10/18/2012 07:00:53 AM
We stumbled across this video on YouTube. It has some terrific graphics and is well worth a look. It also has a spectacularly deep voiced star-trek type talking us through some of the neurochemical processes that occur when tissue is injured or inflamed. Some of you might recall a quasi game called Searching for Rene, which forces us to carefully monitor what we are saying to people in pain, because they are often searching for any piece of evidence in what we say or how we say it that would su [..]
10/15/2012 15:30:36 PM
While pain may be a universal experience, one experience that can often plague and frustrate everyone is that moment when something works one moment but then all of a sudden doesnt work the next. If youve ever had the pleasure to experience a moment like this youll find that it applies to a great deal of things in life whether it be the temperamental office photocopying machine or in my case a very battered TV remote. In these moments after the initial bout of frustration we usually go thr [..]
10/11/2012 07:00:11 AM
One of the best workshops I attended at the IASP congress in Milano was on placebo analgesia, run by three very classy speakers: Luana Colloca, Ulrike Bingel, and Regine Klinger. I learnt lots about the neurobiological mechanisms of placebo and nocebo, and came away with lots to ponder.
10/08/2012 15:00:34 PM
As we know there have been any number of chronic pain syndromes identified but most people dont go onto develop chronic pain. What causes chronic pain in some people where others heal fine? This may be down to individual variability but if so is this caused by nature or nurture? Is the variability caused by environmental factors or inherited? This is the question that gave me the most pause for thought at the recent Word Congress for Pain.
10/04/2012 07:00:08 AM
Always wanted to see the Keynote Speaker do something outrageous? Think Lorimer would look fetching in football socks and a school dress? Now you have the chance - donate here now.
10/01/2012 15:00:01 PM
Labelling things becomes tricky when the things that we are trying to label arent necessarily things in the objective sense. The feelings we have, our perceptions, the qualia are open to a plethora of interpretations that can find themselves awkwardly grouped under broad umbrellas.
09/27/2012 19:17:24 PM
At the recent World Congress on Pain, there were enough exhibition stands to keep even the most mischievous amused. One of the most mischievous is Sarah Haag. Here she gives an account of the first of her investigations.....
09/25/2012 23:04:27 PM
I just read a fascinating paper in a recent issue of Pain. This paper evaluated the relationship between interoception (ie, the ability to consciously perceive signals from the body) and pain perception.
09/20/2012 06:00:03 AM
No pain no gain! Recently published research suggest that the decision to avoid or persist in pain-evoking activity does not fully depend upon fear, but also on the goals that are related to that activity, and that once we decide to persist, our brain helps protecting these goals by suppressing attention to pain.
09/17/2012 15:00:57 PM
Could it be possible that this mix of personal story, pain, athletic supremity, unbridled elation and self-efficacy could take us to a new place biologically? A neurogenic, neuroplastic, anti-inflammatory state in which adaptation is optimised?
09/13/2012 08:00:39 AM
"When you live with injustice, you just want to share it. How does this affect recovery?
09/10/2012 15:00:55 PM
Lorimer went to a splendid topical workshop at the World Congress on Pain. The workshop was about the relative contribution of periphal and central contributions to fibromyalgia. There were three speakers. This blog will focus on the first - Jordi Serra from Barcelona.
09/06/2012 08:00:13 AM
Is there any evidence that might support the idea that staying active following injury is good for you? Mind you, I am not looking for any obvious things like the potential effects of movement on fear or mood; I am specifically on the hunt for something at least slightly esoteric!
09/03/2012 15:00:36 PM
Several factors have been suggested to contribute to knee instability. This study asks how does hypoesthesia (decreased sensitivity to mechanical stimuli and vibration) influence knee stability?
08/30/2012 15:00:40 PM
Scientific conferences usually have a poster section which provide a rich and condensed source of research that is currently being done. The International Association for the Study of Pain congress in Milan had a huge array, hundreds of new posters every day, ranging from treatment approaches to ethics and law. Some of the BiM team are presenting posters which we have loaded here. Here is a summary of the topics and links to individual posters
08/27/2012 15:00:43 PM
Keeping up to date in chronic back pain research is a busy process and yet it is rare that a new paper really catches the eye. But today a trial of a new therapeutic approach was dredged up in my search alerts. It is clearly novel and ground breaking. It is
. wait for it
08/22/2012 16:00:45 PM
It may take a variety of professionals to unravel the complex contributions to persistent pelvic pain. It may be that you are comfortable screening for pelvic pain but have no intention of treating it. Happily there are physiotherapists, MDs, social workers and other professionals that can be part of an interdisciplinary team for these patients.
08/20/2012 15:00:29 PM
Here is a nice video about neurones. TEDEd does truly bring together some clever people to make education more fun, more effective and more available. I am not sure that all the language in this video is consistent with how I understand the nervous system as it relates to pain, but I would welcome any and all comments on it.
08/16/2012 21:28:22 PM
On this day in 2009 BiM published it's first blog post. Now we have regular 3,800 visits to the site a week from all over the world. Over 3,000 people who have come to see us on Facebook, of which many regularly contribute. Our LinkedIn group has another, possibly somewhat different, group of people who regularly comment, and for you twitterphiles - thanks for the retweets and also the good information you push our way. We get very excited to see readers in far flung places of the world. In the [..]
08/13/2012 21:11:19 PM
TweetOpioids. We all know what they are and that there are a lot of them going around, but it wasnt until I was asked to write this blog on the information overloading review by Manchikanti and friends (2010) that I realised quite the extent. And to tell you the truth, its painfully scary! In a [...]
08/09/2012 15:00:37 PM
These days, academics routinely talk about their work and place pictures of themselves on the web. However, the picture we choose to show the world may reveal more about the way we see ourselves than we realise.
08/05/2012 21:35:06 PM
TweetIn my general physiotherapy practice about one in five patients come with complex pain, disability and loss. I love sorting out the pieces of the puzzle that creates these situations. A challenge is not to get lost amongst all the pieces. So I take the patient on a journey of discovery as I find all [...]
07/30/2012 21:14:24 PM
The National Prescribing Service and the George Institute for Global Health have jointly launched a new decision support tool, Back Pain Choices, to assist primary care clinicians diagnose and manage back pain in line with best practice guidelines.
07/26/2012 08:00:26 AM
Ever read something and asked 'So how do I integrate all this stuff when I assess a patient and plan treatment? Here is a general guide that we use to interpret how a patient describes their pain. Free to download.
07/23/2012 15:14:19 PM
Social attitudes affect unconscious sensorimotor mappings but how important are differences in skin colour for determining what is and is not part of our own bodies.
07/20/2012 00:04:44 AM
When treating phantom limb pain, treatment outcome is likely to be affected depending on whether your patient is imagining or actually moving their phantom limb. Karen Reilly explains
07/16/2012 18:54:22 PM
Non-specific low back pain (NSLBP) is, by definition, a case of I am not quite sure what is wrong with you and thus I am not entirely sure of how to fix you. Despite a plethora of management options, it appears no one treatment works for every patient. In the latest issue of the Lancet, Balagué and colleagues1 reviewed the recent literature to see what advances we have made in treating this condition.
07/12/2012 07:07:24 AM
Every saga has a sequel in the previous blog post on learning and pain-related fear in chronic pain, I explained how pain-related fear can be acquired through associative learning. In this blog post, I will focus on how we can reduce pain-related fear once it has been acquired.
07/09/2012 14:58:10 PM
There is no doubt that there is heaps of wisdom in the Star Wars saga. For example, Master Yoda said once: Fear is the path to the dark side. When it comes to chronic pain, and in particular how acute pain might turn into chronic pain, Yodas quote is spot on! Fear-avoidance models consider pain-related fear as an important factor in the development and maintenance of chronic musculoskeletal pain
07/05/2012 15:11:28 PM
Based on a recent narrative review in Neuroscience Letters from Atlas and Wager I have come away with a healthy respect for the role of expectation in pain. This review considers placebo and nocebo responses, and stimulus expectancy effects and gives a great overview of the various responses, body systems, and brain and spinal cord regions possibly involved or related to expectancy.
07/02/2012 15:15:27 PM
When it comes to treating someone in pain we have one way of knowing if our treatment has effected pain relief, and that is the patients verbal report. Perhaps another way of knowing whether pain has changed is to look at whats happening in the brain. Well, this review is addressing precisely this question
06/26/2012 21:05:54 PM
Genesis: To cut a very long story short, Smudj was born from a very dark period in my life. So dark that not a pin prick of light could be seen. I was on the knife edge of suicidal, wanting to be sliced into oblivion.
06/20/2012 15:00:44 PM
I know that many of you out there are 'in the 'hood' with respect to writing and reviewing manuscripts. For the rest of you, here are some cracker reviews we got on a paper concerning the development of CRPS. I have had to remove some bits because they give away the journal and the study, which we will resubmit somewhere else. If you have any similarly complimentary reviews you are prepared to share, we could start a repository for them. Might make a good book one day....
06/18/2012 14:36:17 PM
James Kerr on the Didge
06/14/2012 14:41:52 PM
A human foetus can do it, as can a newt, even a starfish has got it nailed; yet when it comes to you and I, regeneration is a struggle. That is not to say we cant repair ourselves, we do so but the end result a scar - can have a profound effect on the physical and psychological aspects of sufferer.
Fiona Wood strives to change this. World renowned for her work with burns victims, she graced the recent NOI conference with her seminal ideas on tissue healing that were far from skin deep, ent [..]
06/11/2012 14:49:34 PM
What sections of a research paper do you routinely read. Honestly. The abstract? The introduction or discussion? On closer scrutiny most will manage the conclusion of the abstract. A whole paper boiled down to one or two sentences. Two new papers in the musculoskeletal field have just been published that speak loudly to this problem. The first is a fantastic cautionary tale...
06/07/2012 15:29:09 PM
I had the pleasure of meeting Steven George at the American Pain Society meeting. He has done some excellent work and is part of a truly impressive group of people working out of the University of Florida. Now this blog post is simply to pay tribute to what is a great achievement Dr George has just been announced as the winner of the 2012 Ulf Lindblom Award from the IASP
06/04/2012 15:00:59 PM
Explaining Pain has been put through its paces on the Burns test of 5 criteria that need to be met if we are to accept a theory of how a treatment works. Now I am going to put graded motor imagery (GMI) through the same test, just to give you all an idea on how far we have to go.
05/31/2012 15:00:37 PM
It might work, but does it work in the manner you think it does? We sometimes have some pretty whacky mechanisms to explain treatments that work and I am on the record as saying that we need to be open-minded about how an apparently effective treatment might work. Well, it seems that the psychology world is dealing with the same issues...
05/28/2012 15:03:36 PM
Vania Apkarian and his group at NorthWestern in Chicago have been working for over a decade on functional and structural brain imaging in people with chronic pain. Over that time, his group has stamped its name on much of what is known about the brain of people in chronic pain. Here is a bit of what his group, and others, have discovered.
05/24/2012 14:00:44 PM
There is probably no one on the planet who would have contributed more to our current understanding of opioid use for analgesia than Prof Levine and his recent work sheds light on a question often raised Do men and women respond in the same way to opioids?
05/21/2012 15:35:18 PM
Immune activation can produce some powerful and longlasting behaviour changes. Take single event learning for example - Ader and Cohen's seminal study proved that the immune system response could be behaviourally conditioned. So how does thinking about immune activation have the potential to change our intervention?
05/18/2012 02:45:31 AM
Perhaps our language has always hinted at the involvement of glial cells in injury? And, when glial cells outnumber neurons in the brain by 20 to 1, it begs the question who is really in charge of synaptic activity (should that be plasticity) in the brain?
05/08/2012 21:31:45 PM
TweetMany of us here at BiM went to the Festival de NOI a couple of weeks ago. It was fab. However, we know that most of you couldn’t make it and we thought we wold briefly recap some of the talks so you can feel the passion for yourselves. Here is the first one….. This [...]
05/03/2012 20:43:45 PM
Last Sunday, April 29th, saw the first ever UniSA Ride for Pain. The day can only be described as a rip-roaring success. The stats were impressive over 550 riders, 400 of whom took on the whole 100km and most of those conquering the mighty Corkscrew Challenge but it was the terrific stories that capture the essence of what really was a terrific day. I will recount one here...
04/19/2012 15:16:08 PM
There is an old and well known adage that stress causes negative health outcomes including the formation of gastric ulcers, heart disease, and cancer. How this takes place in any specific individual is difficult to sort out. However, sometimes when complex things are too complex its nice to look for some of the possible mechanisms.
04/16/2012 21:31:46 PM
There is some evidence that classical conditioned responses play a role in chronic pain. Can you unlearn a classically conditioned response? How do you inhibit a memory?
04/12/2012 15:08:26 PM
TweetIt has been about a month since I wrote a post reflecting on this pain I have in my shoulder. I must say I was overwhelmed by the many offers of diagnostic and treatment advice – it left me both chuffed and a little apprehensive about revisiting it. To start, let me say that my [...]
04/09/2012 19:38:02 PM
Not too long ago The New York Times ran an article proposing a positive side of post-traumatic stress disorder (PTSD). It featured the US Army Comprehensive Soldier Fitness Program, an ambitious application of positive psychology initiated by BG (Ret) Cornam with guidance from Dr. Martin Seligman.
04/05/2012 15:05:44 PM
Many patients with CTS also have coexisting neck and/or arm pain. It remains unclear whether identified altered pain thresholds are truly caused by CTS, or are just a result of the coexisting neck or arm disorders. To address this issue, we investigated whether the presence of abnormal extraterritorial pain thresholds can be substantiated....
04/02/2012 15:00:29 PM
I think my 7 year old son knew that if he used this phrase enough it would eventually sneak into a blog post. Well congratulations Lord Adorable SqueakyPants, it has! It has made it in because we are pretty excited that a project we have been working on for some time is almost done - it is at the printing press as we speak.
03/29/2012 15:00:23 PM
Our research at The University of Nottingham unexpectedly stumbled into the media spotlight: Mind tricks may help arthritic pain; Illusions can halve the pain of osteoarthritis the headlines read. They were referring to our MIRAGE multisensory illusions box, which can create a powerful illusion that the hand or fingers are being stretched or shrunk...
03/26/2012 15:30:05 PM
n the previous blog post we discussed a model for a way in which a neutral stimulus when repeatedly paired with a biologically significant stimulus might come to elicit a conditioned response that is similar to the response to the biologically significant stimulus. Well here is a bit more on that very theme...
03/21/2012 15:41:54 PM
In the realm of chronic pain, problem learning discussion usually revolves around the processes of sensitisation (i.e. central) and operant conditioning (i.e. development of habitual pain behaviours through reinforcement processes). Ironically, perhaps the most famous form of learning has received the least attention by researchers in chronic pain. I am of course talking about...
03/15/2012 16:00:08 PM
Come to what looks like a fabulous evening in Sydney, run by the innovative MIND special interest group of the Australasian Faculty of Rehabilitation Medicine Happiness, depression and health care: Is the pursuit of happiness making us miserable. It will be worth it.
03/12/2012 22:48:20 PM
TweetA recent article in the Journal of Medical Internet Research (JMIR) looked at whether it is feasible to measure social impact of, and public attention to, newly published research articles by analysing buzz in social media – specifically twitter. It also asked whether these metrics are sensitive and specific enough to predict highly cited articles [...]
03/08/2012 15:30:43 PM
TweetI have a painful shoulder. It has been hurting since mid-December. I can recall no incident – just woke up one morning with severe pain on pretty much any movement. Now, I am not looking for diagnoses, nor in fact sympathy. What I would like to do instead is to run you through some interesting [...]
03/05/2012 20:47:54 PM
A closer look at the role of spinal stabilisation exercises in chronic low back pain. Do patients get better after core stability exercises for the reasons we think they do?
03/02/2012 07:36:17 AM
The education within the field of Physical Therapy profession is rapidly changing but we still don't understand why our patients are in pain. Please support our grassroots effort urging the Commission on Accreditation in Physical Therapy Education (CAPTE) to change this and incorporate pain science into entry-level physical therapy education.
02/27/2012 22:03:34 PM
This PhD research investigates the effect of cupping therapy in the treatment of chronic neck pain. We know patients with chronic low back pain show body image distortions and we wondered if this would apply for chronic neck pain as well. So we adapted the design of the body image drawings for the neck area and patients who suffered from chronic neck pain were asked to draw the neck area as they felt it.
02/23/2012 15:01:56 PM
The first time I rode up Corkscrew Road I thought, there are so many metaphors here. Youve got to be patient, you cant go too hard, youve got to be courageous ... all the things I required to get up that hill were what people with chronic pain require on a longer, tougher basis. We shouldnt be looking at people with chronic pain as malingerers and fragile; we should be looking at them as tough and courageous and with potential to get better.
02/20/2012 17:42:39 PM
In clinical practice, Health Care Professionals attach value to measurements of cervical spine Range of Motion (ROM) for diagnostic, prognostic and treatment evaluation purposes. There is evidence that cervical ROM can help us with diagnosis of whiplash associated disorders but this systematic literature review found conflicting evidence that cervical spine ROM is valuable for prognosis for poor outcome following a whiplash injury.
02/16/2012 21:51:13 PM
'Chocolate cake breakfast could help you lose weight' really made my eyes pop when I was reading the Telegraph and I almost ended up at the bakery. But then I read the original study...
02/14/2012 20:37:40 PM
Did you know that apparently the first medical journals were published some 300 years ago? And that the idea of peer review arose about the same time? Just published, here is a systematic review of peer review for scientific manuscripts.
02/09/2012 11:55:42 AM
WOO HOOOO! You can register for the most important cycling event of the year - UniSA's Ride for Pain. April 29th 2012. There is something for everyone - a choice of the easy 35km on the flat, the 45km into the hills, or for the more serious - a 100km through the Adelaide Hills.
02/06/2012 14:30:07 PM
As a small child I was fascinated by my uncle's psychic knees. And by psychic I am really describing the situation where he would look at me and knowingly state, Its going to rain
my knees are aching."
02/02/2012 14:00:04 PM
Teaching people about pain symposium. Lorimer Moseley, David Butler, Adriaan Louw and Mick Thacker
01/30/2012 21:11:40 PM
What is the role of health professionals in managing acute whiplash associated disorders. Some research suggests this is a moral hazard.
01/26/2012 17:46:00 PM
Evidence has been accumulating that shows that people with chronic pain have modifications in body awareness. Camila Valenzuela-Moguillansky writes about a large review just published on this research
01/23/2012 14:16:55 PM
You may not know what the The Pain Science Division of the Canadian Physiotherapy Association get up to. Here is more about what they do and some of the people involved. You may know them.....
01/19/2012 13:39:18 PM
This is the first functional MRI brain scan study to investigate the impact of physical abuse and domestic violence on children.
01/16/2012 14:29:27 PM
Glial cells keep appearing everywhere I look. No, I have not been shrunken by some Rick Moranis-like character and made to wander around the body (a reference to Honey, I shrunk the kids)! But, I have been wandering around the pages of journals, ever-so-slowly trying to get a grasp of how the nervous and immune systems talk to each-other. What usually stands out?
07/05/2011 00:32:58 AM
Some of you might have heard of repetitive transcranial magnetic stimulation (rTMS) and its use in chronic pain - what is the efficacy?
06/28/2011 23:20:45 PM
TweetReduction in pain and disability with a graded sensorimotor retraining program in chronic back pain Our team recently returned home from Darwin, where we all attended the Australian Pain Societys Annual Scientific Meeting. We all presented
06/23/2011 03:58:03 AM
At the world congress on pain in Glasgow, 2008, a small group of CRPS researchers got around a table and asked each other something like isnt it high time we got together and wrote a current concepts in CRPS pathophysiology paper?
06/15/2011 18:41:09 PM
I went to Dublin the other day. I like Dublin. I like the Irish actually. One Irishman who seems particularly likeable is a fellow called David Fitzgerald. He offered to take me to the airport. We got there and then, out of his dubious looking backpa
06/13/2011 19:13:49 PM
I was fortunate enough to meet with a bunch of (mainly) Californians in a lovely Jacaranda-laden Campus of St Mary's College, LA. There was a competition to write a limerick about current concepts in pain science and implications for clinical practi
06/09/2011 01:30:18 AM
Unpublished data must stay unpublished for research papers to be accepted for publication, yet with smart phones it's very easy to share pics of slides on facebook, blogs, and twitter. This is what happens when you ask your audience to turn off their
06/06/2011 15:30:38 PM
A while back Ben Wand blogged here about grey matter density changes in the brain and chronic pain. A new study, published in the Journal of Neuroscience by David Seminowicz et al tells what appears to be a similar story.
06/02/2011 08:30:37 AM
Does proprioceptive input, from muscle spindles and joint receptors for example, contribute to our sense of body ownership?
05/31/2011 01:30:17 AM
People with chronic pain have some pretty odd perceptual disturbances. In an attempt to integrate this smorgasboard of body-related dysfunction, we recently proposed the idea of a cortical body matrix.
05/26/2011 01:10:42 AM
There is a new paper just out in Pain that raises the possibility of a quick and easy analgesic strategy crossing your arms. My mum reckons that her mum was onto that decades ago
05/23/2011 15:41:28 PM
Our study aimed to evaluate a treatment-based classification algorithm for low back pain. This algorithm was created to provide a clinical decision-making paradigm to help guide treatment selection for back pain. Were the assumptions correct?
05/19/2011 08:37:40 AM
This study aimed to evaluate a treatment-based classification algorithm for low back pain. This algorithm was created to provide a clinical decision-making paradigm to help guide treatment selection for back pain.
05/17/2011 01:00:59 AM
I recently read an interesting article from Vraceany et al titled Less specific arm illnesses". The authors make some very good points about what are frequently futile clinical approaches. However, the foundations they erect to support these argum
05/11/2011 22:03:17 PM
TweetThe University of South Australia runs these public lectures called the Knowledge Works series. The community here seems to enjoy these lectures and it is, in my view, a terrific thing for the Uni to be doing. What is more, I love the opportunit
05/09/2011 22:14:47 PM
TweetI must have been a very good boy last year because Santa brought me some lovely books. One of these was Naming Nature by Carol Kaesuk Yoon and it outlines the history of biological classification. A major theme in the book is the conflict
05/05/2011 08:05:16 AM
TweetTo tweet or not to tweet, that is the question. Nature journal recently put out “Peer review: Trial by Twitter: Blogs and tweets are ripping papers apart within days of publication, leaving researchers unsure how to react”. The fact
05/02/2011 01:41:09 AM
TweetBIM invited me to add my two pennyworth (two cents worth for the rest of you!) following Lorimers series of excellent blogs. Despite his protestation there is no going back
., the end of neurocentricity is nigh! No one interested i
04/27/2011 22:49:49 PM
A new blog has appeared that we think is worth checking out: theICECReam.org
04/25/2011 15:22:35 PM
The last in the neuroimmunology series I am trying to get my head around the role of cytokines in facilitating long term potentiation and nurturing neuroplasticity.
04/21/2011 01:07:30 AM
The last post discussed the role of T cells and T cell-derived IL-4, an anti-inflammatory cytokine. This post will focus on other inflammatory cytokines, in particular IL-1, IL-6 and TNF-?. First, IL-1.
04/18/2011 21:42:44 PM
A common way to investigate what role particular biological markers play is to breed (in the loosest sense of the word - ie genetically engineer) an animal that doesnt have those biomarkers. Mice are the usual suckers. Mice can be bred to h
04/13/2011 18:17:07 PM
TweetI was going to call this post Immune effects on thinking, memory, neuroplasticity and neurogenesis but I thought it sounded a bit high-brow. In fact, for the first time in my brief bloglife I have found myself stuck on an opening, but I
04/10/2011 15:34:26 PM
Some time ago, a very impressive person by the name of Helen, came and had coffee at a pretty average cafe in Oxford, hoping to extend stuff we had done with left/right hand judgements to back pain. Well, I have recently met another impressive person
04/06/2011 23:03:01 PM
Over the past month the Australian health and medical research sector has been advocating for the continued support of medical research funding as part of the federal budget process. BiM researchers have put this case to government, as have a number
04/05/2011 00:51:38 AM
Recently, I attended a conference in Melbourne the International Low Back Pain Forum for Research in Primary Care. This conference is organised by researchers who are interested in low back pain epidemiological research in can you guess it?
03/31/2011 07:30:48 AM
A while back I wrote a piece about Consciousness and Pain, in which I argued that consciousness might be the key ingredient for pain. I even tried my hand at a bit of maths, with this little equation (not to be taken too exactly): pain = nociception
03/28/2011 14:30:16 PM
Diagnosing low back pain is a nightmare. It established that apart from the 15% of back pain cases which can be attributed to a specific spinal pathology, the majority of cases fall under the unsatisfactory umbrella label of non-specific low back
03/22/2011 14:28:26 PM
I had my annual viewing of Susan Boyle on Britains got talent this morning. Then I came across this amazing demonstration of what photoshop can do. Is it possible that if you think you look a particular way, your body changes the way it works to