WEBVTT

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... just as everyone goes,
'Great, quick nap.'

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Don't have a nap!

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Raise your hand - just squeeze
your left ear as hard as you can.

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Raise your hand if it hurt.

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Fantastic. Thanks for having me.

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(Laughter)

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No, no - it's not true.

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Let me tell you a story.

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I just want to take that
off the screen for the moment.

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I want to tell you a story
that will explain to you

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the first three years
of the Neurobiology of Pain

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that you would study
at university.

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Eight years ago, 
I was walking in the bush.

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I had a sarong on.

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(Laughter)

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Very cool. This is what happened.

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Did you see that?

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Hang on, this is what happened.

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Biologically, I'm going to tell you 
what happened just then.

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Something touched the outside 
of my left leg in the skin.

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That activates receptors

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on the end of big fat, myelinated,
fast-conducting nerve fibres,

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and they stream
straight up my leg - whizz -

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straight into my spinal cord - 
whizz - up to this part of my brain,

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and they say,

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'You've just been touched on the outside
of your left leg in the skin.'

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(Panting) (Laughter)

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Meanwhile, whatever it was

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is sufficiently intense
to activate free nerve endings;

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we call them 'nociceptors'.

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They're thin, unmyelinated, 
slow-conducting Lada Niva -

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someone knows
what a Lada Niva is -

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(Laughter)

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nerve fibres.

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And that message travels
up to my spinal cord,

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and that's as far as it goes.

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And it says to a fresh neuron
in my spinal cord,

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'Something dangerous has happened on
the outside of your left leg in the skin,

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mate.'

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(Laughter)

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And the spinal nociceptor
takes that message up to the thalamus,

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which sits in there somewhere,

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and says, 'There's danger on the outside
of your left leg in the skin, mate.'

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Now the brain has to evaluate 
how dangerous this really is.

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So it looks at everything.

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And the way that I make sense of this,
of what happened to me,

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is the brain thought, 'Frontal lobe,
have we been anywhere like this before?'

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Hang on, I'll just ask 
the posterior parietal cortex.

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Have we been in this environment before?

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Yes, we have.

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Has it happened at this stage
of the gait cycle?

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Yes it has.

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Is it coming from the same location?

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Yes it is.
What is it?

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Well your whole life growing up, 
you used to scratch your legs on twigs.

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This is not dangerous.

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I'm going to give you,
the organism, something

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so you can kick off the twig
and continue on your merry way.

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And that's what happened for me.

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I can't show you now, 
but I took off my sarong,

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got in the river, got out of the river,

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and that's the last thing I remember,

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having been bitten
by an eastern brown snake.

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(Mumbling)

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Survivor.

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(Laughter)

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Thank you very much.

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(Applause)

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Now, for some reason,

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the eastern brown snake
works by poisoning you - clearly -

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and one of the things it does is
activate nerve fibres.

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So actually my brain
would have got these messages

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saying, Danger! Danger! Danger! Danger!

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and, in its wisdom, it said, No. No. No.

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Six months later, I'm walking
in the bush with a boring talker.

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You know what a boring talker is?

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Those people, it doesn't matter
what they say, it's boring.

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(Laughter)

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It's irrelevant, but we'll call her Naomi

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because that is her name.

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(Laughter)

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Anyway, this is what happened, right?

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Ow! Wah!

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And I'm in agony.

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I have got a white-hot poke of pain
screaming up my leg.

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I'll tell you, biologically,
what's happened.

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Something touched the outside 
of my left leg in the skin.


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That activates big, fat, 
myelinated nerve fibres

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which send a message -
whizz - whizz - up to here.

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Just been touched on the outside 
of your left leg in the skin.

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It's sufficiently intense to activate
these free nerve endings.

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Danger receptors take
the message to my spinal cord:

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something dangerous has happened on
the outside of your left leg in the skin.

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(Audience) Mate.

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Yes!

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(Laughter)

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Well done, you weren't planted.

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That goes to the thalamus
and says the same thing:

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something dangerous has just happened

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on the outside
of your left leg in the skin.

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(Audience) Mate!

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So the brain says, thanks very much, 
Thalamus, kids alright? Good, anyway ...

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(Laughter)

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Frontal cortex,
anything to tell me about this?

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Hang on, I'll ask the posterior 
parietal cortex: where are we?

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We're walking in the bush.

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You're a bit 'mate' happy.

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At this stage of the gait cycle?

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Where's it coming from?
Have we been here before?

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Oh yes, we have.

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Last time we were here, you almost died.

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I'm going to make this hurt so much 
that you can do nothing else.

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And I was in absolute agony 
for what seemed like minutes.

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Screaming pain -

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until one of my mates looked at my leg,
and there's a little scratch from a twig.

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(Laughter)

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The pain in those situations 
was totally different

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because of meaning.

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I want to convince you that pain
is an illusion 100% of the time.

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Here's a visual illusion ...

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So have a look at this picture,

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you've got a square that's got A in it
and one that's got B in it.

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Raise your hand if you think 
that the square with A in it

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looks darker than the square with B in it.

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Thank goodness for that.

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None of you have a really socially
embarrassing, neurological disorder.

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Except you.

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(Laughter)

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That's not true.

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Watch what happens 
if we have another look at this.

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These are those two squares
taken out of that picture.

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Hopefully you can see they're identical,
and some of you may not believe me.

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I'll just put A on top of that, 
and I'll put B on top of that.

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Some of you may still not believe me,

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so why don't we 
just move A over on top of B,

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or B over on top of A.

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No matter how long you look at this, 
A will look darker than B

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because your brain's doing 
some really groovy stuff,

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really quickly, outside of your awareness.

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Have a look at this.

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Turn your head on the side
and have a look at the same picture.

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Nothing changes.

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(Laughter)

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Fantastic. 100% take!

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So what really happens here,

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exactly the same frequency 
is hitting your retina,

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and that sends a message 
to the back of the brain,

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and then all of this groovy stuff
happens very quickly

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to ask the question,
What does this really mean?

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What's biologically advantageous for me?

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and then you get a visual image.

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This is a visual illusion, 
and vision's not about emotion,

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vision's not necessarily about survival,

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but pain is.

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Now, some of you might not know, 
if you're not medically trained,

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but what's happening
at this guy's right leg,

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that's not right, that's ...

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(Laughter)

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that's a dangerous situation,

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and that danger message
arrives at the brain,

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and the brain has to ask 
exactly the same question.

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What does this mean? 
What should be done here?

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And hopefully, the orchestra in this 
person's brain will make your leg hurt.

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In the work that
I've been doing for a long time,

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we're trying our best to work out 
how do we convince people in pain

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that we understand they're in pain,

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but it's not just about
the tissues of their body.

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How do we convince them of that?

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And a key conceptual shift
that we think is really important

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is that you can understand 
that pain is the end result.

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Pain's an output of the brain 
designed to protect you.

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It's not something that comes
from the tissues of your body.

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There's nothing there.


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We show patients a really sharp knife,

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and we say this knife is sharp, yeah?

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Yeah.

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And it might be a bit cold;
it's hard; it's got all those properties.

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This knife - painful as it sits out there.

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No, it's not. That knife does not 
have the properties of pain.

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And when you stick it into their belly -
we do this regularly, straight through -

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the belly doesn't adopt 
the property of pain.

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The brain has to do some 
very rapid and groovy things

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to project this illusion 
that pain exists there.

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100% of the time, 
pain is a construct of the brain.

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We can mess with pain easily 
without touching the tissues.

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This is an experiment we did a while ago

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where we got supposedly 'normal'
healthy volunteers.

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They're not normal people,

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because they're volunteering
for a pain experiment,

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(Laughter)

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but let's say they are
reasonably normal, right,

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and we put a very cold piece of metal 
on the back of their hand,

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and we just show them one of two lights.

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One light is red, and one light is blue.

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We don't tell anything about the lights, 
we just show them the light.

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I see that hand.

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We ask them, 'How much does it hurt?'

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And if they see the red light, it hurts
more than if they see the blue light.

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The stimulus is exactly the same,

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what's different is 
the meaning of the stimulus.

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Now there's a cue that says,
'This is really hot.'

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Because red means hot.

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So the sensible brain,
the clever brain should say,

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'Well, I really don't want you to do it,
so I'm going to make it really hurt.'

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There's people in the States that are
allowed to get their psychology students

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to participate in experiments
in exchange for credit points -

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or sex, or something -

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anyway, they put their head inside what
they think is a stimulator for their head,

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and they make sure that
the subject can see the intensity knob.

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And as they turn up the intensity knob,

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this little figure there showing
the lines going up at a steady rate,

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that's their reported head pain,

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and it matches the intensity knob.

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But the stimulator's doing nothing.

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It's just one of those
old-fashioned plastic hair dryers

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that doesn't do anything.

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You know those things?

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You probably use one - yeah?

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The trick is that they
have to see the intensity knob.

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I always think it'd be fun
to do an experiment

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based on that Spinal Tap film
where the intensity knob goes up to 11.

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Remember that film?

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What's really important
from a clinical perspective,

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and I'm a clinical neuroscientist,
and I see patients in pain,

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any piece of credible evidence
that they're in danger

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should change their pain,

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and they're all walking
into hospital departments

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with models like this on the desk.

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What does your brain say
when it sees a disc

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that's slipped so far out
it's sitting on its own?

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(Laughter)

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If you've ever seen a disc in a cadaver,
you can't slip the suckers.

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They're immobile, you can't slip a disc.

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But that's our language,
and it messes with your brain.

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It cannot not mess with your brain.

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We can even modulate the location of pain.
We can do some groovy things.

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It's quite well established
that referred pain

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gives you pain in an area of your body
that might be physiologically normal.

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Most of you would have heard
of referred pain.

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(Sneezing)

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Bless you.

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We do experiments where we give you
pain in an artificial limb -

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it's not even yours.

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This is Meng, who was a postdoc
in my lab in Oxford in the UK,

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and we stole a prosthetic limb,

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which is a whole other story
which is really funny -

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but I won't tell it to you -

00:11:29.668 --> 00:11:32.638

and we can do this manipulation

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so that you start to feel like
the plastic limb in front of you is yours.

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And we can make the rubber hand hurt.

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And we can bring in a knife,
and run the knife across the rubber hand,

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and you have your brain responses
to protect that rubber hand.

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You're feeling pain
in a lump of plastic, effectively.

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Here's a groovy experiment where
we take two Microsoft clipart people,

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and we put a webcam
on the forehead of one of them

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and a set of virtual reality glasses
on the other one.

00:12:06.153 --> 00:12:08.436
And then we get them to shake hands.

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And as they're shaking hands,

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the person on your right,
who's wearing the goggles,

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their visual field is coming
from the other person's forehead.

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Have you got it?

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So they are effectively looking
at the other person, thinking it's them

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because they're shaking hands,
the motor command fits, everything's good.

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And then we come in and put
a painful stimulus on that person's arm,

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and they see it hit that arm
of the person over there,

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with whom they're shaking hands,
and they say, 'Ouch! It really hurts.'

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And we say, 'Where does it hurt?'

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'On that man's arm.'

00:12:43.901 --> 00:12:45.731
(Laughter)

00:12:45.731 --> 00:12:48.511
They get it right every time,
pointing exactly where it is,

00:12:48.511 --> 00:12:51.651
but if you were on the outside,
taking a photo, they're literally -

00:12:51.651 --> 00:12:55.465
we've got the painful stimulus here,
and they're saying, 'It hurts there.'

00:12:55.880 --> 00:12:59.751
So the brain is not only producing pain,

00:12:59.751 --> 00:13:02.751
it's projecting it
to this location in mid-air.

00:13:03.211 --> 00:13:04.846
We can mess with that.

00:13:04.846 --> 00:13:07.292
This all becomes really important
when pain persists

00:13:07.297 --> 00:13:09.998
because two things happen
when pain persists

00:13:09.999 --> 00:13:12.560
that make the life
of someone in pain really difficult,

00:13:12.560 --> 00:13:15.525
that costs our country
40 billion dollars a year.

00:13:15.672 --> 00:13:17.645
It costs Australia more than cancer,

00:13:17.645 --> 00:13:20.998
cardio-vascular disease
and diabetes combined.

00:13:21.981 --> 00:13:25.979
Thanks for that facial expression,
I wanted someone to go ...

00:13:27.939 --> 00:13:30.749
This is the problem,
that if we keep running the neurons,

00:13:30.749 --> 00:13:34.739
the brain cells that produce pain,
they get better at producing pain.

00:13:35.076 --> 00:13:36.795
They become more and more sensitive,

00:13:36.795 --> 00:13:38.896
so we need a smaller
and smaller influence.

00:13:38.897 --> 00:13:42.244
The illusion, if you like,
in increasing sensitivity

00:13:43.367 --> 00:13:44.854
becomes very unhelpful.

00:13:44.854 --> 00:13:48.634
It's trying to protect you from something
that's not needing protection.

00:13:49.114 --> 00:13:50.224
It's very real.

00:13:50.734 --> 00:13:53.488
The other thing that happens
is that all of these networks

00:13:53.488 --> 00:13:57.986
lose their capacity to be specific
and precise, so the pain spreads.

00:13:58.296 --> 00:14:02.752
The pain changes its quality.
Ultimately, it's not even informative.

00:14:02.752 --> 00:14:05.502
It's both unhelpful and uninformative.

00:14:06.678 --> 00:14:10.468
Maybe the next TED Talk ever
is the really important question,

00:14:10.468 --> 00:14:12.208
'What do we do about it?'

00:14:13.112 --> 00:14:14.532
Who knows?

00:14:14.997 --> 00:14:15.997
No, we do know,

00:14:15.997 --> 00:14:19.729
that's what we're really researching,
but that's the end of my 18 minutes.

00:14:19.729 --> 00:14:21.869
Thank you very much for having me.

00:14:21.869 --> 00:14:25.129
(Applause)