thank you thank you for having me today
I'm trying to convince you that pain is
actually a perception and not a
sensation there's a photograph of Andy
Murray after the Washington open in 2018
when the commentator thought that Andy
Murray was overcome with the emotion of
victory and in fact later on Andy Murray
went on to describe that this was the
point at which he felt he was broken he
was broken by his pay Andy Murray a
developed persistent pain in his head no
treatment seemed to be working this is
what he said about it it was consuming
like all of my thoughts I was worried
about all of the time unfortunately Andy
Murray's not alone some 40% of the UK
population and 20% of the world
population lived with daily pain mrs.
led the world outs assembly to declare
their pain relief he should be a basic
human right so let's try and discover
what we mean what what is this thing
called pain so the old idea a as my
intention suggests is that pain is a
sensation and this really dates back to
the time of the French philosopher and
neuroscientist Rene Descartes
he gave the idea that we have a specific
pathways for each specific stimuli were
able to feel as human beings in this
case he was depicting what he called the
pain pathway but he also describes
similar pathways for touch and for
vision and what he really was getting
that was that whenever we have one of
these stimuli it will always produce the
same response but I want you to consider
this this went viral on the internet a
couple of years ago this dress we had
people sat in the same room looking at
the same image not able to decide really
what colors it was yeah I can never see
the true color which is black and blue
most people actually didn't see the real
color they saw the white and gold but if
they can't was correct
everyone looking like that image
would have seen exactly the same colors
so what I would suggest that their ideas
of daco which still dominate our
understanding of pay and its management
should firmly be put in a non recycling
bin so what is this thing called
perception and why is pain after section
so there's delve into what perceptions
really are this is an image taken at the
back of the Rays theater and a slightly
different date of the day and if we were
to try and walk our way through this
actually to achieve that task we're
facing a lot of what's called sensory
noise now we're not talking about some
per se we're talking about a lot of
unexpected activity with the people you
see in the sea and how we do that is
based on our perceptions and how we do
that is to take our experiences have
been in crowded situations before and
try to predict what might happen well
also we rely on social etiquette how
people are likely to behave in that sort
of situation and to do that we need a
nervous system that is not this this is
a couch potato baked arts ideas propose
that your brain in your nervous system
act rather like a cognitive couch potato
just waiting for information to flow
into the system and then doing some
think about it but what we now know and
we have a model called predictive
processing that tells us something about
this is the brain and the nervous system
are continuously predicting what's
likely to happen to us and we only use
the sensory information to either
confirm that those predictions are
correct what's in the gate them now if
they're sensory stimuli confirm those
predictions nothing needs to happen
we've got a relatively good model that
can explain away what's going on however
if we have negation of the prediction
then we send sensory signals up towards
the higher centers this is vastly
different to de cartes model where
information is transferred from the
periphery up to the brain without any
filtering or alteration and what this
really depends on is a sea
some models throughout the nervous
system and they're not made of wood as
this diagram shows but they're made of
neural networks and neural connections
and some of you will have read about the
term plasticity neuroplasticity and some
of you here will think this takes place
over weeks or months or years but this
is a dynamic that happens all the time
in fact one of the pleasures of standing
in right now is I'm changing the way in
which your nervous system is wired and
there's good news and bad news within
that story because neuroplasticity can
be adaptive can be fit for purpose or it
can be maladaptive causing problems talk
more about that in a second
and what we really get in that is
regularities where I am with my friend
Albert Einstein then what you're looking
at is a mask of Einstein's face and if I
rotate his face 180 degrees this mask I
know where you can see it but you
probably still see in Einstein's nose
come out towards you even though what
you're looking at is the concavity and
turnout around this eye
why is that and that's because one of
the firmest regularities you have which
is fall very early in development is
that noses come out from faces and
that's what we should expect that's the
regularity in fact you're probably
worried every time you meet someone
whose nose doesn't come out from their
face and you should be but these are
form these models are formed by
interaction with our world and taking
action on our walk babies continuously
play and interact with objects putting
them in their mouth because it's the
first place in which they can sense
objects we should continue to play and
we should continue to manipulate things
and we should continue to discover so
that we broaden our repertoire of models
as we develop
and have you ever wondered why have to
go to the dentist now having a tooth
extraction you feel the huge desire even
though dentist has told you not to
I get very surety about this to not put
your tongue in the socket but the reason
you're doing that is to try and
rediscover to get a new mouth feel to
try and find a new model of what your
new mouth feels like I noticed some of
you made a small sound when you saw this
some of you probably felt very
uncomfortable and that's because you're
not just trying to make sense of
yourself you're also trying to make
sense of other people you interact with
your tried to make sense of situations
you find yourself in and an important
thing is in perceptions is that you can
only ever attend to one perception at
any point in time there is no such thing
for anybody however tell it that they
are for dual tasking or multitasking you
can switch tasks quickly but you can't
concentrate on one thing more than
another and I would suggest that pay as
primacy you will attend to pain over
other perceptions if you like pain cuts
through the noise of daily life so
what's the value of thinking of pain as
perception when it might make sense of
situations where we know we can have
pain without damage and we can have
damage without pay so this is an example
that was written up in a medical journal
about 20 years ago now we're a builder
jumped off some scaffolding no nail
15-inch nail penetrated his boot
he was taken straight away by his
colleagues to the accident emergency
department showing all the cardinal
signs have been in agony been in pain he
was vocalizing he's very protective he
was sweating profusely and he was taken
off to the x-ray department when he was
brought back to the examination room the
doctor who was examining swiftly removed
the boom yet let out a Yelp but then
immediately started to
the doctor showed him the x-ray and the
nail had penetrated the space between
the big toe and the second toe it hadn't
gotten too into any of his tissue at all
this is an example of pain without any
physical damage or any stimuli if
Descartes was right and payments a
sensation there's no reason this would
have hurt pain is a perception and
equally the opposite is true this is an
example from the American Civil War this
guy's had his arm blown off by a
cannonball and the record that went
alongside this said that he felt no pain
at the time he was incredibly serene and
calm and only two hours after you had
the wound repaired did he start to
experience any pain and report pain was
gross amounts of tissue damage here but
no perception of pain pain is a
perception not a sensation and this has
led some people however to think that
all pain is in your brain and this is
quite an understandable assumption to
make however I believe and many other
people believe it's incorrect this is a
person who was born congenitally
insensitive to pain many are small
changes in their genetics that mean that
they cannot put the first input of
noxious stimuli damaging or dangerous
stimuli from the periphery and these
people never ever have a pain experience
by the way they generally die young this
person died when he was 21 and the
reason why they probably never
experienced pain is they've never been
able to formulate the models which
underpin our perception of pain perhaps
where all this comes together best is
the understanding of placebos or no C
bows where we can give an inert compound
like sugar or say lie to somebody and do
it in the right context in the right
environment do it in a most medically
theatrical way and many people will
an analgesic effect but equally there's
an opposite effect a nocebo response
where if people have negative attention
negative expectation negative
understanding of what the treatments
about their pain
in fact gets worse so what does all this
mean for the treatment of pain or the
management of pain well unfortunately
we're right at the edge of an abyss in
the US and then Australia they fall on
the other side the chasm
they're deeply ingrained in the opioid
epidemic we are really just about to
fall into it if we don't do the right
things and unfortunately there's no
evidence that people are motivating
forces to do those things
so people are dying because of our gold
standard drug for pain and many of the
drugs and many of the other treatments
we have to pay were formulated in this
idea that pain is a sensation not a
perception so could the idea that pain
is a perception and not a sensation lead
to newer and different forms of
treatment and actually it already has
many pain management groups around the
world or employ in the principles and
the practice of meditation as part of
their therapy now the good news is you
don't have to shave your head or Jess in
red robes will sit on a beach to be
mindful you can be mindful wherever you
are many of you have probably been
mindful right a second I know you are
all right how does mindfulness work we
think that it improves the flexibility
of those models that the nervous system
built and paying and patients who suffer
in pain often have very narrow response
profiles to an old range of stimuli that
in most people wouldn't result in a
perception of pain but if they are a
loud noise or they're put in a
threatening situation or someone comes
close to a part of their body they feel
vulnerable they have a pain perception
where as we wouldn't normally expect
them to
we think that that's due to narrowing of
models and this one may be one mechanism
by which we can make those models
flexible again equally there are
techniques of distraction and this is a
great example from the University of
Washington where they've used virtual
reality and produced the program called
snow world to manage the pain of people
who have had burdened and managed them
while having treatment for their boom
burns and it's intentionally a snowy
cold scene it's intentionally blue in
color
we normally relate heat and burns to red
and too hot and heat and this is
intentional to cause distraction away
from their ideas of pain and their
perception of pain and it's not new
actually it was first really developed
as part of hypnosis and in the days gone
by hypnosis was a medical treatment not
a stage show media so people used
hypnosis in in management of pain and
other conditions well before Paul
McKenna came along and this is from my
own work what we did is we established a
thing called the rubber hand illusion if
we take most of you in this room and sit
you down and make you look at a rubber
hand and hide your real hand and then
strike both the rubber hand and the real
hand at the same time most of you would
start to embody now you start to feel
the rubber hand is euro and what we did
with this group of people is we
established the rubber hand illusion and
then we checked whether or not they'd
ever received acupuncture in their life
before and also if they knew what
acupuncture did and if they answered no
to both of those things then we
re-established the rubber hand illusion
and then we put acupuncture needles into
their other hand and then we tested the
sensation on their way or hand that
never had acupuncture and we showed that
their sensitivity to potentially painful
stimuli like heat pinprick
and certain types of chemicals were all
reduced they'd add an analgesic effect
from a sticking needles into a rubber
object now if Spain was a sensation it
would have made any difference but
because pain is a perception we were
treating some of these sensual models
directly and the news is not all bad for
drugs but maybe we need to be a bit more
inventive this is myself fortunately or
unfortunately not having taken
psychedelics but psychedelics are
proving to be a really exciting
opportunity for us to use drugs again in
the management of pay and again our de
psychedelics work well all of the
literature on psychedelics tells us that
they change and make models within the
brain and nervous system more fluid more
amenable to change they alter
perceptions I now only work together
with the group books in in the center of
psychedelics research Imperial College
we've got some early results that
suggest that this might be a really
beneficial thing to do with people so
I'd like to conclude my talk by saying
that understanding pain is a perception
and not as a sensation will enhance
society's understanding not only of pain
itself but also of those people who are
suffering ongoing pain particularly
those where we don't see any damage
we're told often they're crazy or
putting things on a better understanding
of pain in terms of perception rather
than sation will facilitate better ways
of managing patients particularly those
who will prove refractory to
conventional therapies we're about no
response to conventional treatments and
lastly together those things will out
reduce the individual and societal
burden of this thing we call pay and
hopefully will help us achieve a
fundamental human right which is to be
pain-free thank you for listening
[Applause]
you