Dr John Booth from The University of New South Wales

1. Museum of Human Disease Disease Discovery Evening Know Pain No Gain

2. The Faculty of Medicine and the University of New South Wales recognise the unique position of the Aboriginal and Torres Strait Islander peoples in Australia’s culture and history. That Aboriginal and Torres Strait Islander peoples have inhabited Australia for well over 50,000 years and that their unique cultures and identities are bound up with the land and sea. They acknowledge that the Aboriginal people are the original owners of the lands occupied and used by the Museum of Human Disease. I would like to acknowledge that this training is being held on Aboriginal Land and recognise the strength, resilience and capacity of Aboriginal people in this Land. We are on Facebook.com/MuseumofHumanDisease and twitter @diseasemuseum #MOHD #Diseasediscovery#painnight

3. DISEASE DISCOVERY 4 Monday 20 June 2011 Dr John Booth: Know Pain or No Gain Welcome to the Museum of Human Disease. Throughout the session and your visit to the Museum we would ask that you adhere to the following: - No food or drink is permitted within Museum Gallery. - Strictly no photography. - Specimens consist of generously donated human tissue. Please view specimens with appropriate respect and dignity. Thank you for your cooperation and we hope you enjoy your visit! We are on Facebook.com/MuseumofHumanDisease and twitter @diseasemuseum #MOHD #DDE4#painnight

4. We are on Facebook.com/MuseumofHumanDisease and twitter @diseasemuseum #MOHD #Diseasediscovery#painnight

5. Museum of Human Disease Disease Discovery Evening Know Pain No Gain

6. KNOW PAIN OR NO GAIN! Dr John Booth (PhD) – Exercise Physiologist Senior Lecturer, School of Medical Sciences, Faculty of Medicine, UNSW

8. The nature of pain

9. The problem with persisting pain

10. Treating/managing persisting pain

13. Sometimes pain can persist well beyond the expected healing time and termed ‘chronic or persisting pain’ Move it or lose it! Do something now!

14. DESCARTES, EXPECTATIONS, CULTURE Pain operates like a rigid fixed system and a particular injury generates a set amount of pain Pain is physical and mechanical so fix it! Renaé Descartes 1664

15. A Conundrum! Pain can persist without tissue damage or injury (e.g. chronic back pain) Seemingly painful experiences aren’t painful (Aron Ralston, injured soldiers) Expectation can alleviate pain (placebo) Expectation can increase pain(nocebo pain)

16. Pain persists not only in the absence of tissue damage but in the absence of any tissue (i.e. phantom limb pain)!

18. The central nervous system becomes more sensitive “turning up the pain volume”

19. The spinal cord and brains network of pain centres increases

20. The sympathetic or ‘fight or flight’ nervous system kicks in and can drive the pain process

22. With longer term pain, pain is elevated to the forefront of consciousness!

24. Did your thoughts flow and engage in one different thing after another?

27. There is competition for consciousness awareness, with one perception tending to grab control

28. Some thoughts don’t get prioritised and are dealt with at a sub conscious level

29. Pain can command attention even against determined efforts to resist it and attention increases with anxiety

31. Most successful contemporary pain treatments involve a combination of education, knowledge, understanding and movement (in conjunction with appropriate drug therapy when necessary).

32. Decrease nociceptive information, anxiety and painful information and sensations from dominating consciousnessDESIRED OUTCOME

34. The body’s response to pain

35. The brain and pain

36. The role of thoughts and emotions

37. Changes in pain processing with longer term pain

39. Exercise activates the endogenous opioid system producing compounds with chemical structures reminiscent of opiate drugs (e.g. endorphins)

40. The endogenous opioids synthesised and released in parts of the brain that modulate pain perception

41. Bind to receptors making some neurons that relay pain signals down the spine less excitable

42. Levels opioids might be higher with aerobic exercise and higher intensity exercise

44. More oxygen to the brain better mood and sleep and increased endorphins the body’s natural pain killers

45. Improved psychological wellbeing

46. Decreased fatigue

47. Increased relaxation and promotes the ‘rest and digest’ nervous system

48. Tissue tolerance increases, pain threshold and pain tolerance increase

50. Choose enjoyable activities and include aerobic activities

51. Avoid doing more on your good days and less on bad days

52. Discomfort with movement and exercise is a “yellow” not “red” light to continue

54. The pain experience is specific to each individual

55. Pain and tissue injury can be poorly related

56. Longer term pain results in significant changes in the body systems, tissues and brain

57. Treating chronic pain requires the focus to shift from pain abolition to improving function and managing and coping better

60. Gough Sections Related Specimens 507.8 specimen number bay number

61. DISEASE DISCOVERY 5 Monday 18 July 2011 Dr Ben Colagiuri: The Placebo effect