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Saul Marquez:
Hey, everybody! Saul Marquez with the Outcomes Rocket. I want to welcome you back to the podcast. Today, I’m privileged to have a familiar face and name on the podcast. Dr. Amy Baxter. Amy, do you want to say hi?

Amy Baxter:
Hello. It’s good to be back.

Saul Marquez:
It’s good to have you here. The name sounds familiar, that’s because Amy’s been on the podcast. This is, we’re actually chatting before we started recording. Podcast number four with Amy, I don’t know that anybody has been on four times yet, so kudos to Amy for making it on the air four times. She’s a clinical associate professor at Augusta University, the Department of Emergency Medicine. She’s an emergency medicine physician, but also the CEO of an amazing company, Pain Care Labs. She’s the funded researcher, and she’s here really her focus. She’s nationally recognized and internationally recognized on pain, opioid use, health tech innovation, and many other things that you guys care about. So excited to have her here on the podcast again to talk about some recent exciting things. And with that, welcome to the podcast again.

Amy Baxter:
Thank you. I think I’m just on so many times because I keep getting interested in different things. It’s eclectic, it’s not always the same stuff.

Saul Marquez:
It is, and look, it’s things that related to pain. And then, during the pandemic, you were doing some really fascinating things that really help educate our listeners around staying healthy during the pandemic. So you do a nice job of staying recent and up-to-date with the work that you do, so kudos to you on that. Look, for anybody that maybe hasn’t had a chance to meet you, what would you share beyond what I did in the introduction?

Amy Baxter:
Well, probably just that my background, clinically, is pediatric emergency medicine. Then I did a fellowship in child abuse, and I did fellowship in emergency pediatrics, then I did a clinical research fellowship, then I subspecialized and was one of the founding members of the Society for Pediatric Sedation, and all of that led to a very comprehensive interest in varying parameters of human suffering. I’m super fun at parties.

Saul Marquez:
I know you are. You’re so much fun to talk to. And we’re here now, fast forward, we’re past the pandemic, COVID’s part of our lives, we know how to manage it, but this pandemic of the opioid crisis continues. And so talk to us a little bit about what you’ve been doing and some of the latest that people listening could actually learn more about what’s going on with pain and the use of opioids.

Amy Baxter:
Yeah, so I did a TED Talk in April, and since then, I’ve learned even more about some of the fallacies that are fueling the opioid crisis. What I’ve learned is that we only get about 12 hours of pain education in medical school, in Canada they get 20, but most of that is still pharmacology, it’s not understanding pain, and pain is the number one reason people go to the doctor. So it’s a little weird for us to not know about pain as physicians feel like it’s not our job because we’re supposed to solve a problem or diagnose a problem, but we’re not supposed to make you more comfortable while we do it, and if your problem is not being comfortable, then that’s on you. And that perspective was left over, I think, in some ways, from the way we get into medical school, which is there’s one right answer, so a multiple choice thing. And then also the way the Sackler Purdue Pharma, OxyContin, filled this void of education for young doctors, and so, why a whole bunch of us in the 90s were taught and still believe that pain-free is the goal, and a pill is the path to get there.

Saul Marquez:
Yeah, and so really cool that, you know, teased out. How many hours did you say? 12 hours?

Amy Baxter:
Yeah, yeah.

Saul Marquez:
That’s a very small amount compared to the, I don’t even know how many hours, how many total hours?

Amy Baxter:
I have no idea, but it’s got to be in the thousands.

Saul Marquez:
Yeah, it’s like a fraction of it. And so there’s an opportunity here to really get around the mass education that drug companies have done on the opioids themselves and an opportunity to solve a really big problem in our society, and that’s addiction to opioids. So talk to us, first, let’s talk about your TED Talk, right? So that TED Talk is going to be available, guys. You’re curious about what we talk about here? Tip of the iceberg. The TED Talk is going to be available in the show notes. So make sure you check that out because it’s really darn good, and you’re going to learn a ton. But Amy, tell us a little bit more.

Amy Baxter:
Yeah, so I want to solve the problem of pain. That’s why we started the company, was to eliminate unnecessary pain. And it turns out that’s really critical in solving the opioid crisis because a number of things, and you’re very kind, but when people are listening to this, the TED Talk will have really just come out. It really shakes up a bunch of paradigms about what we think pain is. So I think that most people, including me, after medical school and residency, think that pain is what happens in your thumb or wherever you’re cut, and it turns on a pain switch in the brain, and opioids turn the switch off. And the reality is that pain is about a third the physiology of what’s getting transmitted to the spine that then goes to the brain, and about a third, how afraid of it you are and how much control you feel you have over it. Most of what you feel is what you expect to feel. If you think about a punch in the arm, it’s going to hurt more when it’s a bully punching you than when it’s your best buddy. And if you’re in a dark room and people have scared you, and you’re afraid you’re going to get killed, that punch is going to be remembered as something extremely painful. But if you’re at the bus stop and you see somebody cute, and your buddy punches you and says, go over there, you don’t remember that at all. So there are a whole lot more examples, but what we, the reason we understand how this works now, is because we have something called Functional MRI. So FMRI is able to look at what parts of the brain are involved in processing different signals, and a work by Thomas Fisac in 2020 shows that there are connections between sensation, the switchboard in the brain, the conductor, and thalamus enters the neocortex, but also then fear and memory and sorting and where in your brain you look at options and what the implications are going to be for your future. And all of these things light up in one big spasm when you feel pain, and you can override that by making the conductor get distracted, and I talk about some biohacks in the TED Talk as like you can actually stop it from connecting, and it can cut pain in half. The other thing that Functional MRI shows us is that opioids activate the reward system, which happens to be scattered liberally with a lot of these different places in the brain that experience pain, but it doesn’t turn off pain. It just makes you not care because you’re so dopamine-high, and that is a real important difference. And so once we know that, then there are a lot of other ways that you can decrease pain that are not addictive.

Saul Marquez:
Yeah, that’s really interesting. And really, we’re talking one-third physiologic, one-third control, and one-third fear.

Amy Baxter:
Yeah, it’s more of a guideline, really. But you’ve got, an amputation probably is going to be a little bit more on that physiology part, but certainly, context really matters. The same pain from a vaccine is going to be, somebody’s freaked out about the vaccine, that’s going to be overwhelming, but they can get a tattoo or a piercing without a problem because it’s a different context. So it’s not what you’re feeling, it’s what that feeling means to you, it’s how safe your brain thinks you are. And we’re used to taking that for granted or take it as gospel. Well, this is pain, this must be bad for me. The brain exaggerates, the brain can be wrong.

Saul Marquez:
I love that. Thank you, Amy. And there’s a ton of great stuff here, guys. Check out the show notes for the TED Talk. As I said, tip of the iceberg, but that was the trailer for it.

Amy Baxter:
Jokes, I’ve got some jokes.

Saul Marquez:
And there’s some jokes in there that I think you’ll enjoy, so definitely check that out. That’s the call to action of the show today. Check out the TED Talk. So moving on, there is some recent research that you conducted. So Dr. Amy Baxter conducted some really interesting research here, and I was intrigued by it, and certainly, I think you will choose. So talk to us about that, and we’ll also reference this in the show notes.

Amy Baxter:
All right. So, first of all, disclaimer. Yes, I am funded by the NIH, and what we’re doing is we’re researching whether a low back pain device that combines multiple different vibration frequencies and heat and cold and a whole bunch of options that are able to reduce pain, whether those can actually reduce opioid use. So that’s my real research, and it uses some of the stuff from the TED Talk that options, not opioids. What really works for pain is knowing you’ve got options and having access to them. But because of this and because we are in an opioid crisis and we’re talking a lot, I think 90% of what I see people researching on is helping once people are addicted. And opioid use disorder is so intense, and the reason we need medication-assisted treatment is because the receptors for rewards that opioids hit are more direct and more intense than any other substance that people enjoy, like alcohol or misuse or cigarettes or anything. Opioids are a hundred times more rewarding, so that’s why, without blocking those receptors, it’s really hard to fix it. As a pediatrician, and as Saul, I’ve talked about needles here, I talk about preventing COVID, I’m into the prevention side of things because it’s easier and it’s less effort, and I’m used to stopping things and not wasting time after they’ve gotten started. This is the thing that I’ve been looking at the numbers over the past week and trying to really go, okay, well, we know that we have leftover opioids in circulation, we know kids who start experimenting or young adults who start experimenting are mostly getting their opioids from other people’s medicine cabinets. That was my call to action from the TED, is throw away the pills in your medicine cabinet. But just exactly how much of our ongoing opioid crisis is caused by this? And this was the thing, Saul, that blew me away. Last night, I finally finished calculating all these numbers, and it’s like, oh my goodness, it’s all the writing of excess opioids. It’s almost all, and it’s surgically, it’s not the chronic pain. Those people aren’t putting opioids in circulation, they’re using them; it’s not the people with genetic diseases, those people rarely get opioid use disorder; and it’s not the opioids in the hospital itself, that actually is preventative of post-traumatic stress and chronic pain. It’s almost a 1 to 1 that we’ve got 84 million prescriptions put into circulation for post-surgery, for wisdom teeth, for all these things. About 6.5% of people who have a surgery, or their wisdom teeth out, or are given opioids for an acute pain incidence that we physicians are doing, they get addicted. They get opioid use disorder, and-

Saul Marquez:
5%?

Amy Baxter:
6.5%. I mean there’s a paper by Schrader et al. 2019 in JAMA, and it showed that it was like 6.8% developed opioid use disorder compared to 0.4% of adolescents getting their wisdom teeth out whether they were given opioids or they were not. Just the risk factor of having the opioids around, that’s what led to 6.4%. Well, it turns out that’s the same for almost all these surgeries. And it doesn’t, I mean there’s, a colonoscopy’s got more of an 18%, I mean colon surgery. I mean, it depends on the intensity of the surgery. Spine surgery is worse, so a little device is going to hopefully prevent spine surgery. But it, so what we’ve got going on here is about a third of people are probably genetically set up to get opioid use disorder, and you give them surgery and opioids, and a third of them succumb. So now that’s, or a little more, so that’s your 6.5%. But the rest, all the random people who are getting pills from their parent or their friend’s medicine cabinet, the numbers that they are getting every year is about 300 or 3 million new opioid use disorders every year, they would use about 1.5 billion pills. Guess how many pills are put in circulation by surgeons, mostly, emergency doctors, family practice doctors, and actually nurse practitioners? A lot, it’s about 1.17 billion leftover extra pills. It just matches up. So we just need to quit prescribing home pills for pain, but then the problem is, what else do we use?

Saul Marquez:
Right, and there’s some gaps there in, what else do we use? Because CMS approved reimbursements for alternatives, right? Like some of the things that you offer at painkillers.

Amy Baxter:
And time-sensitive, too. There, for quite some time since 2017, some senators, Shelley Caputo from West Virginia, a couple others, have tried to say, hey, if something has been proven to reduce opioids after surgery, let’s go there, and so that NOPAIN Act got finally approved and added to the omnibus spending bill at the end of 2022. It was supposed to go into effect this year, and June 23rd, said, actually, we’re going to make it not take effect until 2025. So there is a write-in period of time I can give you this link, too. There’s a very short window now, when you’re listening to this, to write in and say, no, we need to pay for post-surgical options because doctors won’t recommend them. People can’t get them unless we’re paying for devices and supplements and cryotherapy and all these things that have been supported to reduce pain after surgery. If people can’t afford to pay it themselves, opioids are a buck a pill. So what are they going to choose?

Saul Marquez:
Yeah, for sure. Big problem. We’ll have that link in the show notes, too, so you could check it out. This is something that you care about, there’s an opportunity to take action, so certainly make sure you do that. Amy, it’s always a pleasure to chat with you, and you’ve left us with a lot to look into, … So that’s great. Always appreciate the opportunity. Oh, and there we go. Okay, so this is back brace, maybe you want to share something about that as well.

Amy Baxter:
How did you guess? It’s like at the end of the Hot Ones, it’s like, all right, get the camera, tell us what you got going on. All right, this will not be widely available until we’re finished with the trial, but it did reduce pain 57%. Yeah, so DuoTherm is a plate that has multiple different specific frequencies of vibration so that you can concentrate it either it’s spine thing or a muscle thing or a nerve root thing, but also you can put hot or cold in here so it can’t hurt you if you fall asleep on it, it will just become body temperature. But there are places for myofascial trigger points, and if you got one spot, there’s, it turns out what people need for reducing pain is options. So I designed this with 1,220 different possible permutations of options, and you can wear it under your clothes, and it’s just, it loosens up the fascia over the back, and I will know more once we’re finished with our trial, but in the phase one, it reduced pain 57%. What we’re really excited about is, can it reduce opioids in acute and chronic pain, and can it reduce the need for surgery. So stay tuned on that one. I’ll tell you when I know more.

Saul Marquez:
We’ll have you back on. So look, folks, definitely a lot of options here. I give Dr. Amy Baxter a lot of credit for the work that she’s pioneering, things that she’s doing to really help at scale with the big problem that we have on opioid usage in our country, and across the world. So, Amy, such a pleasure to have you on, and looking forward to staying in touch.

Amy Baxter:
I look forward to seeing you again and I love your logo.

Saul Marquez:
Thank you.

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