How the brain interprets pain — and new ways to manage it

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I literally feel like I'm a different person. Yes. Do you feel that way? Ideas worth spreading from TED and npr. I'm Minouche Zumarodi. Some kids are obsessed with trains, others love cooking. And then there are the ones who are really into horses.

I was kind of born into it.

This is Kat Nod.

When I was two years old, I actually learned how to canter on a horse for the first time.

By the age of six, Kat knew what she wanted to be when she grew up.

I decided I wanted to go to the Olympics for horseback riding and represent Canada. And my entire life has kind of been centered around that goal of being an Olympic horseback rider.

How much of your life, life, your daily life, did it take up? Like, what was the whole regimen?

Is there a percent higher than 100?

In her 20s, Kat was on track to make it to the 2016 Olympics in a sport called three day eventing.

So it's got three phases over three days. So the dressage is kind of like dancing on horses. You have like a routine you do at certain places in a test. The second phase is called show jumping. That's what you see on tv, where they jump the big jumps with the rails that fall down. And then the third phase is cross country. It's where you're going over big solid jumps that if you hit the jumps, you fall down, not the jump. They'll have like a six foot wide ditch with a wall in the back and you have to jump all of it at the same time or like a seven, eight foot drop into water. And if you make a mistake, the jumps, there's no forgiving.

So there she was at the Olympic qualifiers. She and her horse sailed through the first two events, no problem.

I was actually in first place heading into cross country, which was my strongest phase. And it was my 25th birthday and I was super excited. We headed to the start box to do our two minute countdown. There's nothing that gets me more excited than the last 10 seconds before you get to go. And we set out on course, my horse Jackson and I. The entire course flew by in perfect jumps. There was not even a misstep to a single fence. And we headed to home, to our very last jump, when my horse Jackson and I saw a completely different distance from each other to the fence. And he's enormous, so he's 17, three hands, which is just under six feet where his back is. And the last fence was a big upright table, and he caught the front edge of it with his knees. And we had what's called a rotational fall. What I can equivalent is to a somersault in the air. And he landed on top of me on the other side and slid 10ft with him on top of me. He weighs about 1500 pounds. I lost consciousness for a very brief amount of time. I remember kind of coming back to. And he'd jumped off of me and ran off. And people rushed over, and they're trained to hold you down so you don't get up, just in case you have very severe injuries. And all I could do was try to flail and figure out where my horse was. And that was my main concern is, where is he? Is he okay? Shock kind of takes over in adrenaline. And then I was actually airlifted to the hospital in Seattle. And from there, it was a definitely whirlwind few days.

What, in the end, did they figure out had happened to you? What was damaged in your body?

So I had broken the transverse processes, the wings off both sides of my L2, 3, and 4 vertebrae in my back. I was told if you're gonna break your back, that the way that I broke it was the best way possible. So that's, I guess, good news.

Some comfort. When you were leaving the hospital, what did your doctors tell you to expect?

Yeah, so they said that it was gonna be about four months till I felt more normalized, like I was going to be able to do more activity, more walking, even think about getting back on a horse. It was tough. The pain level was something I'd never really experienced before. I would hit, like, an unmanageable level of pain every single day. When they give you the pain scale, like, I would hit a 10 out of 10 at some point every day.

So what kept you going? Because you thought, okay, well, this is just temporary. I need to get through this initial period, and then I'm gonna feel better. Is that what you were thinking?

Yeah.

So being four months, like, four months in hindsight is not that long. Like in the moment, four months in, that level of pain feels really long. But four months, I was just trying to grind it out to get back to training. I knew there was still some qualifiers left in the season, so if I could recover and get back quick enough, I could try to still make a run for the, you know, being an Olympic athlete. And I had really just expected my body to bounce back.

When did you start to realize that things were not going back to, quote, unquote, normal or before times?

Yeah.

So about the four month mark, I was really not feeling any better, but they said four months. So four months to the day I got on my horse and the first step he took, like, I was instantly 10 out of 10 pain. I was nauseous from pain and I almost fell off just because I couldn't even breathe. And I knew that there was more going on. I knew that something had been missed. I knew that whatever was happening had not healed the way that they were kind of expecting it to. And I had to get instantly off. And I was crushed. They actually found out that my pelvis was dislocated and I was having stability issues. And that's actually why I had so much pain. And I got to the hospital in Vancouver and waited for over four hours in a waiting room on a hard chair with a back that you're thinking any moment, like, what if I sneeze and now I'm paralyzed. So it was quite a scary wait, not knowing what level of stability would happen if I shifted the wrong way. Am I going to make it worse? When they finally called me in to do the check with the doctor, I handed him my requisition and he didn't even look at it. He put it down. He didn't examine me. He didn't ask me a single question about my pain, about what I was experiencing, about what my doctor had said. He looked at me and he said, what drugs do you want? And I was like, no, no, I need help. He said, I'm busy, so you can take the drugs or you can leave.

Yikes. And what did you say? I left.

I wasn't there for narcotics. I was there for help and support, and I got none of that. And it was a really disappointing experience. And for me, I'd been kind of holding out hope that I was going to heal physically. And to be that dismissed, I'd lost hope.

That day.

That day was actually the first day of the downward spiral for me mentally. And a couple months after that experience, I kind of hit My rock bottom of where I just couldn't fight through this anymore.

When you say you hit rock bottom, what do you mean?

I slid into, like, depression quite quickly. And I've actually never had experienced depression anything like depression before. And until, you know, you don't know. And the pain was intolerable. I would dislocate my pelvis and fall and be kind of stranded. I limped every single day. Some days my leg almost felt like a peg leg, like I had to drag it behind me.

Were you getting treatment at that point?

I had stopped. I had kind of given up hope because I had tried so many things previously and nothing had really caused any significant relief or progression of my symptoms. And I'd been told by several doctors that, like, there's a real chance that this is just physically your life and you'll have to acclimate to it. You won't be able to walk normally. You will limp. You will be in high degrees of pain. You will have instability in your pelvis for life. This is your life now. And, yeah, it's like at 25, when you have so much of your life ahead of you, it's really hard to justify spending the rest of your life that way. When you're in that kind of depth of the darkness, you can't see past the darkness. You can't see little light at the end of the tunnel. You're not looking for hope. You are just alone in the dark.

In a single moment, Kat Nod's life was taken over by pain. First acute, then chronic. She felt alone, confused and hopeless. Like most of us, she'd heard about the dangers of opioids. Roughly 80,000Americans a year are dying from opioid overdoses, and. And the opioid epidemic has morphed over the years well beyond a pain pill problem. But we don't hear much about other options for coping with pain. So what do we need to know about the next chapter in pain relief? Today on the show, new understandings about how the brain interprets pain and what we can do to manage pain in the short and long term. Later in the show, we'll hear more from Katnod, but first, please meet pain expert Dr. Amy Baxter.

When you live with chronic pain, it is really easy for it to take over and define who you are.

Amy says that in the 30 years she's been studying and developing methods to treat pain, she has heard all sorts of preconceived notions related to it.

Talking about pain is so nuanced and loaded in our society because we're supposed to be tough and we're supposed to deal with pain. And also because we are a society that fears aging and pain means decrepitude, never doing the things that make you you. And even a little bit of pain carries extra meaning because it means that both you're weak and you may not get over being weak.

Amy suggests we put all those judgments aside because pain affects everyone differently. And as we'll explain later, how the brain processes pain can be confusing. But she says we need to remember one key thing about it.

Pain is a survival system that serves us. And when it ceases to serve us, then we can choose to ignore it. We don't have to let it rule us. That is the most important paradigm shift for dealing with both acute pain and chronic pain. But the thing about pain is there isn't one answer. It is a giant, different complex beast to every different person. And so we in the medical profession are used to one right answer and treating it as one thing. It just isn't.

In a minute, Amy talks us through the past, present and future of pain management on the show today, rethinking ideas about pain. I'm Minouche Zumarotti, and you're listening to the TED Radio Hour from npr. We'll be right back.

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We start early with children saying, oh, you bumped your this, oh, you have a fever, let me give you a pill. We really are telling each other that a pill is the way to solve a problem, and that isn't going to work when that is part of your survival system. You can't shut it down with a pill.

Amy believes that we need to teach or be taught to see pain as a messenger and listen closely to what it tells us rather than fear it. But this is not what Amy learned back in Medical School 30 years ago.

In medical school, pain was a lot less important than diagnosing and treating whatever was causing it. We didn't actually talk much about what the nature of pain was. It was this amorphous bad thing. But as a doctor, it's kind of like pain happens.

Amy did her residency and she specialized in pediatric medicine. And as a young budding physician, she found this approach hard to swallow.

So one of the hardest things about being a doctor is quelling down your empathy because it can get in the way of the diagnosis or the management that you need to be responsible for making sure happens.

But then the theory of putting aside pain to get a diagnosis Faded away. It was the mid-90s, and a new approach was being offered by pharmaceutical companies. Doctors could be pain advocates for their patients thanks to a new line of pain relief medications.

That was when I first heard the concept of pain free. At the time. It sounds great, you know, why wouldn't you want that for your patients? We even had buttons that said pain free on them. And all of us who were pain advocates wore them on our white coats. You know, it's like, pain free. That's I am going to get you to pain free. And what's not to love about being pain free?

Amy remembers the first time she got the opioid pitch. Here she is on the TED stage.

The only pain lecture I remember from the 90s was in a dark room like this after being awake for 30 hours and hungry and finding out. Our noon lecture was sponsored by OxyContin. We got pens, we got great lasagna, and they had very cool slides that showed pain stopped by opioids. And we learned that home opioids aren't addictive. And if you stay ahead of pain, you can keep your patients pain free.

But we've all heard how the story of opioids and addiction has gone.

Patients became customers. And so you were supposed to respond to what a patient wanted. And if they had pain, you needed to both measure it and address it. And I realized that part of what Purdue did was suborn the message of care and make it a message of a prescription. You know, I care about you. I'm going to give you the good stuff. I care about you. I am going to make it so you don't hurt at all.

And beyond the obviously egregious marketing, I think it was framing pain free as the goal that has destroyed countless lives. My friend's son, Christopher, started having severe abdominal pain during this no pain era. Eventually, he was diagnosed with a colon disease and had surgery his senior year. They sent Christopher home with 90 OxyContin and then 90 more. And then as the pain started getting faster and faster, uncontrolled pain is terrifying. So when his ran out and his friend's medicine cabinets ran out, Christopher tried heroin. And Christopher Wolf lost his battle with substance use. At age 32.

Christopher got 90 Oxycontin for a stomach surgery. We would never do that now, but I was in the generation that if I had taken care of Christopher, I would have written for that. It's just what you did. Doctors trained when I was in the 90s, believed that there was no amount of pills you could give someone that would cause a problem if they had, quote, real pain.

So it turned out that the promise that OxyContin was less addictive wasn't true. Purdue Pharma pleaded guilty to federal crimes for false marketing. Yeah, but here we are with researchers saying that more than 2 million Americans now have some degree of opioid addiction. Can you just explain what these drugs do? What is it that happens in our brain that makes us feel better? At least at first?

Yeah. What we didn't know is that taking opioids actually increases your sensitivity to pain because you're used to feeling so rewarded that you don't notice it. So dopamine, which is what opioids address, Dopamine, makes you feel like you're winning, and you're so rewarded that you don't care if you're feeling pain because you just feel great. And if it's a really excruciating pain, opioids are the best thing we found to hardcore trigger the dopamine response that makes you feel rewarded. So it's great for the first couple of days and the first 24 hours after a burn or trauma. The more opioids, the less post traumatic stress, et cetera. But because your brain is constantly adapting, what ends up happening is after about 72 hours, your MU receptors, your dopamine.

I feel great.

Receptors have actually hidden inside cells. And that's about when you go home and you're taking an oral pill that is not nearly as potent as what you were getting through your iv and now you're just getting the risk and the side effects.

What is actually happening that some of us feel awful on Percocet or other narcotic drugs and other people can't get enough of them.

If you've ever been in a Mexican restaurant and somebody at your table says, I cannot abide cilantro. It tastes like soap. And you're like, are you kidding me? Cilantro is great. That's what's going on with opioids. A percentage of the population get opioids, and their taste of it is completely different. So they don't process dopamine in the same way. They don't get as much great taste from the kind of dopamine mastery or novelty or excitement or winning. They're not getting that as much when they get an opioid. Oh, yeah, they get it, huh? And that can be exacerbated by a bad situation.

So the right circumstances with the wrong genes is a dangerous combo.

Yes. Even the. Even the good circumstance with the wrong genes Three days or more is when the risk starts increasing of being dependent.

So it's not necessarily the. No matter how it makes you feel, whether you love it or hate it, regarding pain, it doesn't actually necessarily do the job that we've thought it does.

Yeah, I think this really gets to the nature of pain. What is the job that we want opioids to do and what exactly is pain? As I started unpacking the nature of what Purdue Pharma had taught me, I realized I believed, and I think many believed that pain was a switch, on, off, and you don't want to have it. But pain isn't a switch. It's not as magical as if you are in pain and then all of a sudden the pain goes away.

Amy now believes that the best definition of pain comes from the International association of the Study of Pain.

They say it's an unpleasant sensory and emotional experience that is associated with actual or potential tissue damage.

This idea of pain as a sensory and emotional experience got Amy thinking about where she could begin to try different tactics to mitigate pain. She decided to go back to a place she knew well, a place where many of us first experience acute pain. The pediatrician's office.

I noticed that other doctors weren't addressing needle pain for kids, like getting a vaccine.

Like, my daughter still screams and she's a teenager.

Yeah, well, here's the deal. You and I got six injections and we got them before we were two and we don't remember and we think we were really cool because we don't mind needles. But yes, starting.

That's so true. I know.

Well, so, ah, so here's the thing. I started looking back at the history of vaccines and I was like, whoa, I had no idea what we have 36 separate shots now. And I realized this when my 4 year old had his vaccines and he had such an awful experience that afterwards he threw up and I was like, if he gets old enough to drive himself to the doctor, he won't.

A shot punctures the soft tissue of the arm. The sensation goes to the spine, the then the brain, and the brain remembers that feeling. So if we anticipate fear, feeling that sensation again, that memory can make every future shot seem so much worse.

Pain is this contextual response to whether you're safe or not. When you're afraid, your neurotransmitters that say danger are elevated and your memories of fear are elevated and that fear increases your perception of pain. And certainly when you're in pain and you're afraid of not being able to get relief. That fear lays down tracks in your brain. I mean, all of these things happen. That increases your perception of pain.

So Amy wanted to stop kids from associating shots with extreme pain. How to do that? Lessen the initial sensation.

Twenty years ago, I just wanted to have a fast cure for needle pain for IV access and my kids shots. I was driving home one night after a graveyard shift, and my hands were vibrating on the steering wheel because we needed to get the tires balanced. I was ignoring that to think about pain. And when I got home and reached for the door of my house, my hand was numb. Vibration. So I burst in. My boy scout husband grabbed some frozen peas, and we had ourselves a genuine eureka moment where cold and vibration blocked pain. Over the next decade, I found the.

Right frequency to block pain.

I got a grant, and I created Buzzy, which is vibration plus ice in a B shape. And you put it on your arm when you're getting an injection. And to date, 45 million needle procedures had decreased pain. And over 80 randomized controlled trials independently all around the world have been published. So the reason that vibration decreases pain is because the physiology of the nerves of light, touch, pressure, stretching, and motion all race pain to the spine. We now know that motion is what's most effective at shutting the gate on sharp pain. This is called gate control. And the exact right frequency of vibration triggers the nerves that decrease pain.

So if you burn your finger and you stick it under cold water, instantly, the burn feels better. If you've ever tried putting it just in ice water, but not moving it, you will find the cold itself doesn't do it. You have to actually stir your finger around to make it work. The movement's the critical part. The cold helps well, to manufacture this sensation of movement, I stumbled upon vibration.

The physiology of ice is different. So the cold goes up to the brain, where the conductor goes obnoxious, but not dangerous. I will decrease sensations coming from everywhere, and it decreases pain everywhere. If a child was so freaked out from previous experiences that even the swab hurt physiology wasn't as helpful. So we added distraction, like a monkey poster. And what we discovered was combining counting plus making a decision cut pain in half. So, for example, how many monkeys are actually touching the bed? Activates the decision switchboard. I know what you guys are doing. It's five. The biggest hack, though, is understanding why distraction works. And now, through functional mri, we can actually see pain happen. And it's not one place. Pain is a symphony of connections from the sensation area to the conductor to the decision decision switchboard, and then to fear, memory, meaning, control. So if the decision switchboard is occupied sorting monkeys, it can't notify fear and meaning, and you feel less pain. What you feel is mostly what you expect to feel.

So there are so many different things you can try. Cold, vibration, distraction, mind games.

Yeah, you've always got one other thing to try, so it keeps you from being afraid. A big part of my pain reeducation came when I was asked to do a talk in Wisconsin for a child life conference. I'd been invited to talk about different medications for sedation because that was my specialty and how to deal with pain. And an amazing woman who invited me, Regina Yocum, told me afterwards from her wheelchair where she had been since she was young from juvenile arthritis. She said, you know, I appreciate knowing about these medicines, but the thing is, there's only a finite number of medicines. There are a much larger number of physical interventions, and there are so many different ways to activate your brain so that you just don't mind pain. That really what pain management is for us and for her personally is knowing there's always another option. That changed everything for me.

Choosing physiologic options that you can layer that work for you decrease pain like heat, cold, vibration, deep relaxation, acupuncture, capsaicin, exercise, meditation. There's more. Christopher probably had 10 of these around his house and just didn't know it. Having control over your options decreases pain. Deep breathing increases control. Choosing what to focus on increases control. Fear and control are the volume knobs for pain. Fear controls so many of our sensations. This shouldn't be unusual, but we don't practice it for pain. So if you're home alone and you hear a clunk, your hearing becomes hypersensitive. But when you remember your kids home from college, your fear dials down and your brain overrides it and says, don't worry about it. St. Augustine called pain the greatest of evil. But if it is a survival system, it cannot be all evil. So instead, think of pain as your nagging, safety obsessed, exaggerating friend who's sometimes wrong. And it's okay to ignore or override your friend if you know that you're safe. This takes practice. On a flight that was turbulent, I had an entire cup of scalding hot coffee dumped straight on my ankle. Electric jolt through my scalp. I ripped off my sock. It was already red. It was going to blister. There was no way I could get my foot into that little sink to get cold water on it and Then I remembered physiology hack. I had an unopened cold beer.

Medical.

Grade cold beer went on my ankle station. I had a vibrator in my carry on because I would on my ankle and then the pain kind and Payne MacGyver. I was no longer that concerned. Although then I realized I'm that guy with my barefoots sticking out in the aisle on a plane with a beer on it.

So that's dealing with acute pain. But in a minute, physician and pain expert Amy Baxter explains more about how all of these methods can also help with chronic pain on the show today, Pain relief. I'm Anoush Zumarodi and you're listening to the TED Radio Hour from npr. Stay with us.

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It's the TED Radio Hour from npr. I'm Anoush Zamorodi. Today on the show, we're looking into the past, present and future of how we treat pain. We've been talking to physician and pain expert Amy Baxter, and as we heard, Amy decided to research different ways to relieve pain after working as a physician throughout the opioid crisis and seeing the lack of options given to patients. Living pain free, she says, was a false promise made by the pharmaceutical industry. But dealing with chronic pain requires multiple strategies, especially as we better understand what long term pain actually is, it's something.

Of a moving target as we get better information from functional mri. It used to be that pain was defined as acute until three months and then magically it became chronic. My own personal opinion based on the way the brain changes is that probably it's more of a 72 hour thing. The thing is that the body adapts really really quickly to what's going on and starts making different coping mechanisms. Those are probably the better definition of acute versus chronic pain. And we've moved the goalpost from three months to one month. But I think that probably the scientific literature is going to move it even closer to the event of the tissue damage in the next decade or so.

If someone is listening and they're thinking okay, just tell me what to do. If I am going in for a procedure and I want to deal with acute post op pain and then what I can do for chronic pain.

One thing that's important and I even this morning got a letter from somebody who is outraged that I wanted to take people's opioids away. I do not mind if people who are chronically managed with opioids have the same dose from now until the rest of their lives because they rarely overdose and they rarely increase the doses. That is not where the problem is. My real mission is to stop giving pills out after surgery. By not having other pain options, we leave doctors with no choice but to give opioids at home after a surgery because they want to help. But it's about 6% of every surgery have people who are still on opioids 90 days later who weren't before. It is so clearly consistent despite the caliber of the surgery. And we should make people aware of this before they take a medicine that they may be be better off with ibuprofen or an ice pack or vibration or having a whole bunch of friends.

Over.

Power over pain isn't always pretty, but it is possible and it is absolutely critical. So what do we do? Well, in my dream world we have healthcare systems pay for options and coaching and we quit giving double digit prescriptions for opioids for for home recovery.

In the real world, 80,000 people died.

In the US last year from opioid overdoses. And 80% of substance use disorder starts with a pill prescribed for pain usually taken from your friend's medicine cabinet. You all now know to throw away the opioids in your medicine cabinet. You now know that there are options you can use to decrease pain. And you know that that pain free should Be ditched for more comfortable. And whether you dump skullding, coffee or pain wakes you and exhausts you every day, options that are in your control can allow you to reframe pain.

So one of the options for dealing with acute pain is a tool that you created called Buzzy. It's for kids. It both cools and vibrates. It looks like a little bee. And it has FDA approval. But what about, say, a grown up with chronic back pain? Do you have tools for that?

Amy so I will say that low back pain is the number one source of disability worldwide. It is the number one reason people go from acute low opioids to chronic. And what we know about low back pain now is the same with a lot of injuries that go on to become chronic. The problem is not the original insult. The problem is that the small muscles that are holding you still so you don't increase pain. Those muscles aren't designed to have that much load. They try to rise to the challenge and they don't have the plumbing, so they lose the blood supply. They have lactic acid and hurt like you've worked out too hard. And over time they get fatty changes that further decrease the blood supply and then they start getting shrunken. And so I started reading and I started playing around with different frequencies. What we do now is we have three different frequencies that decreases fatty changes. And then we played around with the amplitude so you can get it to penetrate different depths of tissue. And the final pivotal trial, we'll be done with the chronic patients on June 30th. What we are hoping is that we will have not just a reduction in pain, but actually reduction in opioid use. But it's not ever going to be enough to have one thing. People need to realize that a little bit of magnesium is perhaps going to shave 10%, maybe 30% off of how much pain they perceive. But it's going to take a few days to kick in a little bit of exercise, just bending over and lifting up 10 times a day and then gradually getting to 20 times a day and then doing it with a tiny weight. That I have heard from people who have overcome their back pain and they're doing the same thing we're trying to do. They're rehabilitating those little muscles, but it's very slow. I wish people with chronic pain knew it was okay not to think that they're going to find one thing that's going to fix their pain.

Oh, but Amy, it would be so nice if there was like this one magic thing, thing that just took care of it. What you're describing, that's like taking on a part time job.

Yeah, it is. It's a part time job. It's a remodel of your brain. And nobody in it wants to hear that. If they did a whole bunch of things every day for six months, they would feel a lot better because it's really hard to get up the energy to even do two.

You are reminding me of the story you told in your talk about your friend's son Christopher, who ended up addicted to opioids after major surgery and later overdosed. What would you have done for Christopher now?

Oh, wow. Well, if you ask what I would do for Christopher now, Cami Wolf, Christopher's mom is actually doing it for people at Grady Hospital in Atlanta who have trauma. They're teaching them about how to go home without opioids.

And I thought, how can I warn people? How can we stop this in hospitals? I didn't even think one second to ask the doctor about the medication he was being given. But when you're on OxyContin, you know, you can become addicted with one prescription. And of course, I had no idea. None.

This is Christopher's mom and Amy Baxter's friend, Cami Wolfe Rice. She vividly remembers bringing Christopher home from the hospital.

He was going home with a hole in his stomach and a bag and he needed psychological counseling. Right. To deal with that for a 17 year old boy. Right. A senior year in high school. They didn't prep us for what we were going home with. And not one single solitary word about any risk involved at all. Zero. Christopher, you know, his dream was to be a Navy seal. He was very disciplined. He was an AP student. Just super book smart is the way I would describe. But a hugger.

Years passed and he didn't stop taking the pills.

So he was just constantly on the opioids and still managed to go to college, graduated college. But then he's the one that came to me and said, mom, I have got a problem. I need this medicine just like you need air, breathe. He fought it for 14 plus years. I'm talking multiple rehabs. But when it hijacks your brain, you trigger, things happen and you relapse. And he kept thinking he was failing us, he was failing himself. Which of course depression sets in and you could have never in a million years would have I ever thought that Christopher would have done heroin. But he couldn't get the pills and so he had to go to the street.

He overdosed in 2016.

And it literally took me two years to even talk to my family because of the stigma that we have in this country. As sadly as it sounds, I didn't want him to have a disrespect death. I didn't want people to think of him horribly because he was such a wonderful person. So I think there was enormous guilt that I was feeling that I failed as a parent. I feel I failed as a mother. You know, I failed as a mother. But then I realized that silence is deadly and we need to be able to speak out because if everybody was honest about it, everyone knows somebody that's suffering with addiction, everybody.

That's when Kami came up with an idea to give patients someone to guide them through the shock of dealing with pain. A kind of pain coach that she called a life care specialist.

We use coaches for everything in our society except for when you're in a health crisis. I felt like there was a missing person on the healthcare team. So the job of a life care specialist, number one, is to educate you on the pain medication that you've been prescribed. Then we provide non narcotic pain management techniques, things to distract your brain. So all of our life care specialists are certified also in techniques to deal with the mental side of a patient. When you're in the hospital, if you're in the hospital, you probably have anxiety, stress, depression and ptsd. Sometimes they need somebody to validate their pain, to validate their frustrations. Why did this happen to me? Why am I here? And they don't have that listening ear. And then follow up once you leave the hospital, are you off your pain medicine? How to properly dispose of your opioids? And we found that patients, 70% of patients didn't even know they were taking an opioid. A gentleman said, oh my God, I did not know I was taking an opioid. And my wife is in recovery, so I'm so glad you told me. So we were able to provide a lockbox so he could lock up his medicine. You know, there's a lot of little stories like that.

At first, Kami was very strategic with where she placed life care specialist, but now she's hoping to expand.

We started in orthopedic trauma because the that's where young people have their first introduction to opioids. Typically it's a football injury, a car accident, a gymnastics injury, whatever the case may be, they go home with a big bottle of opioids and that's where the problem starts. So we started an orthopedic trauma. But we've expanded into Multiple departments. And now at the rural hospital, we're really, we're on the floor across the board. If Christopher would have had a life care specialist, if I would have had somebody telling me about the dangers of the medication he was going home with, he would be here today. And so I really feel like we're saving lives one patient at a time. And it's definitely a preventative role that needs to be in every hospital across the country.

That was Cami Wolfe Rice. She is founder of the CWC alliance the Christopher Wife Wolf Crusade. She's also the author of the Flight My Opioid Journey. Many thanks to her. And of course, Dr. Amy Baxter. She is a pain specialist physician and also the founder of Pain Care Labs. You can see her full talk@ted.com before we go, we wanted to give you a quick update on Katnod, the equestrian whose horse fell on her and who was trying to live with her chronic pain drug free. Kat went through a period of complete despair, but she read a lot of self help.

And finally I just decided that it was enough, that I'd had enough of the pity party and that I was going to fight for my life because that is at that point what I was fighting for. And I decided to challenge myself to move and get out and just five minutes a day of moving my body. And those five minutes were torture. They were not easy or fun. That five minute walk felt like it took an hour and a half every single time. But then slowly that five minutes became a little easier and a little longer. And the thing that I was torturing myself to do every day became thing that was actually getting me out of bed every day.

How are you today? Are you living with chronic pain?

Yes, and I will live in chronic pain very likely forever. And that's okay. I have a way better mental control over my pain. And although yes, I still am at like a 5 or 6 out of 10 almost every single day, it's more like background noise. Now when it's so constant, you kind of learn to tune it out and you learn to focus on the good things in your life, you learn to focus on other things that are stimulating. Because when all you have in your life is pain, that's really dark. But if you can bring other things into your life that bring you joy, bring you happiness, keep you moving, keeping you working, distracted, it does make it easier to kind of let that pain level fall into the background. I know it's there, but it's something I have a way better mental control over now. Pain is Very complex, especially the chronic pain. And because there is a brain aspect to it, because your brain is so used to being in pain and there is the physical aspect of it because obviously most of the time it stems from some sort of injury or something happening. Nerve pain, like all of these things. And so you kind of have to break it apart and treat all of the pieces instead of just treating one as a whole and break that cycle. So for me, I found the chronic pain clinic and I did what they call an ablation. So they cauterized a bunch of nerves in my from basically my neck to my tailbone. Very unpleasant experience. But it did help break a little bit of the cycle. I was in pain wise because the nerves couldn't communicate to my brain the same. And that really helped as a reset. And then I used that time to really strengthen and train my body around the injuries to have better support. And then I do also I've seen natural pass and lots of people like that to help find some natural supplements to help with inflammation and pain as well that aren't opioids.

It's a full time job.

Oh, it's a commitment for sure. But you know what, when your choice is do I commit to not being here anymore or do I commit to finding a way through this and coming out the other side stronger, more knowledgeable and to be honest, I think healthier right now than I was before my injury. I'm going to choose that route all day long.

Are you still involved with horses?

Yes, actually. So I am training and back to competing and have really high hopes for where that journey could take us and whether that means all the way to the Olympics. That's definitely a goal. Wow, does hurt to ride. But do I notice it when I'm riding? No, Riding is the thing that is my therapy and a little extra physical pain that I can work through from a stable and healthy mental place is definitely worth it for me.

That's Katnod. Her book is called the Other side and you can see her TED talk@ted.com Many, many thanks to all the people we had on this show about pain relief. This episode was produced by Rachel Faulkner White, Matthew Cloutier, Fiona Guerin and Chloe Weiner. It was edited by Sanaz Meshkinpour and me. Our production staff at NPR also includes James Delahousy, Katie Monteleone, Harsha Nahada and Arin Noguchi is our executive producer. Our audio engineers were Ko Takasugi Chernovin and Robert Rodriguez. Our theme music was written by Ramtin Arablouei. Our partners at TED are Chris Anderson, Helen Walters, Alejandra Salazar, and Daniela Balarezzo. I'm Minouche Zumarotti, and you've been listening to the TED Radio Hour from npr.

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