345 ‒ Chronic pain: pathways, treatment, and the path to physical and psychological recovery

Sean Mackey is a professor of pain medicine at Stanford University & the director of the Stanford Systems Neuroscience & Pain Lab, where his research explores the neural mechanisms of pain & the development of novel treatments for chronic pain. In this episode, Sean joins Peter for a wide-ranging discussion on the multifaceted nature of pain—as both a sensory & emotional experience—& its evolutionary purpose as a critical survival mechanism. He dives into how pain is transmitted through the nervous system, the different types of pain, & why different individuals perceive pain so differently. Sean shares insights into pain management strategies ranging from medications like NSAIDs & opioids to neuromodulation techniques such as transcutaneous electrical nerve stimulation (TENS). Additionally, this episode explores the interplay between sleep & chronic pain & the psychological & emotional dimensions of pain, & it includes a personal story from Peter about his own experience with pain & how Sean’s expertise helped him more than two decades ago.

View show notes here: https://bit.ly/4ji2czu
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We discuss:
0:00:00-Intro
0:01:34-The definition of pain, & how our understanding of pain has evolved from a simplistic to a nuanced biopsychosocial model
0:09:42-The biological mechanisms behind how we perceive pain
0:15:15-The role of consciousness in the perception of pain
0:24:02-The four types of pain
0:35:17-Using fMRI to identify objective biomarkers of pain in the brain
0:40:38-The evolutionary role of pain in human behavior & survival
0:46:52-How the brain processes & modulates pain signals, Gate Control Theory, the variability in individuals’ pain perception, & effectiveness of neuromodulation techniques like TENS
1:01:36-The brain’s influence on pain: the role of emotion, beliefs, sleep
1:14:38-Peter’s personal journey with chronic back pain
1:20:00-The pharmacology of common pain medications—NSAIDs, COX-2 inhibitors, & acetaminophen
1:33:19-Muscle relaxants: benefits, drawbacks, & personalized strategies
1:43:25-The definition of chronic pain
1:44:43-The role of antidepressants in pain management
1:49:11-Opioids: their controversial & nuanced role in pain management
2:13:04-Alternative therapies: acupuncture & cannabis
2:21:09-Fibromyalgia & chronic pain: clinical features, brain mechanisms, & emerging treatments like low-dose naltrexone
2:38:24-Possible brain benefits of low-dose naltrexone (LDN) for people with mild cognitive impairment
2:44:38-Peter’s recovery from severe chronic pain—how he went from immobility & high-dose opioids to full functionality
2:57:14-Breaking the pain cycle: how physical rehabilitation & psychological recovery work together
3:07:08-Sean’s struggle with cluster headaches, & the value of knowledge, preparation, & empathy in both managing chronic pain & caring for patients


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About:

The Peter Attia Drive is a deep-dive podcast focusing on maximizing longevity, and all that goes into that from physical to cognitive to emotional health. With over 90 million episodes downloaded, it features topics including exercise, nutritional biochemistry, cardiovascular disease, Alzheimer’s disease, cancer, mental health, and much more.

Peter Attia is the founder of Early Medical, a medical practice that applies the principles of Medicine 3.0 to patients with the goal of lengthening their lifespan and simultaneously improving their healthspan.

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