INSIGHT – OUCH
JENNY BROCKIE: Welcome everybody, good to have you here with us tonight. Ryan, you're one of the best fast bowlers in Australia. You're hoping to play again for Australia in the Ashes? You say that pain is your constant companion?
RYAN HARRIS, TEST CRICKETER: It's my friend.
JENNY BROCKIE: It's your friend?
RYAN HARRIS: Yeah.
JENNY BROCKIE: Why?
RYAN HARRIS: I guess with everything I do and what I do and the stress I put on my body I've always got it. I've always had it since I was, you know, probably 12 or 13 when I started bowling at a decent pace.
JENNY BROCKIE: How intense is the pain that you feel when you're on the cricket field?
RYAN HARRIS: Yeah, it sort of differs I guess or varies from day-to-day, but when I'm actually bowling it's probably, it feels, it's probably the less, it's at its less painful.
JENNY BROCKIE: You say your knee gives you the biggest trouble?
RYAN HARRIS: Yeah.
JENNY BROCKIE: Tell us about that?
RYAN HARRIS: I've got a bad knee basically where I'm bone on bone inside and out, obviously the way I land, the way I twist, but it's, as I said, it's a day-to-day thing. I have really good days and I have really, really bad days.
JENNY BROCKIE: Bone on bone and you're putting that amount of pressure on your body. I mean, just describe for people who might not understand how intense that pressure is that goes down onto your knees and you your feet?
RYAN HARRIS: Joints and ankles, so basically our, well between six and nine times your body weight goes through, goes through our joints so I'm right handed so my left leg will cop six to nine times my body weight. I weigh, you know, 95 kilos, um you know, some guys are less, some guys are more, so if you think about the weight that goes through my, again through my good knee, I guess, and my ankle, it's quite a lot of weight.
JENNY BROCKIE: I'm interested that you say you feel it least when you're bowling, so you feel it least when you're piling the pressure on?
RYAN HARRIS: Yeah, I think obviously because the blood's flowing and everything's warm. My first probably four or five balls really hurt, you know, because I haven't done that for a while, that movement for a while, and so it takes me, you know, it takes me probably an over to get that blood flowing and to get that good feeling back, I guess.
JENNY BROCKIE: You have pain in your hips and your shoulders as well, how often?
RYAN HARRIS: Yeah, I've got a hip that, oh, probably eventually will require surgery just to clean up, I guess, and my shoulder's, just from the sheer force that we put through, or I put through my shoulder through bowling and, you know a lot of bowlers have got the same sort of thing. We train for it, we lift weights for it - we do a lot of shoulder exercises.
JENNY BROCKIE: How often would you walk out on to the pitch pain free?
RYAN HARRIS: Oh, never. As I said, it's something, that's why I call it my friend, and when I say me, it's not just me, it's bowlers in general. Every bowler would feel, I'd love to meet a bowler who'd walk out onto a cricket field pain free, I don't think I've met one yet.
JENNY BROCKIE: You mentioned first thing in the morning, Cherie, what's he like first thing in the morning?
CHERIE HARRIS: Oh sometimes he's a pain, he's a whinger.
JENNY BROCKIE: He's a pain?
CHERIE HARRIS: He's a pain, yeah. Yeah, it takes him a while to get up and get out of the body. He needs a good push while he's playing some times, yeah.
JENNY BROCKIE: So what do you think when you watch him running in to bowl like that?
CHERIE HARRIS: Yeah. I don't know, because when he's playing you don't kind of see that, I don't know, yeah.
RYAN HARRIS: It's probably - it's again something you're used to. I get up sometimes and I say to Cherie I don't know how I'm going to do it today. You know, and that's sort of it. Once I get up the first three or four steps to the shower or to the bathroom, whatever it is, you know, she virtually laughs at me and then probably thinks the same thing. But you know after that, every step after that it literally sort of starts to feel better.
CHERIE HARRIS: Yeah.
JENNY BROCKIE: Shelley, you started boxing about five years ago and now you're a Commonwealth Games gold medallist, congratulations on that. When an opponent lands a big blow on you when you're boxing, what do you feel?
SHELLEY WATTS, COMMONWEALTH GOLD MEDALIST: A lot of the time you don't feel it, or you don't feel any pain from it. Obviously you do feel an impact but I, I've had 56 fights now I think, as well as many, many rounds of comps, sparring and stuff like that and I can only tell you two times that I remember an actual pain from the punch.
JENNY BROCKIE: Okay, we're looking at you here. That's you in the red?
SHELLEY WATTS: Yes.
JENNY BROCKIE: Yeah, ouch. Ouch again.
SHELLEY WATTS: You honestly don't, I don't feel it.
JENNY BROCKIE: I don't feel it at all?
SHELLEY WATTS: No.
JENNY BROCKIE: Even when it's right in the face?
SHELLEY WATTS: Nope. There's only been, like I said, two punches in my four and a half years so far, yeah.
JENNY BROCKIE: Okay, so you're really focused on what you're doing?
SHELLEY WATTS: Yeah.
JENNY BROCKIE: Is that the same with you Ryan?
RYAN HARRIS: Very similar, yeah. When you're in the moment, I can't imagine boxing, but that to me is too scary, but when you're in the moment you're right. You don't, I guess you don't sort of think about it. You're so focused on what you're trying to do that your mind's working on that I guess.
SHELLEY WATTS: Yeah, definitely, yeah.
JENNY BROCKIE: Alright David, how can that be? You run training programs at the AIS, the Institute of Sport, how can these two withstand stuff that would floor the rest of us and keep playing elite sport while they've had to it happen to them? I mean how is it they can do that and I bet most of us can't?
DR DAVID MARTIN, AUSTRALIAN INSTITUTE OF SPORT: Yeah, I think it's a really good question and a lot of us probably wonder about the precise mechanisms, but from my experience they're very engaged in a task that they're incredibly committed towards and so Ryan wants to play cricket and he wants to win and he wants to get a wicket and he wants to, he wants to help his team win and so he's so focused on that concept and the crowds yelling for him and the games going his way and he's a big part of it. Like Shelley said, thinking about what's she's got to do and so she's like parking that part of processing pain so that she can, now I suspect that when she wakes up in the morning she'll say wow, my cheek's a little tender…
SHELLEY WATTS: Yeah.
DR DAVID MARTIN: She's not pain free, it's not like either of them can't feel pain, it's just during the heat of the moment. To me, I like to think of it is that they're just parking the pain, they're distracted from the pain.
JENNY BROCKIE: You're nodding all the way through that?
RYAN HARRIS: Yeah, spot on.
JENNY BROCKIE: Yeah?
RYAN HARRIS: Exactly how you feel. You know, you talk about, in my situation you're out in the middle of the ground, you're doing something that you love, you dream of doing, you've got your team mates there, you've got the crows there, adrenalin kicks in, you just don't think about it. The only time you think about it is if you and you walk off the ground at the end and you are a bit sore or the only time you think about it.
SHELLEY WATTS: Yeah, I remember leading into my final fight because I'd had three fights previously at the Commonwealth Games before the final and I almost, I couldn't lift my arms up and I was thinking to myself, how am I supposed to lift them, put them into my guard and be able to throw the punches at this person? But once you start to warm up, and once you realise, you know, you've got a task to do, it just completely goes. And I guess you just let your mental capacity override any of that.
JENNY BROCKIE: This might be painful for you to watch actually but we're going to go to the 2010 Ashes with you running in to bowl. Let's have a look.
RYAN HARRIS: I haven't seen this footage for a while.
COMMENTATOR: That’s the one that tends to go a little bit more into the air. Hello! Not a good sign, he has trouble with his knees. I think it’s the turf he got caught in on that occasion. That’s locked – it’s locked again, when he gestured there. His bad knee which has nothing in it, no cartilage what so ever, is his right knee, so this looks like a shoe, a foot problem that is for sure. He was talking to the physio out this morning at warm ups when he was bowling a few and he said "Yep, yep, all OK."
JENNY BROCKIE: What had happened?
RYAN HARRIS: Yeah, basically I'd cracked my the bottom of my ankle, or top of my ankle, so basically leading into that game I had a little bit of soreness on top of my just, yeah, top of my ankle I guess and that morning probably an hour and a half before that happened I actually had an injection into the ankle to try and take that pain away and you know, it worked. I went out and warmed up and everything was good. I probably bowled, I think that was my second over of the morning, I actually literally said to Ricky Ponting, who was at mid-on, he said to me how's your ankle and I said great and then literally that ball it just broke, there was a big crack, it was a shock. I think because, because I'd had an injection in it, there was some cortisone and local anaesthetic in it, I think that saved me a because once that wore off later that day I've never felt anything, that the pain I felt I've never felt anything like before. It was just excruciating.
JENNY BROCKIE: Okay, so you weren't feeling as much pain then when that happened?
RYAN HARRIS: It was, it was, how do you explain it? It was sore, don't get me wrong. But actually I walked off the ground, I walked, there's obviously a big walk from the MCG, I actually walked off.
JENNY BROCKIE: And you played with a broken foot?
RYAN HARRIS: Yeah, that was another occasion. It was my first game for Queensland back in Adelaide against South Australia and one of the South Australian batsmen hit one back along the ground after I bowled it and I stuck my foot out to try and stop it.
JENNY BROCKIE: Stop it?
RYAN HARRIS: And I did, I actually kicked it a fair way, and again I managed to bowl about four more overs and I stopped my spell and went off and changed the pair of boots. It was feeling sore but again it was just, just being hit by a ball. Obviously you know, can hurt. So…
JENNY BROCKIE: How do you think you'd have been in backyard cricket if that had happened?
RYAN HARRIS: Well if someone's hitting a ball that hard in backyard cricket I probably wouldn't be playing them. But yeah, I don't know.
JENNY BROCKIE: But if you'd hurt, you know.
RYAN HARRIS: Yeah, you'd probably, you'd stop straight away, I guess, yeah.
JENNY BROCKIE: David - yes, Michael?
PROFESSOR MICHAEL COUSINS, PAIN MANAGEMENT RESEARCH CENTRE: Just add a couple of quick things. The transmitters play a part in this process, a very, very powerful. One of them is the endorphins and the other's the adrenaline system.
RYAN HARRIS: Yep.
PROFESSOR MICHAEL COUSINS: And they can produce the sort of pain relief and more that you described so much so that you can actually do bad things under the influence of that.
RYAN HARRIS: Yep.
PROFESSOR MICHAEL COUSINS: The second thing is, it's not the pain itself that matters, it's the meaning of the pain, same as when you're bowling, you'll take a lot of pain because you're trying to get another wicket and then another one and another one.
RYAN HARRIS: Yep, exactly right.
JENNY BROCKIE: Yeah. David, I know that you're interested in the idea of resetting people's pain barriers in sport?
DR DAVID MARTIN: Yeah.
JENNY BROCKIE: Yeah. Isn't that dangerous?
DR DAVID MARTIN: It can be, it depends on what stage of the development you're involved in. What we're trying to do with athletes that are starting to engage in a sport like boxing or like cycling, we're trying to grade the process so we're actually layering in adversity in a graded format.
JENNY BROCKIE: So layering in hurt?
DR DAVID MARTIN: It is essentially layering in hurt. We're layering in sleep deprivation like they'd get when they travel overseas, we're layering in long hill climbs, even in the rain, early morning starts.
JENNY BROCKIE: It sounds like torture to me.
DR DAVID MARTIN: It sounds like torture but in fact we're convincing ourselves it's almost unethical not to allow people to gradually…
JENNY BROCKIE: Yeah, to not prepare them?
DR DAVID MARTIN: …experience the adversity than to just jump into the adversity. One of the ways of resetting the pain, the analogy we use a lot is eating hot peppers or Tabasco sauce or spicy food. You might be given a Tabasco sauce and say how hot is it on a scale and how painful is it and you say that's a ten, that's really hot. And then you give them a different type of a chilli pepper like that's really hot and once they eat that their head nearly explodes, and then you go back to the Tabasco and say how would you rate that pain again? Well now that's only a five. Now the trick with all this is to keep it safe.
JENNY BROCKIE: Mmm, and every elite sportsmen I've spoken to, you know, pretty much wants to be out there, particularly in the big matches, yeah, regardless of what your physically state is?
RYAN HARRIS: Yeah, that and I think cricket's got one of the best medical teams I think in the world around our team at the moment, they're always advising me of the pros and cons, I guess, on going out and playing or not.
JENNY BROCKIE: And you ignore them?
RYAN HARRIS: Sometimes, yeah, and that's my choice to do that, I'm in control of that, they're not. But they can try and pull me back and say you're not going out there but I'll go and do it myself.
SHELLEY WATTS: Someone else can't tell you how much pain you can handle and I think it's very mental I think the pain in anybody necessarily. Like for myself to get punched in the face I don't have an issue with it, but I may walk down the hallway and stub my toe and I'm not anticipating the pain, I'm not ready for it, and so that will absolutely be excruciating and all you've done is stub your toe, in comparison to being punched in the face.
JENNY BROCKIE: And is that because of the meaning issue that Michael raised?
SHELLEY WATTS: Yeah.
JENNY BROCKIE: That you're not in the Commonwealth Games when you stub your toe?
SHELLEY WATTS: Yeah.
JENNY BROCKIE: So Ryan, bone on bone on your knee, what are you like when you stub your toe at home?
RYAN HARRIS: I'm exactly like that because you don't expect it I guess. It hurts. One thing I'm scared of is I've had a number of needles in my time and fluid taken out, the sight of a needle I almost faint.
JENNY BROCKIE: Lorimer, you're a clinical neuroscientist, what does all of this tell the rest of us about pain? We're not elite athletes but what does this tell us about pain?
PROFESSOR LORIMER MOSELEY, UNIVERSITY OF SOUTH AUSTRALIA: I'm just loving the conversation I might just say. I think I would agree with this emphasis on meaning, but I think the most powerful shift that we can undergo in our own sense of what pain is, is to let go this of idea of a pain being sent to your brain because that doesn't happen. There's no such thing as a pain message, right? What we're all talking about here is danger signals and then the brain has to decide should I protect you here? We talked about it from the context of the Ashes, you know, this - you're doing what you love or the Commonwealth gold, my take on that and one that I think you can defend with confidence is that it's not in your interests to have pain at that time because if you did you would behave in a way to get out of pain.
RYAN HARRIS: Exactly.
PROFESSOR LORIMER MOSELEY: It's not in your interests Shelley to hurt when someone hits you in the pain in a title bout.
SHELLEY WATTS: Yep.
PROFESSOR LORIMER MOSELEY: So the brain is so much more clever than I think we give it credit for.
JENNY BROCKIE: Now when you say, I want to just rewind here, that when you talk about a pain message what do you mean? That a pain message as such isn't what exists because a lot of people I think think that?
PROFESSOR LORIMER MOSELEY: I agree.
JENNY BROCKIE: You get the message to your brain that says you've hurt yourself, you've cut your hand and that's why it hurts?
PROFESSOR LORIMER MOSELEY: Yeah, and I would just replace pain there with a danger signal. I mean these, ultimately it has to be receptor in the nervous system that detects something's wrong or something's on the verge of being wrong and alerts the brain to that message.
JENNY BROCKIE: Alright, you've got a story. Do a show and tell. Come up and tell us your story. What happened to you? It's a great story.
PROFESSOR LORIMER MOSELEY: Do actions? Okay.
JENNY BROCKIE: Yeah, do the actions, we want the full actions.
PROFESSOR LORIMER MOSELEY: So hello everyone. Very intimidating up here, I wish I was as glamorously dressed as you. But I was once walking in the bush down near Mittagong and I'm going to re-enact for you what happened and use that as a way to describe how I think pain works. So this is me walking, I put on my sarong, very, very cool and I was walking along. Did you see that? I'll do that in slow motion in case you missed it.
I was walking along and what's actually happened is that something has touched the outside of my leg in the skin and that's detected by receptors, they're there, they're touch receptors and they send a touch message to my brain, and it's very fast, they're like Ferrari fibres, nerve fibres, and it gets to my brain and it says you've just been touched on the outside of your leg in the skin. And meanwhile whatever it was was sufficiently dangerous to activate a totally different type of nerve and we call these nerves danger receptors or note receptors, noxious receptors and they're quite slow and they send the message up into the spinal cord and then it goes from there up into the brain and it tells the brain a slightly different message and the message is there's danger on the outside of your leg in the skin - mate. They're Australian.
So then the magic happens the brain has to evaluate everything really quickly and it says where are you? The answer, I'm walking in the bush, right? Whereabouts in your walking phase are you? I'm about here. Where is the message? It's this far off the ground? Goes to the frontal lobe, now the frontal lobes can be a little bit, you know, problematic, says well, you needn't worry too much because growing up you always scratch your legs walking in the bush on twigs and bushes and things like that. So the brain took all of this information really quickly and evaluated the meaning of that which is this is not dangerous, kick off the twig and carry on your way and that's what happened and I was, I went on to the river and I got out and then that's the last thing I remember because I'd actually been bitten by an eastern brown snake which is a really deadly snake, right? So my system let me down. No, a lot of danger, no pain. Can I tell a sequel?
JENNY BROCKIE: Yeah, quickly.
PROFESSOR LORIMER MOSELEY: Okay. The sequel is walking in the bush without a sarong and I scratch my leg, something touched me on the outside of the leg, the same thing happens, gets to the brain and the brain says where are we? We're walking in the bush. What stage of your walking are you? You're there. Frontal lobe, anything to tell me? Well, last time we were in this exact situation it meant a catastrophic scenario, I need to protect you from that and I will make your leg hurt so much because then you cannot do anything but protect your leg.
JENNY BROCKIE: So how did you react?
PROFESSOR LORIMER MOSELEY: Well I always feel self-conscious re-enacting the second one because I feel like a bit of a ding…
JENNY BROCKIE: Bat.
PROFESSOR LORIMER MOSELEY: Yes, but its excruciating burning pain screaming up my leg and I was thrown off the path and if you were a health professional…
JENNY BROCKIE: This is not the snake?
PROFESSOR LORIMER MOSELEY: This is not the snake, this is a twig, yeah.
JENNY BROCKIE: Yeah, after?
PROFESSOR LORIMER MOSELEY: And I agree it's all about meaning but I think the key, the key shift that I've seen revolutionise the management of pain around the world is that pain is produced by your brain to make you protect yourself. And if protection is not the best thing right now it won't hurt.
JENNY BROCKIE: Ryan, you lost your right hand in an accident more than a decade ago but you say you can still feel it?
RYAN KAGAN: Yes, absolutely.
JENNY BROCKIE: Describe that for me, what do you mean?
RYAN KAGAN: Sure. Well, the terminology is phantom pain and ever since the accident first took place it's always been there. It's quite obvious for me I'm missing my right hand and for me it feels like everything's still there in its complete form and structure.
JENNY BROCKIE: So what do you feel?
RYAN KAGAN: In terms of how it first felt, it was quite excruciating course - through the course of the accident, it involved me holding a bottle as tight as could be and when I first lost my hand the feeling was as if I was …
JENNY BROCKIE: Like you were clenching like that?
RYAN KAGAN: Constantly gripping a bottle as tight as possibly could.
JENNY BROCKIE: And is the pain associated with the accident?
RYAN KAGAN: Essentially, yes, yeah, it is absolutely and that whole feeling of clenching onto a bottle as tight as can be is the very last, my image that, well the very last action that my hand was doing as I, as I lost it. And it's interesting it was actually through a course of the mirror box therapy which I went through some years ago.
JENNY BROCKIE: What's that?
RYAN KAGAN: So it's effectively a box which allowed me to put both limbs, i.e., my hand and wrist into a space and through a course of mirrors they were able to replicate what was a reverse image of my left hand. So as I looked down into the box, I effectively saw a right hand which was just a mirror copy of my left. But very interestingly enough, given that association and feeling like the hand is still there, it was almost like an innate response that as soon as I started moving my left fingers, my right finger started to move in sync as well and the feeling matched up with the, you know, the visuals matched up with the actual sensation. And to come back to your question of what happens when you go and touch where the non-existent hand is, if you now go like this on my fingers, I actually get that tingling sensation in that finger. I know it seems strange and I'm just tickling thin air and I can look at it, but the feeling is still there.
JENNY BROCKIE: But you're getting the feeling. So if you dive into cold water are you feeling it on both hands?
RYAN KAGAN: Yeah.
JENNY BROCKIE: A phantom hand and your real left hand?
RYAN KAGAN: That's right, yes, absolutely. It's as if you're sticking your hand into a bucket of ice water. I get that pain through again that non-existent hand.
JENNY BROCKIE: How constant is that pain you describe?
RYAN KAGAN: It's a hundred percent of the time, it's always there and like I said, it's probably always going to be there. But through different courses of action and learnings, just as like the mirror box therapy, I feel like I've got this ability to engage with it.
JENNY BROCKIE: Lorimer, what's going on here? I mean with that feeling, that sensation, that notion that it's there, that it's locked in that position it was in when the accident happened?
PROFESSOR LORIMER MOSELEY: Yeah, that's quite a common report and it's really important to understand your brain produces the sensation and all of our sensations are like that. In one way to try and grasp that Ryan has an advantage because he can see, he knows he feels his hand, he knows he feels his hand but he also knows his hand is missing. All of us know we feel our body but our body is there so it's hard to understand that this is just a creation of the brain.
JENNY BROCKIE: Show us what you mean. You've got another show and tell that you're going to do and we've got a volunteer, Andrew, he's not a plant, we've asked just a member of the audience to join us and I think we've got something coming on here. Okay.
PROFESSOR LORIMER MOSELEY: I'm just going to drape this over your shoulder and I can talk people through this. So here we have a rubber hand, it's an unclaimed prosthetic hand and I'm going to align this with your hand Andrew. So we cover, we cover the main piece of information, you people can't see over the other side, we just covered the end of that rubber hand and…
JENNY BROCKIE: Your hands shaking just a bit Andrew.
PROFESSOR LORIMER MOSELEY: It's a rubber hand that's shaking, possible. And if you close your eyes Andrew and just point with your left hand where your right hand is. Alright. Good, now you can open your eyes, I'm going to just stroke your fingers, alright, and I want you to watch somewhere around here, you can watch this brush if you like. Alright, now as Andrew's watching that, what we're doing is telling his brain that the stimulus he can see here is the same as the stimulus that's coming from the touch system and if we keep doing that, then Andrew will start to sense something a bit odd going on. Alright, so we go around that a little bit. The important thing is that his brain is getting the information together. And then we can just come in and do that, give him a real shock.
JENNY BROCKIE: Are you okay?
JENNY BROCKIE: You really jumped then. Wow.
PROFESSOR LORIMER MOSELEY: Well done Andrew. So all we've done there Jenny is a really…
JENNY BROCKIE: Are you okay?
ANDREW: Yeah, yeah.
JENNY BROCKIE: Tell me what it was like, what did you feel like?
ANDREW: Just a sudden jolt. Like, not even like it didn't hurt at all afterwards but when he hit it I felt like something was going to happen but then didn't.
JENNY BROCKIE: Okay, so did you…
PROFESSOR LORIMER MOSELEY: And then the illusion is broken straight away because the brain's got two bits of information.
JENNY BROCKIE: Yeah. So what's happening there?
PROFESSOR LORIMER MOSELEY: Well, Andrew's brain is clearly a very clever one and can quickly integrate what's most sensible and it's most sensible that the visual input, it's happening at the same time as the touch input, then the brain says clearly, well this is the stimulus that I'm seeing on the rubber hand. That's the stimulus. And that's not true but we've tricked your brain and there are many illusions like that and these have been, these sorts of illusions have been around for a hundred years.
JENNY BROCKIE: The question is what else can you do with it for other people? I mean can you train your brain to think differently about pain?
PROFESSOR LORIMER MOSELEY: You absolutely can and I think that that's really the most powerful tool available to human kind, to, to reduce pain. The problem Jenny is that it's really difficult to train the brain not to protect you because it's a life and death situation.
JENNY BROCKIE: Okay. Let's all move back to our spots, thank you very much Andrew.
PROFESSOR LORIMER MOSELEY: Thanks Andrew.
ANDREW: No worries, cheers.
JENNY BROCKIE: Round of applause for Andrew. Michael?
PROFESSOR MICHAEL COUSINS: Jenny, lest it be thought that is all sort of phenomena, we know quite a lot of about what happens with amputation, neuroplasticity is really important in this sort of pain and what happens when you lose a hand is that the area in your brain that normally represents the lips moves across in the brain to occupy the area that was previously occupied by the hand. Why does it do this? The brain's got to keep getting information. Without information it can't do the sorts of things we've talked about earlier on today. Now we've done some work with spinal cord injury patients and found that the amount of this neuroplasticity change is directly proportional to how much pain the patient has. So it provides a method now with special brain scanning, not the standard scanning but research scanning, it gives a method of evaluating new methods which will overcome that sort of problem.
JENNY BROCKIE: Mmm. Anne, you had a knee reconstruction five years ago, what happened afterwards?
ANNE GLEESON: Well I had really bad osteoarthritis in my knee so I had a knee replacement and after the surgery the pain in my leg just got worse and worse and worse, but then my leg started to change colour and it went purple so I went back to the doctor who put me on some pretty heavy duty pain killers. Then I went back to hospital.
JENNY BROCKIE: There's your leg there?
ANNE GLEESON: Yes, very attractive, isn't it? As we move through this, I went into hospital and I was really lucky, I guess, that I was diagnosed with complex regional pain syndrome.
JENNY BROCKIE: What's that?
ANNE GLEESON: It's a condition that results in agonising pain that's not, um, equal to the, to the causal event basically.
JENNY BROCKIE: Tell me what the pain was like? What was it like?
ANNE GLEESON: The pain is like someone has filled your leg with molten metal. It's a burning pain that's just …
JENNY BROCKIE: And there all the time?
ANNE GLEESON: Yeah. Some days, like today it's not that bad. Probably on a scale of one to ten the pain today is about a four. Sometimes people say well, you know, what's your pain at today and I'll say 58 and they look at me as if I'm joking but that's where it is some days.
JENNY BROCKIE: And you say it's spread?
ANNE GLEESON: It's spread into my left arm, the side of my neck now.
JENNY BROCKIE: Okay, had you heard of this syndrome before?
ANNE GLEESON: No, and one of the worst things was I'd never heard of it before, one of the nurses in the hospital initially gave me a printout from the internet and all I saw was "excruciating pain" and "there's no cure".
JENNY BROCKIE: That's not very encouraging, right?
ANNE GLEESON: No. So for about the first six months I barely left the house. I was working previous to that so I had to give up work.
JENNY BROCKIE: And the word "chronic" had a big impact on you, yes?
ANNE GLEESON: Yeah, chronic, how long is this going to last? Will I be better tomorrow? I will I be able to go back to work?
JENNY BROCKIE: Yeah, so a complete mystery. Michael, you are a pain specialist, tell us what this thing is, complex regional pain syndrome?
PROFESSOR MICHAEL COUSINS: Well quite obviously it causes chronic pain, it's one of the rather more complicated causes so that's why it's called complex, and the complex means that it affects the sensory system, it affects the motor system. So for example, the patient might have a tremor; they might have a lot of trouble with the disconnect between their brain and their limb. They suddenly find they really can't move the hand very much or it responds very slowly and that's pretty disconcerting.
JENNY BROCKIE: And what causes it? Why do some people get it and other people don't?
PROFESSOR MICHAEL COUSINS: We don't entirely know the answer to that question. However, it appears that there's, this is partly due to genetic predisposition and this is also probably the case with a lot of post trauma and post-surgical pain, it's not just genetics by itself. There has to be a key interaction between that genetic predisposition and the environment.
JENNY BROCKIE: So how treatable is it? How do you treat it if it's that complex?
PROFESSOR MICHAEL COUSINS: Look, we have very few good tools for this condition and we've got to be honest with patients about that. There are some things in the field of pain that we really don't often do very well and this is one of them I'm afraid.
JENNY BROCKIE: Do we know the extent to which the brain can play a role in this?
PROFESSOR MICHAEL COUSINS: Oh, we know that a lot of this is going on in the brain so I referred to neuroplasticity. This is neuroplasticity in spades. The brain has become tricked into thinking there's something that needs a response that's not a helpful response. It's a maladaptation so you've got to get it to go back the other way.
JENNY BROCKIE: How do you do that?
PROFESSOR MICHAEL COUSINS: Well you do that firstly by invoking the motor system. You've got to get weight bearing going in the lower limb and to a certain extent in the upper limb. You've got to get as full a range of normal activity going as possible. Very often if it's an upper limb you get a frozen shoulder; you've got to get in really early to prevent that frozen shoulder and re-educate the muscles how to work. You can do things such as desensitisation - try to get the patient to overcome the extreme sensitivity that I assume you must have had.
ANNE GLEESON: Yes, I still get that, that sometimes for instance I can't wear a pair of jeans because I can't stand the weight of the jeans on my leg.
JENNY BROCKIE: And also in water you said?
ANNE GLEESON: Water, cold water.
JENNY BROCKIE: Cold water?
ANNE GLEESON: Just absolutely is like standing…
JENNY BROCKIE: What does it feel like?
ANNE GLEESON: … in ground glass and the glass swirling around your leg. It is just agonising.
PROFESSOR MICHAEL COUSINS: Then there are what we call cognitive behavioural strategies, so giving the patient correct information about what's going on and what you really can do that's likely to help.
JENNY BROCKIE: Terry, you're Anne's husband, how did you react to this diagnosis? What did you think was going on with her leg when this happened?
TERRY GLEESON: Well I didn't believe it. I thought that they'd done something wrong. I thought they'd left something in there, a pair of scissors or something there because she was in so much pain and…
JENNY BROCKIE: You did check that they hadn't left a pair of scissors in there?
TERRY GLEESON: Well I guess they did but I couldn't check. Yeah, and then after talking to doctors and things with my wife about it and I still don't understand what it is really but, you know, she's always in pain.
JENNY BROCKIE: Yeah, but it must have really surprised you to see her leg change like that?
TERRY GLEESON: Oh yeah, yeah.
JENNY BROCKIE: And see that kind of severe…
TERRY GLEESON: And it was like, not only was it the colour and all, it was hard, it was like rock hard.
JENNY BROCKIE: How did friends react to this?
ANNE GLEESON: Oh, friends are full of useful advice. Some friends are full of useful advice. They says thing like have you tried acupuncture? Have you tried, you know, whatever, hypnotherapy, all of that. And yes you do try all of those alternate sorts of things. After the spinal cord stimulator made the pain worse, I said to the doctor, the pain specialist just turn it off, just leave it there. And he said well I think you should see a psychologist. Well I went home in tears, I said to Terry he thinks I'm mad. Seeing the psychologist was probably the single best intervention that I did.
JENNY BROCKIE: Why?
ANNE GLEESON: She taught me about, she taught that I wasn't going mad in the first place because sometimes I used to think I was going crazy. Sometimes I'd look at my hand and think oh, that's not my hand, that's not my arm.
JENNY BROCKIE: This is the disconnect?
ANNE GLEESON: Yeah, that's not my leg. She taught me how to deal with all of that and she also taught me about mindfulness.
JENNY BROCKIE: What's mindfulness for people who don't know?
ANNE GLEESON: Um, my layman's definition of it, it is what it is. I have got pain and I have to live with that pain and you just connect with that pain.
JENNY BROCKIE: And did that mindfulness decrease the pain or alleviate the pain for you? Did it help?
ANNE GLEESON: It helped, it helped. The pain, it helped me cope with the pain, I guess. And then through talking it through with my pain specialist and we talked, I was on lots of narcotics and opiates, we decided that wasn't the way to go so I've stopped all that and I'm going back to a rehab program and, yeah.
JENNY BROCKIE: So what are you doing now? When you feel that that pain what do you do?
ANNE GLEESON: Well once upon a time I would panic. I don't panic any more, it is what it is. Okay, this is bad. Is it because I've done too much? If it's not that I've done too much I must be having a bad pain day, a bad flare, and you just move through it. And instead of not doing anything maybe just do a little bit. Might go for four or five days where I don't sleep because of the pain and again use the mindfulness it is what it is.
JENNY BROCKIE: Steve Pete in Oregon, you have an altogether different problem with pain. What is it?
STEVEN PETE: Well, I was born with the rare genetic condition where I do not feel physical pain.
JENNY BROCKIE: At all?
STEVEN PETE: At all.
JENNY BROCKIE: Ever, no matter what happens to your body or no matter what you go through, you don't feel anything?
STEVEN PETE: No, no broken bones or any, you know, cuts or anything like that, nothing at all.
JENNY BROCKIE: And your late brother Chris had this as well, had this genetic condition as well?
STEVEN PETE: Yes he did.
JENNY BROCKIE: What was it like for you as kids to start with because kids engage in all kinds of risky behaviour, what was it like for you? What sort of things happened?
STEVEN PETE: Well we would kind of take things a little bit to the extreme, like riding bicycles down a steep driveway and using each other as jump, and gosh, climbing high trees, jumping out of, jumping off of rooftops, all kinds of things.
JENNY BROCKIE: And how often would you get hurt, seriously hurts, as a result of doing those things because you couldn't feel the pain?
STEVEN PETE: Well, so far I'm 33 years old and I've had probably over 70 broken bones so far in my life. So, and the majority of those happened in my childhood between birth to about 14 or 15. So…
JENNY BROCKIE: How did you parents cope with it? What did they tell you?
STEVEN PETE: I think my parents still haven't coped with it but they deal with it the best that they can. They made a point to discuss with my brother and I ways of trying to detect injury, being that we don't feel pain, and they used to watch us as much as they could but try to give us as some kind of independence.
JENNY BROCKIE: Brothers often fight physically. What were your fights like when you had fights with one another?
STEVEN PETE: We usually involved objects which ever were in the room for weapons against each other. Sometimes knives and you know, a shovel or a crow bar, whatever was nearby at the time.
JENNY BROCKIE: Wow. So some very serious injuries you must have had, both of you?
STEVEN PETE: Mm-mmm, yeah, quite a lot.
JENNY BROCKIE: And you would stitch up your own injuries sometimes as a child, is that right?
STEVEN PETE: Yeah. I didn't want my parents to find out I'd injured myself so I stitched up my right arm and right handed so I had to do it left handed at the time with some fishing line.
JENNY BROCKIE: Okay, lots of intake of breath here. And at one stage you were actually removed from your parents' care, is that right, because the authorities…
STEVEN PETE: Yeah.
JENNY BROCKIE: ….thought that you were being abused?
STEVEN PETE: Yeah, I was quite young when that happened back then when someone came, you know, saying hey my child doesn't feel pain, this is why they have all these injuries, it was a little bit harder to believe than what it is now. And that information, even though it was being provided to authorities by a physician, it was still being overlooked for quite some time, about three months before I was returned to my parents.
JENNY BROCKIE: Wow. What do you understand pain to be?
STEVEN PETE: I'm asked that quite a lot and it would probably be as if I were to ask someone what it would be like to live without pain. Their first reaction would probably be oh that would be a fantastic thing to live life without feeling pain and they start to think about it and they go well, you know, maybe there is a downside in not feeling pain. And then if you ask me that question I'd say well you know, maybe feeling pain would be great but then now that I've got all these injuries, feeling pain would be quite a horrible experience. So I really try not to give too much thought about pain or what it would be like to live my life with pain.
JENNY BROCKIE: So your wife, for example, gets migraines, I understand?
STEVEN PETE: Yeah.
JENNY BROCKIE: Can you empathise in any way with that? Do you have the capacity to empathise because you can't know what it's, what pain's like so how can you know what she's going through?
STEVEN PETE: Yeah, I think my empathy more towards my wife and my children is more like a learned behaviour than anything. It's not something I'm really, that I do naturally when I experience someone who is going through a painful situation. So it's kind of difficult for me.
JENNY BROCKIE: And what about internal things that you can't see - something like appendicitis.
STEVEN PETE: Yeah, appendicitis is the one thing I worry about the most but something more recent that occurred with me was my T8 and T9 vertebra were fractured and I went probably seven or eight months not even knowing that it had occurred. Just had a little bit of discomfort and once I found out about it, then I had to go ahead and go through a whole list of procedures to try to remedy it or try to remedy as best as I can. It wasn't even until like a week ago when I finally recalled what it was I had done to myself that had caused the injury. So …
JENNY BROCKIE: Which was? What had you done?
STEVEN PETE: It was really stupid. We were out in the parking lot, it was snowing so there was a good foot and a half of snow. We were out there with my children and we were all inner tubing down the hillside and I kind of did like a run and a jump on the tube and I just kind of bent my back in an awkward position and that's what it was. I had fractured my T8, my T9 vertebrae.
JENNY BROCKIE: Okay. Yes, questions here?
DR DAVID MARTIN: I have one question, in athletes we're always trying to understand discomfort versus pain, and I wonder if you have any sensations, do you feel pressure, do you feel cold or do you feel heat? I'm wondering how you differentiation.
STEVEN PETE: I feel discomfort, heat, cold. Like with my left knee, for example, I've had three arthroscopic surgeries on it from the time I was 14 years old till the time I was about 17. It's swollen to about the size of a grapefruit now and I've got constant discomfort with this. Just bone rubbing on bone all the time. I can feel the pressure from the swelling and if I'm moving I can feel the bone kind of grinding on bone. So it's different from what my right knee is experiencing which is normal movement. So it's just those two differences.
JENNY BROCKIE: But it's not hurting?
STEVEN PETE: No.
JENNY BROCKIE: It's just a sensation of discomfort. Ryan, how do you control your pain or that pain you feel when you're bowling?
RYAN HARRIS: Oh it is a very good question. I guess I'm so used to it, I guess that's how I control it.
JENNY BROCKIE: Do you take drugs, do you take pain killers?
RYAN HARRIS: I have taken Panadeine Forte, I constantly taken Voltaren to control that inflammation.
JENNY BROCKIE: How often?
RYAN HARRIS: When I'm playing and training I take Voltaren morning and night. Panadeine Forte I only take when I play to try and control that pain.
JENNY BROCKIE: And have you ever tried anything like mindfulness or meditation?
RYAN HARRIS: I haven't, I must admit I haven't. I'm very fascinated listening to it, listening to people using it. I use psychology, psychologists quite a lot, more about how to get through, what to think and how to get through certain situations where I think I'm struggling or I think my body's struggling.
JENNY BROCKIE: How much does your emotional state affect the extent of the pain that you feel, or does it?
RYAN HARRIS: Enormous. It controls it.
JENNY BROCKIE: David, you think it does?
DR DAVID MARTIN: Yeah, I do. It is and this is a real interesting scenario that plays out in the sporting world. I stumbled across this concept of a therapeutic presence, that some people connect with another person who is in pain very well and this is all very emotional. They are on that emotional level where they really connect with the person with the pain and they have the empathy and they give them hope, whatever they do works.
JENNY BROCKIE: Anne, you're nodding your head?
ANNE GLEESON: Just in terms of do your emotions play a part in this, I know around the time that my dad was dying my pain was much worse because I wasn't attending to it if you like. I was very emotional, very upset and the pain was off the scale.
JENNY BROCKIE: Yeah, Lorimer?
PROFESSOR LORIMER MOSELEY: I completely agree with that and we can link that not just to emotion in a fluffy way but when you have a feeling you change the biochemistry of your body and that changes the way neurons work. Pain is so complex and so personal and we all really want to understand what it's like for Steve and want him to understand what it's like for us. But I can't understand what it's like for you, your pain, because it's not mine, it's an internal thing and we find ourselves describing our pain in terms of the injury because then someone else can understand it. So you know, Ryan's talking about bone on bone in there and we all get it but we're having to describe it in terms of danger, not in terms of pain because it's this internal thing. All of these complex things move into it and I think you can say well actually, it's simple, the brain evaluates what tells me I'm safe and what tells me I'm in danger and needs to protects and that can be anything. Not just the sensory information. We know the people with a car accident and they have a sore neck and everything's going well in their rehab and they go back to that roundabout where they had their accident and their pain comes on, that's completely sensible to someone who understands biology. There's nothing illegitimate or unreal about that pain.
JENNY BROCKIE: But the questions is what can you do with that knowledge to help people like Anne, or to help people who have on-going pain? Lesley, you're getting agitated up here and I know that you've had chronic osteoarthritis since your 30s and you're in your 70's now. But what I'm interested in, because I know that you're very active in this area.
LESLEY BRYDON, PAINAUSTRALIA: Yes.
JENNY BROCKIE: As an advocate and what I'm interested is what you make of this role of the brain and what it might mean for anyone in managing pain.
LESLEY BRYDON: Well Jenny, that's actually where we are at today, we have good evidence now that people who undergo what we call pain programs, which is a multi-disciplinary program where they learn firstly to understand their own pain and the causes of it and the drivers of it, the triggers for it, and then learn techniques to manage it such as the techniques we've talked about, meditation, mindfulness, gentle exercise, managed exercise. I mean psychological therapies like cognitive behavioural therapy play a major role in pain programs and fortunately we're now starting to see them introduced.
JENNY BROCKIE: You want pain to be considered a disease?
LESLEY BRYDON: No, not necessarily Jenny. For me I think that's an academic debate. I mean for me chronic pain is a very nasty insidious chronic condition. It is relentless, it is not curable, it is debilitating and disabling and it's a terrible burden on the health system and the economy so it needs to be a health care priority but it does not need necessarily to be recognised as a disease. I think the government, federal government, state and federal governments all recognise it as a chronic medical condition which is eligible to be treated under a chronic disease care plan. So theoretically you can get allied, allied professional health, help, sorry, to learn some of these techniques under Medicare.
JENNY BROCKIE: Michael, do you think chronic pain should be considered to be a condition in its own right?
PROFESSOR MICHAEL COUSINS: Absolutely, I mean there's a vast amount of evidence of maladaptations that occur in the brain. We're just now starting to get evidence in the spinal cord which has been very hard to get in humans but it is there. There's evidence of abnormalities in the functioning at the receptor level at the body surface damages the spinal nerves go into the spinal cord. I'm very comfortable with calling it a condition. It makes no difference, it needs to be recognised.
JENNY BROCKIE: Okay, but it's a disease or a condition. Lorimer, I know that you've got a problem with that idea. Why?
PROFESSOR LORIMER MOSELEY: I agree with Michael that there's very good evidence that chronic pain is associated with these changes but I think it puts a ceiling on our hope and our possibility and I think that ceiling is already being shifted upwards with the advances that are happening in the different pain sciences.
PROFESSOR MICHAEL COUSINS: Look, I must disagree with you that this will stifle progress. I think looking very hard at the disease processes that have currently been discovered and more that are being discovered we will get some new options for treatment and that's what we need. We need more tools to help people.
JENNY BROCKIE: Dave, yes?
DR DAVID MARTIN: I wanted to just see if there's a comment, Lesley I think, that there's a lot of the attention on the person who's suffering with pain. I'm a support person and that is my role. I wonder is there something that the people that care for people with pain, or the spouse or the partner or the brother or the sister, is there any words of wisdom on how to cope and deal with someone who is suffering with pain?
JENNY BROCKIE: You don't talk about it, I know, because we did a whole interview with you for this show and you didn't talk about your own situation at all which I found really interesting.
LESLEY BRYDON: Well I think that, well there is a very simple reason for that Jenny and that is, you know, that I recognise the stigma that's attached to chronic pain. People perceive them as weak, as not able to cope, as quite pathetic in fact if they don't deal with pain. People, pain is invisible so you can't actually see always what is wrong with somebody. So you think that they are imagining, you know, people think you're imagining it so it's not talked about.
JENNY BROCKIE: What's the best thing you can do to help them?
LESLEY BRYDON: Well I think you listen and you believe them initially is a starting point. And if people say they're in pain then simple believe them, accept that and try to be supportive and not be critical.
JENNY BROCKIE: Anne, what have you learned about managing your pain now do you think?
ANNE GLEESON: I think I've learnt that it is what it is.
JENNY BROCKIE: And Ryan, what about you? What do you think you've learnt about your own?
RYAN HARRIS: What I do causes the pain I've got. The only way I can stop the real pain that I get is to finish and stop what I do and I don't…
JENNY BROCKIE: And what are the chances of that?
RYAN HARRIS: And that's not happening I love doing what I do, I've got the best job in the world. I know before I walk onto the field, I know when I walk off I'm going to be sore and painful. So it is what it is and I deal with it.
JENNY BROCKIE: And how are you feeling about making the Ashes team?
RYAN HARRIS: Oh, it's exciting, yeah, and that's something that I've had a chance of winning the Ashes, I've got injured and lost the Ashes and I want to win them again and that's the drive for me to keep going and the pain takes, sort of a back seat to that.
JENNY BROCKIE: Thanks so much for joining us, thank you to everybody for joining us for this discussion. It's been fascinating.