Stuff You Should Know - How Pain Works

Episode Date: November 17, 2020

In recent decades we’ve come to understand that there’s a lot more to pain than: touch hot stove/feel burning hand. Pain is a far more sophisticated experience and, unfortunately, a system that can often go haywire, with terrible effects. Learn more about your ad-choices at https://www.iheartpodcastnetwork.comSee omnystudio.com/listener for privacy information.

On the podcast, Hey Dude, the 90s called, David Lasher and Christine Taylor, stars of the cult classic show, Hey Dude, bring you back to the days of slip dresses and choker necklaces. We're gonna use Hey Dude as our jumping off point, but we are going to unpack and dive back into the decade of the 90s.

We lived it, and now we're calling on all of our friends to come back and relive it. Listen to Hey Dude, the 90s called on the iHeart radio app, Apple Podcasts, or wherever you get your podcasts. Hey, I'm Lance Bass, host of the new iHeart podcast, Frosted Tips with Lance Bass. Do you ever think to yourself, what advice would Lance Bass

and my favorite boy bands give me in this situation? If you do, you've come to the right place because I'm here to help. And a different hot, sexy teen crush boy bander each week to guide you through life. Tell everybody, ya everybody, about my new podcast and make sure to listen so we'll never, ever have to say. Bye, bye, bye.

Listen to Frosted Tips with Lance Bass on the iHeart radio app, Apple Podcasts, or wherever you listen to podcasts. Welcome to Stuff You Should Know, a production of iHeart radios, How Stuff Works. Hey, and welcome to the podcast. I'm Josh Clark. There's Charles W. Chuck Bryan over there,

and Jerry's out there running around somewhere. We just gave her a hot foot. It was hilarious. And this is Stuff You Should Know. Tried. Our continuing exploration of pain. What else have we talked about with pain? We did one on the pain scales a couple of years ago,

and then we did one on something about perceiving pain. Well, this one, this one, this is just totally Stuff You Should Know then because we did a bunch of more niche stuff and now we're going back and doing the umbrella topic. Right. And we're talking about pain, which is a super ancient, old evolutionary trait,

I guess, that's shared basically throughout all living things. I would say it's a pretty fair guess. Is it? I think so, yeah, because there's something that pain, pain specifically, which is this, we'll get into defining it and how hard that is in a second,

but it seems to be a fairly universal, almost universal process where our body says, hey, there's something really bad going on, say on your hand. So move your hand away from wherever it is in space right now. And hopefully that will help keep it from getting further damaged. Like pain is a signal saying, do something dummy, move.

And it's, I mean, that's, you know, you see it in basically any animal we've ever encountered, including the beaver and the porcupine. That's right. And by the way, we did other people who can't feel pain 10 years ago. Yeah, it actually seems longer ago than that. That's funny, cause I thought pain scales was forever ago

and it was 2017. So I have no sense of time anymore. So we are talking about pain, Chuck. You feel pain, right? Do you have a high pain threshold or are you sensitive? Well, you know, it's funny cause I went back and listened to the pain scales and I kind of chatted about that for a bit,

but I have a pretty high pain threshold. Yeah. Okay. I would say mine's average. Let's just go with that. I wonder what I said in the pain scales up. Cause I, there's no way I didn't respond to your, your thing. You know.

It'll be a mystery. So apparently pain is the most common reason that people go seek medical attention. But when they go seek medical attention as we talked about in the pain scales episode, the whole reason there is such a thing as a pain scale is because it's a fully subjective experience. And it's really difficult to describe.

And it's taken medicine like many, many years to get to a point where they tell the people, their training doctors and nurse practitioners and medical staff, like if somebody tells you they're in pain, they're experiencing pain. You have to take them at their word. And that's actually kind of a new development because there are plenty of times when it appears

that there's absolutely nothing wrong and that the person shouldn't be in pain. And for years, doctors just kind of treated people like that, like kooks and didn't believe them, which was very sad. And now we're finally figuring out their situations where you can be experiencing pain, even though there's no reason for you

to be experiencing pain, which really underscores just how subjective it is. That's right. In 1973, there was an actual definition for pain that was introduced that has a couple of really important caveats that will kind of play out through this episode. Pain is an unpleasant sensory and emotional experience.

There's the first caveat. Associated with actual or potential tissue damage or described in terms of such damage, which is a big caveat there because you can walk into a doctor's office and say, I've got some big time tissue damage doc. I'm experiencing big time pain and they can look you over and be like,

and this guy didn't have any tissue damage at all. Right. So that's in the actual definition of pain. So I think that the reason they caveated that was for the very simple reason that pain can be emotional. And I don't mean like real emotional pain. I mean, a physical pain that is maybe made worse by emotion or brought on by emotion,

or that you really don't have a pain, like you've got a chronic pain, let's say, but nothing's going on under the hood to cause it. Yeah, and we've learned so much about pain since 1973 that I saw that just this past July, the International Association for the Study of Pain updated and revised their definition. It's still basically the same,

but they've included a lot of stuff that we're gonna talk about in this episode. Does it say pain, whatever you say, dude? Right, that's the definition. They said pain is 2020. Yeah, it is so far, at least. There's a bunch of different types of pain though. We're actually not that many, but there's a few.

Acute pain, which is very short lasting if you put your finger on the burner of the stove or something like that or slam it in a window, that's gonna be an acute pain where it's really helpful, so your body's gonna say, wait a minute, that's super hot. Or by the way, dummy, you just put your finger in a window and you immediately have a reaction to stop that immediate acute thing from happening,

even though the pain is gonna still be there. It's not like you slam your finger in the window, yank your thing away and shake it a little bit and it's gone. Right, it can be depending on the level of pain, but it makes sense that it would still linger even in acute pain, which from what I can tell is like the ideal version of pain.

It's like you said, it makes you stop doing whatever you're doing, but the fact that it still hangs around for another minute, it's almost like it's teaching you a lesson. Like not only stop doing that, don't do that again. Yeah, and there's some overlap in these by the way. So when we talk about the next one, no susceptive pain, this comes about from tissue damage,

like real tissue damage by like physical or a chemical agent. We're talking a chemical burn or a trauma or a surgery. This can also include slamming that finger in the window. It can also include, you worked out really hard the day before and you're really sore the next day. Yeah, as long as there's some sort of like mechanical reason or some sort of damage to tissue

or even temporary damage like a sore muscle. And it also includes malignant pain, which is cancer pain, which is where a tumor starts growing in your tissue and presses on nerves and blood vessels and creates pain like that. And no susceptive pain is what most people think of when they think about pain. And it can be both acute and chronic,

but I guess the best way to kind of differentiate no susceptive pain from the rest of it is there is actually something going on that is causing the pain signal to be created. And like I said, it can be short lasting or long lasting. And it's different from a different type of pain appropriately enough called neuropathic pain, whereas no susceptive arises from tissue damage.

Neuropathic arises from damage to the actual nerves themselves. Yeah, like, I don't know if you remember this story from almost a year ago, it was last October when I hit my shin on my bed so hard that water started leaking out of my eyes. I wasn't crying, it was just literally water coming out of my eyes. And I'd never felt pain like that before.

And it was clearly some kind of literal nerve damage because for three or four months, I had like a three inch by three inch square on my shin that was completely numb. Wow. And it's the worst pain, like physical pain I've ever felt in my life. I mean, that would definitely qualify as neuropathic pain.

You clearly messed up the nerves in that little area. And you're lucky that it only lasted three months because apparently neuropathic pain, which can include everything from hitting your shin to banging your funny bone, your elbow, to things like sciatica or even multiple sclerosis. Anytime the neurons in your nerve fibers are damaged, that's neuropathic pain.

And it can last, it can very easily translate from acute pain over to chronic pain, which is pain that lasts six months or longer, which can itself be nociceptive or neuropathic. It can also unfortunately be psychogenic chronic pain can be, which is where you have lasting sustained pain over six months or longer for no good reason whatsoever.

Yeah. And this is, you know, it gets really sort of murky and confusing here. We are not saying that chronic pain is all in your head, but we're saying that in some cases that there is no reason behind you continuing to feel chronic pain. But so many people suffer from chronic pain. I think roughly it kind of varies, you know,

depending on the year, but somewhere in the neighborhood of 20 to 25% of adult Americans suffer chronic pain every single year. And it's, when you hear people talk about that, like I just feel bad for them. I can't imagine what it's like to walk around in constant pain. And it's probably even more frustrating

when a doctor can't trace it to a thing. Like, hey, we fixed that. It shouldn't be hurting anymore. Right. Especially if they're being patronizing and treating you like you're kooky. Well, that's a bad doctor. You should not go. Sure. But again, I mean, like, I feel like people with fibromyalgia or chronic fatigue,

I don't know if you experienced pain with chronic fatigue, but have long been treated like they're nuts, like it's all in their heads just because, you know, science has not been able to identify exactly what the deal is. Yeah. I would say if your doctor is like that, go to a doctor with a little better bedside manner at least. They might be saying the same thing, but they should treat you with respect.

Yeah. And if they're wearing oversized clown shoes, so much the better. That's usually a dead giveaway for a great doctor. That's right. I don't think we said that we talked about nociceptopain, but nociception is taken from the Latin word for hurt. And pain is its own thing, like pain perception. We're talking about what's going on

with the central nervous system and the peripheral central nervous system as well. And how it processes this information is really interesting and still cloudy because the brain is involved. And we've done dozens and dozens of podcasts that involve the brain and at some point during all of them, we usually say something like,

this is kind of their best guess right now because the brain is still such a mystery. Yeah. We have made like advances by leaps and bounds since the sixties when we kind of started to change our understanding of pain and definitely refining it. But one of the things we figured out is that nociception itself is separate

from the experience of pain. It's like the body giving the brain information about something that's going on with your body right now, but it's not pain itself. Pain is the brain responding to that information. And so nociception, as we'll see, is kind of this process where your body detects some sort of noxious stimuli and the nociceptors, your specific kind of little sense receptors

that are tuned to pain, as we'll talk about. They send a signal to your brain saying, hey, there's something going on here. And then in your brain, your brain starts to sort through the whole thing and decides how to respond. So nociception and pain, they're very much intertwined, but they're definitely different things. And we've actually seen that one can exist

without the other. Yeah. I mean, they've done studies that, and I mean, we had to have talked about this and other people that can't feel pain. Right. Congenital analgesia. I don't remember ever saying those words before. I think we had to have.

Sure, there's no way we got it on it. Although knowing us, it's possible we walked around that one. Well, maybe so. But there are studies, including ones on that, people who can't feel pain that have shown that nociception can occur without the experience of pain and pain can be experienced with the absence of nociception. So it's sort of a two-way street.

Yeah, that's like that psychogenic pain where there's no reason for you to be feeling that pain right then, right? Yeah, and because it's the brain, and you put it in here, it's like, it sounds funny, but your brain is what's feeling the pain. Like when you smash that hand in a window, you might think that's your hand feeling the pain,

but technically it's your brain, if that makes sense. Yeah, or even that, like, that hand, that window smashing your hand set off a specific unique kind of signal that transmits a pain signal directly. Your brain, your brain experiences the pain. That's just not quite right. That's actually Rene Descartes' interpretation of it.

And considering, well, considering he was working in the first half of the 1600s, he wasn't that far off the mark, especially considering that before him, the Greeks had thought, basically up to Descartes, everyone had thought, starting with the Greeks, that pain was like a spirit intrusion. It was like something external.

And in fact, our word pain comes from pina, like subpina, which means penalty. So this pain was considered a punishment from the gods. And Descartes was like, no, I think this is an internal process. And he had the broad strokes of it. It's just that he didn't have the details that we have now today.

Yeah, he kind of got, well, he got one half of it pretty right. But I mentioned it was a two-way street. It's a two-way street in a lot of ways. Because what we've learned since Descartes is that we do have pain signals that go up from nerves in the body to the brain to say, hey, I'm hurt.

Those are called ascending signals. But then we also have another signal going, I'm just gonna call it downstream, for lack of a better term, descending signals that come from the brain that can kind of mute the pain or turn off the pain signals. And that's, as we'll see later,

when it comes to medication and stuff, it's sort of managing that two-way, like whatever traffic light is on that two-way street. Yeah, well, that was like a huge thing, Chuck, like to figure out that, wait a minute, like first of all, the experience of pain is totally in the brain, right? Your hand itself isn't actually hurting.

Your brain is what hurts. It just feels like it's coming from your hand. And then secondly, the idea that your brain can influence the experience of pain, that was just revolutionary. And so as a result, we've come to kind of see pain as the brain, there's a neuroscientist named V.S. Ramashandran, who's just brilliant.

And he said that pain, this is paraphrasing him, he said that pain is the brain's opinion of the current state of your health. You got no pain, it's all good. You got pain, your brain is interpreting, there's something wrong with like your hand or your leg or your guts or something like that. And it's just an opinion and the opinion

can be gotten wrong too. Well, you know what they say about opinions. Yeah, everybody's got an elbow of them. All right, I think we should take a break. And we're gonna come back and dive into some hard science right after this. On the podcast, Hey Dude, the 90s called David Lasher and Christine Taylor, stars of the cult classic show, Hey Dude,

bring you back to the days of slip dresses and choker necklaces. We're gonna use Hey Dude as our jumping off point, but we are going to unpack and dive back into the decade of the 90s. We lived it and now we're calling on all of our friends to come back and relive it. It's a podcast packed with interviews, co-stars,

friends and non-stop references to the best decade ever. Do you remember going to Blockbuster? Do you remember Nintendo 64? Do you remember getting Frosted Tips? Was that a cereal? No, it was hair. Do you remember AOL Instant Messenger and the dial-up sound like poltergeist?

So leave a code on your best friend's beeper because you'll wanna be there when the nostalgia starts flowing. Each episode will rival the feeling of taking out the cartridge from your Game Boy, blowing on it and popping it back in as we take you back to the 90s. Listen to Hey Dude, the 90s called on the iHeart radio app, Apple Podcasts,

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or wherever you listen to podcasts. All righty, so your brain has an opinion about the current state of your health. We're still at the stage where we're sort of testing out how pain is generated and how we experience it. But what we kind of think right now is what we mentioned a little bit earlier is that some of the sense receptors located

on the nerve endings are really finely tuned to different kinds of pain, but really tuned to different kinds of thing that might cause pain, like a hot stove or a needle going to your arm. Yeah, and you can pretty much divide them into three categories, mechanical, which is pulling, stretching, tearing, cutting, chemical, which say like exposure to acid or something,

and then thermal, like heat or cold. And the idea that these no-susceptors are capable of being triggered by exposure to those kinds of stimuli from the external world, that that is what kicks off the no-susception process. Yeah, and they're all very different and they have different ways of communicating with the brain.

There are some that do things really, really fast. There are some called A-fibers. They have a little, it's kind of like a little express train instead of having to make stops along the way. It has a fatty myelin sheath that's gonna insulate the electro conduction basically on the wire.

And it really just zaps it there really, really fast. Not a lot of information loss is going on. And that's like that first really intense pain you feel when you burn your hand or when you slam it into the window is kind of what's going on with the A-fibers. Right, and then you've got C-fibers which aren't insulated and they are slower conducting but they also have a bunch of,

they recruit a bunch of them to conduct signals from different parts or different areas to the brain to say, hey, this is actually pretty problematic. We got a real thing going on here. And they account for the follow-up like usually burning, throbbing kind of sensation that can be followed by that first like bolt of pain

that the A-fibers deliver. And then that's from the actual like nociceptors. There's other stuff that happens too. Like if you cut open your hand, those damaged cells, you know, spill their guts. And so like potassium and glutamate and substance, P-starch start like change start firing off like other neurons in the area.

You might have an inflammatory response. So things like histamine show up and they start setting off other nerve fibers too. So it's more than just the, you know, the cut hand nociceptor is telling the brain that something's happening. Like a whole bunch of different responses from the area are going to arrive at the brain

and produce this really complex rich message saying, here's generally what's going on and here's how bad it is. You ever had a bad burn? Yes. Man, those are the worst. They are pretty bad. I don't even remember what happened, but I definitely have burned myself pretty bad.

Yumi has this same spot on her hand that she gets in like the convection of it. Like basically every time it heals, she just re-ups it again. She's always got this little thing on like, I think it's her pinky knuckle on her right hand. And she always like hits the same spot on the, oh man. Every time you get that lady a good glove, a hot mitt.

Yeah, I think by now it's just so callous that she... That's just dead. She fights sailors with it these days just to show it off. Yeah, those burns really linger. And that's like every time I hear of someone or see somebody that has been in a fire and had really, really bad burns over a lot of their body, I just, I can't imagine the lingering pain

that they go through. I know we've talked about this on some episode before, but just those burns, it seems like they hurt forever. Yeah, I mean, you've got exposed nerves fibers to just the air, which as we'll also see, when you undergo a particularly brilliant experience of acute pain, it can be so thorough in its energizing of your nerves

that they actually become sensitized. So like they become more sensitive than they would have before that, which is actually also a problem with chronic pain too. But if you experience burns like that deep over all of your body, not only are you going through the normal pain, you're probably more sensitive now to normal stuff

like air blowing on your exposed nerves than you would have been otherwise. And that just makes it that much worse. Yeah, and then some things that you might think really hurt don't hurt like cuts. I've had cuts before that don't hurt. They might freak you out to look at it and to see like your skin exposed

and some people are really freaked out by the blood. I've had other people I know, I've never broken bones that have had some pretty gnarly injuries like that that said it didn't really hurt that much. Yeah, they're walking around like a skeleton you hang on the door with their arms just flopping back and forth.

It's really interesting how it all works. But it really underscores how the brain can get its opinion of what's wrong with the body based on the pain information wrong sometimes. A lot of times like think about a hangnail. A hangnail is no threat whatsoever to your survival but those things hurt or a paper cut. No one's going to die from a paper cut

but it really, really hurts too. It can be overblown, it can be underblown but it really goes to show like it's the brain taking all this different information together and saying here's how bad I think this is. Yeah, it's pretty cool and painful. So let's say you get hurt. Let's say you slam your hand in the window

like I was talking about, which I think has happened. I don't know why I keep going to that. Got your worst fear? I don't know, I don't think it's ever happened. That better not be your worst fear, that is not that bad. That'd be hard. It's a lot easier to shut your hand in a car door than a window, but-

Oh man, that hurts. Either way, yeah man, I had knock wood. That hasn't happened to me in a long time. Yeah, same here. Every time my daughter shuts the door which I try to let her do whatever she can on her own I'm always just like, don't do it. Do you put oven mitts on her hands first?

No, no nanny stayed at our house. Okay. So you get hurt on your hand, let's say. The signal that is gonna travel, it travels through the, into the gray matter of your spinal cord. And there are gonna be a lot of different connections made with the spinal neurons there.

And it's gonna cover a broad area of the body which is why sometimes if you get hurt, especially if it's like an internal injury, you don't know exactly where the pain's coming from. You might tell your doctor, you just might rub around your whole torso when in fact what's actually hurt is a fairly small area. Yeah, or it could be like a completely different part

of your body or kind of near. It's called referred pain. Like if you're having a heart attack, you usually feel pain in your arm. Yeah, yeah. If you have brain freeze, that's your blood vessels on the roof of your mouth expanding because they're cold.

But you feel it on like your forehead really terribly which doesn't make any sense. So yeah, I think that's from the nerve or the C fiber information where it makes it tough to also figure out where it's coming from. You ever been to a cardiologist? No.

I'm going to one this week. Have you? I'm going to one this week, man. I've known two people in the past like a month that have dropped dead that are like my age. What? One friend of mine from college had been experiencing chest pains and he went to drove himself to the hospital

and like collapsed and died on the way into the hospital. Oh my God. That's terrible. And I haven't been out of touch since college but it really hit me hard to where I was like, you know what? I want to go like just see what's going on in there. That's great.

Yeah. And then get some preventative or not preventative but just some proactive tests done, you know where they see how your arteries are doing because I've got cholesterol issues because of my family history and stuff. Oh yeah. And I don't want it to be one of the things

where they're like, oh well it turns out that, you know, you were 90% clogged this whole time. Right. So I don't care what they say, I'm going to demand those tests. Yeah. I think you probably will have to pay for them out of pocket

but that's not the end of the world if like you have concerns about it. No, I want to know. And if you have genuine concerns, a cardiologist might actually go ahead and prescribe it anyway. Well, I don't have concerns in that I have chest pains or anything but.

Right. But if you have a family history, they may go. Yeah. I just, I want to know what's going on. I'll pay for it. I think that's great. And actually it's funny, like you had suggested we do something like that too.

So maybe we'll see you at the cardiologist's office. Well, I think for women, you can go get heart screenings for women very easily. And I don't know if it's because I thought it was for both and I talked to the lady on the phone, she said, oh, that's only for women. And I guess that's because women are less likely to talk to doctors about their heart

because I think it's maybe generally thought of as something that men experience more. Yeah. Yeah, I guess now that you say that it does seem like more of a man. So I think they're trying to be proactive and saying like, hey, women, you need to think about this stuff too.

So we'll offer like a hundred dollar heart screening or something like that. Gosh, is there anything socialized medicine can't do? So we were talking about those first, those first set of spinal neurons. Then you have secondary neurons that are going to send their signals up through the white matter of the spinal cord.

And this is an express way where all the traffic from all of these lower segments just speed up the spinal cord. Yeah, yeah, which is normal for any kind of sensory information, but the pain information follows the same super highway and it goes through your brainstem, your medulla, and then it synapses again

onto a third set of neurons in your thalamus, which is your brain's relay center. And then from there, things start to get kind of murky. It goes out to different parts of the brain and we'll talk about pain in the brain in a second, but one thing that it does, it was helpful to me to imagine a pain signal as like a pinball when you hit it with the flippers.

Say that's like you're cutting your hand. That pinball goes up and it's going up to the top of the pinball machine, but on the way, it goes through all these other things like these gates that it flips around 360 degrees a bunch of times. Imagine that it's doing that in your brainstem or in the gray matter of your spinal cord.

It's going through all these different things and as it does on its way to that final destination of the brain's somatosensory cortex, it can have effects on the way too. Like if it's bad enough, it may enter what's called a spinal reflex loop where that pain signal doesn't even make it to the brain before part of it gets redirected back down to say your hand

to make your hand jerk away from that hot stove before it even hits your brain. Literally before your brain even knows that there's pain going on, you have a signal going down to your arm to say, move that hand, dummy. Yeah, because if you think about burning your hand, the burn, I mean, it's very fast and very fast succession.

The actual burn, pain burn happens after you've jerked your hand away. Right. And like I said, it's pretty lickety-split, but you jerk that hand away. It's not like you keep it there and you're like, oh my goodness, I feel pain on my hand. Oh my Lord, it's got fire on it.

I should probably move it eventually. Another thing that can happen is pain signals can set off your fight or flight pathways. Oh yeah. As it's going through the medulla, it's been a long time since we talked about fight or flight. Yeah, it's been so long, they added a third one freeze since the last time

we talked about it. It's like an old friend coming back to visit, but bringing a new obnoxious friend with it. Yeah. So it could set that off through the medulla and what happens there is your heart rate's gonna go up, your blood pressure's gonna shoot up, you're gonna start sweating if you're me, rapid breathing,

and it really depends on the intensity of the pain, but it can definitely set off that fight or flight or I guess freeze. And again, all of this is before it even gets to the brain. And then finally, like I said, when it does get to the brain, we're not quite sure what happens there. We know from observations that the brain is definitely

involved and one of the ways that we know this is because you will move your hand. Sometimes it's not an immediate reaction, but sometimes it's a little later. So clearly some of those signals get sent to the motor cortex to say, okay, get that hand out of there. But we also can tell from things like the fact

that if you consciously distract yourself from thinking about the pain with something else, like you remember how Edward Norton in Fight Club, when he had that lie on his hand, he kept trying to think of like a snow covered forest or something. And he went to his happy animal, I think was a penguin. That's right, that's right.

He started to try to concentrate on that. And that, it didn't work then, but it could have worked depending on what other kind of tissue damage was going on. And it really kind of underscores the fact that if you think about something else, your pain may decrease. Well, if the brain has nothing to do with pain or controlling pain,

then that wouldn't happen at all. And so observations like that and some other ones show us that, okay, the brain's definitely involved in this in some way, shape or form. And pain is not just the reception of a pain signal coming from the lower parts of the body up to the brain, but there's also a reciprocal thing like you were saying where the brain descends or there's descending pathways

that the brain uses to say, okay, all right, let's just all chill out down there. Okay, let me figure this out. Everybody just shut up, shut up. I can't think when you're all screaming at me. Yeah, and as those signals are on the way down, there might be those ascending nerve signals going up. And those descending signals could overpower and say,

hold on, you stop right there, buddy. I'm trying to calm this person down. You just stay put. Right. And so there's other things that we figured out that can actually influence your experience of pain. Like to say that it's subjective is just no joke. There's probably no experience more subjective

than the experience of pain. And there's all these different factors that are involved that will have an impact on how much or how little pain you experience, you know? I think improv comedy is the first. That's right. Man, to see good improv is just, it's just so rare, but it's so good when it is good.

Oh yeah, I mean, I've seen a handful in my life that just blew me away and I've seen a bunch more that it's tough to get through. It's like horror movies. Like a truly great horror movie is really tough to beat, but there's a lot of really bad horror movies out there. Yeah, a lot of good ones these days though. We're in a new renaissance.

What you got? Well, I mean, in the past five or six years, I think it follows in the Babadook and... I didn't like the Babadook. Hereditary and I think there's been a bunch of new horror masters. So now this was not a horror movie, but I want to shout out Inola Holmes on Netflix.

Have you seen it? No. It's a coming of age movie about Sherlock Holmes's younger sister. Oh, interesting. And it's super cute, but it's also really smart, like very smart and it takes it for granted that the viewer is smart in paying attention.

It's a really great, great movie. Great movie. I want to check that out. It's Millie Bobby Brown as Inola Holmes. She's just about as charming as they come. Yeah, she's wonderful. I'll check that out. Yeah, not a horror movie,

but definitely worth watching regardless. Is that based on any literature or anything? Or did they just say like, hey, what if he had a little sister? I hadn't thought about it, but I think it's the ladder of the two, which makes it all the more amazing because they did such a great job

of capturing that whole world. Very cool. Yeah. Where are we? Should we take a break? Yeah, why not? Let's take a break and then we'll come back and talk about a few of the factors

that influence your experience of pain. On the podcast, Hey Dude, the 90s called David Lasher and Christine Taylor, stars of the cult classic show Hey Dude, bring you back to the days of slip dresses and choker necklaces. We're going to use Hey Dude as our jumping off point, but we are going to unpack and dive back into the decade of the 90s. We lived it, and now we're calling on all of our friends

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on the iHeart Radio app, Apple Podcasts or wherever you listen to podcasts. I'm Mangesh Atikular. And to be honest, I don't believe in astrology. But from the moment I was born, it's been a part of my life. In India, it's like smoking. You might not smoke, but you're going to get secondhand astrology.

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Apple Podcast, or wherever you get your podcasts. So we were saying before we started talking about Enola Holmes and horror movies that there is a lot of different things that will influence an individual's experience of pain. And it has to do with not just you biologically, but weirdly also you sociologically too. Yeah, and this first one, age, is to me

a little counterintuitive. In some ways, as you age, your brain circuitry is just going to degenerate a little bit. That's just the sad fact of the matter. And if you are one of our seniors, and if you're a senior that's listening, hello, got an email from a lovely 80-year-old lady the other day that just warned my heart.

Oh, yes, she was great. She was great. So if you are one of our senior listeners and you, you might have a lower pain threshold and more problems dealing with pain. This seemed a little counterintuitive because I could also see a case where the neurons don't fire in the correct way such that you could be feeling

something painful and not really realize it. So the way I took it was a little different, that it was almost like, you know how when you form a habit or a memory or something, it's because the neural connection has gone over again and again. So like that pathway is just kind of blazed a little more clearly. My interpretation was that the same can be true with pain

to where once you fire a few times or over and over again, it becomes easier to conduct that pain signal more efficiently. And so that would account for sensitization. That's how I took it. But I, you know, hey, I'm no VS Rama Sham Drawn. There's also gender. And because we're talking about medical research,

they are basically still saying men and women and they're not doing research along the gender spectrum. So having said that, research shows that women have a higher sensitivity to pain than men. Could be maybe psychosocial stuff at work because, you know, men are supposed to not show their pain or not report pain or just suck it up, dude. There could be that at work.

There also could be sex-linked genetic traits or hormonal changes that might change that pain perception. Right, or even the culture you're raised in, like women in Uganda, I read are expected to be stoic in the face of pain, whereas men in Ukraine are expected to not experience pain at all or show any kind of pain whatsoever. So like the idea that culture can affect your interpretation

or how you experience pain is kind of weird if you think about it. It's also weird because I know many, many women who would say, are you kidding me? My husband is the biggest whiny baby every time he gets sick. Right. And I generally suck it up as the wife. It's so Ugandan.

It's so Ugandan. There's also memory. Like if you've experienced pain before, your memory of going through that pain can impact how you experience it a follow-up time too. Yeah, and for both ways, like I used to be really, really, really scared of needles. And I think that was because I went a long time

without getting shots. I think when I was younger and in college, like I wasn't giving blood like I should and I wasn't getting flu shots like I should. But now that I'm a real sentient adult and responsible adult, I have needles in me all the time. And they don't really hurt that bad anymore. So when I go back, I get that initial fear of the needle

because I've always had it, but then my brain tells me, hey, Chuck, it's not that bad, remember? Do you just suck it up and get the shot? My sister-in-law is like a genuine shout-no and run out of the room like needle person, yeah. Needlephobe, that's a great band name. Oh my God. That's pretty good.

That's the best band name in years, Chuck. What kind of band is that? Needlephobe is clearly some sort of metal, maybe new metal if it were gonna be ruined, but there's definitely something in there. Maybe along the lines of like Queen's Reich or something. Yeah, I could see that. Or maybe even like horror metal.

Oh yeah. Like that Norwegian stuff. Sure. Okay, so it's about to get weirder, Chuck. So you're talking about needles. If you look at a needle injected into your arm, it hurts more than if you're not looking. Even if you're thinking about the needle injecting

into your arm, being injected in your arm, just not looking at it makes it hurt less than the studies have shown, which is weird. But in a sense, it also makes sense because you're being provided with additional information about that through your eyes. So your brain has more information than it otherwise would have,

which can actually make it hurt more. Yeah, and I know I've mentioned this. I still gotta look. I used to request a mirror to look at dental work as it was going on. I don't do that anymore. I try and just check out, but I always have to look at the needle.

There's no way. Yeah, same here. I'm like, do it slower. Yeah. You're not a needlephobe. You're a needle, whatever the opposite is. File. That's right.

A needle file. So, and then there's emotions too. And not just, you know, like you were saying earlier, there's something, there's a different thing, psychic pain where you are, your emotions are so overwrought that you actually feel physically uncomfortable or hurt from it.

That's different. Your emotions can actually affect physical pain as well. Yeah, and back when we were trying to understand, and we're still trying to understand this, but why emotions and stuff might influence pain in the 60s, of course, when all this kind of cool research was going on, there were a couple of dudes named Ronald Melzak

and Patrick Wall who threw up a proposal about a gating mechanism existing among the connections in the body sensory pathways that can help determine how you're gonna feel pain and how that works with the brain. Yeah, because so there's the ascending painful pathways and then the descending, let's all just mellow out pathways.

And I don't know if we knew that before Melzak and Wall or if we know it as a result of them, but the current general understanding of pain is this gate control theory where there's stimulation of these pathways going up to the brain. And they have to be of like a certain amount to overcome an inhibitory neuron.

And so if I just like press my arm, I'm sending somatosensory information through those same pain pathways, but the inhibitory neuron that keeps those, the pain projector neurons from firing are not overcome. But if I took a butcher knife and cut that same part of my arm, they would be overcome.

The inhibitory neuron would basically be turned off by the signal, the intensity of the signal and that projector neuron would fire. And now our brains would have that pain signal saying yeah. So in that case, the gate is fully open for business. And when otherwise, when there's no pain, no sensory information, the gate's closed. Or if it's just normal somatosensory information,

the gate's still closed. It's just when it's that intensity of the pain information that the gate flies open. Yeah, and this is interesting because it doesn't explain everything, but it does explain like when you, like if you smash your thumb with a hammer and your reaction is to go and shake your hand really hard

or to suck on it maybe, if you smash your finger with a hammer, it seems like a weird thing to do. I know it is, but it works. It does. That stimulates your normal somatosensory input to those projector neurons and that's gonna help override the projection neurons

that basically kind of close that gate down. Okay, so now that you understand the gate theory of pain, and this is the general understanding among Western science and medicine of pain, this is pretty much the common knowledge now, you can understand how it can go wrong. And so they think that this also explains how you can experience psychogenic pain

where people have fibromyalgia or chronic pelvic pain or tinnitus or TMJ or chronic back pain when there's no reason whatsoever for them to experience this. The really great author and surgeon, Atul Gawande, I believe he writes for The New Yorker. He's also, he writes some books as well. He's one of the best writers out there right now

and he's also a very accomplished surgeon. And he likens that situation to a faulty car sensor where if you have a sensor on your dashboard coming on saying like, hey, you got an engine problem. You go to the mechanic and the mechanic's like, you don't have an engine problem. Eventually they're going to figure out that the problem's with the sensor itself.

And they think that this is because of this gate being open, the sensor is open even though there's nothing tripping it, that that is the problem, that that is what accounts for psychogenic pain. Very interesting, and that makes sense. Yeah, definitely. So when it comes to managing pain,

there are a bunch of different routes you can go depending on what your doctor might recommend, depending on what you as a human, what road you want to go down. And we'll get into these, but these vary from like over-the-counter medications to prescription medications to surgery to go into a massage therapist

or an acupuncture specialist, acupuncturist. But as far as the medications go, you've got a couple of different kinds. You've got your non-opioid analgesic, like this is a Tylenol or an Aleve or an Advil or something like that. And it's going to act at the side of the pain. When you have that damaged tissue,

it releases enzymes that stimulate the pain receptors locally. And what these do is they interfere with those enzymes, they're going to reduce inflammation and hopefully reduce pain. Yeah, which is really interesting because that is your mind saying, this pain is not nothing that my brain needs to worry about.

I'm going to actually go to the site and cancel out those pain signals where they're beginning because I'm judging that they're not that important. Right. It's pretty cool. Yeah, it is cool, but these can have effects on the liver and kidneys if you use them a lot. So, you know, you don't want to pop an Advil every day if you have like back pain, that kind of thing.

Yeah, and then there's opioids, which they actually go to the gate and they can close the gate on the one hand. And then they can also go to your brain and excite the descending pathways, which will bind with like opioid receptors. And of course, those are hugely addictive and have a huge possibility of overdose as well,

but they do help treat pain a lot. Yeah, we should do one of the opioids in the opioid epidemic at some point. I agree, I agree. It's been one of the darker spots of the new era. Yes. The new era? What is that even? The dystopia?

I don't even know. The last 10 or 15 years is what I mean. I call that a new era. The modern era is what I meant. Sure. What else do we have there? You can actually use medicines that aren't meant for treating pain to treat pain

like anti-epileptic drugs. Off-brand stuff. Anti-depressants, anesthetics, they all do things like, they block nerve conduction in some specific area. And so they weren't meant to be treated or used for pain, but they actually can come in handy for things like chronic pain or neuropathic pain.

Yeah, you can also have surgery as kind of a last resort. If you have severe, I've had a couple of friends actually who have had back surgery where let's say you have a herniated disc and that thing is compressing on a nerve as a last resort, they can go in there and maybe remove a little bit of that disc that's hitting that nerve and relieve that pressure.

Yeah, and from what I've seen, yes, that is meant to be a last resort. There's also like cordectomies where they go in and say, we're just gonna snip that gate so that it just doesn't function at all anymore. They make you a super soldier. And then there's also alternative therapies and mental control techniques.

And these work to varying degrees. One of my favorite alternative therapies is the TENS unit, Transcutaneous Electrical Nerve Stimulation. And it sends electrical impulses from the site of pain it's basically like a defibrillator for your pain gate. It's saying your pain gate is open and it shouldn't be open. So we're gonna send some nerve stimulation

in the hopes that we can restart that inhibitory neuron and get it closing that pain gate. Or and or we can make it all the way up to the brain and get the brain's descending pathways kickstarted as well. Is that like when I had a back thing about five years ago where they gave me this electro stimulator thing that I put these little pads on the pain zone? Yeah, and there was like a little handheld thing

about the size of a Game Boy that was connected to you? Not mine, but I'm sure they're all different kinds, but you could basically level the amount of sort of low level shock. And when you turned that thing all the way up, man, it was pretty intense. Yeah, that's a TENS unit. And as a matter of fact, that's based on some

really ancient thinking. Apparently a pre-dynastic Egyptians from like 5,000 years ago used electric catfish from the Nile for the same effect and impact. Wow, that's pretty amazing. Isn't that amazing? Yeah. And then we mentioned going to the chiropractor,

massage therapist. Obviously there are hot compresses and cold compresses. There's acupuncture. There is relaxation and hypnosis. And we've already talked about distraction. If you want to know what you think about hypnosis, we did a pretty good episode on it a while back. So yeah, there are all sorts of mental ways

because they've shown that, oh, I'm blanking out. What do you call the drugs that aren't real drugs? What are the sugar pills? Placebos. Placebos, yeah. Yeah, that placebos have been shown to work sometimes with limiting pain.

Yeah, yeah, I mean, you can trick the brain for sure into not feeling pain, like phantom limb treatment usually, or sometimes involves a mirror, where you put a mirror over the amputated limb that's experienced pain and you move the other limb while you're looking in the mirror. So it looks like your amputated limb is back and you're tricking your brain into being like,

oh, okay, it's there, it's fine. I don't have to experience pain anymore and it actually works. Yeah, but there's a threshold there. Like you can mind over a matter to a certain degree, but as you say in the article, your mind and your brain are two different things. So you can't shut down that gateway just by thinking it away.

No, and there's a real push to believe that over the last few decades, but it's becoming clear you can impact it to some degree, but just not to a full degree. Yeah, and I think the mind over matter is a person, like the pain doesn't go away. You're just able to mentally overcome it such that you're not gonna either show it

or let it get to you or let it affect you. Right, you have actually a lower stress response. And at the same time, it also cuts down on suffering, which is different from the experience of pain. It's like associated with pain and that's like that whole why me thing. And that seems to be fixated on anticipating more pain in the immediate future.

And people who are mindful and meditate can actually cut down and alleviate that suffering. So the experience pain, but it goes away a lot faster and their response to it isn't nearly as pronounced. Right, very interesting. So it does have an effect, you know? Yeah. Chuck, this is a good one, man.

Pain. Pain in the house. And if you wanna know more about pain, well, I'm not even going to suggest what you can do. How about you just go read up on it a little more? And since I said that, it's time for listener mail. I'm just gonna call this the Las Vegas Beavers. Just got done listening to the Beaver podcast,

which by the way, we got a lot of response on that one. Sure. People love their Beavers. Especially baby Beavers. Oh yeah, they're the best. Just wanted to give you a fun little tidbit of information. Chuck said that you can't find, or that you can find Beavers almost everywhere

except the desert, which is somewhat true. They can't live out in the open amongst the cacti, but the sizable population of Beavers in Las Vegas is testament to their ability to survive the heat. There are about 80 to 100 Beavers living in the Clark County wetlands just about 20 to 30 minutes from the strip. That's crazy.

It was a shock when I first heard of this, but I've since taken several trips to see them. Thanks for all the work. Enjoy the show. That's from Josh. Very short and sweet. That's from Josh Eretics. That's a great, great first name.

Great last name, Josh. I love how that email just kind of petered out at the end there. Yeah. So we're gonna, his new name is Josh Peter Eretics. Okay. Great. Thanks for the email, JP.

And if you want to be like JP and send us an email, you can do so. Wrap it up, spank it on the bottom, and send it off to stuffpodcast.ihartradio.com. Stuff You Should Know is a production of I Heart Radio's How Stuff Works. For more podcasts from I Heart Radio, visit the I Heart Radio app.

Apple podcasts are wherever you listen to your favorite shows. Hey Dude, the 90s called David Lasher and Christine Taylor, stars of the cult classic show, Hey Dude, bring you back to the days of slip dresses and choker necklaces. We're gonna use Hey Dude as our jumping off point, but we are going to unpack and dive back

into the decade of the 90s. We lived it, and now we're calling on all of our friends to come back and relive it. Listen to Hey Dude, the 90s called David Lasher and Christine Taylor, stars of the cult classic show, Hey Dude, bring you back to the days of slip dresses to Hey Dude, the 90s called on the I Heart Radio app, Apple podcasts, or wherever you get your podcasts.

Hey, I'm Lance Bass, host of the new I Heart podcast, Frosted Tips with Lance Bass. Do you ever think to yourself, what advice would Lance Bass and my favorite boy bands give me in this situation? If you do, you've come to the right place because I'm here to help. And a different hot, sexy teen crush boy bander each week to guide you through life.

Tell everybody, ya everybody about my new podcast and make sure to listen so we'll never ever have to say bye, bye, bye. Listen to Frosted Tips with Lance Bass on the I Heart Radio app, Apple podcast, or wherever you listen to podcasts.