Dr. McCurdy, it is an absolute pleasure
to meet you here in Wilmont Gardens at the University of Florida. You’ve been
here for a couple of years doing research. Really excited, thanks so much
for joining. – Thank you for having me. So you have been researching, really what so
many people in this country are suffering and dealing with. And that’s
this sort of intersection of where pain and addiction meet.
– That’s right. Tell us a little bit about it.
– That’s right. So um. we’ve spent a lot of years in my
laboratories studying pain, trying to come up with new ways to treat pain, not
just the opioid means that everyone has been using for, for years and years and
years, but trying to come up with maybe some non-addictive ways to treat pain,
but also realizing the power of the opiate system and understanding that
it’s really difficult to try and compete with that level of pain relief that
opiates can give. And so, trying to find alternatives that not only interact with
the opiate system, but maybe interact with other systems that can counteract
some of the effects or the addictive or abuse liabilities associated with those.
So, we’ve been looking at those areas and then that court sort of falls right into
the addiction area as well, and looking at ways that we can try to treat those
that are addicted. Trying to alleviate some of that disease and help them return to
a more productive quality of life. So it’s not just in
opiates. We focus also on psychostimulants in my laboratory over the years. So we’ve
looked at treatments for cocaine and methamphetamine as well.
They’re still no approved treatments for those two drugs. Of course
we have some treatments for opiate addiction, but they’re again, opiates
themselves. And they tend to be more of a replacement or a step-down type therapy
than something that really can move people off and away from those medications.
– When you talk about pain, from your experience, and the research that you’ve done, how do you
define pain? And what- yeah, really curious about sort of like the definition of pain.
– I think it’s, it’s a really difficult thing because pain can
be many, many things. Of course there’s the acute pain that we can experience if
we slam a finger in a car door, or we get burnt on the stove. Something like that. But then there’s
emotional pain and how do we, how do we even even focus or think about emotional pain, and
treating that emotional pain? And then there’s visceral pain, so just this
really deep-seated pain inside their bodies- organ pain. Those types of things
that that can be extremely difficult to pinpoint and treat. And so, pain is really,
as far as a definition goes, it’s almost impossible in my mind to define it.
Because there’s so many different ways that our body can experience pain.
It’s really tough. And I think this has been a really big challenge in research
for us to try to understand how do we treat that pain. And we’ve been studying pain
models in animals for the same ways for for really decades. And it’s not a
surprise to me that we haven’t to move that, that treatment paradigm
forward, because we just can’t find anything better than what we already
have. We can find different ways to try and approach this, but we’re still
treating our studies the same way we have for, for decades. And really trying
to move away from what is really an acute pain measurement. So the way we
test pain medications is really just the way I’ve described earlier. If it’s too
hot, we try to extend that animal’s interaction with heat so we put them on
a hot plate. It’s exactly what it sounds like that you might put a cup of coffee
on to keep it warm. But those animals were going a hot plate for a
defined amount of time, usually within a second or two without any drug treatment, they’re already starting to lick their paws and you can remove them. And
then if we give them something like morphine, they’ll stay on that plate
till the time point that we cut them off, where we don’t cause any tissue damage.
We protect the animal really well. – Right.
But this is really reflexive measures of pain. So you’re experiencing something, the the brain sort of
realizes there’s a painful stimulus input and then the body reacts to that by in this
case, they’ll lick their paws to pull them down. There’s another way we do it,
which is it’s called a warm water tail flick, where you actually put animal’s
tail- mouse or a rat’s tail into warm water bath and they’ll withdraw it out
of that water bath after a second or two. And then we can do the same thing. We can
look and see if we can extend that time frame that they interact with that water
by giving them something like morphine or any other drug to see if we can enhance that timeline. So those are the real main ways that we study trying to find new pain medications. And so we’re not
looking at- and we don’t have really good models of chronic pain, of what we see in
actual humans that have been suffering from you know, maybe sciatica, or complex regional
pain syndrome, for which there’s still no real good diagnostic tests. There’s
really difficulty in us trying to model the real human pain conditions in an
animal and then try and study that with new drug treatments. So to me, it’s
not a surprise that as researchers, we’ve been stuck in a rut for the last 50 years or so, and we haven’t seen new pain medications really coming out. That’s very interesting. So you’re saying, because we’re not able to emulate some of the animal models around pain, we’ve been in this rut for
these 50 years. And I think to your point, I’m really excited to continue the
conversation around you know, where pain management goes and how it intersects
with addiction. But when you think about pain, and you know, I’ve grown up hearing
you know, someone has a high pain threshold, someone else has a low pain
threshold. Can we build a resilient- like are we able to become stronger and more
resilient to certain pain? How how does that change in our lives?
Yeah, I don’t know if you can sort of teach yourself to become more tolerant of
pain. You probably can. I mean as people go on through life, they will push further and further, and harder and harder. And they’ll you know, “If it doesn’t kill you, it makes
you stronger,” statements. – Right.
But pain is a very subjective thing. So in fact, you know, when you go into the hospital
you go to see the the medical team, they’ll ask you, what’s your pain level
on that scale from 1-10? Well, 10 for you, maybe 5 for me or vice-versa,
and there’s no real way to say the pain they’re experiencing is different from
the pain I’m experiencing. But we perceive it as something very different.
Every single individual does. Now how does that change over time? I don’t know. It’s interesting
because considering that pain is supposed to be the fifth vital sign now.
– Oh, really? It’s the only vital sign that we don’t have an objective way to measure.
– Okay, say that again. So pain is the fifth vital sign that’s common. So if you
were to be checked into an emergency room, or you go to see the doctor, the
physician will ask you, you know, how’s your pain level today? Where do you feel
on this scale of 1-10, and then they’ll give you some facial recognitions
of what should be a 1. You know, you’re kind of happy, no problem. Versus a 10
where you would be in very excruciating pain, tears, and just can’t stand yourself. But
this is now, this is now recognized as the fifth vital sign. It’s the only one
we don’t have a way to objectify. So we can take blood pressure. That’s very
straightforward. We can take temperatures, very straight forward. So all these vital
signs that we have been used to recording and making sure
we can keep track of. And we can really watch how those vital signs are changing
in response to drug treatment, or just lifestyle enhancements. Pain is not
one of those. So it’s really a difficult one. and then you really have to trust the person that’s telling you, yet today I’m
a 5, or if today I’m an 8, or today I’m a 10. And I think it’s really, it’s really a
difficult position to be in, especially for physicians. And then
physicians end up in sort of a catch-22 place where they want to treat the
patient, have the patient get out of this pain. And then you know, I think we end up
sort of in this situation that we’re at today with the opioid crisis, because
we’ve sort of gone to the extreme of over prescribing and trying to keep
everyone comfortable, trying to keep everyone that with pain. Now why are we
as a country, why are we so much in pain? That’s a whole other question and I
think it’s something that I can’t answer. But again, it comes back to all
those different types of pain. Not just the acute pain, or the chronic pain, but
those types of pain. And then as we try to move forward and understand this
better, we really have to adapt our research efforts. We really have to start
looking at animals that are in chronic diseases, that cause chronic pain. So one
one thing that’s very common is diabetic neuropathy. So lots of diabetic patients,
their nerves will start to die off, and they will start to get very painful feet,
and hands and limbs. And we don’t have a good we don’t have a good way to try and
model this in an animal. We do have animals that could spontaneously develop
diabetes and will go on to progress to something like diabetic neuropathy. But
then there’s so much variability in the animals and there’s so much difficulty
in trying to understand that. We have other neuropathies that can be
induced by chemotherapeutic agents. Those we can model fairly decently in the
animals now, because we can actually cause the nerves to be damaged by
constant treatment with chemotherapeutic agents. We also have the same thing with HIV
treatment. So some of the heart therapies, the highly active antiretroviral
therapies, are causing neuropathies about 90% or so of those
patients that are being treated with with the HIV cocktails develop
neuropathies as well. And so these are really things that happen over a period
of time. It’s not just that acute injury from a broken bone or something, like a
tooth extraction, right. This is something that’s developing much differently, much
different type of pain. And then we have these visceral pains that- I don’t really know how we’re ever going to develop good animal models to understand that. And visceral pain can be even more difficult because it can be a referred pain. So you can actually have something wrong with a kidney, but you
feel it in your upper back or your shoulder or something very
strange. And so that can be misleading in terms of trying to get to diagnosis and
trying to understand what’s going on. How do we model those in animals? It’s really difficult. Because animals can’t talk to us either. – Right. And it’s so interesting when you’re talking about the visceral pain. I was you know,
just reading the other day, how women with heart disease, or a heart
attack that may be coming, the symptoms are not what we would sort of say are
the classic symptoms. So it can be anxiety, it can be restlessness, it can be
you know not being able to sleep a lot, fatigue. These sort of things that you wouldn’t necessarily associate, which may be you
know, relate more to different types of maybe pain or
you know, emotional pain. Or you think they’re being triggered by emotional
pain. Things like that. Very confusing. – Very.
Very, very confusing. Stress plays a huge role into
all of that as well. And stress plays a huge roll into
pain. And that’s another component that we’re faced with and actually challenged
with in animal research. Because when you handle an animal, it causes a stress
response in that animal. So they’re releasing cortisol, they’re releasing
other types of endogenous compounds that can interfere with the studies that
we’re trying to do, and trying to come up with new drug interventions for treating
pain. So, it can all get really complicated in a real hurry.
– Yeah, so stress and pain for us, we’re releasing that cortisol. How does that- how does that work?
Yeah, I’m not really, I’m not really sure on that whole level. But I know it causes heightened sensitivity to pains. You can also get inflammation, more inflammation starts to add more to those pain. And then the mediators of inflammation that get released in the body- all that sort of
ramping up inside, inside their system there’s this sort of internal war going
on with all these chemicals trying to handle the stress, trying to handle the
inflammation. And what the end result is, is this sort of not good feeling, painful
feeling, and then how do we combat those things. – Fascinating.
It’s very, very challenging and everybody is different. Yeah, absolutely. With um, we’re gonna
get into some of the natural compounds. We’re gonna get into
addiction. But if you were to- based on your research, give us a couple of ways
that we can with our own body, without ingesting anything, help to work with
different types of pain. What would your one, two, three top recommendations be?
– Yeah, that’s a great question, because I have chronic pain myself.
– Oh, you do? Yeah, and being a pharmacist and
being a trained pharmaceutical scientist as well. So I got my
pharmacy degree, have my license to practice pharmacy, then went on to
graduate school and got a PhD in medicinal chemistry and drug design.
I’m not one that likes to take drugs. – Yeah.
So it’s kind of ironic that I try to find new drugs to help people, but I suffer from sciatica. I suffer from a lot of my own chronic pain. And the way that I found to treat it is really diet changes that can really
help with reducing those inflammatory markers in your body. So
eating more, at least for me, more pure unprocessed foods, more clean vegetables
and fruits and meats that haven’t been treated with a lot of chemical preservatives,
especially. Because preservatives are not only enhancing that meat for
lasting longer, but they’re also going to give problems for us down the road, ingesting them. So really eating a good diet. I do a lot
of exercise, personal trainer to help strengthen a lot of those muscles
that normally you wouldn’t be using. But having that extra support, those support muscles, those other things that you don’t even realize they’re there until you start using them. I do the same thing. I love it. The strength and conditioning and postural work. It really, really helps. And it’s amazing because before I started that, every morning it
was a struggle to get out of the bed because of back pain and hip pain.
And after getting in with a trainer for several months and strengthening a lot
of those secondary muscles or support muscles, I’m able to do that. And that combined
with I think more healthy eating, a lot more fish, a lot more chicken, a lot more of that
kind of meat. I still love my steak though. So I still have my steaks. Just really focusing in
that area. Then I do deep tissue, therapeutic massage as well,
which has been really incredibly helpful for me with getting a lot of those muscles
loosened up, and moved around and adjusted. I don’t do a chiropractor, but a therapeutic massage for a couple hours every 10 days or two weeks has really helped me. So those are the natural things I do.(- Yeah.) I tend not
to want to take medications as a joke, pharmacist has drugs to sell, not to take.
– Oh, yeah. So, and that’s bad (laughs). But that’s
kind of the joke. And that’s where I go. I mean when I have to resort to, I’ll resort to taking
medication and it works. And it’s great – Yeah.
But I try to avoid it the most that I can. – Awesome, very inspiring. Thank you so much Dr. Chris
– Thank you.