0:00

This message comes from Discover,

0:02

accepted at 99% of places

0:04

that take credit cards nationwide.

0:06

If you don't think so,

0:08

maybe it's time to face

0:10

facts. You're stuck in the

0:12

past. Based on the February

0:14

2024 Nelson Report, more at

0:16

discover.com slash credit card. This

0:18

is the TED Radio Hour. Each

0:21

week, groundbreaking TED Talks. Our job

0:23

now is to dream big. Delivered

0:25

at TED conferences. To bring about the

0:27

future we want to see. Around the

0:29

world. To understand who we are. From

0:32

those talks, we bring you speakers and

0:34

ideas that will surprise you. You just

0:36

don't know what you're going to find.

0:38

Challenge you. We truly have to ask

0:41

ourselves, like, why is it noteworthy? And

0:43

even change you. I literally feel like

0:45

I'm a different person. Yes. Do you

0:48

feel that way? Ideas worth spreading. From

0:50

Ted and NPR. I'm

0:52

Manouche Zamorote. Some kids

0:55

are obsessed with trains, others

0:57

love cooking. And then they're

0:59

the ones who are really

1:01

into horses. I was kind of

1:04

born into it. This is

1:06

Catnod. When I was two

1:08

years old, I actually learned how

1:10

to can't or on a horse

1:12

for the first time. By

1:14

the age of six, Kat

1:16

knew what she wanted to be

1:19

when she grew up. I

1:21

decided I want to go

1:23

to the Olympics for horseback riding

1:25

and represent Canada and my entire

1:27

life has kind of been centered

1:30

around that goal of being an

1:32

Olympic horseback rider. How much of

1:34

your life, your daily life did

1:36

it take up? Like what was

1:38

the whole regimen? Is there a

1:40

percent higher than 100? In her

1:42

20s, Cat was on track to

1:44

make it to the 2016 Olympics

1:46

in a sport called Three Day

1:48

Aventing. So it's got three phases

1:50

over three days. So the dressage

1:52

is kind of like dancing on

1:55

horses. You have like a routine

1:57

you do at certain places in

1:59

a test. The second phase is

2:01

called show jumping. That's what you

2:03

see on TV where they jump

2:05

the big jumps with the rails

2:07

that fall down. And then the

2:09

third phase is cross country. It's

2:12

where you're going over big solid

2:14

jumps that if you hit the

2:16

jumps, you fall down, not the

2:18

jump. They'll have like a six

2:20

foot wide ditch with a wall

2:22

in the back and you have

2:24

to jump all of it at

2:27

the same time or like a

2:29

seven, eight foot drop into water.

2:31

And if you make a mistake,

2:33

there's no forgiving. So there she

2:35

was at the Olympic qualifiers. She

2:37

and her horse sailed through the

2:39

first two events, no problem. I

2:42

was actually in first place heading

2:44

into cross-country, which was my strongest

2:46

phase, and it was my 25th

2:48

birthday. And I was super excited.

2:50

We headed to the start box

2:52

to do our two-minute countdown. There's

2:54

nothing that gets me more excited

2:56

than the last 10 seconds before

2:59

you get to go. And we

3:01

set out on course, my horse

3:03

Jackson and I, the entire course

3:05

flew by in perfect jumps. There

3:07

was not even a misstep to

3:09

a single fence. And we headed

3:11

to home to our very last

3:14

jump when my horse Jackson and

3:16

I saw a completely different distance

3:18

from each other to the fence.

3:20

And he's enormous, so he's 17-3

3:22

hands, which is just under six

3:24

feet where his back is. and

3:26

the last fence was a big

3:29

upright table and he caught the

3:31

front edge of it with his

3:33

knees and we had what's called

3:35

a rotational fall. What I can

3:37

equivalent is to a summer salt

3:39

in the air and he landed

3:41

on top of me on the

3:43

other side and slid 10 feet

3:46

with him on top of me.

3:48

He weighs about 1500 pounds. I

3:50

lost consciousness or a very brief

3:52

amount of time. I

3:54

remember kind of coming back to

3:56

and he'd jumped off of me

3:58

and ran off and... people rushed

4:00

over and they're trying to hold

4:02

you down so you don't get

4:05

up just in case you have

4:07

very severe injuries And all I

4:09

could do is try to flail

4:11

and figure out where my horse

4:13

was and that was my main

4:15

concern is where is he okay?

4:17

Shock kind of takes over an

4:19

adrenaline and adrenaline and then I

4:21

was actually airlifted to the hospital

4:23

in Seattle and from there it

4:25

was a definitely whirlwind a few

4:27

days What in the end did

4:29

they figure out had had happened

4:31

to you? What was damaged in

4:33

your body? So I had broken

4:35

the transverse processes, the wings off

4:37

both sides of my out two,

4:39

three, and four, vertebra in my

4:42

back. I was told if you're

4:44

going to break your back that

4:46

the way that I broke it

4:48

was the best way possible. So

4:50

that's like I guess good to

4:52

do some comfort. When you were

4:54

leaving the hospital, what did your

4:56

doctors tell you to expect? Yeah,

4:58

so they said that I was

5:00

going to be about four months

5:02

till I felt more normalized, like

5:04

I was going to be able

5:06

to do more activity, more walking,

5:08

even think about getting back on

5:10

a horse. It was tough. The

5:12

pain level was something I'd never

5:14

really experienced before. I would hit

5:16

like an unmanageable level of pain

5:19

every single day. When I give

5:21

you the pain scale, like I

5:23

would hit a 10 out of

5:25

10 at some point every day.

5:27

So what keeps you going? Because

5:29

you thought, okay, well, this is

5:31

just temporary. I need to get

5:33

through this, you know, initial period

5:35

and then I'm going to feel

5:37

better. Is that what you were

5:39

thinking? Yeah. So being four months,

5:41

like four months in hindsight is

5:43

not that long. I was just

5:45

trying to grind it out to

5:47

get back to training. I knew

5:49

there was still some qualifiers left

5:51

in the season, so if I

5:53

could recover and get back quick

5:56

enough, I could try to still

5:58

make a run for the... you

6:00

know, being an Olympic athlete

6:02

and I had really

6:04

just expected my body to

6:06

bounce back. When did you

6:08

start to realize that things

6:10

were not going back

6:13

to quote-unquote normal or

6:15

before times? Yeah, so about

6:17

the four-month mark, I was

6:19

really not feeling any better,

6:21

but they said four months, so

6:24

four months to the day I

6:26

got on my horse and the first

6:28

step he took. was instantly

6:31

10 out of 10 pain. I was

6:33

nauseous from pain and I almost

6:35

fell off just because I couldn't

6:38

even breathe. And I knew that there

6:40

was more going on. I knew that

6:42

something had been missed. I knew

6:44

that whatever was happening had not

6:47

healed the way that they were

6:49

kind of expecting it to and

6:51

I had to get instantly off

6:54

and I was crushed. They actually

6:56

found out that my pelvis

6:59

was dislocated and I was

7:01

having stability issues and that's

7:03

actually why I had so much pain

7:06

and I got to the hospital in

7:08

Vancouver and Waited for over

7:10

four hours in a waiting room

7:12

on a hard chair with a

7:14

back that You're thinking any moment

7:17

like what if I sneeze and

7:19

now I'm paralyzed so it was

7:21

quite a scary wait not knowing

7:23

What level of stability would happen

7:25

if I shifted the wrong way?

7:27

Am I going to make it

7:30

worse? When they finally called me

7:32

in to do the check with

7:34

the doctor, I handed him my

7:36

requisition and he didn't even look

7:39

at it. He put it down.

7:41

He didn't examine me.

7:43

He didn't ask me a

7:45

single question about my pain,

7:47

about what I was experiencing,

7:49

about what my doctor had

7:51

said. He lived in and

7:53

he said, what drugs do

7:55

you want? And I was like, no,

7:58

no, I need help. He said, I'm. so

8:00

you can take the drugs

8:02

or you can leave. Yikes.

8:04

And what did you say?

8:06

I left. I wasn't there

8:08

for narcotics. I was there

8:10

for help and support and

8:12

I got none of that

8:14

and it was a really

8:16

disappointing experience and for me

8:18

I'd been kind of holding

8:20

out hope that I was

8:22

going to heal physically and

8:24

to be that dismissed. I'd

8:26

lost hope that day. That

8:28

day was actually the first

8:30

day of the downward spiral

8:32

for me mentally. And a

8:34

couple months after that experience,

8:37

I kind of hit my

8:39

rock bottom of where I

8:41

just couldn't fight through this

8:43

anymore. When you say you

8:45

hit rock bottom, what do

8:47

you mean? I slid into

8:49

like depression quite quickly. And

8:51

I've actually never had experienced

8:53

anything like depression before. And

8:55

until you know, you don't

8:57

know. The pain was intolerable.

8:59

I would dislocate my pelvis

9:01

and fall and be kind

9:03

of stranded. I limped every

9:05

single day. Some days my

9:07

leg almost felt like a

9:09

peg leg, like I had

9:11

to drag it behind me.

9:13

Were you getting treatment at

9:15

that point? I had stopped.

9:17

I had kind of given

9:19

up hope because I had

9:22

tried so many things previous.

9:24

and nothing had really caused

9:26

any significant relief or progression

9:28

of my symptoms. And I've

9:30

been told by several doctors

9:32

that like there's a real

9:34

chance that this is just

9:36

physically your life and you'll

9:38

have to acclimate to it.

9:40

You won't be able to

9:42

walk normally, you will limp,

9:44

you will be in high

9:46

degrees of pain, you will

9:48

have instability in your pelvis

9:50

for life, this is your

9:52

life now. Yeah, it's like

9:54

at 25 when you have

9:56

so much of your life

9:58

ahead of you, it's really

10:00

hard to justify spending the

10:02

rest of your life that

10:04

way. When you're In that

10:06

kind of depth of the

10:09

darkness, you can't see past

10:11

the darkness. You can't see

10:13

little light at the end

10:15

of the time. Well, you're

10:17

not looking for hope. You

10:19

are just alone in the

10:21

dark. In a single moment,

10:23

Cat Nod's life was taken

10:25

over by pain. First acute,

10:27

then chronic. She felt alone,

10:29

confused, and hopeless. Like most

10:31

of us, she'd heard about

10:33

the dangers of opioids. Roughly

10:35

80,000 Americans a year are

10:37

dying from opioid overdoses. And

10:39

the opioid epidemic has morphed

10:41

over the years well beyond

10:43

a pain pill problem. But

10:45

we don't hear much about

10:47

other options for coping with

10:49

pain. So what do we

10:51

need to know about the

10:53

next chapter in Pain Relief?

10:56

Today on the show... new

10:58

understandings about how the brain

11:00

interprets pain and what we

11:02

can do to manage pain

11:04

in the short and long

11:06

term. Later in the show,

11:08

we'll hear more from Catnod.

11:10

But first, please meet pain

11:12

expert Dr. Amy Baxter. When

11:14

you live with chronic pain,

11:16

it is really easy for

11:18

it to take over and

11:20

define who you are. Amy

11:22

says that in the 30

11:24

years she's been studying and

11:26

developing methods to treat pain

11:28

She has heard all sorts

11:30

of preconceived notions related to

11:32

it Talking about pain is

11:34

so nuanced and loaded in

11:36

our society Because we're supposed

11:38

to be tough and we're

11:41

supposed to deal with pain

11:43

And also because we are

11:45

a society that fears aging,

11:47

and pain means decrepitude, never

11:49

doing the things that make

11:51

you you, and even a

11:53

little bit of pain carries

11:55

extra meaning, because it means

11:57

that both you're weak and

11:59

you may not get over

12:01

being weak. Amy suggests. we

12:03

put all those judgments aside

12:05

because pain affects everyone differently.

12:07

And as we'll explain later,

12:09

how the brain processes pain

12:11

can be confusing. But, she

12:13

says, we need to remember

12:15

one key thing about it. Pain

12:17

is a survival system that serves

12:20

us, and when it ceases to

12:22

serve us, then we can choose

12:25

to ignore it. We don't have

12:27

to let it rule us.

12:29

That is the most important

12:31

paradigm shift for dealing with

12:34

both acute pain and chronic

12:36

pain. But the thing about pain

12:38

is there isn't one answer.

12:41

It is a giant different

12:43

complex beast to every different

12:45

person. And so we in

12:47

the medical profession are used

12:50

to one right answer and

12:52

treating it as one thing.

12:54

It just isn't. In

12:57

a minute, Amy talks us through

12:59

the past, present, and future

13:01

of pain management. On the

13:04

show today, rethinking ideas about

13:06

pain. I'm Manusha Zamorote, and

13:08

you're listening to the TED

13:10

Radio Hour from NPR. We'll

13:13

be right back. This

13:30

message comes from Charles Schwab. When it

13:33

comes to managing your wealth, Schwab gives

13:35

you more choices, like full service wealth

13:37

management and advice when you need it.

13:39

You can also invest on your own

13:41

and trade on Think or Swim. Visit

13:44

schwab.com to learn more. This message

13:46

is from NPR sponsor Spectrum Business.

13:48

From one employee to thousands, Spectrum

13:50

delivers connectivity solutions at a great

13:53

value for any size business. And

13:55

it's all backed by the Spectrum

13:57

Commitment. Learn more at spectrum.com slash

14:00

business. This message

14:02

comes from Charles Schwab. When it comes

14:04

to managing your wealth, Schwab gives you

14:06

more choices, like full service wealth management

14:08

and advice when you need it. You

14:11

can also invest on your own and

14:13

trade on Think or Swim. Visit schwab.com

14:15

to learn more. farm.

14:20

As a state farm agent and

14:22

agency owner, Lakisha Gaines is passionate

14:24

about empowering other small businesses. In

14:26

the last several years, there are

14:28

more business owners than we can

14:31

count. Businesses are opening up quite

14:33

frequently, and I think that shows

14:35

the need, the dreams, and the

14:37

desires of the community to have

14:39

the independence and to have the

14:41

financial freedom that's important to them. The

14:44

reason why it's so important to me

14:46

to be out there to share information

14:48

and to educate the hate the community is because I

14:50

know that a dream doesn't always

14:52

help you to be successful. You need

14:54

the competency, you need the wisdom, you

14:57

need the knowledge. That's where we come

14:59

in as state farm agents. Our ability

15:01

to be able to teach over 100

15:03

years of experience in this world to

15:05

say, hey, we got you. You got

15:07

this and we got this. Let's do

15:09

it together. Talk to your local

15:11

agent about small business insurance from

15:13

State Farm. Like a good neighbor,

15:15

State Farm is there. Hey,

15:18

before we get back to the

15:20

show, I want to tell you

15:23

about our next bonus episode for

15:25

TED Radio Hour Plus. We are

15:27

catching up with Ryan Phelan, head

15:29

of Revive and Restore. This is

15:32

a nonprofit that uses the latest

15:34

technology in gene editing and cloning

15:36

to try and save species from

15:38

extinction. Ryan tells us about their

15:40

new project, which is working with

15:43

the US Fish and Wildlife Service

15:45

to build a genomic library. preserving

15:47

DNA from all of the country's

15:49

endangered species. It's pretty wild. That

15:52

conversation is coming on Thursday. Not

15:54

a plus supporter yet. Please join

15:56

your fellow listeners for bonus

15:58

content, and all

16:01

our episodes sponsor

16:03

-free. Go to plus

16:05

.npr .org/Ted, or give it

16:07

a try right in the

16:09

Apple Podcasts app. And

16:11

thanks. It's

16:14

the Ted Radio Hour from

16:16

NPR. I'm Manush Zamorodi. On

16:18

the show today, pain relief.

16:20

How to rethink and deal

16:22

with physical pain. And a

16:24

warning, some of this episode

16:26

touches on addiction and a

16:28

drug overdose. We were just

16:30

talking to physician and pain

16:32

expert Amy Baxter. Amy says

16:35

our ideas about how to

16:37

treat pain often start at

16:39

a young age. We

16:41

start early with children saying, oh you bumped

16:43

your this, oh you have a fever, let

16:45

me give you a pill. We

16:47

really are telling each other that a

16:49

pill is the way to solve a

16:52

problem and that isn't going to work

16:54

when that is part of your survival system. You

16:56

can't shut it down with a pill. Amy

16:59

believes that we need to teach

17:01

or be taught to see pain

17:03

as a messenger and listen closely

17:05

to what it tells us rather

17:07

than fear it. But

17:09

this is not what Amy

17:11

learned back in medical school 30

17:13

years ago. In medical school,

17:16

pain was a lot less important than

17:18

diagnosing and treating whatever was causing

17:20

it. We didn't actually talk much

17:22

about what the nature of pain

17:24

was. It was this amorphous bad

17:26

thing. But as a doctor, it's

17:28

kind of like pain happens. Amy

17:31

did her residency and she specialized

17:34

in pediatric medicine. And as

17:36

a young budding physician, she found

17:38

this approach hard to swallow.

17:40

So one of the hardest things

17:42

about being a doctor is

17:44

quelling down your empathy because it

17:46

can get in the way

17:49

of the diagnosis or the management

17:51

that you need to be

17:53

responsible for making sure happens. But

17:55

then the theory of putting a

17:58

side pain to get a diagnosis faded

18:00

away. It was the mid-90s

18:02

and a new approach was

18:04

being offered by pharmaceutical companies.

18:06

Doctors could be pain advocates

18:09

for their patients, thanks to

18:11

a new line of pain

18:13

relief medications. That

18:15

was when I first heard

18:17

the concept of pain-free. At

18:20

the time it sounds great, you know,

18:22

why wouldn't you want that for your

18:24

patients? We even had buttons that said

18:26

pain-free on them, and all of us

18:28

who were pain advocates wore them on

18:31

our white coats. You know, it's like,

18:33

pain-free, I am going to get you

18:35

to pain-free, and what's not the love

18:37

about being pain-free? Amy remembers the

18:40

first time she got the opioid

18:42

pitch. Here she is on the TED

18:44

stage. The only pain lecture I

18:46

remember from the 90s was

18:48

in a dark room like

18:50

this, after being awake for

18:52

30 hours and hungry, finding

18:54

out our noon lecture was

18:57

sponsored by OxyContin. We got

18:59

pens, we got great lasagna,

19:01

and they had very cool

19:03

slides that showed pain stopped

19:05

by opioids. And we learned

19:08

that home opioids aren't addictive,

19:10

and if you stay ahead

19:12

of pain, you can keep

19:14

your patients pain free. But

19:16

we've all heard how the story of

19:18

opioids and addiction has gone.

19:21

Patients became customers, and

19:23

so you were supposed to respond

19:25

to what a patient wanted, and

19:27

if they had pain, you needed

19:29

to both measure it and address

19:31

it. And I realized that part

19:33

of what Purdue did was suborn

19:35

the message of care and make

19:37

it a message of a prescription.

19:40

You know, I care about you, I'm going to

19:42

give you the good stuff, I care about

19:44

you, I am going to make it so

19:46

you don't hurt it all." And beyond

19:48

the obviously egregious marketing, I

19:50

think it was framing pain-free

19:53

as the goal that has

19:55

destroyed countless lives. My friend's

19:57

son, Christopher, started having...

19:59

severe abdominal pain during this

20:02

no-pane era. Eventually, he was diagnosed

20:04

with a colon disease and had

20:06

surgery his senior year. They sent

20:09

Christopher home with 90 oxygen and

20:11

then 90 more, and then as

20:13

the pain started getting faster and

20:16

faster, uncontrolled pain is terrifying. So

20:18

when his ran out and his

20:21

friend's medicine cabinets ran out, Christopher

20:23

tried heroin. And Christopher Wolfe lost

20:25

his battle with substance use at

20:28

age 32. Christopher got 90 OxyContin

20:30

for a stomach surgery. We would

20:32

never do that now, but I

20:35

was in the generation that if

20:37

I had taken care of Christopher,

20:40

I would have written for that.

20:42

It's just what you did. Hmm.

20:44

Doctors... trained when I was in

20:47

the 90s, believed that there was

20:49

no amount of pills you could

20:51

give someone that would cause a

20:54

problem if they had, quote, real

20:56

pain. So it turned out that

20:58

the promise that OxyContin was less

21:01

addictive wasn't true. Purdue Pharma pleaded

21:03

guilty to federal crimes for false

21:06

marketing. Yeah. But here we are

21:08

with researchers saying that more than

21:10

two million Americans now have some

21:13

degree of opioid addiction. Can you

21:15

just explain what these drugs do?

21:17

What is it that happens in

21:20

our brain that makes us feel

21:22

better? Yeah. At least at first.

21:25

Yeah. What we didn't know is

21:27

that taking opioids actually increases your

21:29

sensitivity to pain because you're used

21:32

to feeling so rewarded that you

21:34

don't notice it. So, dopamine, which

21:36

is what opioids... address, dopamine makes

21:39

you feel like you're winning and

21:41

you're so rewarded that you don't

21:43

care if you're feeling pain because

21:46

you just feel great. And if

21:48

it's a really excruciating pain, opioids

21:51

are the best thing we found.

21:53

to hardcore trigger the dopamine response

21:55

that makes you feel rewarded. So

21:58

it's great for the first couple

22:00

of days and the first 24

22:02

hours after a burn or trauma,

22:05

the more opioids, the less post-traumatic

22:07

stress, etc. But because your brain

22:10

is constantly adapting, what ends up

22:12

happening is after about 72 hours,

22:14

you're New receptors, you're dopamine, I

22:17

feel great receptors, have actually hidden

22:19

inside cells. And that's about when

22:21

you go home and you're taking

22:24

an oral pill that is not

22:26

nearly as potent as what you

22:28

were getting through your IV. And

22:31

now you're just getting the risk

22:33

in the side effects. What is

22:36

actually happening that some of us

22:38

feel awful on percocet or other

22:40

narcotic drugs and other people can't

22:43

get enough of them? If you've

22:45

ever been in a Mexican restaurant

22:47

and somebody at your table says,

22:50

I cannot abide cilantro, it tastes

22:52

like soap. And you're like, are

22:55

you kidding me? cilantro is great.

22:57

That's what's going on with opioids.

22:59

A percentage of the population get

23:02

opioids and their taste of it

23:04

is completely different. So they don't

23:06

process dopamine in the same way.

23:09

They don't get as much. Great

23:11

taste from the kind of dopamine

23:13

mastery or novelty or you know

23:16

excitement or winning They're not getting

23:18

that as much when they get

23:21

an opioid. Oh, yeah, they get

23:23

it. Huh and that can be

23:25

exacerbated by a bad situation So

23:28

the right circumstances with the wrong

23:30

genes is a dangerous combo. Yes,

23:32

even though even the good circumstance

23:35

with the wrong genes three days

23:37

or more is when the risk

23:40

starts increasing of being dependent So

23:42

it's not necessarily the... no matter

23:44

how it makes you feel whether

23:47

you love it or hate it,

23:49

regarding pain, it doesn't actually necessarily

23:51

do the job that we've thought

23:54

it? Does? Yeah, I think this

23:56

really gets to the nature of

23:58

pain. What is the job that

24:01

we want opioids to do and

24:03

what exactly is pain? As I

24:06

started unpacking the nature of what

24:08

Purdue Pharma had taught me, I

24:10

realized I believed and I think

24:13

many believed that pain was a

24:15

switch on off and you don't

24:17

want to habit. But pain isn't

24:20

a switch. It's not as magical

24:22

as if you are in pain

24:25

and then all of a sudden

24:27

the pain goes away. Amy

24:30

now believes that the best

24:32

definition of pain comes from

24:35

the international association of the

24:37

study of pain. They say

24:39

it's an unpleasant sensory and

24:41

emotional experience that is associated

24:43

with actual or potential tissue

24:45

damage. This idea of pain

24:47

as a sensory and emotional

24:49

experience got Amy thinking about

24:51

where she could begin to

24:53

try different tactics to mitigate

24:55

pain. She decided to go

24:57

back to a place she

24:59

knew well, a place where

25:01

many of us first experience

25:03

acute pain, the pediatrician's office.

25:05

I noticed that other doctors

25:07

weren't addressing needle pain for

25:09

kids. Like getting a vaccine

25:11

like my daughter still screams

25:13

and she's a teenager. Yeah,

25:15

well, here's the deal. You

25:17

and I. got six injections

25:19

and we got them before

25:21

we were two and we

25:23

don't remember and we think

25:25

we were really cool because

25:27

we don't mind needles. But

25:29

yes, starting. So true. I

25:32

know. Well, so here's the

25:34

thing. I started looking back

25:36

at the history of vaccines

25:38

and I was like, whoa,

25:40

I had no idea. We

25:42

have 36 separate shots now.

25:44

And I realized this when

25:46

my four-year-old had his vaccines,

25:48

and he had such an

25:50

awful experience that afterwards he

25:52

threw up, and I was

25:54

like, if he gets old

25:56

enough to drive himself to

25:58

the doctor, he won't. the

26:00

soft tissue of the arm,

26:02

the sensation goes to the

26:04

spine, then the brain. And

26:06

the brain remembers that

26:08

feeling. So if we

26:10

anticipate fear feeling that

26:12

sensation again, that memory

26:14

can make every future

26:16

shot seem so much

26:19

worse. Pain is this

26:21

contextual response to whether

26:23

you're safe or not. When

26:25

you're afraid, you're... Neurotransmitters

26:29

that say danger are elevated

26:31

and your memories of fear

26:34

elevated and that fear increases

26:36

your perception of pain and

26:39

certainly when you're in pain

26:41

and you're afraid of not

26:43

being able to get relief

26:46

that fear lays down tracks

26:48

in your brain I mean all

26:51

of these things happen that

26:53

increases your perception of pain.

26:55

How to do that lesson

26:57

the initial sensation. Twenty

27:00

years ago, I just wanted to

27:02

have a fast cure for needle pain

27:04

for IV access and my kids'

27:06

shots. I was driving home one

27:08

night after a graveyard shift,

27:10

and my hands were vibrating on

27:13

the steering wheel because we needed

27:15

to get the tires balanced. I

27:17

was ignoring that to think about

27:19

pain, and when I got home and

27:22

reached for the door in my house, my

27:24

hand was numb. Vibration.

27:27

So I burst in, my Boy

27:29

Scout husband grabbed some frozen

27:31

peas, and we had ourselves

27:34

a genuine Eureka moment. We're

27:36

cold, and vibration blocked pain.

27:39

Over the next decade, I found

27:41

the right frequency to block

27:43

pain, I got a grant,

27:45

and I created Buzzy, which

27:47

is vibration plus ice in

27:49

a B-shape, and you put it

27:52

on your arm when you're

27:54

getting an injection, and to

27:56

date... 45 million needle procedures

27:58

had decreased pain and and

28:00

over 80 randomized controlled trials

28:02

independently all around the world

28:04

have been published. So the

28:07

reason that vibration decreases pain

28:09

is because the physiology of

28:11

the nerves of light touch,

28:13

pressure, stretching, and motion all

28:15

race pain to the spine.

28:18

We now know that motion

28:20

is what's most effective at

28:22

shutting the sharp pain. This

28:24

is called gait control and

28:27

the exact right frequency of

28:29

vibration triggers the nerves that

28:31

decrease pain. So if you

28:33

burn your finger and you

28:36

stick it under cold water,

28:38

instantly the burn feels better.

28:40

If you've ever tried putting

28:42

it just in ice water

28:44

but not moving it, you

28:47

will find the cold itself

28:49

doesn't do it. You have

28:51

to actually stir your finger

28:53

around to make it work.

28:56

The movement's the critical part,

28:58

the cold helps. Well, too...

29:00

manufacture this sensation of movement,

29:02

I stumbled upon vibration. The

29:05

physiology of ice is different.

29:07

So the cold goes up

29:09

to the brain where the

29:11

conductor goes obnoxious but not

29:13

dangerous, I will decrease sensations

29:16

coming from everywhere. And it

29:18

decreases pain everywhere. If a

29:20

child was so freaked out

29:22

from previous experiences, that even

29:25

the swab hurt. Physiology

29:27

wasn't as helpful. So we

29:29

added distraction, like a monkey

29:31

poster, and what we discovered

29:34

was combining counting plus making

29:36

a decision, cut pain in

29:38

half. So for example, how

29:40

many monkeys are actually touching

29:43

the bed activates the decision

29:45

switchboard? I know what you

29:47

guys are doing. All right,

29:49

it's five. The

29:53

biggest tack, though, is understanding

29:55

why distraction works. And now,

29:57

through functional MRI, we can

29:59

actually see pain happen. And

30:02

it's not one place. Pain

30:04

is a symphony of connections

30:06

from the sensation area to

30:09

the conductor, to the decision

30:11

switchboard, and then to fear,

30:13

memory, meaning, control. So if

30:15

the decision switchboard is occupied

30:18

sorting monkeys, it can't notify

30:20

fear and meaning, and you

30:22

feel less pain. What you

30:25

... is mostly what you

30:27

expect to feel. So there

30:29

are so many different things

30:32

you can try, cold, vibration,

30:34

distraction, mind games. Yeah, you've

30:36

always got one other thing

30:38

to try, so it keeps

30:41

you from being afraid. A

30:43

big part of my pain

30:45

re-education came when I was

30:48

asked to do a talk

30:50

in Wisconsin for a child

30:52

life. conference. I'd been invited

30:54

to talk about different medications

30:57

for sedation because that was

30:59

my specialty and how to

31:01

deal with pain. And an

31:04

amazing woman who invited me,

31:06

Regina Yoakum, told me afterwards

31:08

from her wheelchair where she

31:10

had been since she was

31:13

young from juvenile arthritis. She

31:15

said, you know, I appreciate

31:17

knowing about these medicines, but

31:20

the thing is there's only

31:22

a finite number of medicines.

31:24

There are much larger number

31:27

of physical interventions and there

31:29

are so many. different ways

31:31

to activate your brain so

31:33

that you just don't mind

31:36

pain, that really what pain

31:38

management is for us, and

31:40

for her personally, is knowing

31:43

there's always another option. That

31:45

changed everything for me. Choosing

31:47

physiologic options that you can

31:49

layer that work for you,

31:52

decrease pain. Like... Heat cold

31:54

vibration, deep relaxation, acupuncture capsaic,

31:56

and exercise meditation. There's more.

31:59

Christopher probably had 10 of

32:01

these around. and just didn't

32:03

know it. Having control over

32:06

your options decreases pain, deep

32:08

breathing increases control, choosing what

32:10

to focus on increases control.

32:12

Fear and control are the

32:15

volume knobs for pain. Fear

32:17

controls so many of our

32:19

sensations, this shouldn't be unusual,

32:22

but we don't practice it

32:24

for pain. So if you're

32:26

home alone and you hear

32:28

a clunk, Your

32:31

hearing becomes hypersensitive. But when

32:33

you remember your kid's home

32:35

from college, your fear dials

32:38

down, and your brain overrides

32:40

it and says, don't worry

32:42

about it. St. Augustine called

32:45

pain the greatest of evil.

32:47

But if it is a

32:49

survival system, it cannot be

32:51

all evil. So instead, think

32:54

of pain as you're nagging,

32:56

safety obsessed. exaggerating friends who's

32:58

sometimes wrong. And it's okay

33:01

to ignore or override your

33:03

friend if you know that

33:05

you're safe. This takes practice.

33:07

On a flight that was

33:10

turbulent, I had an entire

33:12

cup of scalding hot coffee,

33:14

dumped straight on my ankle.

33:17

Electric jolt through my scalp,

33:20

I ripped off my sock,

33:22

it was already red, it

33:24

was going to blister, there

33:27

was no way I could

33:29

get my foot into that

33:32

little sink to get cold

33:34

water on it, and then

33:36

I remembered, physiology hack. I

33:39

had an open cold beer.

33:41

Medical grade cold beer went

33:43

on my ankle stat. I

33:46

had a vibrator in my

33:48

carryon because I would on

33:50

my ankle stat. and then

33:53

the pain kind. And pain

33:55

MacGyver, I was no longer

33:57

that concerned. Although

34:05

then I realized I'm that

34:07

guy with my barefoot sticking

34:09

out in the aisle on

34:11

a plane with a beer

34:13

on it. So that's dealing

34:16

with acute pain. But in

34:18

a minute, physician and pain

34:20

expert Amy Baxter explains more

34:22

about how all of these

34:24

methods can also help with

34:26

chronic pain. On the show

34:29

today, pain relief. I'm Anusha

34:31

Zamorote and you're listening to

34:33

the Ted Radio Hour from

34:35

NPR. Stay with us. This

34:37

message comes This

35:19

This message comes from NPR sponsor State Farm. If

35:21

If you're a small business owner, it's

35:23

your life. life. State Farm are small

35:25

business owners owners so they can help

35:27

you choose personalized policies. Like a good

35:30

neighbor, State Farm is there. Talk

35:32

to your local agent today. It

35:35

comes from ServiceNow. People should do

35:37

the creative work they actually want

35:39

to do. Not boring busy work.

35:41

Now with AI agents built into

35:43

the ServiceNow platform, you can automate

35:45

millions of repetitive tasks in every

35:47

corner of your business, IT, HR,

35:49

and more. So your people can

35:51

focus on the work that they

35:53

want to do. That's putting AI

35:55

agents to work for people. It's

35:58

your turn. Get started at

36:00

servicenow.com/AI dash agents. Support

36:05

for NPR and the following message

36:07

come from Rosetta Stone, the perfect

36:09

app to achieve your language learning

36:12

goals no matter how busy your

36:14

schedule gets. It's designed to maximize

36:16

study time with immersive 10-minute lessons

36:18

and audio practice for your commute.

36:21

Plus, tailor your learning plan for

36:23

specific objectives like travel. Get Rosetta

36:25

Stone's lifetime membership for 50% off

36:28

and unlimited access to 25 language

36:30

courses. Learn more at Rosetta stone.com/NPR.

36:49

It's the TED Radio Hour from

36:51

NPR. I'm Manouch Zamorote. Today on

36:53

the show, we're looking into the

36:56

past, present, and future of how

36:58

we treat pain. We've been talking

37:00

to physician and pain expert Amy

37:03

Baxter. And as we heard, Amy

37:05

decided to research different ways to

37:07

relieve pain after working as a

37:10

physician throughout the opioid crisis and

37:12

seeing the lack of options given

37:14

to patients. Living pain-free, she says,

37:17

was a false promise made by

37:19

the pharmaceutical industry. But dealing with

37:21

chronic pain requires multiple strategies, especially

37:24

as we better understand what long-term

37:26

pain actually is. It's something of

37:28

a moving target as we get

37:31

better information from functional MRI. It

37:33

used to be that pain was

37:35

defined as acute until three months,

37:38

and then magically it became chronic.

37:40

My own personal opinion based on

37:42

the way the brain changes is

37:45

that probably it's more of a

37:47

72-hour thing. The thing is that

37:49

the body adapts really really quickly

37:52

to what's going on and starts

37:54

making different coping mechanisms. those are

37:56

probably the better definition of acute

37:58

versus chronic pain. And we've moved

38:01

the goalpost from three months to

38:03

one month, but I think that

38:05

probably the scientific literature is going

38:08

to move it even closer to

38:10

the event of the tissue damage

38:12

in the next decade or so.

38:15

If someone is listening and they're

38:17

thinking, okay, just tell me what

38:19

to do if I am going

38:22

in for a procedure and I

38:24

want to deal with acute post-op

38:26

pain. and then what I can

38:29

do for chronic pain. One thing

38:31

that's important, and I even

38:33

this morning got a letter from

38:36

somebody who is outraged that I

38:38

wanted to take people's opioids away,

38:40

I do not mind if people

38:42

who are chronically managed with opioids

38:44

have the same dose from now

38:46

until the rest of their lives,

38:48

because they rarely overdose and they

38:50

rarely increase the doses. That is

38:52

not where the problem is. My

38:55

real mission is to stop giving...

38:57

pills out after surgery. By not

38:59

having other pain options, we

39:01

leave doctors with no choice

39:03

but to give opioids at

39:06

home after a surgery because

39:08

they want to help. But

39:10

it's about 6% of every

39:12

surgery have people who are

39:14

still in opioids 90 days

39:16

later who weren't before. is

39:19

so clearly consistent despite the

39:21

caliber of the surgery, and

39:23

we should make people aware

39:25

of this before they take

39:27

a medicine, that they may

39:29

be better off with ibuprofen

39:31

or an ice pack or

39:33

vibration or having a whole bunch

39:35

of friends over. Power of our

39:37

pain isn't always pretty, but it

39:40

is possible, and it is

39:42

absolutely critical. So what do

39:44

we do? Well, in my dream

39:47

world, we have health care

39:49

systems. pay for options and coaching,

39:51

and we quit giving double-digit prescriptions

39:54

for opioids for home recovery. In

39:56

the real world, 80,000 people died

39:58

in the US. last year from

40:01

opioid overdoses, and 80% of substance

40:03

use disorder starts with a pill

40:05

prescribed for pain, usually taken from

40:07

your friend's medicine cabinet. You all

40:10

now know to throw away the

40:12

opioids and your medicine cabinet. You

40:14

now know that there are options

40:17

you can use to decrease pain,

40:19

and you know that pain-free should

40:21

be ditched for more comfortable. And

40:23

whether you Dump skeleton coffee or

40:26

pain wakes you and exhausts you

40:28

every day. Options that are in

40:30

your control can allow you to

40:32

reframe pain. So one of the

40:35

options for dealing with acute pain

40:37

is a tool that you created

40:39

called Buzzy. It's for kids, it

40:41

both cools and vibrates, it looks

40:44

like a little B, and it

40:46

has FDA approval. But what about,

40:48

say, a grown-up with chronic back

40:50

pain? Do you have tools for

40:53

that, Amy? So I will say

40:55

that low back pain is the

40:57

number one source of disability worldwide.

40:59

It is the number one reason

41:02

people go from acute opioids to

41:04

chronic. And... What we know about

41:06

low back pain now is the

41:08

same with a lot of injuries

41:11

that go on to become chronic.

41:13

The problem is not the original

41:15

insult. The problem is that the

41:17

small muscles that are holding you

41:20

still so you don't increase pain,

41:22

those muscles aren't designed to have

41:24

that much load. They try to

41:26

rise to the challenge and they

41:29

don't have the plumbing. So they

41:31

lose the blood supply. They have

41:33

lactic acid and hurt like you've

41:35

worked out too hard. And over

41:38

time, they get fatty changes that

41:40

further decrease the blood supply and

41:42

then they start getting shrunken. And

41:45

so I started reading and I

41:47

started playing around with different frequencies.

41:49

What we do now is we

41:51

have three different frequencies that decreases

41:54

fatty changes and then we played

41:56

around. with amplitude so you can

41:58

get it to penetrate different depths

42:00

of tissue. And the final pivotal

42:03

trial will be done with the

42:05

chronic patients on June 30th. What

42:07

we are hoping is that we

42:09

will have not just a reduction

42:12

in pain, but actually reduction in

42:14

opioid use. But it's not ever

42:16

going to be enough to have

42:18

one thing. people need to realize

42:21

that a little bit of magnesium

42:23

is perhaps going to shave 10%

42:25

maybe 30% off of how much

42:27

pain they perceive, but it's going

42:30

to take a few days to

42:32

kick in, a little bit of

42:34

exercise, just bending over and lifting

42:36

up 10 times a day, and

42:39

then gradually getting to 20 times

42:41

a day, and then doing it

42:43

with a tiny weight. That I

42:45

have heard from people who have

42:48

overcome their back pain. And they're

42:50

doing the same thing we're trying

42:52

to do. They're rehabilitating those little

42:54

muscles, but it's very slow. I

42:57

wish people with chronic pain knew

42:59

it was okay not to think

43:01

that they're going to find one

43:03

thing that's going to fix their

43:06

pain. Oh, but Amy, it would

43:08

be so nice if there was

43:10

like this one magic thing that

43:13

just took care of it. What

43:15

you're describing, that's like taking on

43:17

a part-time job. Yeah, it's a

43:19

part-time job. It's a remodel of

43:22

your brain. And nobody in it

43:24

wants to hear that if they

43:26

did a whole bunch of things

43:28

every day for six months, they

43:31

would feel a lot better, because

43:33

it's really hard to get up

43:35

the energy to even do too.

43:37

You are reminding me of the

43:40

story you told in your talk

43:42

about your friend's son, Christopher, who

43:44

ended up addicted to opioids after

43:46

major surgery and later overdosed. What

43:49

would you have done for Christopher

43:51

now? Oh, wow. Well... If you

43:53

ask what I would do for

43:55

Christopher now, Cammy Wolf, Christopher's mom,

43:58

is actually doing it for people

44:00

at Grady Hospital in Atlanta who

44:02

have trauma. They're teaching them about

44:04

how to go home without opioids.

44:07

I thought, how can I warn

44:09

people? How can we stop this

44:11

in hospitals? I didn't even think

44:13

one second to ask the doctor

44:16

about the medication he was being

44:18

given. But when you're on OxyContin,

44:20

you know, you can become addicted

44:22

with one prescription. And of course,

44:25

I had no idea. None. This

44:27

is Christopher's mom and Amy Baxter's

44:29

friend, Kami Wolf Rice. She vividly

44:31

remembers bringing Christopher home from the

44:34

hospital. He was going home with

44:36

a hole in his stomach and

44:38

a bag, and he needed psychological

44:41

counseling, right, to deal with that,

44:43

for a 17-year-old boy, right, a

44:45

senior year in high school. They

44:47

didn't prep us for what we

44:50

were going home with, and not

44:52

one single solitary word about any

44:54

risk involved at all. Zero. Christopher,

44:56

you know, his dream was to

44:59

be a Navy SEAL. He was

45:01

very disciplined. He was an AP

45:03

student. Just super book smart is

45:05

the way I would describe, but

45:08

a hugger. Years passed and he

45:10

didn't stop taking the pills. So

45:12

he was just constantly on the

45:14

opioids and still managed to go

45:17

to college, graduated college. But then

45:19

he's the one that came to

45:21

me and said, Mom, I have

45:23

got a problem. I need this

45:26

medicine, just like you need air

45:28

to breathe. He fought it for

45:30

14 plus years. I'm talking multiple

45:32

rehabs. But when it hijacks your

45:35

brain, you trigger things happen and

45:37

you relapse. And he kept thinking

45:39

he was failing us. He was

45:41

failing himself, which of course... depression

45:44

sets in and you could have

45:46

never in a million years would

45:48

have I ever thought that Christopher

45:50

would have done heroin but he

45:53

couldn't get the pills and so

45:55

he had to go to the

45:57

street. He

46:00

overdosed in 2016. And it

46:02

literally took me two years

46:04

to even talk to my

46:06

family because of the stigma

46:08

that we have in this

46:10

country. As sadly as it

46:12

sounds, I didn't want him

46:14

to have a disrespectful death.

46:16

I didn't want people to

46:18

think of him horribly because

46:20

he was such a wonderful

46:22

person. So I think there

46:24

was enormous guilt that I

46:26

was feeling that I failed

46:29

as a parent. I failed

46:31

as a mother. You know,

46:33

I failed as a mother.

46:35

But then I realized that

46:37

silence is deadly. And we

46:39

need to be able to

46:41

speak out because if everybody

46:43

was honest about it, everyone

46:45

knows somebody that's suffering with

46:47

addiction. Everybody. That's when

46:49

Cammy came up with an idea

46:51

to give patients someone to guide

46:53

them through the shock of dealing

46:56

with pain, a kind of pain

46:58

coach that she called a life

47:00

care specialist. We use coaches for

47:02

everything in our society, except for

47:04

when you're in a health crisis.

47:07

I felt like there was a

47:09

missing person on the health care

47:11

team, so... The job of a

47:13

life care specialist, number one, is

47:15

to educate you on the pain

47:17

medication that you've been prescribed. Then

47:20

we provide non-narcotic pain management techniques,

47:22

things to distract your brain, so

47:24

all of our life care specialists

47:26

are certified also in techniques to

47:28

deal with the mental side of

47:31

the patient when you're in the

47:33

hospital. If you're in the hospital,

47:35

you probably have anxiety, stress, depression,

47:37

and PTSD. Sometimes they need somebody

47:39

to validate their pain, to validate

47:42

their frustrations. Why did this happen

47:44

to me? Why am I here?

47:46

And they don't have that listening

47:48

ear. And then follow up once

47:50

you leave the hospital. Are you

47:53

off your paid medicine? How to

47:55

probably dispose of your opioid. And

47:57

we found that patients, 70% of

47:59

patients didn't even know they were

48:01

taking an opioid. The gentleman said,

48:04

oh my God, I did not

48:06

know. I was taking an opioid

48:08

and my wife is in recovery.

48:10

So I'm so glad you told

48:12

me. So we were able to

48:14

provide a lockbox so he could

48:17

lock up his medicine. You know,

48:19

those are a lot of little

48:21

stories like that. At first, Cammy

48:23

was very strategic. where she placed

48:25

life care specialists, but now she's

48:28

hoping to expand. We started in

48:30

orthopedic trauma because that's where young

48:32

people have their first introduction to

48:34

opioids typically. It's a football injury,

48:36

a car accident, and gymnastics injury,

48:39

whatever the case may be, they

48:41

go home with a big bottle

48:43

of opioids, and that's where the

48:45

problem starts. So we started in

48:47

orthopedic trauma, but we've expanded into

48:50

multiple departments, and now at the

48:52

rural hospital, we're really... were on

48:54

the floor across the board. If

48:56

Christopher would have had a life

48:58

care specialist, if I would have

49:01

had somebody telling me about the

49:03

dangers of the medication he was

49:05

going home with, he would be

49:07

here today. And so I really

49:09

feel like we're saving lives one

49:12

patient at a time and it's

49:14

definitely a preventative role that needs

49:16

to be in every hospital across

49:18

the country. That

49:23

was Cammy Wolf Rice. She is

49:25

founder of the CWC Alliance, the

49:27

Christopher Wolf Crusade. She's also the

49:29

author of The Flight, My Opioid

49:32

Journey. Many thanks to her. And

49:34

of course, Dr. Amy Baxter. She

49:36

is a pain specialist physician and

49:38

also the founder of Paincare Labs.

49:41

You can see her full talk

49:43

at ted.com. Before we go... We

49:45

wanted to give you a quick

49:47

update on Catnod, the equestrian whose

49:50

horse fell on her, and who

49:52

was trying to live with her

49:54

chronic pain drug-free. Cat went through

49:56

a period of complete despair. But

49:58

she read a lot of self-help.

50:01

And finally I just decided that

50:03

it was enough, that I had

50:05

enough of the petty party, and

50:07

that I was going to fight

50:10

for my life, because that is

50:12

at that point what I was

50:14

fighting for. And I decided to

50:16

challenge myself to move and get

50:19

out and just... five minutes a

50:21

day of moving my body and

50:23

those five minutes were tortured. They

50:25

were not easier fun. The five-minute

50:28

walk felt like it took an

50:30

hour and a half every single

50:32

time. But then slowly that five

50:34

minutes became a little easier and

50:37

a little longer and the thing

50:39

that I was torturing myself to

50:41

do every day became the thing

50:43

that was actually getting me out

50:46

of bed every day. How are

50:48

you today? Are you living with

50:50

chronic pain? Yes, and I will

50:52

live in chronic pain very likely

50:54

forever, and that's okay. I have

50:57

a way better mental control over

50:59

my pain. And although, yes, I

51:01

still am like a five or

51:03

six out of ten, almost every

51:06

single day, it's more like background

51:08

noise now, when it's so constant,

51:10

you kind of learn to tune

51:12

it out and you learn to

51:15

focus on the good things in

51:17

your life. You learn to focus

51:19

on... other things that are stimulating.

51:21

Because when all you have in

51:24

your life is pain, that's really

51:26

dark. But if you can bring

51:28

other things into your life that

51:30

bring you joy, bring you happiness,

51:33

keep you moving, keeping you working,

51:35

distracted, it does make it easier

51:37

to kind of let that pain

51:39

level fall into the background. I

51:42

know it's there, but it's something

51:44

I have a way better mental

51:46

control over now. Pain is very

51:48

complex, especially the chronic pain. because

51:51

there is a brain aspect to

51:53

it because your brain is so

51:55

used to being in pain and

51:57

there is the physical aspect of

51:59

it, because obviously most of the

52:02

time it stems from some sort

52:04

of injury or something happening, nerve

52:06

pain, like all of these things.

52:08

And so you kind of have

52:11

to break it apart and treat

52:13

all of the pieces instead of

52:15

just treating one as a whole

52:17

and break that cycle. So for

52:20

me, I found the chronic pain

52:22

clinic and I did what they

52:24

call an ablation, so they cauterized

52:26

a bunch of nerves in my,

52:29

from basically my neck to my

52:31

tailbone. very unpleasant experience, but it

52:33

did help break a little bit

52:35

of the cycle. I was in

52:38

pain-wise because the nerves couldn't communicate

52:40

to my brain the same, and

52:42

that really helped as a reset,

52:44

and then I used that time

52:47

to really strengthen and train my

52:49

body around the injuries to have

52:51

better support, and then I do

52:53

also, I've seen natural pests, and

52:55

lots of people like that to

52:58

help find some natural supplements to

53:00

help with inflammation and pain as

53:02

well that aren't opioids. It's a

53:04

full-time job. Oh, it's a commitment

53:07

for sure, but you know what,

53:09

when your choice is, do I

53:11

commit to not being here anymore,

53:13

or do I commit to finding

53:16

a way through this, and coming

53:18

out the other side stronger, more

53:20

knowledgeable, and to be honest, I

53:22

think healthier right now than I

53:25

was before my injury, I'm going

53:27

to choose that route all day

53:29

long. Are you still involved with

53:31

horses? Yes, actually, so... I am

53:34

training and back to competing and

53:36

have really high hopes for where

53:38

that journey could take us and

53:40

whether that means all the way

53:43

to the Olympics. That's definitely a

53:45

goal. Wow. Does hurt to ride.

53:47

But do I notice it when

53:49

I'm riding? No. Riding is the

53:52

thing that is my therapy and

53:54

a little extra physical pain that

53:56

I can work through from a

53:58

stable and healthy mental place is

54:00

definitely worth it for me. That's

54:03

cat nod. Her book is called

54:05

The Other Side, and you can

54:07

see her TED Talk at ted.com.

54:09

Many many thanks to all the

54:12

people we had on this show

54:14

about pain. relief. This episode was

54:16

produced by Rachel Faulkner-White, Matthew Cloutier,

54:18

Fiona Gyrin, and Chloe Weiner. It

54:21

was edited by Sana's Meshkinpore, and

54:23

me. Our production staff at NPR

54:25

also includes James Delahousi, Katie Montelion,

54:27

Harsha Nahada, and Arin Naguchi is

54:30

our executive producer. Our audio engineers

54:32

were co-Takasougii Chernovan, and Robert Rodriguez.

54:34

Our theme music was written by

54:36

Romtine Arablui. Our partners at TED

54:39

are Chris Anderson, Helen Walters, Alejandro,

54:41

and Daniela Balareso. I'm Manushe Zamorote,

54:43

and you've been listening to the

54:45

TED Radio Hour from NPR. This

54:48

message comes from NPR sponsor Informatica.

54:50

Everybody's ready for AI to help

54:52

them with the next big breakthrough.

54:54

Except your data. Get your data

54:56

AI ready at informatica.com/AI. Informatica, where

54:59

data and AI come to life.

55:01

This message comes from Charles Schwab

55:03

with their original podcast, Choisology. Choisology

55:05

is a show about the psychology

55:08

and economics behind people's decisions. Download

55:10

the latest episode and subscribe at

55:12

schwab.com/podcast. This message comes from NPR

55:14

sponsor Ted Talks, a podcast. Ted

55:17

Talks Daily brings you a new

55:19

talk every day. Learn about the

55:21

ideas shaping humanity from connecting with

55:23

your inner monologue to finding out

55:26

of aliens exist. Listen to Ted

55:28

Talks Daily.