Your Brain Invents Pain. Here's Why.

13:27Hannah Fry:Do you know where the word pain comes from, by the way? No, I don't. It goes back to Latin, unsurprisingly. Poina, which is penalty or punishment. Also in the Greek, poigni, which is blood money. and it's sort of like the price that you pay for spilled blood. Right. But underneath all of it, it's like the root of the word pain is to pay to kind of atone. It's like pain is sort of a debt that you are paying.

13:56Michael Stevens:Interesting. You know, my mother's maiden name was Payne. Oh, really? Now you guys can all steal my bank monies. Wait, spelled how? Spelled P-A-Y-N-E. Like Thomas Payne, common sense. Anyway, so pain is a punishment, but nowadays it looks more like it's a verdict our brain comes to. I think that's a great word to use, verdict. It looks at the evidence and it just kind of has to come up with a decision and it might be wrong. Even in other words that are to do with pain, like excruciating, excruciating has the word sort of crux as in the cross, right?

14:34Hannah Fry:Like the crucifix hidden inside it.

14:36Michael Stevens:Right. Oh, wow. Yeah.

14:38Hannah Fry:And I think that people have always filed pain under this idea of it being a curse or a sentence. And now, because as you say, actually, we know that it's a verdict because we know that it's not sort of a direct reading of your environment. In 2020, the official definition of pain changed. Pain is now defined as associated with or resembling that which is associated with actual or potential tissue damage. huh and this is an important distinction because there are some people who actually have really serious chronic pain in their bodies without there being the tissue damage or the underlying physical cause that can be treated to cut the pain off yeah my hand is still very cold yours

15:28Michael Stevens:must be so cold still like i was sitting on it and now i've got it in my um leg pit the other side of my knee. I don't know. What is that called?

15:38Hannah Fry:Instead of an armpit.

15:39Michael Stevens:Yeah. The crook of your arm, the crook of my leg, I'm like squeezing it. See, look how hairy my legs are. That gives you a sense of how warm I am all the time.

15:51Hannah Fry:Insulation all over the place. Right. Should I give you some quick pain facts?

15:54Michael Stevens:Yeah, please do.

15:55Hannah Fry:So nociception is essentially your perception of pain.

16:00Michael Stevens:That's a great word, by the way. Nociception.

16:03Hannah Fry:Isn't it good?

16:04Michael Stevens:Is there any Susception? No, susception.

16:06Hannah Fry:There is none. None at all. So no susception, that's your sensory nervous system. It's the process of actually detecting and encoding pain stimuli. And it's not the same thing as pain. No susception is like the raw signal that is kind of traveling up the nerves. And the pain is what your brain decides to do with it. Ah, it's the qualia of it all. Right, totally. Because you can have the signal with no pain, right? Right. Under anaesthesia, your body is like cut wide open. These signals are definitely firing towards your brain, but you're not registering it. And you can have the reverse. You can have pain with no signal.

16:44Hannah Fry:So people who have had limbs amputated, for instance, can end up feeling phantom pain for limbs that are no longer there.

16:52Michael Stevens:Right. Right. True.

16:53Hannah Fry:So the two things are not, it's not like a one-to-one thing. But in terms of that signal, that nervous system signal that travels through your body, I'm sure that you will have noticed this just by like stubbing your toe. There are two different pain signals. If you hit your thumb with a hammer, for example, then you get like a very precise jab. It's like, ouch, very quickly, like pull your hand away. Sort of if you put your hand on a hot hob, for instance, as well, that's the other one, incredibly quick signal that is going through these fibers that travel to your brain at 20 meters per second.

17:27Hannah Fry:But the dull pain that you get after you pulled your hand away from being hit by a hammer or like if you stub your toe for instance these are your c fibers and they move at one meter per second so actually i always think about when i stub my toe i really notice this stub my toe and then i sort of in my head i'm like one two there it is and that's literally the pain signal physically traveling up your body and into your brain yeah it has a

17:57Michael Stevens:different speed. I made a little YouTube short about the speed of pain before. Both of these kinds of pain have their own purposes. That initial urgent fast pain is like, move. It makes you move away or stop. But then the slower throbbing pain that lasts longer is there to keep reminding you to tenderly treat the injured part of your body.

18:22Hannah Fry:Yeah. Don't ignore it. I'll tell you where you don't get those pain receptors, which is in your brain where the actual pain is constructed overall.

18:29Michael Stevens:Oh, funny. Yeah.

18:30Hannah Fry:Even when you have a headache, it's not your brain that's hurting at all. It's sort of the surrounding of your brain. I mean, you see this with brain surgery.

18:38Michael Stevens:Yeah, right. So if someone said, I'm going to torture you by stabbing right where you feel pain, you wouldn't feel it. You wouldn't feel it because there's no pain receptors in your brain. That is a weird thing, by the way, that I want to look into more. So first of all, we've all seen like, I don't know if we all have, but open brain surgery is so weird because the person doesn't have to be under anesthesia. There's like local anesthesia for where their skull has been cut in the flesh. But then you can just poke around, slice around, ask them like, okay, so can you still feel your fingers? And they're like, yep.

19:10Michael Stevens:And they're like, okay, I guess you don't need that part of your brain. I don't think that's exactly how it goes. Surgery by Vsauce. That's how I would do it. I would use an obsidian knife though, by the way. Yeah, thank you. That's a call out to a previous episode or an episode to come, depending on the editor's schedules. But I've always wondered about the feeling of mental exhaustion and what causes that. It's not pain, but it is a feeling we have where if you have been very focused for a long time, if you've been thinking a lot, you feel like you've used your head. Is that because you've actually been using your eyes a lot?

19:46Michael Stevens:What is that feeling? It's not pain, but our brains don't have nerves in them that give us feedback on like how it's doing. Is it hurting? So what's up with mental exhaustion as a feeling?

19:58Hannah Fry:So I don't know the answer to that for sure. Right. And maybe there's going to be people in the comments who know way more about this than I do. But one thing I will say, have you ever come across the electrical current stimulators that you wear on your head? The EEG nets? No, no, this is. Oh, it's a stimulator. Yeah. Not a detector. Okay. So here's this idea, right? Is that actually what's going on in your head when you're thinking and actually when you're feeling pain, I mean, pretty much everything that you sort of sense in your body, what's happening is that charged particles are moving around.

20:28Hannah Fry:Sure. Yeah. One of the theories, I guess, is that exhaustion, but also things like depression are really amplified by there just not being enough charged particles in the right place.

20:41Michael Stevens:Yeah.

20:42Hannah Fry:So anyway, I have this thing. I have this headset that I wear sometimes. It sounds crazy, but it's actually it's FDA approved. It's like used by the NHS. And it just applies this very small electrical current on your head. And then suddenly your brain fog just goes away. Like suddenly you actually.

21:02Michael Stevens:Well, you got to show it to me. Where is it? Go get it.

21:05Hannah Fry:If I can get it. Yeah.

21:06Michael Stevens:A few moments later.

21:08Hannah Fry:It's like this little headset.

21:10Michael Stevens:Ah, OK.

21:13Hannah Fry:The thing is, this is a medical device, right? You sort of have to do it under supervision of a doctor. So how did you get it? From a doctor.

21:21Michael Stevens:Right. Okay. So you said, hey, my charged particles just aren't flowing.

21:24Hannah Fry:My charged particles aren't flowing. Hit me up. And this has a bit of a reputation, these kinds of things, because, you know, in the 1950s, 60s, 70s, electric shock therapy was really dramatic. And I think quite unethical in a lot of the ways that they use this. But we're talking like really gentle and it's just about sort of, so you get a little, there's a slight difference in current from one end to the other end. You've got an anode and a cathode.

21:48Michael Stevens:So how does it affect inside your skull? Is it like the electric field, like almost a magnet or?

21:56Hannah Fry:I mean, essentially everything that's going on in your neurons is about charged particles moving from one place to another.

22:03Michael Stevens:Right, yeah. Squirting around different concentrations of sodium ions.

22:08Hannah Fry:Exactly. So what this thing does is it changes the resting membrane potential of the neurons.

22:17Michael Stevens:Aha. So could it be dangerous if misused?

22:21Hannah Fry:I mean, probably. I think there's very good evidence about this thing. It's also, by the way, an incredibly low electrical current. You couldn't even feel it, really, if you put your fingers on it. But the idea is that you just give your brain a bit of a head start, and then over time, you sort of build new pathways.

22:37Michael Stevens:Okay, so you've had good results from it.

22:40Hannah Fry:Yeah, I really like it. I really like it.

22:42Michael Stevens:How often do you use it? Five times a week. Oh, wow. So every day, except on the weekends where you just let your brain... Chill out. Chill out and deionize. Deionize. What is it called? Transcranial direct current stimulation. Oh, interesting. I've done transcranial magnetic stimulation on Mindfield. Oh, yeah. In a lab where they try to change how your neurons are working, specifically in Broca's area, just to demonstrate that they can stop you from being able to speak. And this also has a lot of therapeutic uses. So it sounds like what you have is a like at-home version of that technology.

23:26Hannah Fry:Hey, it's Kelly Rowland. You may not know this, but I have eczema. So I get how it can steal your time. But why let eczema take over when you can talk to your doctor about ebglyss?

24:02Michael Stevens:Reactions can occur that can be severe. Eye problems can occur. Tell your doctor if you have new or worsening eye problems. You should not receive a live vaccine when treated with EpGliss. Before starting EpGliss, tell your doctor if you have a parasitic infection. Paid partnership with Lilly.

24:15Hannah Fry:Respect your time. Ask your doctor about EpGliss and visit epgliss.com. Or call 1-800-LILLY-RX or 1-800-545-5979.

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25:06Michael Stevens:$15 per month equivalent. Taxes and fees extra. Initial plan term only. Greater than 50 gigabytes may slow when network is busy. See terms.

25:16Hannah Fry:Here's the thing, though. All thinking and feeling that's going on in your body is essentially these charged ions passing through different channels. I mean, they're sort of squirting around your body, right? That's essentially what's happening. The way that pain works, we know this now, the way that you feel pain is that at the tip of every pain nerve is this little tiny gate that the ions sort of get squirted through, this like little sodium tunnel. And it's called NAV 1.7. It might be that people call it NAV, but I'm going to call it NAV 1.7. So if that gate is open, then the little ions get squirted through and get up to your brain and you're like, oh, I feel pain.

25:57Hannah Fry:Ouch. But if that gate is blocked or sort of modified in some way that stops the ions being allowed to pass through, then you would feel no pain. You would still have sensation. You would still be able to like feel and touch things, but you would have no pain whatsoever. And it turns out that there is a gene, it's called SCN9A. There is a mutation in that gene that mucks up this particular little gate and means that there are some people who can feel no pain whatsoever.

26:31Michael Stevens:Wow. I've read fictional accounts of people with such a condition in the Flowers in the Attic series when I was a kid. Right. There's a child in like the second books and on who doesn't feel pain. And so they always have to be so careful because this kid won't know if they've scratched themselves. They can get an infection. They won't know if they've broken a bone.

26:53Hannah Fry:I've met someone with this condition. Really? Yeah. He's called Stephen Pete. He is so amazing. American guy. Has worked with researchers who are trying to like isolate this particular pathway, try and work out if there's different pain medication. He was so amazing, but I have to confess to you, it's the only time I've ever interviewed someone where I had to pause the interview midway through to go and be sick. I had to vomit because it was so horrific, the stuff that he was telling me. I couldn't handle it. And I basically threw up in the middle of the interview.

27:26Michael Stevens:Oh, wow. The only time I've ever actually felt really sick and I had to excuse myself was when I was at Berkeley looking at actual human brains. And I pretended like it was the formaldehyde smell that made me sick. And I'm like, I got to go. I got too big of a whiff. But really, it was the idea that I was holding someone's identity. Like everything they'd felt, every memory, every time they'd taken a child to the playground, it all happened in this organ that we don't understand. And I was holding it. We were just looking at it. And I'm like, oh my gosh, this is too, too close to a human. So there's my admission that it wasn't the formaldehyde.

28:06Hannah Fry:Yeah. Wow. Right. It's incredibly profound. Okay.

28:09Michael Stevens:So his name is Steven Pete. Yeah. Talk about a Mondegreen. That also sounds like it's two people, Steve and Pete. It's true, Steven Pete. People do that to me, Michael Stevens. And they're like, so is your name Steven or Michael? And I'm like, you can see there, it says Stevens. No one's first name is Stevens. If my name was Michael Steven, then maybe I'd get it. But this happens to me every time, not every time, but a lot. I think you're a better Michael than a Steve. If I had a son, I told my wife, I really wanted Steve Stevens. I did meet a guy whose name was Stephen Michaels. He's a brilliant musical performer, performed at my daughter's preschool years ago.

28:44Michael Stevens:And I'm like, dude, Stephen Michaels, I got to tell you, my name is Michael Stevens. And he was like, oh, that's neat. Later. And I was like, no, but we're destined to be together. Where'd you go?

28:56Hannah Fry:Oh, that's good. I like that. I have two friends, a gay couple who are both called Emma, which I really enjoy. And they've got a little daughter. To the daughter, it's like, oh, what's your mummy called? Oh, my mummy's called Emma. And my mummy's called Emma. I just really like that a lot. Oh, wow. Yes. I think Michael Stevens and Stephen Michaels, you could have been the most beautiful gay romance story. That would have been so lovely.

29:19Michael Stevens:What would we have called our kid? Because there's only those two permutations of two things. Yeah. We'll figure that out later.

29:26Hannah Fry:Anyway. Okay, I'm going to tell you some of the stuff that Steven Peake told me, okay? But I'm editing this very heavily, obviously, because I don't want you to throw up during this.

29:33Michael Stevens:First, I want to say Cycle Mevens. That could work or... Then me. Maybe that one if we wind up having a second. I think you should have Steven Stevens and Michael Michaels. That would be good, especially if they were twins. But how do you change the last name of your own child? You can do whatever you want.

29:50Hannah Fry:You can do whatever you want.

29:52Michael Stevens:Well, not everything you want. I did a video on this. There are names that you aren't allowed. Sure. You know what? Funny enough, a name is a human right. The UN has said that a name is a right that you have as a human. So yeah, it's a human rights abuse to not name children.

30:07Hannah Fry:Wow. Yeah. I mean, it's legal requirement, right? Should I tell you some of the stuff that he told me? Because the thing is, is that this whole idea of not feeling pain, especially if you live with chronic pain, I think it feels like, oh, this would be such a blessing, but it is the most horrific curse, the most horrific curse. So they found out that he had this condition when he was a baby and he was teething. I mean, as I was talking to him, I sort of noticed that his speech was impaired slightly. And basically what had happened when he was teething was he had bitten off a chunk of his own tongue and not even realized.

30:41Hannah Fry:They diagnosed him by holding an open flame underneath his foot and he didn't flinch. Like this is a little baby, right? Keeping your toddler safe full stop is quite difficult, but like when they're not feeling pain, he would sort of use it as a way to get what he wanted. So if his parents, you know, as a teenager were like, you need to do this, he'd be like, mm-hmm, and would sort of sit there and break his fingers just to...

31:04Michael Stevens:Oh no, wow.

31:06Hannah Fry:The mortality rate of people with this particular mutation is incredibly high. Lots of them die in childhood, particularly historically, and if not, you know, in their teenage years, it's really, really, really not nice you know if you want real proof of like the fact that that not having any pain at all is like such a horrific curse leprosy which people had historically thought was a condition which rotted flesh actually in the 1940s there was a surgeon called paul brand who discovered that actually that's not what it is at all all it does is a bacteria that kills the nerves so means that you cannot feel pain and thus it's your own actions effectively that mean that you lose toes you lose fingers these are self-inflicted wounds that are unfelt essentially it's a really horrible story about him going to india to a lepers colony to sort of study people and at night time he would have to stay up to sort of fight the rats away from kind of chewing on people who were asleep because they just couldn't feel it.

32:08Hannah Fry:They couldn't feel the pain.

32:09Michael Stevens:Whoa, I didn't know that about leprosy. I know that there's like wet and dry leprosy, or at least that's what they were called back at the time of Papillon. Have you ever seen that movie?

32:18Hannah Fry:No.

32:19Michael Stevens:There's a really cool scene where Papillon, an escaped prisoner, is trying to find a safe harbor and he comes to a leper colony and they're going to kick him out. And they're like, we'll let you stay if you smoke for my cigar. So the idea is like, oh, it's contagious. But he grabs the cigar anyway and he smokes from it and gives it back and the guy goes how did you know that i didn't have contagious wet leprosy and papillon goes i didn't i'm just that desperate it's just worth the gamble for you to protect me yeah it's a very cool scene so hold on wet leprosy is contagious and dry is not that's at least what i learned from the movie right and i have not looked deeper into it but i do think it is true that there is a contagious and non-contagious version

32:59Hannah Fry:but i mean it's a bacteria that causes it so presumably i mean it's not particularly prevalent disease, at least in the Western world now, right? It's not something that you have to particularly be concerned about.

33:08Michael Stevens:Yeah, I haven't run into it. Oh, you're right. Yeah. Nerve damage may result in the loss of nociception. There you go. Let me just look up contagiousness. Okay. So all I'm seeing here is that leprosy is not highly contagious. They can live with their families and attend school and work. This is right from Wikipedia. So I don't know if there's two different kinds. All I know is that in the movie, Pavilion, and maybe also in the novel, it was supposed to be a bit of a documentary. It's based on the guy's life story that he wrote. But anyway, pain. So I didn't know leprosy was related to the loss of nociception.

33:48Hannah Fry:I mean, the main thing that I know about leprosy is from being a Catholic, right? Because boy, do they talk about it a lot in the Bible.

33:54Michael Stevens:A lot of people get it. Yeah.

33:56Hannah Fry:A lot of people get it in the Bible. There's something really interesting here, which is that when you look at the origin of the word pain, it's like a curse, but actually the real curse is not having it at all. The sort of perception of what pain is and what it is kind of doing for us, not only that has changed, but like how you can measure it itself. Because there have been people who've been like, right, well, let's just create a scale here. Let's just create numbers where 10 means something, a particular type of pain and then we'll just be able to everyone will be able to scale it right so there was the doll orimeter which is a lamp that would um focus on a sort of blackened patch of forehead and then the idea was that there would be like a unit of agony the doll scale 0 to 10.5 which is i think frankly upsetting that there goes to 10.5 but at eight dolls it would leave second degree burns on the skin but it was just a bit all over the place and what they tried to do they tried to calibrate this with different people they would go in when people were in labor when women were in labor they would go in and in between contractions they would try like burn their hands oh and ask how it compared it's like well what hurts more this or or the actual child how many dolls are you feeling right now how many dolls and i'm quoting here one subject became so hostile which you would that they they abandoned her anyway the point is they tried this right but the numbers never reproduce.

35:25Hannah Fry:They couldn't find, they couldn't manage to extract like a certain level of heat that then correlates to a certain number on the scale.

35:33Michael Stevens:No, it would depend way too much on the set and setting. You know, like we've said, if someone was more stressed, they're going to feel it differently than if they're focused or chill. It's going to matter whether their hair is red or not, apparently. Right.

35:49Hannah Fry:But the point that you just made about how you're feeling being such this integral key part of it, it is, as it turns out, almost all of the story is what's going on in your head. There was like some early indications of this when people were studying this, particularly during war settings, right? So like in World War II, there'd be soldiers who had these catastrophic wounds who are kind of getting up and walking around and like apparently feeling nothing. And there is actually a physical mechanism that can cause that. So there is this kind of descending control system. So it's not that you just have pain happens here, it goes straight to your brain.

36:29Hannah Fry:Actually, you kind of have this gateway through the spinal cord. and what can happen is your body can effectively like close the gates in the spinal cord before you've ever actually felt anything. This, by the way, is one of the reasons why if you have a kid who falls over and then you're like, oh, rub your knee, right? You can actually help because if you have like a harmless touch, then it can help to confuse the signal and basically stop it reaching your brain. It kind of closes the gate when it gets to your spinal column.

36:58Michael Stevens:That makes sense.

36:59Hannah Fry:But there is some amazing research in Oxford University by Irene Tracy, who I've gone to go and meet. She's amazing, by the way. She's known as the Queen of Pain. What a title.

37:10Michael Stevens:What a great title. She has this lab, which she cheerfully calls the torture chamber, where she has different ethical ways in which to inflict pain on people.

37:22Hannah Fry:So she stabs people with needles. She burns them with like chili pepper on the skin. It's like cutting, burning, what are the other ones? Stinging. Thermal grilling? Thermal grilling. She doesn't thermal grill, or at least I didn't see her thermal grill. I think she was actually just causing genuine pain. But she does this to people when they are inside of an MRI scanner. And what they can do is they can inflict a kind of discrete, measurable amount of pain with these needles that have like particular pressure. So you know that the physical sensation, or at least the cause of the physical sensation, is kind of very well controlled between people.

38:05Hannah Fry:and then you can see how people construct or react to that sensation in their brains depending on on what particular state they're in and you're absolutely right that basically the more stressed you are the worse it is the more relaxed you are the easier it is the more that you've had experience of pain in the past the easier it is the more that you think that the pain signifies something dangerous the worse that it is. But like all of these things end up really contributing to your experience of what is actually going on.

38:40Michael Stevens:Yeah. If I am worried about it, I'm going to think about it a lot more, which also might explain why kids can be so much more affected by what seems like it shouldn't hurt as much as they're acting. But I mean, it's the first time they felt that. And they're so powerless. Like, of course, this is a big deal. And it also makes sense how your pain will lessen when help arrives because you no longer need to be as careful or cry out for help. It's arrived. It's not necessarily a placebo effect. It's just a straight up your body going, okay, phase one is over. Now we'll begin phase two. It is just a straight up.

39:20Hannah Fry:Actually, it's okay. You're safe. There was one thing that I used to do with my little girls when they were really young. I tried to teach them that when they would fall over to immediately do jazz hands. Oh. I like to sort of make it into a happy moment because I think that they really feed off of your reaction to something. I think if you are like, oh no, this is serious, then it's like the panic arises and all of a sudden it becomes a really, really big deal. Whereas if you are like happy and clappy and it's like, hey, no big deal. Let's crack on. We're still playing. It's not just that they ignore the pain, it's that the actual pain that they feel is lower.

39:57Michael Stevens:That's right.

39:57Hannah Fry:I think that's really it here. We're not talking about placebo. I mean, placebo feeds into this a little bit in the sense that you're tapping into the same thing. But what we're really talking about here is you actually feel it differently. Like your physical sensation is different depending on how you're feeling.

40:14Michael Stevens:So is there a way to measure pain at all? I mean, I know we have those like scale of one to 10, you know, point to the smiley face. Which one are you? I guess that works because it's a subjective thing, but we can't build a painometer, plug it into your brain and go, or plug it into your nerves and go, ah, nah, there's no pain.

40:35Hannah Fry:In the same way that we can't build a delicious-o-meter.

40:38Michael Stevens:Right.

40:38Hannah Fry:Or like a happy-o-meter.

40:40Michael Stevens:A love-o-meter. Which of your cats do you love more? We're going to find out today using our love-o-meter. It never goes wrong. It just doesn't work. It doesn't work.

40:49Hannah Fry:I mean, at the same time, we do know lots of things about it. Like we know that your belief changes it, but we also know that your memory about it afterwards changes. We know that you don't store it as like a running total. You store it as like a peak and the end. This is some Kahneman work. He was researching colonoscopies. Colonoscopies are not very nice. They're not very comfortable. Unfortunately, never had one. But, you know, my understanding is that it's just not a very nice experience to be part of, but they were talking about people's perception of the pain when the probe was removed immediately afterwards, or when the probe was really slowly removed and then sort of paused before the final removal.

41:32Hannah Fry:And actually, even though the whole process was lengthened, it was a longer period of time with the gentle removal, people's memory of the colonoscopy was that it was less painful when the ending wasn't so bad.

41:47Michael Stevens:Right. Of course. Yeah. No, when I'm thinking of times I've been in pain, I don't remember the middle of it. I remember like how it started, how it felt after. But yeah, that's interesting. The way I remember my pain is not the way I remember a movie.

42:05Hannah Fry:No, it's not. It's the peak and the end. That's essentially what you remember. The thing about this idea that your brain is giving you kind of free analgesia, right? I think there's something really extraordinary in that. Because I think for the last 150 years or so, what science has done in the pursuit of mitigating pain has been, okay, take this drug. You know, we'll compare it against the placebo, but let's see how much extra this drug gives you compared to placebo. And kind of all of the focus has been on that. And in a lot of ways, I feel like we've sort of thrown away the half or maybe more that actually makes a really gigantic difference, which is much more woo woo.

42:56Hannah Fry:I'll admit, you know, it's much more sort of like softly, softly, like huggy feelings. But it's also the bit that doesn't come with any side effects.

43:03Michael Stevens:Yeah, it's woo-woo adjacent. And I'm glad that we're taking it more and more seriously. Because here's something weird I heard when I was at McGill University. Acetamidaphin. In America, what we call Tylenol, especially Tylenol. Paracetamol in the UK, we call it. Right. So, since Tylenol entered the market, it has become more effective at reducing pain. As a pain reliever, it's gotten better. The chemical formula has not changed. So there's this open question, what's happening? Are our bodies changing? Have we evolved to work better with Tylenol? The best answer seems to be that no, we just trust that it will help the pain more now.

43:47Michael Stevens:When it was first introduced, people thought, I don't know. Now we just go right to the Tylenol. You take it and you feel better because your brain goes, it's going to work. So the placebo effect has become more powerful.

43:58Hannah Fry:I think that we can do a whole other episode on the placebo effect specifically. But it's more than just the sort of illusion, as it were, of like feeling like you're being cured. This is actual like physiological facts, right? Which is that pain is not a deterministic thing. It is a sensation that is constructed by your brain subject to your entire experience. Yeah, I do sort of think we've been kind of ignoring that a little bit. As I've mentioned on this show before, I had cancer a few years ago. And I always think that actually the doctors might have cured me, but the nurses made me better.

44:41Michael Stevens:Oh, interesting.

44:42Hannah Fry:And I think that is it, right? Like the nurses were the ones who actually made me feel like it was going to be okay. You know, they were the ones who were there, like with the tea and sympathy. They were the ones who were like calmly and carefully helping me through the process of like removing all the tubes and what, you know, all of this stuff. And I think that what they were doing, a really, really good nurse is one who knows how to tap into your brain's free analgesia.

45:13Michael Stevens:They do. That's what makes them good nurses. I think that effect extends to all kinds of other professions. I feel like physics keeps me safe on an airplane. Yeah. But the flight attendants make me feel safe. I know that the plane can deal with this amount of turbulence. But when I look at the flight attendants and they're like not even paying attention to it, they're just doing their own thing, looking annoyed or whatever. I'm like, thank goodness. I'm so much less worried because you are, I'm like marrying your behavior.

45:44Hannah Fry:Pain is definitely a social phenomenon, a phenomenon of the mind and not just the brain. Totally agree. At the same time, the last thing I want to tell you about is, so I guess there's like the different places to target pain. And as I said, if you are someone who suffers from chronic pain, it's like, well, that's all very good. But, you know, I can't just like wish myself better. And I agree. It's like it's really, really difficult to do this. You do also want sort of effective pharmaceuticals. And the thing about like all of the stuff that we have really, you know, opioids being the most effective at blocking the pain, it kind of like blocks everything else as well.

46:19Hannah Fry:You can't really function. It's, you know, it's not specific enough. But going back to that NAV 1.7, the little gate that allows all of this ions through. So there is some work that is going on now, which is, okay, well, is there a way that you could design a drug or maybe genetically engineer your neurons? Or is there something that you could do that targets that channel in particular, right? That little gateway in particular. Because actually the other way around And it does happen. So, you know, the bullet ant. Don't.

46:53Michael Stevens:No.

46:54Hannah Fry:Okay. So this is supposedly, I mean, there's like some crazy scientists. Justin Schmidt was one in particular who deliberately go out and get themselves stung by absolutely everything in order to rank them. He writes like sommelier-like notes for different things. So he says a yellow jacket wasp is sort of hot and smoky, but almost irreverent in the feeling that it gives you. Okay. Oh, I love that. Yeah. But the bullet ant is like top dog in terms of how much it hurts. He describes it as a flaming charcoal with a three inch rusty nail in your heel burning for 24 hours. Okay. Now, the reason why the bullet ant wins in terms of pain is because its venom actually attacks NAV 1.7.

47:41Hannah Fry:Like the exact same channel. Yeah. And so what it does is it just jams the gate open effectively so that your pain nerves just fire over and over and over and over and over and over and over again and won't switch off. You're doing the exact opposite of what happens with the people who feel no pain whatsoever. This gate is like wide open as opposed to completely closed.

48:01Michael Stevens:But yet the bullet ant bite is not probably any more dangerous than a black widow, which might not hurt nearly as much and yet is so much more potentially lethal.

48:11Hannah Fry:Right, just because of this very particular sort of biological formulation. And so the question is, can you do something that directly targets that NAV 1.7? And some people have tried, right? They tried, they tried. I definitely shouldn't laugh about this because it would be amazing if you could. There are different drugs that people have constructed. And there was one of them that actually looked like it was going to be really promising that would target NAV 1.7, which closed that channel, and then you could choose to turn on and off pain. Unfortunately, NAV 1.7 is also really close in design in sort of the way it's structured to NAV 1.5, which is absolutely critical to maintaining a heartbeat.

48:49Hannah Fry:Oh my gosh. So if you get even a slightly bit wrong, you just start end up closing the pathways that are closing these gates that allow your heart to beat. That's unfortunate. That is unfortunate. But all the same, I think as we are getting further and further into really amazing molecular biology design, sort of synthetic biology, this is I think the hope, right, is that there will come a point in the future where we can create something that allows you on demand to take some kind of pharmaceutical that just switches off that NAV 1.7 when you need it and not when you don't.

49:29Michael Stevens:Right. So this could have less addictive potential than opioids. It could help people with chronic pain as well.

49:37Hannah Fry:Exactly.

49:38Michael Stevens:But there's always the balance of you need some pain. You need to know what's going on with your body. But when it's not helpful, it's not helpful. Exactly.

49:47Hannah Fry:Okay. So I guess to sum this up then, pain isn't this payment, right? The word says that it's a punishment, but the actual mechanism itself is, I think, more of a gift, actually. this verdict that your brain is creating, this kind of call, this decision that is being made on your behalf. And honestly, mostly in your favor. It's just unfortunate that for some people that message keeps on blaring even when it shouldn't. Yeah, but its intentions are good. Its intentions are good.

50:16Michael Stevens:But we know what's paved with good intentions, so.

50:19Hannah Fry:Very true, the road to hell. Okay, I guess that brings us to the end of this episode of The Rest of Science. Thank you very much for staying with us all to this. But look at you guys. Look at you go. You're the real ones, you know? Painless, honestly. The real Gs.

50:34Michael Stevens:Yeah. Thanks for listening. We really appreciate all of your support and especially your questions. Please keep them coming in. The rest is science at goalhanger.com. See you next time. Bye.

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