podcasts
Collection
Collection for podcasts • 511 items • Updated • 2
speaker stringclasses 2
values | text stringlengths 4 5.61k |
|---|---|
A | Welcome to the Huberman Lab podcast, where we discuss science and science based tools for everyday life. I'm Andrew Huberman, and I'm a professor of neurobiology and ophthalmology at Stanford School of Medicine. My guest today is Doctor Sean Mackey. Doctor Sean Mackey is a medical doctor. That is, he treats patients as... |
B | Oh, it's a pleasure to be here. Thank you. |
A | Now, this is a long time coming. We're colleagues at Stanford, and I'm familiar with your work. But today we're going to take a pretty broad and deep survey of this thing called pain. So I'll just start off very simply and ask, what is pain? |
B | Pain is this complex and subjective experience that serves a crucial role for all of us to keep us away from injury or harm. It is both a sensory and an emotional experience. And I think that gets lost on people. That includes this emotional component to it, and it is incredibly individual. And we'll get more into that... |
A | I'm glad you pointed out this link between the sensory and the emotional experience. Every once in a while I'll pull something or I'll have kink in my neck or my back. And fortunately for me, it resolves pretty quickly. But I notice that when I'm experiencing that kind of pain, that I become slightly more irritable, pe... |
B | It's clearly in our brain and can I take a moment to kind of lay a little foundation for some of that to help clear up some of the mystery of pain. We know that pain, most pain, all starts with some stimulus, whether it be that kink in your neck or your shoulder from working out or turning the wrong way. What's going o... |
A | So when you say we put that on them, you mean when somebody reports being in pain, we have a hard time understanding what they are experiencing because it's going to be very different than the way that we experience pain. Conversely, if somebody's in pain, they tend to assume that people are experiencing pain the way t... |
B | You have it perfectly right. And it actually, if I can build on that, it gets worse, because sometimes you have conditions like fibromyalgia that maybe we'll get into where outwardly, visibly, you don't see anything wrong. We're used to thinking of pain as a fractured, you know, bone, as a swollen ankle. We see that, a... |
A | I have a question that's somewhat mechanistic, but we'll keep it accessible to anybody, regardless of their background. So you mentioned the nociceptors are in the body and everywhere in the body and on the surface of the body to be able to detect certain kinds of stimuli. And then those signals are sent up into the br... |
B | Yeah, that's a great question, because we'd all love if there was a pain center in the brain that we could just go knock out. But it's not that simple, and in part because pain is such a conserved phenomenon. It is there, it is so wonderful because it is so terrible, unless it goes wrong. But when you knock out one pat... |
A | So when somebody takes a so called painkiller, let's take a typical over the counter painkiller like ibuprofen or acetaminophen to lessen pain of some kind. Where is that drug or drugs acting? Is it in the body or is it at the level of the brain? Or both? |
B | Yeah. And this is where some of the challenges we get into with language, because technically, nsaids, nonsteroidal anti inflammatory drugs like ibuprofen, like naproxen, they're actually not analgesics. They're not technically pain killers. |
A | So an analgesic is the descriptor for a pain to quote unquote painkiller. |
B | Yeah, that would be more correct. Like an opioid would fit into that category. The nsaids are anti inflammatory drugs. They're also, there's another. This is a technical term. They're anti hyperalgesic drugs. And so one of the things that happens after an injury is that we get sensitization of the area that's injured. ... |
A | Folks, please don't do that at home. |
B | Don't do that at home, please. |
A | Or anywhere, for that matter. But you're describing pain and the local inflammation response and the hyperalgesia, the increase in pain in that general area, as something very adaptive, very important. It raises the question, what is the threshold for saying that somebody should treat their pain, reduce their pain? I m... |
B | Yeah, I think the threshold is when it's impacting your quality of life and your ability to take care of the activities of daily living, engage with family, friends, go to work. And that serves kind of your threshold for whether it's reasonable to take a medication or not. There's a lot of controversy in the space righ... |
A | Ibuprofen non steroid anti inflammatory drugs. |
B | Indeed. |
A | Could we maybe list off a few of those? So I mentioned ibuprofen, acetaminophen, so sometimes referred to as the classic advil tylenol. We won't throw out name brands there, but what are some others? Naproxen. |
B | Naproxen is another one. Tordol or ketorolac is another one. The two over the counter nsaids, the prototypical over the counter ones are ibuprofen and naprosen. Those are the ones you can buy over the counter without a prescription. Tylenol actually has a slightly different mechanism of injury, but still fits in that s... |
A | When you say centrally, you mean brain? |
B | Brain. Thank you. |
A | Yeah, thank you. And is aspirin considered an NSAT, I. |
B | Don'T believe would fit into that category of basically a Cox cyclooxygenase inhibitor. This is one of the chemical mediators that gets released during injury. And that chemical substance has a tendency to wind up or amplify the nociceptors. So that after an injury you note that you're more sensitive there. After a sun... |
A | So I will bring you along as we go. |
B | But to your point, you don't want to. For instance, let's imagine you have a fractured ankle. You don't want to be reaching for a very potent opioid just so that you can continue walking on a fractured ankle that you haven't gotten evaluated by a clinician and perhaps casted. That wouldn't be safe. Those are rather ext... |
A | I'm sure it goes on okay. Yeah, well, there's all sorts of other things. I get contacted all the time, professional teams and athletes, asking how they can get back in quicker nowadays. The big thing are these peptides that can certainly accelerate healing. People are traveling out of country, get stem cell injections,... |
B | Okay. |
A | Yeah, yeah. |
B | Well, when you're making millions of dollars a year, and I get being back on the field, but for the rest of us mere mortals, I think that's where we would want to draw a line, get medical attention if you've got. |
A | An acute injury going a little bit deeper into mechanism, because I think it's going to serve us well now and going forward. You mentioned the nsaids, and this cox cox is one. Is it in the family of prostaglandins? Can we talk about prostaglandins? Because I think there are a lot of people nowadays we hear about inflam... |
B | Yeah. And you're getting into the nuance, the complexity of this problem, because we've been talking about nsaids, the ibuprofen and naproxens, and as I said early on, we used to just give these out all the time, but then the research comes out and shows that by blocking inflammation, by blocking that, we may be blocki... |
A | I've heard before that nsaids should be taken no more than once every 6 hours. People will alternate different types of nsaids every 3 hours. That's usually to try and reduce fever. Another situation where an adaptive response, fever, people go out of their way to block it to prevent the brain from cooking. But again, ... |
B | Yeah. So we've got a lot more data on the benefits of nsaids, this class of medication reducing pain, than we have data showing the bad consequences of it. And so we're still needing more data on the whole healing message. I think that a lot of the orthopedic surgeons out there prefer people not to be on nsaids after, ... |
A | And what about aspirin? I've heard that aspirin can benefit heart health. So I take a baby aspirin every day, and if I have a pain that is just too intense for normal functioning, as we're defining it, then I'll increase that dose of aspirin. And I just assume aspirin is the healthiest. And sad for me because, well, it... |
B | For you, your logic is perfect. And that's where it gets to the individual person. And for a lot of people, that model would work as well. So baby aspirin, 81 milligrams a day, acts as an anti platelet agent. It helps, you know, here, even though we're getting controversy over the role of baby aspirin, if you dive into... |
A | Current literature, even baby aspirin is controversial. |
B | Even baby aspirin these days. And now what they're doing with the data is defining age ranges. When they say baby aspirin, yes. Baby aspirin, no. And so we're learning a lot more about that. I still take a baby aspirin every day. Yeah, I take a baby aspirin. You get to the higher doses, say four times as much, up aroun... |
A | I'd like to take a quick break and acknowledge one of our sponsors, athletic greens. Athletic Greens, now called ag one, is a vitamin mineral probiotic drink that covers all of your foundational nutritional needs. I've been taking athletic greens since 2012, so I'm delighted that they're sponsoring the podcast. The rea... |
B | Yes. And that's where caffeine can be used effectively for headaches, for migraines, and it can help potentiate the analgesic response. Some people get stomach irritation, though, with caffeine. So just again, mind that you take an nsaid with a lot of coffee, have some food in your stomach you brought up earlier, aceta... |
A | Very useful information. Thank you. Here we're talking about chemical interventions to the pain process. What about mechanical interventions? So, I was taught in my basic neuroscience about, I think it's melzac and Wall's gate theory of pain. Do I have this right, where we all have this instinctual response? Animals ha... |
B | Absolutely. And first, you're right. So, in your first part, Patrick Wahl, Ron Melzak, luminaries in the field of pain back in the sixties defined the gait control theory of pain. And one of the things to build on the story that we talked about with nociceptors going to the spinal cord signals going to the spinal cord,... |
A | Nice yell. |
B | Some people swear. And it turns out there are studies that show that swearing works. |
A | Really? Swearing reduces pain better than using non explicative, loud vocalizations. |
B | Yes, swearing works. I don't know why, but there's been. It caught some press when that paper came out, and I'm not giving carte blanche. We're not saying everybody can go out and swear every time they're in pain. |
A | Well, they can, but they'll have to bear the consequences on an individual basis. We're absolving ourselves of any responsibility. |
B | So rubbing, shaking is another one, which basically is activating those touch fibers. |
A | Oh, it is. Because I do that. |
B | Yeah, everybody does that. Everybody does that. Running it underwater, which it doesn't matter whether in this case it's hot or it's cold water. It's the running of the water underneath it. And what is it doing? We all think it's reducing the stimulus out here, and it is nothing. |
A | In the periphery. |
B | In the periphery. What's magical about that, I think, which is so cool, is you're actually changing the signals in your spinal cord way. |
A | Back here in the neck. |
B | This is the cheapest free version of what we refer to as neuromodulation that's ever been discovered. You're actually, by doing that, you're changing things, the connections back in your spinal cord, and it's reducing the nociceptive signals coming in here. That's why we do it. And it works. It works beautifully. That'... |
A | What about the kiss? The kids, sometimes they want to kiss, you know, or a romantic partner will sometimes, like, injure themselves. I guess it depends on the nature of the relationship. And they'll say, like, can you kiss it? Of course, you know, and you kiss it, and then, like, they feel better. Is that purely psycho... |
B | Well, okay. I think an important point to ground here when it comes to the experience of pain is that everything, when we say psychological, means neuroscience. I know. You know? |
A | No, no, forgive me. I have to be careful with the wording that I use. That's my fault. |
B | But it's accurate still. It is psychological, but it is neuroscience based. I mean, they're really becoming one and the same. But to answer your question, yes, by kissing it, you're activating touch fibers. We can also agree that there's a positive emotional salience that's associated with that. And that positive emoti... |
A | Amazing. |
B | It's cool stuff. |
A | It's very cool. And I love that you emphasize that when we're rubbing the periphery or shaking our hand, the periphery again being the body surface away from the brain, that the real mechanism of action is taking place back in the spinal cord because it really speaks to the body wide and the circuit wide, the nervous s... |
B | Thank God for that. |
A | I just sent you about ten questions. Forgive me. Yeah, so what is pain threshold? |
B | Yeah, no, it's a great place to start and maybe, I don't know if you want to circle back around at some point to the heat and cold to finish up the mechanical. |
A | Yeah, forgive me. |
B | No, no, no, let me answer your, get to your pain threshold. So the pain threshold is that stimulus intensity that results in the onset of the experience of pain. The first onset of the experience of pain. So, you know, when you turn up the heat, it's not when it's warm, it's not when it's just hot. It's when the heat b... |
A | Because the tough part is a subjective label, right? I mean it gets to a whole bunch of different issues around the adaptive role of pain, right? I mean one could argue that if your threshold for pain is lower that yours, it serves a more adaptive function, right? Fewer injuries, et cetera. I mean, I guess it gets into... |
B | It does. But it also misses, I think, the big point, which is people are not averages. So what I mean by that is while the average for a woman may be somewhat less than a man. If you look at the distribution of the curves, they highly overlap, meaning the individual variability within men and within women is much great... |
A | So it's not unlike height, for that matter, there are a lot of women that are taller than men. |
B | That's exactly it. |
A | But on average, men are taller than women. |
B | On average. And I would say within this area of pain threshold differences, it's even closer, it's even tighter. I'm making this up. The equivalent, I think the average height of a woman is at 5354 the average height of a man. Five. 9510. This is imagining the average height being five six for a woman and five eight fo... |
A | Does increased anxiety increase one's perceived pain? |
B | Yes. |
A | Okay. |
B | Yeah, it does. Your early life experiences with this. So have you had traumatic experiences in the past that alters brain circuits? |
A | Can I interject a question? If one was told, just suck it up a lot, or if one whimpered or cursed when they hurt themselves, if they were told, don't be a wuss, don't be a wimp, do we know whether or not that increases or decreases the subjective feeling of pain later? I could imagine it going either way. I could imagi... |
B | Don'T know you're getting into this is a good point. Getting into pediatric pain, and if there's been experiments in that space, I stay mainly in the adult area, and my experience with raising a child is an n of one with one son. |
A | He's done great. |
B | Thank you. |
A | I happen to know him very well. He's what you call a great example of highly successful reproduction. |
B | What do they say? It's better to be lucky than good. |
A | I'm sure there was a lot involved, so don't discard any credit. |
B | Thank you. Thank you. My approach with Ian was not to say necessarily suck it up, but I would make light of it, I'd have fun with it, and I would kind of laugh, and I'm like, way to go, buddy. And I would find he would often laugh. So I think a lot of it is the cues they're taking off the parents. And again, this is ju... |
A | I will tell just a very brief anecdote. When I was growing up, I observed a total of zero children and friends who, you know, cried out in pain or complained of pain, who were told that was an inappropriate response. Sometimes I might have heard parents say, come on, just suck it up or rub it. You'll be okay. That kind... |
B | Yeah. |
A | But clearly had no regard for the pain that the injury probably caused. Now, I haven't followed up with that kid. I think we can all agree that by today's standards, that would be considered abusive parenting. Or perhaps one could say that was on the far extreme of a response, but I'll never forget that. And I went hom... |
B | Yeah, can I make a commentary about that scenario? And I want to bring in another neuroscience concept that that dad may have been doing inadvertently, and that's something called conditioned pain modulation. So there's another cool phenomenon in pain, that pain inhibits pain. So what I mean by that is, when you were, ... |
A | You and I must have grown up with the same friends. Oh, yeah. |
B | And they'd say, well, now, doesn't your arm feel better? And I'd be like, well, yeah, it does. And, yeah, I did grow up with those friends. I tell this story to some people, and I sometimes just get the wide eyes like they did what? |
A | Yeah, we are not making recommendations here. |
B | We're not making recommendations, but it's a real phenomenon. It was described by Labarre's late seventies, 78, or something like that, in rodent models initially. And what happens is that when you engage a nociceptive stimulus or a painful stimulus in a site distal, different from where the primary pain is, it engages... |
A | He wanted to make him feel worse, so he didn't go near the band saw without being more cautious. |
B | But it probably did reduce the pain a little bit to some extent. Now, where it's key is, and maybe we'll get into it later with chronic pain, is in some chronic, painful conditions, the CPM or the D NIc doesn't work, like fibromyalgia being one. So pain inhibits pain is another neuroscience concept related to pain. Tha... |
A | No, you answer the question, expanded on it in a completely surprising and far more interesting way than I ever anticipated. So thank you. I'm betting that 98% of people listening to this, including myself, have never heard that pain inhibits pain. Incredible. Let's go back to heat and cold. We briefly touched on heat,... |
B | Sure, sure. Well, putting aside the contemporary controversies over the mechanisms you described, which are, I think, very real and need to be sorted out traditionally, historically, we tend to think of applying cold for the first 48 hours or so after an acute injury and then heat thereafter. Cold has some really cool ... |
A | How cold should one make the point on their body that's in pain, assuming, of course, that they're not going to give themselves frostbite meaning. Do you want to numb the area, get past that point where it's a little bit painful, and then basically you're shutting down some neural pathways and you don't feel anything t... |
B | I mean, that's a reasonable suggestion. |
End of preview. Expand in Data Studio
README.md exists but content is empty.
- Downloads last month
- 6
Size of downloaded dataset files:
101 kB
Size of the auto-converted Parquet files:
101 kB
Number of rows:
265