Huberman Lab
Dr. Sean Mackey: Tools to Reduce & Manage Pain
Episode guests
Podcast summary created with Snipd AI
Quick takeaways
- Pain perception involves both sensory and emotional components, and the brain actively shapes and interprets pain signals.
- Rubbing, shaking, and the use of heat and cold can provide effective relief from pain by altering signals in the spinal cord and activating touch fibers that inhibit pain.
- Pain thresholds can vary among individuals due to factors like genetics, context, and beliefs, and can be modified through cognitive training and exercise.
- Personalized nutrition platforms can help optimize health markers through personalized recommendations on nutrition, supplements, and behavioral modifications.
- Mindfulness-based stress reduction and distraction techniques are effective approaches for managing chronic pain, engaging specific brain networks and fostering non-judgmental acceptance of pain.
- The opioid crisis is driven by illicit fentanyl rather than prescribed opioids, and appropriate prescribing practices along with education and alternative pain management techniques can help address this crisis.
Deep dives
The Origins and Nature of Pain
Pain is a complex and subjective experience that serves a crucial role in keeping us away from injury or harm. It involves both sensory and emotional components and is highly individual. Chronic pain is a widespread problem that takes a toll on individuals and society. Understanding the foundations of pain and dispelling misconceptions is essential for effective treatment options.
The Brain's Role in Pain Perception
Pain originates from stimuli detected by nociceptors in the body, but it is ultimately perceived and experienced in the brain. The brain actively shapes and interprets pain signals, incorporating emotional and cognitive factors. Different brain regions contribute to the pain experience, and there is ongoing research in identifying these networks. Medications like NSAIDs and opioids act on the brain to modulate pain, but their use should be approached with caution.
Mechanical Interventions for Pain
Rubbing, shaking, and the use of cold or heat can provide effective relief from pain. These mechanical interventions work by altering signals in the spinal cord and activating touch fibers that inhibit pain. Therapeutic heat increases blood flow and relaxation, while cold reduces inflammation and nerve activity. The choice between heat and cold depends on individual preferences and can vary in effectiveness depending on the specific type of pain.
Factors Affecting Pain Thresholds
Pain thresholds can vary among individuals due to factors like genetics, context, and beliefs. Men generally have slightly higher pain thresholds than women, but there is significant variability within each group. Emotional and cognitive factors, past experiences, and anxiety levels can also influence pain perception. Pain thresholds can be modified through cognitive training and exercise, but further research is needed to fully understand these mechanisms.
The Role of Personalized Nutrition in Health
Personalized nutrition platforms, like Inside Tracker, analyze data from blood and DNA to help individuals understand their bodies and reach their health goals. These platforms provide personalized recommendations on nutrition, supplements, and behavioral modifications to optimize metabolic factors, lipids, hormones, and other health markers.
Exploring Mindfulness Approaches to Pain Management
The podcast delves into the question of whether distracting oneself from pain or intentionally focusing on it is the most adaptive mindset. Mindfulness-based stress reduction and distraction techniques are discussed as effective approaches for managing chronic pain. While distraction engages specific brain networks and can significantly reduce pain, mindfulness, characterized by non-judgmental acceptance of pain, has also been shown to be helpful in numerous studies.
Understanding the Difference Between Hurt and Harm
Distinguishing between hurt and harm is crucial when managing pain. Perception of pain and injury can vary, and it's important to recognize the difference. Addressing pain from a cognitive reframing perspective, avoiding catastrophizing thoughts, and accepting pain non-judgmentally have shown to be effective pain management strategies. This understanding helps individuals avoid unnecessary fear and anxiety associated with pain and fosters a more constructive approach to pain management.
The Complexities of Opioid Use
Opioids have both positive and negative impacts on people's lives. While overprescribing opioids has been an issue, there are cases where opioids have significantly improved quality of life for individuals suffering from pain. It is important to approach opioid use on a case-by-case basis and not view it as a one-size-fits-all solution. The opioid crisis is driven by illicit fentanyl rather than prescribed opioids, and appropriate prescribing practices along with education and alternative pain management techniques can help address this crisis.
Different opioids and their effects on pain
The podcast episode discusses the different types of opioids commonly used for pain management, such as morphine, oxycodone, and fentanyl. It emphasizes that while opioids can provide pain relief, they also have side effects. The speaker mentions that some patients may experience improved pain control and a reduction in side effects when transitioning to lower doses or alternative treatments.
The role and controversy surrounding Kratom
The episode delves into the topic of Kratom, a natural substance with opiate-like properties. The speaker shares his experiences with discovering Kratom and the passionate responses from people who believe it has helped them manage pain and reduce dependency on prescription opioids. However, the speaker points out the lack of concrete scientific evidence regarding Kratom's safety and efficacy and suggests that more research is needed to determine its role in pain relief.
The effectiveness and controversies surrounding cannabis and CBD for pain management
The episode tackles the debate surrounding the use of cannabis and CBD in pain management. While laboratory studies show that cannabis may reduce neuropathic pain, larger epidemiological studies and clinical trials have yielded mixed results. The speaker highlights the need for further research to determine the effectiveness of different cannabis strains and ratios of THC to CBD for pain relief. Additionally, the speaker advocates for easier access to research on cannabis by reclassifying it to a lower DEA schedule, facilitating studies on its potential benefits and risks.
In this episode, my guest is Dr. Sean Mackey, M.D., Ph.D., Chief of the Division of Pain Medicine and Professor of Anesthesiology, Perioperative and Pain Medicine and Neurology at Stanford University School of Medicine. His clinical and research efforts focus on using advanced neurosciences, patient outcomes, biomarkers and informatics to treat pain.
We discuss what pain is at the level of the body and mind, pain thresholds, and the various causes of pain. We also discuss effective protocols for controlling and reducing pain, including the use of heat and cold, acupuncture, chiropractic, physical therapy, nutrition, and supplementation.
We also discuss how pain is influenced by our emotions, stress and memories, and practical tools to control one’s psychological perception of pain.
And we discuss pain medications, including the controversial use of opioids and the opioid crisis.
This episode will help people understand, manage, and control their pain as well as the pain of others.
For show notes, including referenced articles and additional resources, please visit hubermanlab.com.
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Timestamps
(00:00:00) Dr. Sean Mackey
(00:02:28) Sponsors: LMNT & Waking Up
(00:06:13) Pain, Unique Experiences, Chronic Pain
(00:13:05) Pain & the Brain
(00:16:15) Treating Pain, Medications: NSAIDs & Analgesics
(00:22:46) Inflammation, Pain & Recovery; Ibuprofen, Naprosyn & Aspirin
(00:27:51) Sponsor: AG1
(00:30:19) Caffeine, NSAIDs, Tylenol
(00:32:34) Pain & Touch, Gate Control Theory
(00:38:56) Pain Threshold, Gender
(00:44:53) Pain in Children, Pain Modulation (Pain Inhibits Pain)
(00:53:20) Tool: Heat, Cold & Pain; Changing Pain Threshold
(01:00:54) Tools: Psychology, Mindfulness-Based Stress Reduction, Catastrophizing
(01:08:29) Tool: Hurt vs. Harmed?, Chronic Pain
(01:12:38) Emotional Pain, Anger, Medication
(01:20:43) Tool: Nutrition & Pain; Food Sensitization & Elimination Diets
(01:28:45) Visceral Pain; Back, Chest & Abdominal Pain
(01:34:02) Referenced Pain, Neuropathic Pain; Stress, Memory & Psychological Pain
(01:40:23) Romantic Love & Pain, Addiction
(01:48:57) Endogenous & Exogenous Opioids, Morphine
(01:53:17) Opioid Crisis, Prescribing Physicians
(02:02:21) Opioids & Fentanyl; Morphine, Oxycontin, Methadone
(02:07:44) Kratom, Cannabis, CBD & Pain; Drug Schedules
(02:18:12) Pain Management Therapies, Acupuncture
(02:22:19) Finding Reliable Physicians, Acupuncturist
(02:26:36) Chiropractic & Pain Treatment; Chronic Pain & Activity
(02:31:35) Physical Therapy & Chronic Pain; Tool: Pacing
(02:36:35) Supplements: Acetyl-L-Carnitine, Alpha Lipoic Acid, Vitamin C, Creatine
(02:42:25) Pain Management, Cognitive Behavioral Therapy (CBT), Biofeedback
(02:48:32) National Pain Strategy, National Pain Care Act
(02:54:05) Zero-Cost Support, Spotify & Apple Reviews, YouTube Feedback, Sponsors, Momentous, Social Media, Neural Network Newsletter
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