Today on Something You Should Know, Why Driving and Talking on the Phone is so dangerous when it seems like it shouldn't be. Then, Improving your Visual Intelligence. It's like noticing more of what you see.

It's not so much about looking closely. It's thinking about not only what do you see, but what aren't you seeing. It's called the pertinent negative. The practical example I can give you is for anyone who's a parent, you know that what your children don't say to you is just is as important as what they do.

Also, why you should smile a lot more often, and all the things you never knew about pain and pain relievers, like Tylenol.

We actually don't fully understand how Tylenol works, even though it's been around for a long time. We believe it works by a central mechanism. A lot of people think that it's either Ibuprofen or Tylenol, but believe it or not, you can actually take both together, and they actually work on slightly different mechanisms.

All this today on Something You Should Know. As a listener to something you should know, I can only assume that you are someone who likes to learn about new and interesting things and bring more knowledge to work for you in your everyday life. I mean, that's what something you should know was all about. I want to invite you to listen to another podcast called Ted Talks Daily. Now, you know about Ted Talks, right? Many of the guests on something you should know have done Ted Talks. Well, you see, Ted Talks Daily Daily is a podcast that brings you a new Ted Talk every weekday in less than 15 minutes. Join host Elise Hugh. She goes beyond the headlines, so you can hear about the big ideas shaping our future. Learn about things like sustainable fashion, embracing your entrepreneurial spirit, the future of robotics, and so much more. Like I said, if you like this podcast, Something You Should Know, I'm pretty sure you're going to like Ted Talks Daily. You get Ted Talks Daily wherever you get your podcast. Something You Should Know, fascinating intel, the world's top experts, and practical advice you can use in your life.

Today, Something You Should Know with Mike Carruthers. Hi there, and welcome to another episode of Something You Should Know. We're going to start today with something I'm sure you've wondered about. We all know that it is dangerous to talk on your phone while you're driving. But why? I mean, it doesn't seem like it should be that tough. Psychologists at the University of Kansas discovered the answer. It seems that when you're driving and you're on the phone, your brain is trying to do two things at the same time, and consequently, it can't do either one of them very well. They found that the part of the brain that controls vision becomes less active when you're having a conversation. So even though your eyes you're open and you can see everything, you miss critical visual information, like that car coming at you at the intersection. This is why you're four times more likely to have an accident if you're talking on the phone. The University of Kansas researchers also found that your hands have nothing to do with it. In other words, talking on a hands-free device doesn't really lower your risk of an accident, and that is something you should know.

We're about to talk about something that you may not even know is a thing, and it is something called visual intelligence. I'll let my guest explain it in more detail in just a moment. But basically, visual intelligence is when you look at something or someone or someplace, what is it you see? What is it you don't see? How do you interpret it? How is it different than what other people see? Police, the military, they're trained to hone their visual intelligence, to notice things that others don't. But you can do it, too. The benefits, as you are about to find out, are pretty sensational. Meet Amy Herman. She has provided leadership training to the FBI, the Navy Seals, NATO, the Peace Corps, Georgetown University Hospital, as well as executives at Microsoft and Google. She's author of the best-selling book, Visual Intelligence. There is a new adaptation of book for kids called Smart: Use your Eyes to Boost your Brain. Hi, Amy. Welcome to Something You Should Know.

Hi. Thank you so much for having me. I'm very happy to be here.

What exactly is visual intelligence? That's probably the best place to start. What is it you're talking about when you talk of visual intelligence?

Visual intelligence, I break it down into two categories. It's two things. The first is seeing what other people don't, and the other is gaining clarity from multiple perspectives. Because I think the majority of us run around thinking, Well, I see it, so this is the way it is. One of the things I think about all the time is that whatever I'm looking at, nobody else sees it the way I do, and other people are seeing it in very, very different ways. I have a lot to gain from understanding how other people see things. I think when they have a high visual intelligence or a really honed visual intelligence, it's understanding that they can gain clarity from multiple perspectives and also seeing what other people don't.

Let's start with one of your premises there that people see the same thing differently, that you and I could look at the same thing and we see something differently. It doesn't feel that way. If we look at an apple on the table, we're both just looking at an apple on the table. There's no difference.

It's very different. That's not the way it is at all. In fact, there is no absolute truth to one person's experience seeing something. Not only is it a physiological thing where our eyes are attached to our brain and only my eyes attached to my brain see things in a certain way, but I really believe that multiple perspectives make for better decision making. If I go into a situation knowing that the way I'm looking at it is not the only way to see it, I'm going to open myself up to listening to what other people have to say about their perspective, and it will give me other insights. People cannot, in a in a myriad of situations, cannot say, Well, I see it this way, and that's the way it is. That just doesn't work physiologically, intellectually, in any way. By helping people hone their visual intelligence, I'm bringing them around, at the risk of making a terrible pun, to see that there's always more than one way to see something.

How do you hone your visual intelligence and see things differently than the way you see them now?

That's the whole crux of what I do. I show people to look at works of art because we can talk about it, we can go back and forth and talk about what you see and what I see. But if we have no visual grounds on which to anchor these assumptions that we're making, we're saying, Well, this is what I see. So I use art as the common ground. And so I work with people across professions to look at art together to illustrate how differently we see things. And art is not threatening, everybody sees something, but we can all look at the same painting or sculpture and photography. Ten people can look at it and we'll have nine different observations. They come away thinking, Well, if I just saw that differently from the guy standing next to me, what's happening in the operating room or the courtroom? I'm using art as the vehicle to hone people's visual intelligence.

Well, if you and I are looking at the Mona Lisa, how is it going to be all that different? How's mine going to be any different than yours? I mean, not completely the same, but it seems like it's going to look pretty sound pretty much the same.

It's not. It's not for many reasons. First of all, I was just in the Louver, I don't know, seven or eight weeks ago, and I went into the gallery, and the gallery is always mobbed. Two things struck me. I was looking at the painting, but I was also looking at all the people looking at the Mona Lisa. But if you and I are standing in the gallery, it looks like we're both looking at the Mona Lisa, but I wasn't looking at the Mona Lisa at all. I was watching all the people looking at the Mona Lisa. The other thing that struck me is directly on the wall behind the gallery where the Mona Lisa is, is another da Vinci painting, and no one was standing in front of that one. There are so many subtleties and nuances and colors about the Mona Lisa, in no way do we ever see the same thing. No two people ever see anything exactly the same way. It sounds so far fetched, but not only do no two people see anything the same way, no two people focus the same way. If you and I are standing standing next to each other looking at the Mona Lisa, unless we articulate what we're looking at, you have no idea that I'm looking at all the people around the Mona Lisa, and I'm watching them watch the painting, and you're looking at the painting.

If somebody saw the two of us, they'd both say, Oh, look, those two people are looking at the Mona Lisa when that's not true at all. Art is really... It lends itself beautifully to this idea of how we look, how we see, and most importantly, how do we communicate what we see.

You You have done a really good job of explaining your point. You would look at the Mona Lisa in one way, and I would look at it in another, and we would describe the scene differently. And so what? And so what? What do we do with this? What's the big so what here?

Well, there's a big so what because, first of all, when you mention the Mona Lisa, it's one of the most famous paintings in the world, and most people roll their eyes and say, Yeah, Mona Lisa has been there, done that. I've seen it. I can describe it to you. But most people really can't What I'm asking people to do is look at the nuance and the detail in a work of art because it's the nuance and detail that enables us to differentiate among lots of situations. So many things. To give you a prime example, and I'm not going to throw this into the political realm, but we're in an election year now. The same candidates are running now that ran four years ago, but the whole world has changed. Everything in the world has changed. The candidates have changed, the world has changed, and the The ability to articulate nuance and detail is very important. It's very important in medicine. It's important in law enforcement, in crime scenes, it's important in the study of space and looking at missiles. It's important in every field. Most people are not very good at articulating detail and nuance.

I've discovered over the last 20 years, which is why I have so much work to do, because people realize it is important. The so what is a big one.

Taking it out of art politics just in everyday life, why is this important? But how do you do it other than to say, Oh, wait, I heard Amy talk, and now I've got to look at this thing real closely because I don't want to look at it the way everybody else does.

It's not so much about looking closely. It's thinking about not only what do you see, but what aren't you seeing? That's a big part of my program when I'm teaching. It's called the pertinent negative. How do we articulate what we're not seeing, what we're not hearing. So as an example, here are two examples I can give you as part of the so what. So if you're evaluating someone's performance in the office, say they come in for their evaluation, you have to tell them what they did well, but you have to tell them what they didn't do well because they can't fix it unless you tell them what didn't happen. So in one of my exercises, I'll say to a group of special operations forces, Okay, tell me everything you see in this picture and tell me what you don't see. And they say, Well, how do we know what we don't see? Tell me what's missing. Tell Tell me what's not there. Tell me what you expect to be there and is not. The practical example I can give you is for anyone who's a parent, you know that what your children don't say to you is just as important as what they do, what they didn't tell you about their day at school, what they didn't tell you about the test.

I help people train their brain to see what's not there. What did they notice? What did they see? What did they not see? Here's another example I'll give you. In the New York Times today, there was an article about this young German coder who happened to notice notice that something was just off. Something was off as he was looking at, and I won't get into technical aspects of it, but he was doing routine maintenance, and he found a back door in this programming code that he noticed he thought it was slightly strange, and he dismissed it, and he came back to it. Well, he discovered it and he reported it, and it could have had catastrophic consequences. It was the prelude to a major cyber attack, and he's being hailed as a hero. To put it in layman's terms, and I love, this is not my layman's terms, the Times did this. They said it's the equivalent when someone finds a backdoor, inadvertently finds a backdoor, encoding. It's like a bakery worker who smells freshly baked bread, senses that something is off, and deduces that someone has tampered with a global yeast supply. To answer your question, so what?

It's when we notice things that are out of our zone of comfort, out of the normal, when something is just off kilter, how do we articulate it and how do we tell people who can make a difference? Look, this guy saved us from a major, major cyber attack that was going to be global because he noticed just one thing that was off. That's the nuance and detail that I'm talking about.

Yeah. Well, and God bless him for doing that. But in everyday life, I mean, that's not everyday life because I'm not usually stopping cyber attacks. But I imagine this has a practical application just every day when you're not doing something major like that. First, let me remind people I'm speaking with Amy Herman, she's author of the book, Visual Intelligence. So, Amy, as I was saying, I get the importance of doing this, but it also seems like it would want to be something you could turn on and off, that it would be exhausting to look at the world this way all the time?

It's not. I get that question all the time. People ask me, Isn't this exhausting you're looking? It becomes part of your routine. And I find that by looking more more closely and thinking about what I see, it enables me to engage in the world in a way that most people don't. I can engage in the world. One of the assignments that I give my participants is that we all go from point A to point B every day. No two days are ever the same, but we all pretty much do the same thing. And the assignment is, I want you to notice one thing today that you didn't notice yesterday. One thing. Just look to the side, walk a different way, see something that you didn't see the day before. And if you practice that every day, and you can either write it on your phone, write it in a journal, or just make a note of it, you're going to train your brain to look at things differently. And my silly mantra that I keep in my head, sometimes I tell people, is look differently We see better. And why wouldn't we all want to see better?

And people are overwhelmed. I'm not putting anything more on their plate. I'm giving them tools to say, not only can you look at things differently, including your family, your pets, your relationships, your situation, but it enables you to engage in the world, I think, in a more gratifying way. I have met people in the seat next to me in an airplane when most people just put their headphones in, and there's nothing wrong with putting your headphones in. But I've had life-changing conversations because I noticed something. My editor of my book, Save Someone's Life. The title of my book is Visual Intelligence, Sharpen your Perception, Change your Life. I hated the title. I said to the editor, I didn't change anybody's life. He said, You changed mine. I saved a life on the subway because of your book. I said, That's ridiculous. You did not save a life. He said, I did. And what he told me was he was riding the subway. This was pre-pandemic, mind you, and a woman was coughing. Now, in the New York City subway, when someone's coughing, everybody just turns away. Nobody wants to look. My editor noticed that she was fiddling in her bag trying to find something, and it turns out she was having an asthma attack.

And he watched her and she was looking for her inhaler, looking for her inhaler, and her coughing was becoming worse and worse. So at the next stop, he went up to the conductor in the middle car and he said, A person in car 5621 is having trouble breathing. She can't find her asthma inhaler. You need to take this train out of service and call EMS. And they did. And that's what happened. And EMS came and helped the woman and escorted her off the subway. And I said to him, You would have done that if you hadn't read my book. He said, Maybe, maybe not. But you gave me the tools to look with specificity, look at the car number that I was in, knowing that I could find the conductor in the middle car and be able to tell the conductor in a short amount of time what was happening, where it was happening, and what they needed to do. It really can change and save lives when we notice small details. Everybody else got out of the subway car, wanted to get away from that woman as quickly as possible.

Talk about situational awareness. I know the police and military learn about this, but it's important for everybody. So explain what that is.

Situational awareness is very important. I travel for a living, and I've honed my situational awareness to know where restrooms are in airports. If you are with a child and you need to get to a restroom or you need to get to a restaurant, knowing where you are and being able to communicate in your own head enables you to communicate with other people. With all due respect, I've been doing this a long time. This This is across professions. It's not just law enforcement in the intelligence community and Navy Seals. It's nurses and social workers and beekeepers and prison wardens. Anybody that's engaged with humans needs to have a refined sense of situational awareness. Otherwise, we come across as really dull. I think that the ability to look at works of art and be able to transfer the skills of engaging with works of art, it's fun, it's not threatening. Should I use the F word? People actually have a lot of fun. When they walk away, they think, Well, that was fun. I realized how much I don't know, how maybe I don't listen very well, and maybe I need to get better at this.

Getting better at it, you use the example of look at something, find something that you didn't see before the day before on your way to work. But it's got to be more than that. There's How does it feel to be more of a process to this.

Sure. I have two processes. The first one, I'm going to focus on problem solving. Everybody has problems, and you can argue with me and say, Well, we don't all have problems, and we're not always looking to solve things. But we have problems from, there are nine people ahead of me at Starbucks, and I need to get my coffee quickly, to my marriage is falling apart. There are problems and there are problems, right? Situational awareness lets us think about short term situational awareness. How am I going to get my coffee? Here, I'll give you a good example. This is an everyday... I was flying from New York to Oklahoma City, connecting in Atlanta, and I had 19 minutes to get from Terminal A to Terminal or Concourse A to Concourse T, which is not a lot of time. I get to Starbucks, and again, there was this long line. Now, for anybody who travels a lot, you know that you can skip the line at Starbucks if you have a tight connection. I've never asked anybody, but I've given up my place in line many times. So I decided to pull the card, and I asked the woman in front of me.

I said, Excuse me, ma'am, because I'm in Atlanta. Can I get ahead of you? I have a tight connection. She turned around, she turned around. She said, No, you can't. And I'm thinking, What do you mean, no, I can't. And she looked at me. She said, The reason I can't let you get in front of me is I'm in pain. She said, My knee was replaced. This airport is so big, and I've been traveling, and I can't stand one minute longer than I have to. I'm sorry, I can't let you go in front of me. And I said, Please don't worry about it. I'm so sorry about your knee. Meanwhile, I'm thinking, I need to get caffeine before I get on that second leg of the plane. My head's going to explode. I'm looking at the information and I have to reframe it. She finally gets up to the counter. She says to the barista, I'll have a skinny vanilla latte with three stevias. I'm thinking, Fix this, Amy. Because, you know, fix it. I walk up behind her and I say to the barista, Ladies having a bad day. Can you take her skinny vanilla latte with three stevias?

Put my cappuccino with an extra shot of espresso and put the whole thing on my credit card, please. In In about five seconds, everything changed. She turned around and said to me, Well, bless your heart. I know what that really means. But she said, Nobody's done anything that nice for me in months. I said, Look, you're having a bad day. If I can buy your coffee and it makes it better for five minutes, we all win. So we walked out of Starbucks. I made my plane, I made the connection, I got my caffeine, I paid for her coffee. Win, win, win, win. That's what I mean about shifting your situational awareness. It doesn't always have to be life-saving to make a difference to somebody else.

Whereas most people in that Starbucks never took their eyes off their phone and never looked up and never talked to anybody.

That is correct. That is absolutely spot on. I looked around and said, I don't have time to go to someplace else for coffee. Me, and I need to fix what's in front of me. I focus on this visual intelligence to help people solve problems.

I get what you do, and I admire that you do it, but don't you ever get on a plane and really just want people to leave you alone?

All the time. All the time. But I'll tell you one other story. That, again, and I tell this story to my son all the time. Yes, sometimes I just want to go to sleep and hear the pilot say, Welcome to LaGuardia. But in 2012, I got on the plane. A massive headache was starting. I had taught five police departments in five days, and I was really tired. It was just around Hurricane Sandy. I wanted to get home and make sure my refrigerator was still working. I sit down, and I just want to go to sleep, and a woman sits next to me, and she was so lovely. She said, I'm so glad there's someone in my seat. I had such a nice trip. I'm glad I have somebody to talk to. I'm thinking, I don't want to talk to you. I'm exhausted. I have a headache. Well, you know what? I never got around to telling her that I couldn't talk. We just talked. I listened. She was lovely. When we finally got to LaGuardia, I said, You know what? I wasn't my best. Maybe we can exchange cards and have lunch sometime. I had a headache on the flight.

She said, Oh, no, I don't give anyone my card. I said, But you just spoke to me for two hours. Why won't you give me your card? She took mine. She said, Because I'm a literary agent and everyone has a story to tell, but you have a story to tell, and you're going to write a book, and it's going to be on the New York Times bestseller list, and I'm going to be your agent. That was 12 years ago. She's my agent.

Well, what's so fun about this is that you've taken something that we all do to a greater or lesser degree and created it as a topic to discuss. This idea of visual intelligence is really something to pay attention to.

How do you think when you buy coffee at a coffee truck and guy says, Oh, I remember you, two creams, one sugar. How do they know that? Because they remember my glasses, they remember what time I come. It's about human relationships. When someone goes into a diner and says, I'll have the regular, well, how does the waitress know what the regular is? Because they're making note of the visual information. It's good business, it's good people skills, and it's not just about solving crime. But why do sponges get left in people after? Why The surgical tools get left in people's bodies because they don't say out loud, Have you taken the scalpel out? Let's do a checklist. Three sponges were used today. Are they all on the side of the operating table? It's basic information. And yes, it can save lives, but it also can make life a lot more pleasant.

Well, I think this is one of those segments that gets people thinking about something that they probably haven't thought at all about or thought much about before. The idea of honing your Visual Intelligence. Well, it sounds fun, but it also sounds very intriguing. I've been speaking with Amy Herman. She's author of the best-selling book, Visual Intelligence. There's a new adaptation of that book for kids called Smart: Use your Eyes to Boost your Brain. There's a link to both of those books in the show notes. Thank you, Amy. Thank you for being here.

Thanks for having me, Mike. It's really been fun, and you've made me rethink how and why I do my work. So thanks so much for inviting me be on the podcast.

Here's a topic I know you have some interest in and some experience with. The topic is pain. We all have felt pain, and pain doesn't feel very good. However, it turns out to be a very interesting topic because when you understand pain, there are some interesting things that can happen. Here to explain how pain works is Dr. Anish Singla. He is a physician who specializes in treating pain. He serves on the physician faculty at Harvard Medical School, and he is author of a book called Why It Hurt, A Physician's Insights on the Purpose of Pain. Hi, doctor. Welcome to something you should know.

Well, thanks, Mike. Thanks so much for having me. I'm really looking forward to talking to you about one of my favorite topics, which is pain.

Well, it's not one of my favorite topics. It's one of my least favorite topics because I only think about pain when I'm feeling it, and I don't like feeling it. I don't imagine most people do.

You're so right, Mike. I think that pain is unfortunately an unpleasant and uncomfortable sensation. It can be associated with tissue damage, and most of us try to avoid it in our lives. But what's really fascinating about pain, and as a practicing pain specialist, is that over time, I've actually learned that pain actually helps us quite a bit. Even though we try to avoid it, it can be a really powerful, transformative event in our lives.

First, define it. Pain is what?

Pain is an unpleasant, uncomfortable sensory or emotional sensation that can be associated with tissue damage. That's paraphrasing the formal definition of pain. But quite frankly, pain is just something that hurts. It's unpleasant. Even though we don't like it when we're going through it, oftentimes it's a signal that our body is sending us that something's wrong, and there's something that needs to be done about that.

When you cut yourself with a knife by accident, and I cut myself the same way, do we both feel the same thing, or could it be that you have a different pain sensation of tolerance, whatever, that you don't feel the same thing even though we suffer the same injury.

That's exactly right, Mike. We all feel pain differently. We all transmit pain the same way. However, we all have different levels of what we call pain thresholds and pain sensitivities. The crux of it is that when that signal gets to our brains, we also have different ways of interpreting that. We may have, for example, an emotional response to that pain, but we also have a cognitive response. When we injure ourselves or hurt ourselves, we think about the pain, and we can think about it differently. That is a very, very important point about pain. Going back to some of Henry Beecher's work in World War II, where he studied wounded soldiers, the soldiers that had really, really significant battlefield injuries considered to be highly traumatic, when they were offered morphine, 75% of them turned it down. That's because they probably viewed themselves differently Then when a few minutes later, when they're in the hospital ward getting treated, most of them are crying out in pain. It doesn't really change what's happening in their bodies, their pain sensitivity. But what it is, is it's a different story they're telling themselves themselves about their pain. When they're on the battlefield, they're heroes, they're fighting for freedom.

But when they're in the hospital, they're more victims, they're more vulnerable.

Can you actually convince people that something doesn't hurt?

Yes. I would say that you can set expectations. And this actually ties in really nicely to a recent podcast you did on expectations. And let me tell you, people's expectations around pain influence how much or how little pain they feel. So when you go and you explain a certain procedure, say, that we're going to perform on a patient, and you explain exactly what's going to happen, oftentimes, I see that patients experience less pain. Then if you just walk in there and you start performing a procedure with little to no explanation, patients are They're not going to like that. They're going to perceive more pain from that procedure. I think that, again, it ties into, again, that story, that narrative that we're telling ourselves about the pain and how much influence that really does have on how we actually experience and feel that pain.

What I'm thinking about is people who wake up in the morning and expect their back to hurt, expect their whatever to hurt, because every day it hurts. I I often wonder, does it really hurt? Or because you expect it to hurt, it hurts?

That's a really good question. I think that what happens a lot of times in life is that we learn a lot from our bodies. When our bodies undergo a transformative event, for example, like aging, we obviously tend to experience more breakdown of our bodies. The cartilage in our joints may experience wear and tear. Our backs may, obviously, experience a similar phenomenon. And what happens a lot of times is that as we listen to our bodies and we learn more about our bodies, we become more in tune with them. And when we're feeling pain, we hopefully are learning something from that message. For example, if you've got back pain and you're expecting to wake up with it, you might change your nighttime routine. You may change your bed. You may change the amount of sleep you're getting. You may change the position that you're sleeping in. And hopefully, by modifying those aspects of your life and your routine and you're listening to your pain, you've made a modification that not only is going to help you with the pain, but also may help you in the long run, because now you You've taken better care of your body and you may actually experience less problems down the road.

Yeah. Well, is there a way Well, you know the old joke, Doctor, it hurts when I do this. Well, don't do that. I mean, that's how you stop pain is if something hurts, then you don't do it, and then it doesn't hurt. But that's not always a great plan because you can't always stop doing that. But I wonder, is there a way that you can make something that hurts, hurt less, either by exposing yourself to it more? Or is there any way to mitigate your own pain other than to take a pill or get a shot or whatever?

Well, that's a great question, Mike. I would say that it very much is an individual type of a response, and it depends on what actually is causing the pain. I wish I could generalize that, but here I'll give you a specific example. Let's say you've got an injury and you want to mitigate that pain, and you really Why do you want to try to avoid taking painkillers, as you said. Well, you obviously, first of all, need to really get a diagnosis. Say you love running, but you can't do it because you've got knee pain. So what you want to do is get a diagnosis, see your family physician or an orthopedic physician or pain specialist like me, and get some X-rays, get some imaging, get an exam, get an understanding of what's going on. And once you have a better idea of what actually is happening in your knee, you can take some steps to decrease that pain. And that may involve medications that That could involve physical therapy to strengthen the joint, I should say, the muscles and the ligaments around the joint to support it better for the activities that you want to do.

It may involve an injection of steroids into the knee or even a gel-like substance that we can do to increase the cushioning of the joint. Or ultimately, it may involve surgery to get the problem fixed. Those are some tools that we use in the medical field to help treat the underlying problem. But again, we have to remember pain is a symptom. Pain is a symptom of a problem. And if we treat pain in isolation, then we sometimes risk missing the problem that's causing the pain. So I think that's one of the key points that I want to make about pain is that, again, it points us in a direction. And we've really got to take that journey and find out what is causing the pain so that you can actually come up with a really good holistic solution to get that pain under control.

Can you explain, is it possible in layman's terms, if your back hurts or your shoulder hurts or your arm hurts, and not from an injury, or maybe from an injury, but it hurts, what is it that causes the hurt? Very granularly, something's going on in there. What is it that's going on in there that is sending that signal to your brain that Jesus hurts?

That's a great question, and it varies. I wish it were easy to say without a doubt, Oh, it's this causing the pain or that causing the pain. I think that that would certainly make my life easier as a pain specialist. What we have to do is we have to look at the specific area where the pain is being, the symptom is being generated. So let's, for example, use the low back, which is a very common thing in our society. We have lots of folks with low back pain, and folks come in and say, Doc, my back's hurting. Where's this pain coming from? What do I do about it? And again, it starts with taking a careful history, understanding what the physical exam is telling us, what the imaging studies show. If we're talking about the low back, for example, there's many things that can cause pain. The inter vertebral disks, which are cartilage in between the spinal vertebrae can sometimes become degenerated, cracked or torn, and that can cause pain.

But how does it cause pain? What happens that sends the signal specifically?

Well, that's done by nerves. So you have nerves all through your body. And when you have an injury or you have inflammation, for example, that is then transmitting a signal down that nerve into your spinal cord and then ultimately to your brain. And pain is really what in this situation is like an alarm system. It's sounding an alarm that, Hey, pay attention to me. There's a problem here. And that's when we have to go and investigate.

So it isn't as simple as something's inflamed and it's rubbing against something else. If I hit myself with a hammer, I can tell you why it hurt. I hit myself with a hammer. But when the pain is internal, is two things are hitting each other, something's rubbing against something? I'm trying to get a sense of what is it?

All of the above. I think that But your example of hitting yourself with a hammer, unfortunately, I've experienced that as well.

Stop doing that, doctor.

Yes, well, that's exactly. So I learned something from that pain, and that is, don't hold your finger too close to the nail when you're using the hammer, right? So that's how pain actually helped me, as it probably helped you. But essentially, in that case, yes, you caused caused trauma from the hammer actually hitting your finger, you caused tissue damage. The nerves in your finger perceived that inflammation and that damage and sent the signal up the nerves in your hand, up your arm, up into the spinal cord in the neck, and ultimately to your brain. That's how you actually are feeling the pain.

When you get a headache or you hurt yourself or whatever, you often it's going to take two aspirin, call me in the morning. You take an Advil, take a Tylenol. What does that do? How does that work?

Great question. A common medication that we use for pain is, say, run of the Advil, Ibuprofen, as you mentioned. What Ibuprofen and other medicines like it, Motrin, Advil, et cetera, what they do is they block an enzyme called cyclooxygenase. Those enzymes enzymes are responsible for producing lipids called prostaglandins. And prostaglandins generate pain and inflammation. And that's how you get a sense of the fact that you've got the response to an injury. Again, let's say you had a knee injury, you ran too much on it, and now it's swollen, and those are prostaglandins at work. And by taking ibuprofen, you're blocking the production of prostaglandins, thereby reducing your pain and inflammation. So that's just one example of a pain medication. There's many medications we use for pain, and I'm happy to go into more detail if you'd like.

But I've heard people say that, well, if it's a headache, you should take ibuprofen, but if it's a shoulder pain, you should take something Is there any truth to that or they all work pretty much the same?

They all work differently. For example, Tylenol, we believe, works by a central mechanism. We actually don't quite fully understand how Tylenol works, even though it's been around for a long time. But we believe it works by a central mechanism. So whereas Ibuprofen might work directly on your muscles or your joints or your knee by blocking those prostaglandins and stopping the inflammation, Tylenol works more centrally. And that's why it's so beneficial when we have a fever, because it can actually lower our fever, and it can also stop the production of or the sensation of pain centrally. So they work synergistically. A lot of people think that it's either ibuprofen or Tylenol, but believe it or not, you can actually take both together, and they actually work on slightly different mechanisms. There's also pain killers that we might use after surgery, for example. Those are opioid medications, also referred to as narcotic medications. But we usually reserve those for more serious cases, not just your run-of-the-mill headache.

But at your house, when you get a headache or you get a pain in your leg or whatever, do you go after different medications? If so, specifically Specifically, which medication works for which pain the best?

That's a great question. I would say that if I've sprained an ankle or experiencing some musculoskeletal type of pain, worked out a little too hard in the gym, for example, then I think Ibuprofen is a great medication to use, and as is Tylenol. So sometimes I reach for Ibuprofen, sometimes it's Tylenol. I would say that both are very reasonable options. They're over the counter, and they have low side effect profiles when used in low doses and in moderation. And if those are not adequate to manage my pain, then I'm certainly going to go see a physician about that to try to, number one, understand what's going on and why is it not going away. I'm going to get imaging. I'm going to try to see what the underlying problem is, and I might have to go on a stronger pain medication if necessary. Fortunately, that hasn't been the case, but certainly that option is there if the pain isn't well-controlled with over-the-counter medications.

What ever happened to aspirin?

Aspirin is obviously a very commonly used medication. It can be used to treat pain, but more commonly, it actually works. A lot of cardiologists use it now to help prevent heart disease because of the antiplatelet effect. It lowers inflammation. It lowers the function of platelets, which are the cells that actually produce blood clotting. So what you find is that a lot of folks who have heart disease are actually on very low doses of aspirin, usually the 81 milligrams. But as we get older and our platelets don't function as well, when we go on higher doses of aspirin, it can actually produce a side effect, which is too much bleeding. So we have to balance out the risks and the benefits. But certainly, aspirin is still around and lots of people still use it.

But not like they used to. It used to be that was the go-to pain medication. Take a Bayer aspirin and call me in the morning. It seems like nobody does that anymore.

Well, luckily, we've improved and evolved in medicine, and we've come out with better ways of treating and managing pain. As with anything, we We do change and evolve over time.

Do you ever have to, as a pain specialist, do you ever have to say to someone, Sorry, you're just going to have to live with it?

Unfortunately, that does happen in our field. And this goes back to what we were talking about regarding expectations. I once had a patient in my office who had come in and was in terrible pain due to widespread cancer. And when someone is suffering from cancer, the cancer may grow into the bones, even into the spinal nerves, and can be quite excruciating. And in those situations, I mentioned earlier, we talked about strong painkillers called opioids. And in those cases, we will use opioids many times to try to control the pain amongst other therapies, for example, injections or even maybe implantable devices to try to to control pain. So in those situations, as much as I would like to alleviate someone's pain and get their pain to a zero, it's also important for me, an all pain specialist, to set the expectations appropriately. And in those situations, what we might do is shoot for a 50 % reduction of pain, which is a more achievable goal. It also helps the patient understand that they've got a problem that isn't going to be easy to manage, but we're certainly going to team up with them and try our best to manage their symptoms in a safe manner.

But also, they're going to also have to be able to find other ways to cope with the pain. That may not be pharmacologic.

I know I've heard about natural ways to control pain through, I don't know, meditation or with your mind, as opposed to with medication consultation or surgery. What about that?

Well, I would say that mindfulness has a huge role in helping to manage pain. We've seen through studies that have been done postoperatively after surgery that incorporating mindfulness into their postoperative regimen actually helps to reduce opioid painkiller usage. And so I think that what's happening is your mindfulness is affecting the cognitive and the emotional aspects of the pain, you may be telling yourself a slightly different story about the pain than, Hey, I'm lying here in a hospital in terrible pain, and I can't go outside and play basketball with my friends, which might increase your pain level because you're suffering in different ways. But if you tell yourself, Hey, I'm going to get through this, and I'm going to be better, and eventually I am going to return to what I love doing, then you may interpret that pain a little bit differently. So I think mindfulness has a pretty significant underutilized role in pain management, and certainly can be very effective as part of a multimodal regimen alongside medications, maybe physical therapy, ERP, et cetera. All of those things can be very, very helpful.

I just find the topic so interesting because pain is obviously as real a thing as it can be, and yet you It can trick people. The dentist does it all the time when he says, You're going to feel a little pressure here. It's not pressure. It hurts like hell. But by setting that expectation, it probably doesn't hurt as much as if he had said, This is going to hurt a lot. It does. It somehow enters into the equation, what you expect is what you get.

Well, I've got a formula for this, and the formula is happiness equals equals reality minus expectations. And what I'm trying to convey with that is that exactly like you said, Mike, if you set your expectations really, really high and reality falls a little short of that, you're probably going to be unhappy. But if your expectations are a bit lower than what your reality is, then you're going to be pretty happy. And I think that does translate into how we interpret our pain, just like you said.

Yeah. It's so interesting. And then it also just seems to be that there are people who, I don't know how else to put this other than to say that they don't let pain get in their way, that they feel it, but they soldier through it anyway. And then other people who succumb to it and go, Oh, God, everything hurts, and whine and complain about it. And that seems to be more of a personality thing, but I imagine it really impacts how you get through life dealing with the pain you're dealing with.

Absolutely. I think that what it comes down to is resilience. A lot of times when we are going through painful events in our lives, we obviously cope with those in different ways, but no one really formally teaches us that. We don't go through courses in high school or college called Pain 101, where you understand how to deal with your pain. It's very much an individual thing. But by using these experiences in our lives, and I certainly don't wish pain on anyone, but when we do have pain and we look at the message that the pain is trying to tell us, whether there's a problem somewhere in our bodies or whether we're just in a toxic situation that we need to get out of, then when we listen to that pain and we grow with it, then we become stronger.

Yeah. Well, not to be morbid about it, but pain is our constant companion. You can't go very long long a day or two, maybe without stubborn your toe or smacking your hand on something or just something happens. We know pain. We all know pain intimately well, and it's so good to get an understanding of what it is and Why it happens and what you can do about it. I've been speaking with Dr. Anish Singla. He's a physician who specializes in treating pain, and he is author of the book Why It Hurt: A Physician's Insights on the Purpose of Pain. If you'd like to check that out, there's a link to that book at Amazon in the show notes. Appreciate you coming on. Thank you, doctor. People generally smile because they're happy. However, it may be a good idea to smile even when you're unhappy. It seems the simple act of smiling has been shown to relieve stress, boost your immune system, lower your blood pressure, improve your mood, make you look younger, and a bunch of other things. But smiling is also contagious, and it makes you seem more approachable to other people. It also makes you appear more attractive and successful.

All of that just from a smile. And that is something you should know. If you have a moment, one of the things that really helps the success of any podcast is ratings and reviews. And yeah, we have a lot of them, but there's no such thing as too many, and the more the better, and it really does help us. It helps because people can see that people are listening and they have good things to say. So if you could leave us a rating and review, it would be greatly appreciated. I'm Mike Kerr Brothers. Thanks for listening today to Something You Should Know. The Bigger Pockets portfolio of podcasts are worthy of your investment. We're having a real conversation as real, realistic investors. New episodes available every day.

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