Good Good Good is in Vancouver this week covering TED2023. This article is part of our ongoing, exclusive coverage of the conference, with more interviews and stories to come. Follow along here all week, or on social media with our hashtag #GGGatTED.
When former pediatric emergency physician Dr. Amy Baxter was in medical school, she said at the start of her talk at TED2023, there were only about two days dedicated to pain education.
And the lecture “was sponsored by OxyContin,” Baxter quipped.
Still, she learned the basics: That pain is an alarm carried by nerves, to our spines, which is translated to our brains, where the sensation of pain registers in the body.
But Baxter believes we’ve been looking at it all wrong.
“What if pain isn’t an alarm to silence, but a learning system for survival?” she asked.
What if we were to reframe the goal of pain management from being pain-free to instead being more comfortable?
That pain-free model is what has led to the overwhelming and dangerous use of opioids — and a world where 80,000 Americans died of an opioid overdose last year, and 80% of substance use disorders start with drugs that were prescribed for treating pain.
By the way, Baxter was sure to remind the TED audience, those opioids don’t always treat pain, so much as they turn on our reward system, allowing us to feel pain but not really care because these drugs are making us feel so good. (That’s not to say they should never be used, but Baxter is on a mission to provide more pain management options.)
So, how do we realign towards a goal of more drug-free pain tolerance — rather than a goal of pain removal with addictive opioids?
Baxter’s answer is simple: Cold and vibration.
Baxter’s eureka moment happened when she was experiencing some pain of her own. As her hand went numb, and her husband grabbed a bag of frozen peas, she named the two things that blocked her pain: Cold and vibration.
Buzzy is a device (shaped like an adorable bumble bee) that includes a small vibrational component with two ice pack “wings.” It was originally designed for children who have a fear of needles to get injections and procedures with less pain and anxiety.
Since her initial research, development, and patent, 45 million needle procedures have decreased pain, and over 80 randomized controlled trials have been published in support of her work.
How does Buzzy work?
Baxter explained like any great pediatrician would: Vibration decreases pain because things like light touch, stretch, slight pressure, and motion all race pain to the spine and attempt to shut the gate on sharp pain.
It turns out, motion (like vibration) is most effective in shutting that gate; the exact right frequency of vibration can trigger the nerves that decrease pain.
Ice, on the other hand, allows for those sensations of cold to go to the brain, where it essentially says, “Oh, this sensation is obnoxious, but it’s not dangerous. I will decrease sensations coming from everywhere.”
This discovery is one Baxter is currently using to create a low back pain device to reduce opioid use — and she’s confident it can work.
In fact, one of Baxter’s colleagues confided that he was in opioid recovery but was about to undergo a knee replacement surgery. He posed a question to Baxter: Could he get through his surgery recovery completely drug-free with the use of just cold and vibration?
“He did it,” Baxter said. “Vibration plus cold replaced OxyContin.”
This success is a delicate balance of confronting fear, maintaining control, and working with physiology.
The sensations from Buzzy are helpful, but folks with big fears of needles or large amounts of pain might also need the help of distraction. Along with the device, Baxter’s team developed a poster with monkeys on it that required counting and decision-making — and it cut pain in half.
Lots of distracting and decision-making exercises can be employed in these situations, allowing people in pain to regain control of what’s going on in their brains.
“Pain is a symphony of connections,” Baxter explained. “From the sensation area, to the conductor, to the decision switchboard — and then to fear, memory, meaning, control. If the decision switchboard is too busy counting monkeys, it can’t notify fear and meaning, and you feel less pain.”
Context is also important. It’s why getting a tattoo might not be as scary as getting a shot, or why tickling yourself doesn’t work the same way as someone else tickling you.
These approaches are personal, Baxter said, and give us the opportunity to layer physiological options (like heat, cold, vibration, exercise, or deep breathing) to feel in control.
“St. Augustine called pain the greatest of evil, but if it is a survival system, it cannot be all evil,” Baxter said. “Instead, think of pain as your nagging, safety-obsessed, exaggerating friend who is sometimes wrong. It’s okay to override or ignore your friend if you know you’re safe.”
All in all, Baxter’s research continues to find drug-free pain solutions for people of all kinds — but her work at Pain Care Labs has already led to an enormous library of resources. From extensive guides on coping with needle phobias, to case studies in children’s hospitals, and expertise on opioid alternatives, Baxter envisions a future where pain is completely reframed.
“Power over pain isn’t always pretty,” she said, “But it is possible, and it is absolutely critical.”
Header image courtesy of Jason Redmond / TED (CC BY-NC-ND 4.0)