Dr Amy Baxter – Discover New Ways To Manage Pain

Content by: Dr Amy Baxter

Watch the full interview below or listen to the full episode on your iPhone HERE.

Stu: This week, I’m excited to welcome Dr. Amy Baxter to the podcast. Dr. Baxter is a double-boarded paediatric emergency physician, and now CEO of Pain Care Labs with a mission to eliminate unnecessary pain. She invented and patented VibraCool, vibrating cryotherapy to treat tendonitis and decrease opioid use, and her Buzzy device has been used to control needle pain for over 32 million needle procedures. She has been named a healthcare game-changer, healthcare transformer and most innovative CEO of the year. In this episode, we discuss the topic of pain management using tools and techniques, including vibration, heat, cold and mindset. Over to Dr. Baxter.

Audio Version

downloaditunes Questions asked during our conversation:

  • How might we know if our pain is normal or if we should see a medical professional?
  •  What strategies do you recommend for managing chronic pain?
  • When should we use ice for pain as some say this strategy is outdated?

Get More of Amy Baxter & Pain Care Labs

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Full Transcript

Stu

00:03

Hey, this is Stu from 180 Nutrition, and welcome to another episode of the health sessions. It’s here that we connect with the world’s best experts in health, wellness and human performance in an attempt to cut through the confusion around what it actually takes to achieve long-lasting health. Now I’m sure that’s something that we all strive to have. I certainly do.

Before we get into the show today, you might not know that we make products, too. That’s right. We’re into whole food nutrition and have a range of superfoods and natural supplements to help support your day. If you are curious, want to find out more, just jump over to our website. That is 180Nutrition.com.au, and take a look. Okay. Back to the show.

This week, I’m excited to welcome Dr. Amy Baxter to the podcast. Dr. Baxter is a double-boarded pediatric emergency physician, and now CEO of Pain Care Labs with a mission to eliminate unnecessary pain. She invented and patented VibraCool, vibrating cryotherapy to treat tendonitis and decrease opioid use, and her Buzzy device has been used to control needle pain for over 32 million needle procedures. She has been named a healthcare game-changer, healthcare transformer and most innovative CEO of the year. In this episode, we discuss the topic of pain management using tools and techniques, including vibration, heat, cold and mindset. Over to Dr. Baxter.

Stu

Hey guys, this is Stu from 180 Nutrition, and I’m delighted to welcome Dr. Amy Baxter to the podcast. Dr. Baxter, how are you?

Amy

01:41

I am doing wonderfully this afternoon for me and morning for you.

Stu

01:45

Yes. Yeah. Connecting via the internet once again. Thank you so much for sharing some of your time today. But, first up, for all those that may not be familiar with you or your work, I’d love it if you could just tell us a little bit about yourself, please.

Amy

01:58

Sure. I am a pediatric emergency doctor by training. I did most of my clinical work in any areas of suffering. So I did a child abuse fellowship, I did pediatrics, I did research in nausea, I invented the BARF scale for children with cancer to be able to say, “That barfing face, that’s the one I feel like.” Now I am a full-time CEO of a medical device company that blocks out sharp pain.

Stu

02:27

Wow, fantastic. Well, interesting topic then because pain is very personal, it’s very unique to the individual.

I guess first question then when talking about pain, many of us will be subject to pain throughout our days, weeks, lives, whether it be headache, sports injury, leading to perhaps more serious complications where pain is involved. How might we know if our pain is normal, i.e., “Oh, it’s just a headache,” or we should see a medical professional?

Amy

03:02

Sure. Well, it’s a huge question, and it’s different for all sorts of different body parts.

I think that it is probably worth knowing, first of all, that our understanding of pain has changed enormously in the last 10 years. It used to be that we felt that pain happened on our bodies, so you have pain on your finger, you have pain on your arm.

We really understand now that pain happens inside your brain, and it is this very complicated back-and-forth, literally, chemistry of how worried you are about the pain, how much attention you’re paying to the pain, and what the actual nerve firings are that are being transmitted to the spine, that then are perceived in the thalamus. Then from the thalamus, it goes to the anterior singular cortex, which is interprets whether it’s dangerous or not dangerous. There’s all of these different ways you can decrease pain by attention or by… We’re going to talk about ice, I’m sure, but it’s really a very complicated back-and-forth song that’s happening in the brain. I think that the best understanding is that pain is your brain’s opinion of how safe you are, so when you start talking about pain as a signal of being safe or not safe, when do you need to worry about pain?

I mean, as an emergency doctor, there are a couple of quick answers to that, which are if pain wakes you from sleep, then you need to worry about it. If pain gets worse after activity, then you need to have it evaluated. Sometimes you may still work through the pain or walk through the pain or still work out. But the thing is if the pain gets worse after activity, then the likelihood is that you’re further damaging something and you need to take it easy.

The only real way to know that after a few days of an injury is to go and get it examined. I think in general, most pains you can wait a few days to get a chronicity, to see is this something that’s increasing, decreasing. With the exception of, say, left shoulder pain or heart attack pain, there are very few pains that are subtle that you need to act on immediately.

But another thing that complicates this whole concept of safety, abdominal pain is something that lots of times you don’t feel until late at night when you don’t have anything else distracting you. So there’s not one quick easy answer to the question about when to worry. If you name a specific body part, I can give you specific answers.

Stu

05:35

Headache. All of us get headaches and, of course, now we’re subject to the greatest encyclopedia ever known to man in the palm of our hands in the form of Dr. Google, and it’s a rabbit hole. We tap away and before we’ve even reached the second or third webpage, we’re convinced that we’ve got a brain tumor.

Amy

06:00

Brain tumors are actually a really good one to give you some rules of thumb for. Brain tumors cause increased pressure in your head. So usually when you have a brain tumor, what you’re going to worry about is nausea first thing in the morning. You’re going to worry about a positional headache. So you’re lying down, you don’t really have a headache. You sit up. All of a sudden, it’s killing you.

What’s happening is that as you sleep, the fluid in your brain collects and builds up, but because of a tumor, you can’t drain that fluid well. So as soon as you sit up, you’ve got all this extra pressure that can’t drain out. The gravity is being held up by the pressure of the swelling of the brain or the tumor or whatever mechanical thing is blocking that going down. This is why people will get, they call it VP shunts, or ventricular peritoneal shunts. They’re getting a tube between the area of the brain and then draining into the stomach so that you can get rid of this extra fluid that’s causing pressure and pain. That happens is mechanically if you start getting a brain tumor, you’re going to have some mechanical pain like that.

In general, you should not be awoken from sleep with a headache unless you’ve been drinking. In which case, you deserve it, suck it up. But the other thing about headaches and brain tumors are that you’re very often going to have some additional kind of symptoms. It’s going to be a balance symptom, it’s going to be a vision symptom, it’s going to be double vision and looking one way or the other, and then your pupils should respond equally. But that’s always hard because pupils are even for emergency room doctors, unless it’s just obvious, like one is completely giant, the other is tiny, pupils are really subtle. So we often get people in the emergency room who are telling me about pupils being different, and a little bit of difference in pupils is actually normal in people.

So the biggest thing I would say is early morning nausea, headache and positional headache. Those are the things that make me want to get a CT scan.

Stu

08:09

Right. Okay. No, that’s good advice. Yeah, many of us will feel rest assured, I think, after popping the odd paracetamol and finding a little bit more peace. I’ve heard you use the phrase unnecessary pain, and I’m keen to understand what that means.

Amy

08:31

Our company’s mission is to eliminate unnecessary pain. When I started in my journey as a physician, I was aware of all of these different creams and ways that we could mitigate needle pain in kids.

What astounded me was that doctors didn’t always use this and sometimes, for example, my first research was in spinal taps for children, for babies with a fever where you have to make sure they don’t have an infection, you have to get blood and urine and fluids from every orifice. Well, all of those children need to have a spinal tap if they have a fever in the first month of life and so that is sort of like an baby epidural. It certainly is painful, and doctors were not routinely, when I started, using pain medicine for this. So to me, that’s unnecessary pain. There is a way to address the pain. There is a humanitarian reason to treat the pain, but for some reason, people aren’t doing it.

That was the first example where I got research to prove that it wasn’t just that using topical creams could decrease pain. It was that the doctors had a better chance of success if they put the pain relief on. I didn’t think that doctors would change their behavior based on pain relief in a baby because of lots of reasons. But I did think if I could prove that it made their success rate go up, then they would do it, and they do. In fact, that practice has now changed to where using topical anesthetic for spinal taps is the norm and not abnormal.

Stu

10:06

Okay. So how do you manage pain, given the fact that it’s very unique to the individual and I’m sure there’d be a sliding scale from the hypochondriac all the way to the big burly guy who doesn’t like to admit that there’s anything wrong ever?

Amy

10:24

Yeah. Yeah. Well, the construct that I like to discuss is pain, fear and focus because pain is not just what is happening on your body. It’s really happening in your brain. And when you feel like you can control that pain, if you know that you can go get a hot pack from the other room, if you know that you’ve got a massager you can put on what’s going to help, you can actually tolerate pain longer because you know that you can control it.

The fear comes in when you don’t know if you can control it, and that’s when pain starts to ramp up. So this cycle back and forth is actually called catastrophizing in the medical literature, and there is a certain personality types, there are certain situations in childhood that predispose people to catastrophizing. It’s kind of like going from zero to a hundred in two minutes. It’s like, “Oh, this hurts. Oh my gosh, it still hurts. Oh, I’m not going to be able to get past this pain, I’m never going to run again.” So that quick ramp-up of catastrophizing also ramps up pain.

What we are doing and what my research is that I discovered for children’s vaccines, wow, 2004, I discovered that if you used a specific frequency of vibration and ice together, you could block needle pain. So pediatrician, I was very interested in vaccination and people becoming afraid of needles. So I started with this for my son, a little B we called Buzzy because it had vibration. But it turns out that over time, this little guy who’s got a very, very high frequency vibration, it turns out that that vibration is doing something that’s actually relevant for knee pain, for elbow pain, for post-surgical pain.

The poster that’s behind me, ta-da, which is very small and hard to see, but I’m really proud of it because I think that it explains a lot of how you can block pain without medications. The deal is that for your body, pain is transmitted on this very tiny A-delta nerve. It’s a very sharp, fast nerve. Whether it’s burning or it’s pricking your finger or an injury or inflammation, it’s all the same nerve, and that really sharp, fast nerve can be overwritten just as easily. If you bumped your elbow, what do you do? You start rubbing it.

Stu

10:24

You rub it, yeah.

Amy

12:44

Or you bang your hand with a hammer, you start shaking it. What you’re doing is you’re stimulating the position sense nerve, and the position sense nerve cancels out pain. It’s kind of like noise-canceling earphones. There’s a specific frequency of

13:00

… position motion that will stop pain. It turns out that the frequency that we started using for the little needle pain device years ago just doing… Poking people in my neighborhood and poking my children until I found a motor that was the right motor [inaudible 00:13:16].

Stu

13:18

Well.

Amy

13:18

… Really insanely [inaudible 00:13:20]. It’s not nearly as loud when you’re [inaudible 00:13:22] across the room. But that really fast frequency stimulates the pacinian corpuscle. And the pacinian corpuscle is the one that dictates where you are in space. So by using that, you can override or cancel out all of the pain to some of the pain. I mean, it depends on how loud your pain signal is. You probably couldn’t do an amputation, but 84% of seniors don’t feel a flu shot at all. So it really is a balancing act.

So to answer your question more carefully or more simply, so the way that you handle pain is to always have another plan. So have multiple things you can try to decrease the fear factor. Whenever possible, have something that is a physical pain relief. Because pharmacologic pain relief has a whole host of reasons why it actually increases fear. We could talk about that if you want to, but have another plan, have a physical pain reliever. And then if it’s chronic pain, there are a whole lot of different mechanisms that are all more effective than medications at dealing with chronic pain.

Stu

14:33

Well, that was actually my next question, chronic pain. I’m guessing that the vibration or the rubbing or the shaking, I mean that will work if you bang your thumb with a hammer. But if we’re moving into the chronic pain territory, does the shaking, rubbing and vibrating work or are there other strategies?

Amy

14:53

There are definitely other strategies, but yes, it does work. So the thing about chronic pain is that chronic pain is not one hum. Chronic pain is my arthritic wrist always hurts but when I’m trying to go to sleep, I notice it more and it hurts more. Or some days it hurts more than others. That is really an acute on chronic situation. And so in those situations, having something like the vibration is going to help instantly on contact. It’s just a matter of how much lower is that pain going to get, because you’ve already got this baseline of chronic pain. So couple of things, cold and heat.

The more options you have for chronic pain, the better it’s going to work. The studies show that concentrating not on pain but on doing what you want to do, it’s called acceptance and commitment therapy. You commit to the things you want to do that are important to you and you based your chronic pain and how you’re doing not on, am I a seven or a 10? But on how many times did I garden? How many times did I lift my grandchild up?

And so you really are concentrating more on what you’re able to accomplish in spite of the pain and ignoring the pain while you are doing what you can to mitigate it so you can do other activities. So yes, we’ve got plenty of people who use the [vibrical 00:16:15] device for arthritis or for knee pain or joint pain. But there are a whole lot of other things that you really need to have a comprehensive, pain care plan.

I think that we get into political territory when people talk about complimentary pain management. Complimentary implies that you’ve got either medical care or you’ve got this other set of things. When in reality, really for chronic pain, you need to bring in as many different things as you can. So you always have something else in your arsenal to try. So you’re not as afraid. So the [inaudible 00:16:52] that I talked about for pain that responds to vibration. There are three other, they’re called mechanoreceptors, three other sensation nerves that also can help with pain.

So one is called the ruffini nerve and it’s a stretch nerve. This also blocks out pain. Which is why yoga, which is why massage, which is why stretching are also good for pain because what you’re doing is, you’re stimulating the ruffini corpuscles and you’re getting a milder form of pain relief than the intense vibration, but it’s still pain relief. Another thing to layer in is magnesium. Oral magnesium is a… it’s an anti-inflammatory in four different ways.

It’s a neuro anti-inflammatory. So, which actually very good for headaches as well. It is particularly for those with migraines, taking 500 milligrams twice a day when you are starting to feel a migraine flare is something that’s helpful. So neuro anti-inflammatory, it’s a small muscle… smooth muscle anti-inflammatory. So asthma, we use it for asthma calming down the lungs, but it also relaxes some of the smooth muscles so you get decreased pain. And then it’s also something called an NMDA blocker. And this is, that if you’re taking opioids already, you get this ramp up where the opioids don’t work as well and the pain gets more and more and more. So magnesium actually blocks that ramp up thing. You can actually decrease the amount of opioids you’re taking by about a third after surgery, if you’re also taking magnesium.

Stu

18:24

Wow, I’ve never heard that. Yeah, magnesium. You mentioned heats and cold, ice as well. I’m particularly interested in the use of ice for pain, because I have heard many a time that using ice for pain, and let’s say for sporting injuries, is outdated on the basis that you’re stopping the body doing what it needs to do by removing the inflammation. And when the body, sending all of its little… whatever the body sends to the site of the injury, it’s almost like shutting the door on the firemen when your house is on fire.

Amy

19:06

Yeah. It’s such an old fashioned conception of pain. Again, it’s that thinking assumes that pain is happening on your body and not in your brain. So one of the things about chronic pain is that, because it goes first to the thalamus to be sorted, they found that for example, people that needed to have total knee replacements. That the thalamus enlarges because of the chronic pain and then once you have your knee replacement and the pain goes away, six months, the thalamus is back down to normal.

Stu

19:36

Wow.

Amy

19:37

So the ice thing, there are two different parts of this. One is, yes, if it’s an acute injury you’re going to decrease the swelling, the inflammation, all of the cytokines that are released with an acute injury, you can stop that from happening by putting ice on. So that’s a different type thing.

The chronic pain type, really it’s more what the person’s perceiving. If the person is perceiving pain and ice makes it feel better, then that’s the right thing to use. Now, there are concerns about blood flow and ice definitely does vasoconstrict. One of the interesting things about high frequency vibration and about 150 Hertz or higher is that it vasodilates. And so you end up increasing the blood flow at the same time as you’re using ice.

So I didn’t show you, but the part of what we did with [Buzzy 00:20:26] was we have these… This was the one for the needle thing, but we also have little ice wings that freeze solid. So it’s important when you’re using ice and vibration together, you have to make sure that the ice is solid because otherwise you’re going to absorb that vibration frequency, and you don’t get any of the mechanical stimulation benefits. But for the ice that you want, ideally is about 20 minutes worth.

So you want something very thin that’s going to freeze solid, so you get an intense reduction as deep in as possible, but it’s a brief period of time. So, totally agree with you also, I wouldn’t do ice for longer than 20 minutes. But, the fact that if you can add vibration to it, so you’re going to get high frequencies. So you get blood flow with it, it balances that out. So in summary, three things.

Acute, always ice is the move to not cause further tissue damage. But chronic, you want to do what feels good. There are times when the muscles are spasmed, ice feels awful, don’t do it. Use heat. You want to shrink your thalamus as much as possible. You want your brain to not be expecting pain from that area. And so the more you can soothe your brain and not get it to be quite so sensitive, the better off you are.

And then the third thing is if you are going to use ice, try to either use it for only 20 minutes or use it with an high enough frequency of vibration so that you can increase the blood flow around it. So that you’re not stopping the good things that you talked about.

Stu

22:00

Okay.

Amy

22:00

The firemen.

Stu

22:00

Yes the firemen. Yeah. Let them in. So pain medication. So I’m not familiar with brands that you have over in the US there. But we have a brand called ibuprofen, which is one of the most popular nonsteroidal anti-inflammatories. Many people will rush to that as the first port of call, when they’re experiencing pain. I have heard that they can disrupt gut microbiome, maybe that it isn’t the best approach to jump for those pills. What are your thoughts?

Amy

22:34

I am of many minds on pharmacology. Since I left medicine, I have really become aware of how suborned we as physicians are by the pharma industry. When you study statistics, you’re studying it in pharmaceutical studies. When you’re studying dermatology, you’re getting a lot of pharmaceutical side effects. When you are studying multiple choice tests, there’s one answer and so it’s always a drug answer. That’s the one problem, one drug approach. And if that drug doesn’t work, then you use a second line drug.

Whereas human beings are comprehensive, we need to have multiple modalities. That said, I adore ibuprofen. If I don’t feel good, I’m going to go for ibuprofen before I go for paracetamol and there’s a lot of reasons why. Now, certainly in the first two years of life, some of the problems that you have with both ibuprofen and paracetamol are that, if you downregulate people’s inflammatory systems, if they are getting a natural fever inflammation, the body needs to learn how to take that down naturally.

So one of the theories about why we have so many more inflammatory diseases like diabetes and arthritis and allergies. One of the theories about why those are increased, is because young children are getting anti-inflammatories. So they’re dysregulating their inflammatory system. Their bodies don’t know how to chill out and [inaudible 00:24:04] they have more inflammatory problems later.

Certainly the most common side effects that are very real and legitimate with nonsteroidals are the same as with any kind of a stomach line or disruptor, you worry about gastritis. So you worry about irritation in the stomach lining and you can certainly have bleeding. So ibuprofen is going to affect how your platelets interact. So not only can you have gastritis, you also can have bleeding. And those two things together, stomach bleeding is the number one side effect with ibuprofen that people talk about.

That said, ibuprofen is non-addictive. If you use it for more than two or three days in a row, you can actually, especially for headaches, you can get a rebound headache. So I wouldn’t recommend that.

Stu

24:48

Okay.

Amy

24:49

But I can’t say I would do differently than I do for myself. I probably use ibuprofen, twice a month. And that’s because I’m 50 now and I’ve got shoulder things that go on [crosstalk 00:25:04].

Stu

25:05

Yeah.

Amy

25:06

Just general pain. So I don’t use it very often, but I will use it to get a better night’s sleep because sleep is medicine and sleep is pain. And so one of the comprehensive things that I should’ve mentioned is, whatever you need to do to get a good night’s sleep in a non-pharmacologic way, that’s important also.

Stu

25:23

Wow. Okay. Well, look, you’ve just hit on the magic word, which is sleep. I’m obsessed with sleep. I think that many of us today are robbed of sleep because of all manner of external distractions namely mobile phones, social media and stress, worries. All of that type of thing. If we are, and again, I mean obviously so many different answers for this because it’s so unique to the individual. Tips, tricks, hacks to be able to get better sleep, deeper, more restorative sleep

26:00

If we are experiencing some form of pain, and let’s just go with, say, muscular pain. I’ve got a sore lower back, it wakes me up. What would you prescribe in that instance?

Amy

26:15

If it’s not every night, ibuprofen works for about six hours, so if it’s not every night, then the times where you feel like it’s flaring before you’re going to sleep, I actually would do some ibuprofen. It’s 10 milligrams per kilo is the dose, so you can go up to 800 milligrams, and I’m just going to say, you look like an 800 milligram man. Someplace between the three pills and four pills, if you’re getting the 200 milligram type.

Stu

26:41

Okay.

Amy

26:41

I know that’s not really the crunchy answer, but sleep is important. Now the other parts for helping sleep, melatonin is something that we’re talking a lot about now with COVID because it’s also a good antiviral in addition to being a sleep medicine.

Stu

26:56

Okay.

Amy

26:57

But what melatonin is doing is it’s resetting your circadian rhythm awareness so that it makes it a little bit easier to sleep through lights, to sleep through things that are disturbances. You don’t take it when you want to fall asleep, like Benadryl or a sleeping pill. Instead you actually take it about an hour and a half before you’re going to try to fall asleep, so that’s one thing. The magnesium I’ve already talked about, but that takes about three days to really kick in and be helpful. Sleeping in a cold room is helpful, between 63 and 65 is optimal sleep temperature. So having as many covers as you need, but making the room cold can be helpful in maintaining your sleep. Turning every, we call them wrackspurts from Harry Potter, every light that you can see, every green light, blue light, the light from your clock, everything else, turn those away or get those turned off, or just put a sleep mask on.

Stu

27:58

Yeah.

Amy

27:58

Even though it’s your back that hurts, if you decrease the stimuli that can wake you up, then the back may not hit the threshold alone, but if it’s the threshold of pain and a light, now you’re awake, so try to get rid of the other stimuli. And then stretching about an hour before bed, it is also something that can be helpful. So in case it’s going to increase any of the pain, you don’t want to do it immediately before, you want to have a chance to try to get relaxed before, but it could be a hot bath, stretching. And again, listen to your body. There are definitely people who are going to feel better with ice.

We are in the process right now of doing a National Institutes of Health low back pain device trial. So I have, I don’t have one right here, but I have a device that I’m calling [doatherm 00:28:51]. It’s a metal plate that’s about this big, and it has three different motors in it and we’re doing different cycles of vibration, because there are some nerves that are spasmed in your low back that can cause the pain, and those spasm nerves, when they have different frequencies applied in different patterns, you can actually get about four hours of relief out of it. So we’re in the process of studying that right now, but it is really interesting that it seems to be between four and four and a half hours. So I’m not sure what we’re triggering, or what we’re turning off, but it is pretty consistent between patients. So hopefully in the next year and a half I’ll have some solid research on that.

Stu

29:32

Fascinating. Wow, you’re doing lots of things. So tell us a little bit more than about pain care labs. I’m intrigued to hear, because it sounds like you really are approaching pain from quite a different perspective other than, here’s the pill.

Amy

29:51

Well, yeah. It started really, it actually used to be in MMJ Labs.

Stu

29:55

Right.

Amy

29:55

And that’s my kids, Max, Myles, and Jill. I had just moved from an academic institution to a hospital where I had a database I wanted to research on putting kids to sleep during procedures, and I couldn’t get access to the database unless I went to this hospital, but I didn’t have a positioning, I couldn’t get grants. So I had to start a company to get something that, federal funding in America, 3% of our NIH funding is for companies. So in order to be eligible, I had to start a company to be able to try to make my little buzzy bee for needles. I got the grant, we launched in 2009, kept just selling people buzzies when they wanted them. Moosebaby is the one who distributes us in Australia.

And over time, our patients who were using it for their in vitro fertilization, or they were using it for their arthritis injections, they were using it for all of these different things that weren’t what I expected. And they started using it for their hip pain, and their shoulder pain. The thing that really dropped the penny, as it were, is that my colleague told me that he had been in opioid recovery for 20 years and he needed a knee replacement. And he asked whether or not buzzy would work for that. And this little thing worked for it, and so he didn’t take any opioids.

From that I decided in 2016 to stop practicing medicine and focused full-time on pain, and that was when I realized that I didn’t want anyone to think that we were the answer to pain. I wanted people to understand, and did so much research and put it out there. Here’s all the different things, there’s supplements, there’s physical treatments, there’s mind, body.

Stu

31:40

wow.

Amy

31:40

I really started learning more about what managing pain meant, and realized how our system is not set up for someone who says, sometimes do this, sometimes do that, there’s not an easy answer. But we changed the name to Pain Care Labs because MMJ became medical marijuana, and all of a sudden people were calling us up and asking about cannabis, which is not the kind of buzz we do.

Stu

32:08

Interesting that you’d say that, cannabis would be offered in some countries for pain management, would it not?

Amy

32:16

Yeah, and it works for some kinds. So there’s the best cannabis, or cannabinoid, because that’s the thing. Cannabis is like 100 different substances.

Stu

32:25

Yeah.

Amy

32:25

I mean, there are a hundred different cannabinoids that are varying concentrations. It does work really well for anxiety, which is related to pain. When you have access to cannabis, the opioid addiction and opioid use goes down, overdoses go down. That’s in our country where we’re dropping like flies. But it doesn’t actually work well for acute pain. There’s about a 10% risk of psychosis, particularly in people who are 26 years age and younger. So some of them just have short term psychotic symptoms. There’s one gene called the COMT gene where if you have that genetic predisposition, even smoking marijuana once can make you schizophrenia. I know, right? So I am absolutely, particularly for veterans, particularly when there’s an overlay of anxiety, and absolutely well-proven for cancer… well some stuff recently, maybe not even as good for cancer pain.

But if you have a chronic condition and it works for you, I am very solidly behind medical marijuana. I think that there is a misperception that it has benign, and there is definitely a misperception that it works for all sorts of pain, and it actually doesn’t. Right now the people I talk to who are in this space say that probably the most effective pain relief is a two to one of CBD to THC.

Stu

33:47

Yeah.

Amy

33:48

CBD is an anti-inflammatory just like magnesium. I have yet to see any papers that show that CBD has better results than magnesium, but they’re both anti-inflammatories, and it could be that you use them and they’re synergistic. But the CBD part for the pain relief seems to be mostly of anti-inflammatory, and the THC seems to be mostly anti-anxiety, and those combinations of those two are why it is effective when it is.

Stu

34:18

Okay, interesting. Yeah, CBD oil is becoming quite popular, and it’s prescription only in Australia, but I have spoken to many people that, it is the magic pill for these guys. Not only does it help with their pain, it helps with sleep. But yeah, certainly not readily available.

Amy

34:39

I think it works a lot better when it’s forbidden fruit and you’re not allowed to get it.

Stu

34:42

Yes, placebo.

Amy

34:44

We can get it here, and there are more people that start on it, but then don’t find it helps them. I think it probably helps about a third of people, and I think that it’s that anti-inflammatory component.

Stu

34:57

Yeah.

Amy

34:58                    A

nd I think the sleep thing too. The thing is there’s no reason not to. CBD is not addictive. The THC part is the issue, but the CBD itself doesn’t have the psychotropic effects, so you don’t have any of those concerns that I mentioned about the psychosis part, that’s all THC stuff.

Stu

35:14

Okay. The poster that you held up before, you mentioned mindset in there. So I was kind of interested just to dial into some of your thoughts, from a mindset perspective, and how we might use the power of our mind and strategies through, well, I’m keen to know what your strategies are to deal with pain from that perspective.

Amy

35:34

Yeah, yeah. Well, one of the best researched ones is this acceptance and commitment therapy. And it is a cognitive reframing of, I’m not going to be focused on how much pain do I have and how is that going to impact my day, it’s really looking at an longer timeframe, looking at a month timeframe, six months is usually the outcome timeframe that they use for chronic pain in these studies, and the people who do acceptance and commitment therapy do better than those on drug therapies. And I’m actually going to read from this, and I’ll give you the link so that you can put in some of these [crosstalk 00:36:12] evidence-based.

Stu

36:13

Yes, please.

Amy

36:13

But many of these mind-body techniques are ones that were taught to me by a woman named Regina Yocum, who is a child life play therapy specialist in Michigan, who has, now she’s an adult, but she’s probably had 30 surgeries for her arthritis. So juvenile arthritis, but really crippling. And she said, “Here’s how you can frame thinking about pain.” So one thing was progressive muscle relaxation, the cognitive reframing, the thinking about, this is not just pain, this is me going through a surgery, or I’ve done this surgery so that I’m going to be able to walk more, and I’m thinking about walking more, I’m thinking about moving, so what is the meaning of the pain?

The Guided Imagery, certainly, Headspace, so many good apps out there, and concentrating on something else activates that anterior singular cortex so your thalamus is not as worried about pain, you’re not as worried about pain because you’re focusing on something else. Deep breathing, diaphragmatic breathing, being able to give your body signals that everything is okay.

Stu

37:27

Yeah.

Amy

37:27

So the parasympathetic system is one that’s activated by deep breathing, it’s the calming one. And that’s where you really want to put your mental energy toward because that ramps down your sensitivity to pain. Some of the other ones, the setting and accomplishing activity goals, which is this acceptance and commitment therapy, but you can also do that even for one day. You know what, today I just want to get out of the house and walk to the mailbox. But the accomplishment, the little burst of adrenaline you get from accomplishing something, is helpful.

And then she also said that one of the things, certainly support groups, talking to people, but also have times that you can look forward to. So make plans to talk to someone at a certain time, make plans to watch a movie, make plans to, all of these different things. We’ve even got some cards that we’ve made, we haven’t put them out for sale or anything, but we’ve put them so that people can make their pain plans after surgery, so that they can actually fill in the activities that they’re going to do. Because if you can just get to that next ibuprofen, if you can just stretch out the time a little bit until the massage, or until whatever, each of those little incremental pieces where you’re not taking an opioid can get you through a painful recovery process.

Stu

38:47

Yeah, it’s fascinating. And your thoughts on perhaps the power of the mind, and its ability to activate or suppress hormones that could support

Stu

39:00

… pain or whatever situation you’re going through. For instance, how about, oh, I’m experiencing some form of pain and I’m really, really stressed. I’ve got lots of stress hormones in my body. I would imagine that that wouldn’t be very supportive, whereas if I can calm myself down and maybe start to reduce, deactivate those stress hormones and increase maybe more of the calming serotonin side of things, what are your thoughts from that perspective?

Amy

39:31

Oh, absolutely. That is going to be the next wave of pain management, I think, is figuring out specific ways. I mean, you mentioned serotonin. Dopamine is actually very much on the pain pathway, and in fact, one of the ways … So, marijuana is a dopaminergic stimulator, so it is an increased dopamine agonist, and some of the pain relieving medications are also dopamine agonists. So, being able to find ways to increase dopamine, serotonin turns out that there is work with specific frequencies and implantable electrical stimulation where using certain frequencies can stimulate dopamine release locally.

So, I think that we’re going to see not only implantable ways, but I wouldn’t be at all surprised if we start seeing different frequencies that are used to ramp up serotonin release to … Now, whether they’re going to decrease the cortisol and the stress hormones, we don’t know, but there already is a … For headaches, there is a little electrical probe that goes on that releases a frequency that seems to decrease headaches. The studies looked good. I still don’t know that we understand the mechanism, but it’s only in the last three years that I understand exactly why the mechanical stimulation frequency we’re using works, and it wasn’t my research. It was one of those at my poster, but this guy, Dan [Hollins 00:41:06], did specific studies on each of these mechanoreceptors to figure out what frequency triggered them and then qualitatively look to see which one was the most effective at blanking out pain.

We’re getting new information so fast now that I think that the cortisol, the breathing, those sorts of things are going to be available now. Swimming, one of the reasons that swimming is good for pain is because it forces you to do yoga breathing. You have to slowly breathe in and out while you’re doing laps, so your workout from swimming leaves you feeling very different from an energy standpoint than an elliptical trainer does. So, I think that the lowering cortisol, the meditation, the mindfulness, all of those sorts of things are a different but related part to the actual neurochemical blunt addressing of pain by actively stimulating different neuroreceptors and different neuropeptides. So, I think that part’s coming, but I think that it’s very clear now that decreasing stress, cortisol, mindfulness, exercise, yoga, all of those sorts of things are clearly helpful in chronic pain.

Stu

42:21

Excellent. Excellent. Well, we’re slowly coming up on time, and I’m keen just to dive in a little bit more than on your thoughts for the future of pain care. You mentioned vibration, and I’ve noticed that at least on the internet at the moment, there are some wearables now that kind of dial into that train of thought in terms of vibrating to try and help you enter different mindsets in terms of calm and things like that. What’s on the radar in terms of where you are at the moment for the future of pain care?

Amy

42:59

Yeah. I am still very suspicious about the concept of things where you have a wearable that’s giving a very low-level electrical or electromagnetic stimulation and pain because many of those studies will say that half of the people responded, and of that half, blah, blah, blah. Well, if only 50% respond, you’ve got a pretty strong placebo effect in about 40% of people.

Stu

43:28

Right.

Amy

43:28

So, I tend to be skeptical of any kind of a pain relief that is electrical that makes claims like that. I mean, granted, I’m a big proponent of magnesium, and that takes about three days to work. So, I don’t think that every pain management modality needs to be immediately effective, but I do think that we’re going to see more in the way of looking at frequencies, amplitudes, trying to really get the noise canceling earphones for pain that are specifically helpful for different places. I think that we’re going to be able to put a low amplitude mechanical stimulation a.k.a. vibration device on after surgery and be able to tune it to the person’s nerves’ wavelengths and be able to just about exactly cancel out what the pain signal is causing using that amplitude and frequency.

I think that we’re going to be able to get better at implantable and peripheral electrical stimulators that are able to do a better job of like what TENS units are supposed to do. One of the things that we now know from this research in the past few years on TENS units, so it’s transcutaneous electrical nerve stimulators. You’re putting two little stickers on and running current between it. The thing is that, first of all, if we want to get the Pacinian corpuscle, the TENS units are too slow. They’re about 120 Hertz. You need to be 200. Second thing is if you’re covered in [Chob 00:45:05], it’s an insulator, and so you’re not getting the penetration down to the deepest nerves you need to because Pacinian are actually the deepest of those mechanoreceptors.

So, I think that some of this knowledge, which is now in the mechanical realm, is going to ricochet back into the electrical realm to fix some of those problems. Some of the reasons why TENS has always seemed like it should work and then it just doesn’t really go as well. So, future, I do think that we’re going to have some close to the head electrical stimulators that are specifically for neurotransmitters. I think we are going to have a much better physical pain modality armamentarium. I think we’ll have a couple of different devices that’ll fit lots of different body parts, and maybe every medicine cabinet will have three of them. Then, I do think that after surgery, we’re going to have much more select, specific tuneable ways to block out pain without using opioids.

Stu

46:01

Fantastic. You mentioned the TENS unit, and it took me back in time 15 years when I tried my wife’s on when she was giving birth to our first daughter. Yeah, don’t want to go back there.

Amy

46:15

Well, we’ve actually had people … We made a … for South Africa. I’m not sure [inaudible 00:46:20]. For South Africa, we made a little LadyBug unit because we had … In South Africa, they have killer bees, so they’re like … Excuse, everyone. So, anyway, so we have a lot of women who now use a little LadyBug for their in vitro fertilization, and then they bring it for their low back pain during labor. One of the people said, one of the few testimonials we got, this woman said, “I want to thank you because I have a baby, and I was going to give up on IVF, but even more importantly, Buzzy is the only reason I’m still married because during labor, if I didn’t have that thing, he was going to die.”

Stu

46:59                    Yeah. Yeah. Not good. So, what’s next for Dr. Amy Baxter? What’s next for pain care labs? What have you got going on right now?

Amy

47:08

We’re excited about the low back pain device. I developed a different design of the … So, we’re going to try, for post-surgery, having this VibraCool Pro design so that we’ve got stereotactic areas. So, we’ve got two different sources of vibration. Just like with ultrasound, where you’ve got three different things that can break up a kidney stone, we’re going to have two different sources, so we’re going to get some clinical trials with that to see if we can be even more effective at not just decreasing pain but actually speeding recovery and speeding bone growth, so those are some exciting areas. The low back pain device, we’re starting our clinical trials in about three months.

Right now, everybody in the U.S. is talking about needle phobia and COVID vaccine. So, I testified to the Department of Health and Human Services about adult needle fear, pain, et cetera, and we’re trying to ramp up production so that when we have enough supply of vaccines, we can make sure that the roughly 28% of people who are vaccine reluctant because of needle fear don’t let that be a barrier so they don’t get protected, so we can get past this annoying pandemic.

Stu

48:27

Boy, oh boy. You’re a very busy person, aren’t you? I’m sure you sleep well. You probably …

Amy

48:34

Yes. My latency is two minutes. I hit the pillow, I’m gone.

Stu

48:38

Yeah. I’ve got about the same actually at the moment. Yeah. It’s fascinating. How can we get more view of your work, dial into Pain Care Labs, all of the above? Where can I send everybody that wants to learn more?

Amy

48:51

Sure. So, paincarelabs.com is our website that has both the VibraCool line of products, the Buzzy line of products, but it has additional resources for needle fear. It’s got resources for chronic pain. It has a whole lot of my blogs that have everything about the resources on why magnesium works, what works for pain. I am delighted to give you the links so that people can download this list of all the different … just so that if you’re going to have surgery, if you’ve got chronic pain, there’s always another set of combinations you can try. My Twitter handle is AmyBaxterMD. I am available pretty easily through any of the normal interwebs, the Facebook. There is in Australia a … Moose Baby sells Buzzy units, and so the Buzzy unit and the VibraCool unit are shockingly similar, so there’s no reason not to just get a Buzzy and use it for pain and put it on but-

Stu

49:58

Fantastic.

Amy

49:59

At this point, right now, we’re not distributing VibraCool in Australia, but Buzzy certainly, you can get locally and-

Stu

50:05

Great.

Amy

50:07

There you go.

Stu

50:07

Fantastic. Well, look. Thank you so much. Really appreciate your time. Everything that we’ve spoken about, all of the links, et cetera, will go into the show notes, and we’ll distribute that, but Dr. Amy Baxter, thank you. Much appreciated, and we look forward to following your progress as it rolls out.

Amy

50:26

Stuart Cooke, this has been a delight. Thank you so much for having me, and I would be happy to come back again when I’m finished with things and have more fun stuff to talk really fast about.

Stu

50:36

Exactly. Thank you so much. We’ll speak soon.

 

Dr Amy Baxter

This podcast features Dr Amy Baxter. She directs innovation, invention, operations and strategy for Pain Care Labs. After graduating from Yale University and Emory Medical School, as a double boarded pediatric emergency physician, Dr. Baxter founded PEMA Emergency Research while also founding Pain Care Labs (initially called MMJ Labs). Accomplishments include... Read More
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