skills are sufficient that when my baseline moves off the

Starting point is 00:34:26 tabletop and starts going to the ceiling, I know I'm going to be able to bring it down to tabletop because we've gained control over those thoughts and our physiology is able to adapt to that. Beautiful. And that's such a beautiful segue into strategies of if you could share a couple of points for people who might actually listen to this and be overwhelmed a little bit.

Starting point is 00:34:48 This is fascinating. And maybe they're not in the medical field and they're like, okay, this is all great, but how do I work with all of this? This seems really complex. And you've touched on some points in your presentation over the weekend of just keeping it simple.

Starting point is 00:35:05 And I'd love for you to share what that means. Yeah, and so I guess the piece here that we have a lot of vulnerable people who experience persistent pain. And unfortunately, in our communities worldwide, there are people who wish to take advantage of people who are vulnerable. So my first advice is if something says that a single thing is going to cure the problem, it ain't going to cure the problem. It's probably a bunch of rubbish.

Starting point is 00:35:35 And for us, I see those regularly on our talkback radio and on our current affair television programs, which basically frustrates me to no end. So let's put those two aside. Simple things in parallel, done together, are critical here to enable the beginning of the resetting process. So when I think about the classic hyponose-susceptive state, the state that is primed to over-respond in a behavioral way to pain, clearly we're dealing with reactive oxygen species, those reactive molecular processes, there's more likelihood for pro-inflammation, there are structural changes, we aren't thinking in a positive fashion, we're in a negative state. and perhaps because of that we're not interacting with communities that are positive and we're not going outside and enjoying outside. So if we invert that let's look at those each of those key points as areas which it doesn't take much but if we do in concert actually has a molecular neurosurgical consequence. So for example reactive oxygen species what can we do? Well we can eat

Starting point is 00:36:47 well. What do we do when we eat fresh foods? We consume a lot of antioxidants. Why do we have antioxidants in these foods? Plants are really complex things. They can't run away from danger. They have to have loads of defense mechanisms in place. Let's eat their defense mechanisms. Those fresh foods enable us to then scavenge our own danger signals, these reactive oxygen species. If we remove those reactive oxygen species from our environment, that means our immune system is not reactive and being a challenge to our physiology. So that's a good thing to do. There are other things that we can be doing in that reactive oxygen species space. There's some great clinical trials out there from Asia showing that things like hydrogenated water,

Starting point is 00:37:35 having these elevated hydrogen in water appears to then act as a really good scavenging molecule. You don't need to buy a $2,000 home hydrogen water system, and you definitely don't want to buy the alkaline water from the shops, but you can get water molecule splitter systems, you know, 20 bucks off of Amazon, you can do that. And in a controlled fashion, that actually gives you a reactive oxygen species capacity, scavenging capacity. But just like that, simply going for a walk outside can also have this beneficial effect. Now, what does going outside do? Well, one, you're walking, so you're exercising. What's exercising doing?

Starting point is 00:38:18 It's a controlled way to turn on the on that then encourages the offs to get turned on. Boom, great. We've started to do that. That's a molecular surgical tool. When we're outside, we're engaging with our complex environments. Our complex environments have diverse microbial species. So don't just go for a walk on the treadmill inside or down just the sidewalk or, you know, in a concrete jungle. Find some green space.

Starting point is 00:38:45 Engage with that green space. We know now that as we engage with that green space, we breathe in the microbes into our respiratory and our oral gastrointestinal tract that allows for that complex microbial environment to change our gut-brain axis. Boom. Brilliant. Then we have other opportunities about starting to think well. And so thinking well comes from mindful practice, gives our autonomic parasympathetic systems

Starting point is 00:39:16 to rebalance to start engaging properly now i personally do that because i'm a um i'm someone who finds it very difficult to just stay still um what i do is i do an active mindfulness and so i do a lot of wim hof breathing because i find that that gives me something to do and yet it's very centering and doing one thing the breathing practice that then gives me that time and space for my sympathetic parasympathetic system to balance now funnily enough those studies are the medical studies around the wim hof practice has actually shown what do you know by doing those practices when you when those people in those clinical trials were exposed to those two to immune challenges very similar to how we know the brain immune system becomes reactive in pain

Starting point is 00:40:06 the immune systems of those individuals had really powerful off switches and to the extent it was like literally a tenfold difference in the off switch capacity of these individuals just in inverted commas by doing this Wim Hof practice that that's you know that's a truly extraordinary thing that if we can gain a better understanding of how to activate these things we're doing we're doing some great things for our physiology but but just let me finish on the example where it probably doesn't matter which of these things collection of things that you do as long as you come at these activities with a positive mindset because the work that's come out from the the studies from Cox who did the work with the Wim Hof group what they did further

Starting point is 00:40:57 examination of, it was the expectancy of the individuals in the trial as to how well the systems would work to keep control of what's happening was as predictive of the beneficial outcome as anything else. So if I go into these practices thinking, this is good for me, I actually had things happen that is good to me now that's fine but from a molecular standpoint it just demonstrates

Starting point is 00:41:29 the power of how our mind thinks but then gains control of our immunology and our body that then informs what happens to our mind and so expectancy within this enables for that feed forward

Starting point is 00:41:45 beneficial process to occur so I would argue that anybody who's listening here who thinks, well, those first three things are stupid, I won't do those, don't do them then. But gosh, those last two sounded great, then do those two because the expectancy of benefit is the key. And critically, I'm not saying you need to go and spend a grand to do something. But if you do spend a grand to do something, then by golly, expect it to work because otherwise you've wasted your money. right right and then the questions well what if they don't expect anything to work right because they've been in chronic pain for several years and have been frustrated and all these negative

Starting point is 00:42:28 experiences with medical providers and with all sorts of complementary alternative medicines and so forth it's it's what do we do then when the expectations are just so low yeah they're shot Yeah. So for individuals like that, for the clinical teams, family, community around those individuals, the simplest thing to work on would be trust. Simple trust. And it might be as simple as let's do a trust exercise and fall back into arms, right? Do you trust that I'm going to catch you? Do you trust that I'm going to do my best to actually take this forward? If we can introduce just a fraction of trust, just break that hard crust to get the trust in there, that trust then immediately can follow with a tiny, tiny sliver of hope. And as soon as that tiny sliver

Starting point is 00:43:30 of hope is then reinforced and it goes trust and hope and trust and hope and trust and hope builds up suddenly we've got some window of expectancy that if we've got a little bit of hope then there might be something good coming from this now that is not going to be a single session outcome that's going to be a multiple long-term journey to undo the allostatic load of distrust and loss of of uh of connection um you know and this is one of the greatest challenges i think that professionals and clinical teams around the world of faith is that in many cases the people who have no trust who have no um hope have that because they've been done poorly by the professionals and the clinical teams and why you susie as someone coming in as a brilliant professional

Starting point is 00:44:25 You're just the same as all of them. You're just telling me all this stuff. Why should I trust you? And right, sure, you've seen 20, 30, 40 other people who haven't done well by that person. I think, though, that we can say, listen, here, let's go through some education. Here's the molecular surgical evidence that is now coming out.

Starting point is 00:44:48 I understand this is happening for you. We don't have the imaging tools. I completely agree. You've had 20 scans. You've had lots of blood tests. It's not there. That's because we're not dealing with the scale of measurement that we need to, to actually see these challenges. That's where we need to be looking at the nanoscale. And if we can start to unpack that for those people who have been hard done by, who have been suffering for so long, to say nanoscale, that's where it's happening. We need to start at single atomic level events. Now, let's start there. Work with me on this.

Starting point is 00:45:24 Let's see how you go. And let's change a few of these atoms in the right direction. That might give that sliver of hope that then opens up further conversations. And the piece that I think we often do is we try to make things too simple. Let's actually talk about the complexity. because in complexity it actually opens up that the complexity of the problem needs to be met head-on with the complexities of the solutions and only through education of these pathways can we actually then open people's eyes to wow our physiology is amazing gosh it's stupid sometimes

Starting point is 00:46:04 and we get problems like chronic pain but if we could only just gain control of small elements of but huge things can happen. Oh, and on that note, hope and optimism and new research. I mean, I'd love to talk about what you're most excited about, where your team is headed as far as advancing the pain science. Yeah, our work at the moment is focused on two main areas. Firstly, it is to advance our ability to actually have a blood test to quantify pain state. that may sound kind of crazy but but we have really good evidence from hundreds of patients

Starting point is 00:46:49 across men and women of variety of different pain states that because the mind is connected to the body the blood actually has markers of the signals which seem to be changing proportional to the experience of pain in those individuals and at the moment that test takes way too long and so we're trying to make it a test that will give us an answer within five minutes. So within a single doctor's visit or an emergency department presentation, a test can be done to determine the state of the individual. And then from that, precision medicine can then be applied. Precision talk-based therapies can be applied to actually intervene. So that's really exciting in human medicine. But where that then takes us immediately is we can't speak the language of any language

Starting point is 00:47:36 with animals. What if we could take this knowledge from humans to inform the ethical practices of the treatment of animals both in conservation through to food production systems and so I'm now a sheep farmer. I have 140 sheep at the university farm where we've been actually exploring the neurobiological substrates of sheep pain associated with husbandry practices and that's been a fascinating journey for us because we now know that the lambs that are undergoing tail docking for example they experience pain very similar at the molecular and cellular level to what we experience we don't know how they're thinking we can't anthropomorphize we don't want to anthropomorphize to what the animal is thinking but at a cellular molecular level we have a

Starting point is 00:48:25 responsibility to intervene to create ethical protein products for us to consume you know have a good old Aussie barbecue with a couple of lamb chops. We want that, but we want that to be done in as ethical way as possible so that we can say hand on heart, these animals have lived a life worth living. And that's where we're doing a lot of work with Australian farmers to advance that understanding

Starting point is 00:48:51 so we can intervene in the best way possible. But then excitingly, if we can do it in lambs, we can do it in people. So let's start that conversation and really fast-track the human-to-animal and animal-to-human innovations so that we can go from measurements-enabled understanding, understanding-enabled precision interventions that then enable a brilliant outcome for humans and for animals.

Starting point is 00:49:17 Mark, well, you just blew my mind, and I'm sure blew the minds of all the listeners and viewers. This has been such a profound conversation with you and an honour, really, to have this conversation with you to share such insight and wisdom and hope for others that their pain situation can change and a beautiful quote that was the theme over the weekend was that change is inevitable how we change is not and it's just beautiful that you're able to support that with with science modern contemporary science thank you thank you so much thank you yes thank you so if folks

Starting point is 00:49:59 wanted to learn more about your work, connect with you on social media. I don't know if you live there or not. You're so busy, I can imagine. Where can people connect with you? Yeah. So on Twitter, I'm prof underscore Hutchinson. Check me out there. I'm the president of Science and Technology Australia, which is the Australian version of the AAAS. So check out what's happening across science and policy, technology policy in Australia at Science technology australia uh and then yeah check out the center for nanoscale biophotonics for all the other cool technologies that we've implemented for ranging from brain surgery to ivf technologies right through to grading um meat eating quality in the abattoir so yeah check us out at cmbp

Starting point is 00:50:43 thank you so much mark and again to all our listeners thank you so much for being here and loving wellness for your pelvis this is dr suzy g until next time my friends Thanks for listening to today's episode. Be sure to head on over to drcg.com where you can get more information, show notes, and related articles on today's topic. Also, if you like what you're hearing, head on over to iTunes, subscribe to the podcast, and leave us a rating and review. We'd love to hear your feedback. Thanks again.

In Your Pants with Dr. Susie G - The brain, immune system, and chronic pain

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