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Dr. Sean Mackey: Tools to Reduce & Manage Pain

Andrew Huberman・145 minutes read

The Huberman Lab podcast hosted by Andrew Huberman with guest Dr. Shawn Mackey explores the relationship between physical and emotional pain, methods to reduce pain, and the impact of perception on pain management, focusing on holistic approaches and various pain relief options. From discussing the origins of pain in the nervous system to effective pain management strategies like behavioral tools, psychological tools, and medications, the podcast aims to provide valuable science-based information to the public for optimal pain relief and improved quality of life.

Insights

  • The link between physical and emotional pain is explored, showing how altering perception of one can affect the other.
  • Pain medication acts in the body and brain to reduce sensitization after an injury, but does not directly affect pain perception.
  • Attentional distraction is a strategy to reduce pain by engaging in activities that divert focus from the source of pain, activating specific brain networks in the prefrontal and singulate cortex.
  • Positive emotions, like being in love, can reduce pain perception through activation of reward-based brain circuits.
  • Efforts to address the opioid crisis include revising prescribing guidelines to empower the physician-patient relationship and compassionate weaning off opioids for some patients.

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Recent questions

  • What are some methods to reduce pain safely?

    The Huberman Lab podcast discusses various tools to reduce pain safely, including behavioral tools, psychological tools, nutrition, supplementation, and prescription drugs. These methods aim to address pain management from different angles, providing a holistic approach to alleviate discomfort. By incorporating a combination of these strategies, individuals can tailor their pain management approach to suit their specific needs and preferences, promoting overall well-being and quality of life.

  • How does temperature relate to pain relief?

    The relationship between temperature and pain relief is highlighted in the podcast, emphasizing the use of heat and cold for managing pain. Cold is recommended for acute injuries to reduce inflammation and slow nerve firing, while heat increases blood flow and muscle relaxation. By understanding how temperature affects pain perception, individuals can utilize these methods to alleviate discomfort and promote healing in a safe and effective manner.

  • What are some common over-the-counter pain relief options?

    NSAIDs like ibuprofen and naproxen are commonly used over-the-counter options for pain relief. These medications reduce inflammation and hyperalgesia, aiding in pain management but potentially delaying healing processes. It is important to be mindful of the timing, dosage, and potential side effects of these medications to ensure safe and effective pain relief.

  • How can distraction help in reducing pain intensity?

    Attentional distraction is discussed as a strategy to reduce pain intensity by engaging in activities that divert focus from the source of pain. By activating specific brain networks in the prefrontal and singulate cortex, distraction can significantly lessen the intensity of pain, particularly effective during the day. Understanding the role of distraction in pain management can empower individuals to utilize this technique to cope with discomfort in various situations.

  • What role do positive emotions play in pain perception?

    Positive emotions, like being in love, are highlighted as factors that can reduce pain perception through the activation of reward-based brain circuits. The podcast discusses how passionate love in early relationships engages neural circuits similar to addiction, providing analgesic effects. By recognizing the impact of positive emotions on pain perception, individuals can explore ways to cultivate these feelings to potentially alleviate discomfort and promote overall well-being.

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Summary

00:00

"Science-based tools for everyday pain relief"

  • The Huberman Lab podcast discusses science and science-based tools for everyday life, hosted by Andrew Huberman, a professor at Stanford School of Medicine.
  • Dr. Shawn Mackey, a medical doctor and PhD, is the guest, discussing the origins of pain in the nervous system and outside interactions between the brain and body.
  • The link between physical and emotional pain is explored, showing how altering perception of one can affect the other.
  • Changes in the nervous system due to pain and the development of chronic pain are discussed.
  • Methods to reduce pain safely include behavioral tools, psychological tools, nutrition, supplementation, and prescription drugs.
  • The relationship between temperature (heat and cold) and pain relief is highlighted.
  • Controversial topics like opioids are addressed, with a warning about their addictive potential and specific clinical circumstances for their use.
  • The podcast aims to provide zero-cost science information to the public, thanking sponsors like Aeropress and Levels for their support.
  • Aeropress is recommended for making coffee or tea quickly and with great taste, offering a discount for listeners.
  • Levels offers a program to monitor blood glucose levels and understand how food, exercise, and sleep impact energy levels, with a new CGM sensor and a discount for listeners.

15:38

Understanding Pain Management and NSAIDs: Key Points

  • Brain networks have been identified to represent the experience of pain, leading to the development of brain-based biomarkers.
  • Painkillers like ibuprofen and acetaminophen are not technically analgesics but anti-inflammatory drugs that reduce sensitization in the body.
  • Pain medication acts in the body and brain to reduce sensitization after an injury, but does not directly affect pain perception.
  • The threshold for treating pain is determined by its impact on daily activities and quality of life.
  • NSAIDs like ibuprofen and naproxen are commonly used for pain relief, with ibuprofen and acetaminophen being over-the-counter options.
  • NSAIDs reduce inflammation and hyperalgesia, aiding in pain management but potentially delaying healing processes.
  • Individual variability exists in the effectiveness of NSAIDs, with rotating medications to find the most suitable option recommended.
  • Timing and dosage of NSAIDs are crucial, with ibuprofen typically taken three times a day with food and naproxen twice a day.
  • NSAIDs can have side effects and adverse consequences, especially for individuals with GI, bleeding, kidney, or heart issues.
  • Aspirin, including baby aspirin, can benefit heart health and act as an anti-inflammatory at higher doses, but individual responses vary, necessitating personalized approaches.

30:32

Understanding Pain: Factors, Thresholds, and Treatments

  • Caffeine interacts with drugs, affecting the prostaglandin pathway, useful for headaches and migraines, but may cause stomach irritation.
  • Tylenol is safer on the stomach than NSAIDs, with a daily limit of 4,000 milligrams, beneficial for liver function and non-alcohol abusers.
  • Cox-2 inhibitors like celecoxib are less harsh on the stomach, akin to naproxen and ibuprofen, prescribed for stomach issues with NSAIDs.
  • Mechanical interventions for pain involve the gate control theory, activating neural pathways through rubbing, shaking, or running under water.
  • Touch fibers like A-beta fibers play a role in reducing pain through rubbing or shaking, altering spinal cord signals.
  • TENS devices use transcutaneous electrical neurostimulation to activate touch fibers, modulating pain signals in the spinal cord.
  • Pain threshold is the intensity where pain is first felt, influenced by fast fibers like AD Delta fibers and C fibers, varying between individuals.
  • Men generally have higher pain thresholds than women for heat stimuli, but individual variability within genders is significant.
  • Pain thresholds are shaped by beliefs, expectations, anxiety levels, early life experiences, and brain circuit alterations from traumatic events.
  • Responses to pain expressions in childhood, like being told to "suck it up" or not to be a "wuss," may impact subjective pain perception in adulthood, potentially affecting emotional expression and pain tolerance.

46:38

"Pediatric Pain Management and Therapeutic Techniques"

  • Pediatric pain experiences are different from adult pain experiences, with the speaker mainly focusing on adult pain management.
  • The speaker's personal experience with raising a child is limited to one son, who is considered a successful example of reproduction.
  • The speaker emphasizes the importance of parental reactions to a child's pain, suggesting that cues taken from parents can influence a child's response to pain.
  • An anecdote is shared about a father's harsh response to his son's injury, highlighting a different approach to pain management compared to current standards.
  • The concept of conditioned pain modulation is introduced, explaining how pain can inhibit pain through neural pathways.
  • The use of therapeutic heat and cold for pain management is discussed, with cold recommended for acute injuries to reduce inflammation and slow nerve firing, while heat increases blood flow and muscle relaxation.
  • The speaker advises using whichever method works best for individuals in managing pain, with caution to avoid extreme temperatures to prevent frostbite.
  • Habituation to pain through regular exposure, such as deliberate cold exposure, can potentially raise pain thresholds over time.
  • Cognitive manipulations, exercise, and mindfulness practices are suggested as ways to change pain thresholds and manage chronic pain effectively.
  • The importance of distraction or focusing on pain during stressful or painful situations is discussed, with considerations for developing top-down mechanisms to cope with chronic pain.

01:01:58

Effective Pain Management Strategies and Approaches

  • Attentional distraction is a strategy to reduce pain by engaging in activities that divert focus from the source of pain, activating specific brain networks in the prefrontal and singulate cortex.
  • Distraction may not eliminate pain entirely but can significantly lessen its intensity, particularly effective during the day but challenging at night when trying to sleep.
  • Mindfulness, like Mindfulness-Based Stress Reduction (MBSR), involves non-judgmental acceptance of pain, proven effective for conditions like anxiety, depression, and pain management.
  • Cognitive reframing focuses on altering perceptions of pain, distinguishing between pain being damaging or simply uncomfortable, forming the basis for Cognitive Behavioral Therapy.
  • Understanding the difference between being hurt and being injured is crucial, especially in sports or chronic pain scenarios, to determine the need for medical attention or continued activity.
  • Chronic pain often extends beyond tissue healing, necessitating education on distinguishing between hurt and harm, crucial in pain management.
  • Emotional pain, like physical pain, is valid and complex, requiring a holistic approach considering factors like anxiety, depression, anger, and sleep patterns.
  • Anger, whether expressed outwardly (anger out) or contained internally (anger in), can significantly impact pain perception and treatment response.
  • Pain management involves targeting physical, psychological, and social aspects of a person's experience, utilizing therapies like pain psychology, physical therapy, and medications.
  • Over 200 medications are available for pain management, with only a few FDA-approved options, highlighting the need for a comprehensive approach to address pain effectively.

01:19:10

"Medications, Nutrition, and Triggers in Pain Management"

  • Anti-depressants borrowed from psychiatrists effectively treat pain by targeting pain-related brain circuits.
  • Anti-seizure medications from neurologists, even for non-seizure patients, work on pain circuitry through ION channels.
  • Cardiologist medications, potent sodium channel blockers, act as oral local anesthetics for pain relief.
  • Treating pain holistically without distinguishing psychological vs. physical pain yields optimal results.
  • Nutrition plays a critical role in managing local or whole-body pain, emphasizing anti-inflammatory diets and trigger avoidance.
  • Personal experience with chronic pain led to identifying triggers like onions and the importance of dietary adjustments.
  • Elimination diets can help identify food triggers causing pain, leading to significant lifestyle changes.
  • Gut infections can sensitize individuals to certain foods, causing pain reactions, necessitating avoidance.
  • Visceral pain, different from surface pain, involves diffuse receptive fields and viscerosomatic convergence.
  • Referenced pain, like heart attack pain radiating to the arm or abdominal surgery pain felt in the shoulder, showcases the complexity of pain perception.

01:35:39

Understanding Neuropathic Pain and Pain Management

  • Pain can be neuropathic, not necessarily starting with an injury or stimulus in the periphery.
  • Neuropathic pain arises from nerve damage in the peripheral or central nervous system, presenting with distinct qualities like shooting or burning sensations.
  • Treating neuropathic pain can be challenging, often requiring specific approaches due to nerve or brain region damage.
  • Light disc bulges usually reabsorb, but caution is advised against excessive spinal flexion like sit-ups.
  • Referenced pain can be psychological, influenced by stressors like job dissatisfaction or relationship issues.
  • Chronic stress can impact the body, causing real pain that may not necessitate surgery but requires addressing stressors.
  • Early life events and injuries can sensitize individuals to future pain vulnerability.
  • Positive emotions, like being in love, can reduce pain perception through activation of reward-based brain circuits.
  • Passionate love in early relationships engages neural circuits similar to addiction, providing analgesic effects.
  • Endogenous opioids, like endorphins, act as natural painkillers in the body, influencing emotional reactivity and pain perception.

01:52:54

"Opioid Crisis: Litigation, Addiction, and Solutions"

  • Opioids present a complex challenge in society due to ongoing litigation and financial interests.
  • Common perception of opioids being overprescribed and addictive, leading to potential interactions with alcohol and illicit drugs.
  • Personal story shared of a lawyer's life spiraling due to opioid addiction after a back injury.
  • Acknowledgment of individual cases where opioids have positively impacted lives.
  • Physicians received inadequate education on pain management, leading to overprescription of opioids.
  • Example of using low-dose testosterone as an alternative treatment for pain in a dog.
  • Three categories of physicians in the opioid crisis: those doing right, those doing wrong for the right reasons, and those doing wrong for the wrong reasons.
  • Fear among physicians led to patients being abruptly cut off from opioids, causing some to turn to illicit drugs like black tar heroin.
  • Fentanyl from illicit sources, not prescribed by physicians, is a major driver of opioid-related deaths.
  • Efforts to address the opioid crisis include revising prescribing guidelines to empower the physician-patient relationship and compassionate weaning off opioids for some patients.

02:09:34

Pain Management Options: Katum, Cannabis, Acupuncture, Ratings

  • Katum is a natural substance with opioid-like properties that has been available for many years.
  • Some people believe Katum helps them stay off prescription opioids by binding to opioid receptors and reducing cravings.
  • However, there is an increase in overdose deaths associated with Katum, often in combination with other substances like alcohol and benzos.
  • Research on Katum is lacking, including information on quality, purity, and dosing.
  • Cannabis has been shown to reduce neuropathic pain in controlled studies but remains controversial.
  • Cannabis is classified as a Schedule One drug, hindering research efforts due to restrictions.
  • Acupuncture is a form of therapy that can help treat certain forms of pain, although its mechanisms are not fully understood.
  • Finding a reliable acupuncturist can be challenging, and recommendations from trusted sources are essential.
  • Patients seeking pain management should consider a comprehensive approach involving medications, procedures, psychological therapies, physical therapy, complementary medicine, and self-empowerment.
  • Patient ratings of healthcare providers can be manipulated, so it's crucial to seek recommendations from trusted sources for finding high-quality clinicians.

02:25:47

"Reliable Recommendations, Chronic Pain Management, and More"

  • Word of mouth and referrals are still considered reliable sources for quality recommendations.
  • A website or app addressing the need for independent patient experiences in finding the best specialists is suggested.
  • Chiropractic and acupuncture are often compared, with insurance more likely to cover acupuncture than chiropractic care.
  • Chiropractic involves nerve manipulation to relieve compression, but risks like vertebral artery dissections exist.
  • Acupuncture has shown benefits in some cases, with Medicare now covering it for certain conditions.
  • Physical therapists play a crucial role in chronic pain treatment, focusing on rehabilitation and functional improvement.
  • Pacing, setting small goals, and avoiding extremes in activity levels are essential in managing chronic pain.
  • Supplements like acetyl carnitine and alpha-lipoic acid have shown benefits for neuropathic pain.
  • Vitamin C and fish oil can aid in reducing nerve pain post-surgery and managing chronic pain.
  • Psychological treatments are vital in pain management, considering the impact of emotions and past experiences on pain perception.

02:43:03

Early Adversity Impacts Brain and Pain

  • Metaanalysis of brain imaging studies on people with early adverse life events revealed abnormalities in emotional processing and functioning.
  • Early life experiences impact adults and alter their wiring, affecting emotional processing.
  • Pain psychologists and behavioral therapists can assist in addressing maladaptive coping and thought processes related to pain.
  • Pain psychology involves teaching skills rather than traditional psychoanalytic methods.
  • Techniques like cognitive behavioral therapy are used to recognize unhelpful thoughts and patterns around pain.
  • Engineers in Silicon Valley favor biofeedback for its closed-loop feedback to calm the sympathetic nervous system during pain.
  • Empowered Relief, a brief intervention developed by Dr. Beth Darnell, offers 8 weeks of cognitive behavioral therapy in 2 hours.
  • Implementation of the National Pain Strategy, a strategic plan for transforming pain care, is crucial for improving the lives of people with pain.
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