Dive into the complex sphere of pain management with the Huberman Lab's enlightening discussion featuring Andrew Huberman and esteemed pain expert Dr. Sean Mackey. In an episode rich with insight, they decode the biopsychosocial model that posits pain as more than a physical sensation, encompassing emotional and psychological factors influencing individual pain thresholds. Dr. Mackey unveils how our bodies process pain, shedding light on central sensitization and the enigmatic nature of referred pain. This multidimensional understanding paves the way for more informed approaches to treating and experiencing pain.
Beyond biological underpinnings, the episode delves into the impact of psychological factors on pain perception, underscoring the potency of our mental state. Dr. Mackey contends with the dual-edged sword of pain medications, including opioids, balancing their undeniable benefits and the peril of addiction. Simultaneously, he and Huberman explore a spectrum of non-pharmacological strategies—from lifestyle changes and ancient acupuncture to the modern promise of psychological interventions like CBT and MBSR. Join the riveting exchange on the Huberman Lab and arm yourself with knowledge that transcends conventional pain paradigms, infusing a holistic arsenal against this universal human experience.
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Dr. Sean Mackey explains the biopsychosocial model as a multifaceted perspective where pain is not only a physical sensation but also involves emotional and psychological components. Pain thresholds and the experience vary across individuals given the complexity of pain perception. Nociception represents physical signals warning of potential harm, while pain is the actual experience processed by the brain, enhanced by factors such as anxiety and emotional states. Pain is acknowledged as an adaptive mechanism to prevent injury, and persistent pain is tied to changes in the nervous system, known as central sensitization. Dr. Mackey also details the phenomenon of referred pain, where pain in one body part is perceived in another, due to nerve connections in the spinal cord.
Dr. Sean Mackey discusses the intricacies of pain medication, particularly opioids. Natural opioids exist in the body, but chemists have also developed synthetic options like morphine and oxycodone for pain relief. While acknowledging the life-changing benefits for those with chronic pain or in palliative care, Mackey also spotlights the destructive potential, including addiction. He urges caution in opioid prescription and argues against demonizing opioids or doctors who prescribe them responsibly. He acknowledges the tragic consequences of abrupt patient disconnects from opioids, leading some to seek out more dangerous substances. He also identifies various opioids, their actions, and the prospects of substances like kratom in addiction management.
Dr. Mackey and Andrew Huberman examine non-medical pain management techniques. They discuss how applying heat can improve circulation and relieve discomfort, while cold can decrease inflammation and slow pain signals. They explain the gate control theory, where tactile stimulation may modify pain signals, and conditioned pain modulation, where one painful experience can inhibit another. Dr. Mackey acknowledges acupuncture's clinical benefits, suggesting needling can reduce the brain's pain response. Furthermore, he advises on dietary influences on pain, advocating for elimination diets to pinpoint trigger foods, citing his own experience with an onion family sensitivity. Dr. Mackey also highlights the potential of supplements like alpha-lipoic acid for neuropathic pain, stressing the importance of awareness of their effects and interactions.
Pain's psychological consequences are thoroughly explored by Dr. Mackey and Huberman. Emotional states, such as anger and anxiety, can exacerbate pain, while past traumas may influence pain sensitivity. Catastrophizing thoughts about pain can predict more severe pain experiences. Psychological interventions like cognitive behavioral therapy (CBT) and Mindfulness-Based Stress Reduction (MBSR) demonstrate efficacy in pain management, addressing stress and promoting healthier coping strategies. Dr. Mackey notes that removing stressors often alleviates pain symptoms, highlighting the psychological influence on pain. Pain psychologists employ various techniques, including biofeedback, acceptance and commitment therapy, CBT, and "empowered relief" to aid people in developing healthier thought processes related to pain.
1-Page Summary
Under the biopsychosocial model, experts like Dr. Sean Mackey consider pain a complex and subjective experience, noting it involves both physical sensation and emotional factors, making it vary greatly between individuals.
Dr. Mackey points out that there is a critical difference between nociception—the body's signal indicating potential harm—and pain, which is the actual experience occurring in the brain. He clarifies that the pain threshold marks the onset of painful experience, not merely the initial nociceptive signals which serve a protective purpose. Those initial fast signals are distinct from the latter arrival of the signal to consciousness, accompanied by emotional unpleasantness.
Dr. Mackey and Andrew Huberman delve into the connection between physical and emotional pain, establishing that alteration in perception of one can often change the other. Anxiety shapes our perception of pain in the brain, such that high anxiety can amplify the pain experience. This link highlights that pain is not merely a physical sensation but also intertwined with one's emotional health. Mackey emphasizes that current levels of anxiety and depression, along with past pain coping mechanisms, play significant roles in how an individual experiences pain.
Pain serves as an adaptive signal that indicates potential or actual tissue damage, thereby supporting injury prevention by guiding our reactions to harmful stimuli.
The occurrences of persistent pain can lead to changes in the nervous system, a process known as central sensi ...
Biopsychosocial model of pain
Dr. Sean Mackey sheds light on pain medications, discussing opioids and their benefits and risks with an emphasis on responsible prescription practices and the complex nature of addiction.
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Huberman and Dr. Mackey elaborate on the subject of opioids, discussing both the body's natural opioids and synthesized prescription drugs like morphine and oxycodone.
Dr. Sean Mackey refers to the naturally occurring opioids in the body, which play a role in pain management.
Mackey explains that chemists have created exogenous opioids starting with morphine, extracted from the poppy plant, and these developments have continued into various synthetic compounds, like oxycodone. He acknowledges the dual nature of opioids, recognizing their potential to positively transform lives for those in chronic pain or nearing end-of-life, but also their destructive power leading to addiction and personal loss.
Dr. Mackey warns against viewing opioids as entirely good or bad but rather as clinical tools to be used with caution. Opioids were often overprescribed in the past due to insufficient education among physicians regarding effective pain treatment.
Dr. Mackey critiques the overprescription of opioids by well-intentioned physicians operating without comprehensive pain management training. He believes that education in proper pain management, opioid prescribing, and deprescribing are crucial.
He stresses the negative outcomes from the targeting of doctors who prescribe opioids, like patients being abruptly disconnected from effective ...
Pain medications
Dr. Sean Mackey and Andrew Huberman discuss various non-pharmacological methods for managing pain, taking care to note the underlying mechanisms and the importance of safe and personalized application.
The podcast explores the relationship between temperature and pain relief. Cold applications can reduce inflammation and the release of inflammatory chemicals, therefore, easing pain. Colder nerves fire less rapidly, which can slow signals from pain-causing nociceptors. Conversely, heat increases blood flow, can relax muscles, and provides a comforting sensation which might explain why applying a hot water bottle to a painful area brings relief.
There is a traditional approach to use cold for the first 48 hours after an injury and heat thereafter. Huberman questions the appropriate level of cold to apply to avoid frostbite while still achieving pain relief, suggesting that numbing might shut down neural pathways and alleviate pain. However, both hosts emphasize the importance of applying heat and cold within safe limits to prevent damage.
Mackey discusses various physical approaches to managing chronic pain, including physical therapy and acupuncture, which he includes as part of complementary alternative medicine. He acknowledges the clinical data grounding acupuncture, noting an NIH-funded study showing differences in brain engagement between true and sham acupuncture. Many acupuncture points overlie peripheral nerves, and needling may create central changes in the brain that turn down the "amplifier" of pain.
Huberman and Mackey also cover the gate control theory of pain, explaining that light touch or stroking activates touch fibers, which can modify the pain signals in the spinal cord, illustrating why people may instinctively rub or shake an injured area. Additionally, Mackey introduces the concept of conditioned pain modulation—pain inhibiting other pain—a phenomenon where a painful stimulus in one area can engage descending pathways to the spinal cord and inhibit pain in a different area.
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Lifestyle approaches to pain
Dr. Sean Mackey and Andrew Huberman delve into the psychological aspects and consequences of experiencing pain. Considering the complex interplay between mind and body, they explore how early experiences, emotional states, and cognitive approaches can profoundly impact one's sensitivity to pain and the overall pain experience.
Although not explicitly mentioned, the discussion implies that past emotional contexts and parental responses during childhood could shape how pain is processed and expressed. This indicates a potential link between early life emotional experiences and later pain perception.
Huberman notes that pain can exacerbate feelings of anger and anxiety, thereby making tasks more challenging and affecting thinking and concentration. While the discussion does not directly address how these emotions amplify pain, it suggests that negative emotional states can influence one's experience of pain.
Huberman emphasizes the importance of not over-interpreting or catastrophizing pain, while Mackey highlights understanding the distinction between hurt versus harm, and the significance of effectively managing pain without falling into catastrophic thinking. Acknowledging the pain without judgment can lead to a better management strategy.
Mackey and Huberman discuss psychological factors like stress from jobs or relationships in relation to acute and chronic pain. They point out that removal of stressors often leads to a reduction in pain symptoms, signifying the role of psychological influences in pain perception and management.
Mackey speaks to the efficacy of Mindfulness-Based Stress Reduction (MBSR) and mindfulness practices in m ...
Psychological impact of pain
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