Dr. Peter Attia
speaker
5,258 appearances
36 recordings
6 series
first heard Jan 2024
last heard Jun 2025
Dr. Peter Attia’s voice in public audio — every appearance, attributed to the second.
Trend
recordings per month · last 12 monthsNo recordings in the last 12 months.Older appearances are listed below; set an alert to hear about the next one.
Appearances
So I'm sure we will get to how you and I met 25 years ago, exactly 25 years ago, and how you played an unbelievable role in bringing me back from arguably the brink of what could have been the end of my life, truthfully. But I want to start with some broader topics around pain. So There's nobody listening to us right now who doesn't know what pain is.
There's nobody listening to us right now who hasn't experienced pain. Yet, if you ask for a definition of pain, I think you'd get a lot of using the word to describe the thing, which isn't truly a definition. So if you were trying to explain to a Martian from another planet who doesn't experience pain what it is, what would you say?
And Sean, just to interrupt for a second, thinking through the history of medicine a little bit, the latter part of the 19th century brought a couple of other tools to pain. So between local anesthetics, cocaine down to lidocaine, and general anesthetics in the form of ether, which finally allowed surgeons to cut people without having to hold them down while they screamed.
It sounds like that didn't shed any new light. That was viewed in the one hand as just a blunting instrument, but it didn't change the model. Didn't change the model.
Okay.
The A-delta is doing two things, if I'm understanding this correctly. Is it creating the spinal reflex where I hit my thumb with the hammer, the signal goes into the spinal cord out through a motor neuron to pull back without me having to think about it?
But am I also feeling the pain? Am I perceiving the pain? If you could do a thought experiment where you could eliminate the C-fiber in an individual, would they still feel pain? Yes.
So there's still a central component to what the A fiber is doing.
Just thinking about this from an evolutionary lens, lots of debate about this in the animal kingdom. Like, does a goldfish feel pain? Do we have a clear sense as to how far from humans and or mammals you go where you still clearly have C-fibers and A-delta fibers?
This is where I was actually going to go, if I can just give you that window. Please. What I was really going to ask is a question about consciousness.
Is consciousness necessary for the internalization of this full gamut of pain?
Yes. And I just want to point out, and this shows you how long I haven't been in surgery, but 20 years ago, my recollection is an anesthesiologist was giving not just one medication, but several. Yes. So they were giving something like halothane, which to my understanding, we didn't know how it worked then. Do we have any idea how it works today? Better.
The anesthesiologist still had to give typically a narcotic. They were still typically giving something like fentanyl, even though the patient was unconscious. They were also often giving an amnesiac so that they wouldn't have any recollection of what was going on. But of course, we all hear the horror stories of the patient. And a paralytic on top of all that, right?
So you hear these horrible stories of the patient who is paralyzed, but somehow conscious. You can miss on this state sort of thing. But just to make sure I understand, in theory, a paralytic and an inhaled anesthetic should be sufficient to eliminate the perception of pain in a patient who is being cut. Yeah.
Got it. So in other words, you give the inhaled anesthetic just to get unconsciousness, but not to fully suppress the nociceptic system. Instead, you bring on the opioid to do the remainder of that work.
So does that mean we are seeing a cortisol surge? We're seeing whatever one would expect a conscious person to experience with epinephrine, norepinephrine, cortisol, all those things still surging out in response to pain.
Arguably more than you would ever experience. Think about what we do in surgery. My God. Take a scalpel and then take an electrocautery and start burning tissue. I mean, there's no level of nociception you could ever experience like that while being awake, unless you're in a burning car. Absolutely.
So let's go back to something you said at the outset from an evolutionary perspective, which is pain and pleasure have been the driving factors that have been the engine of natural selection. But clearly those things have had to work in pre-conscious models. So that means that whatever we're defining as pain there did not include a perception of pain.
Right. Does a goldfish experience pain?
So how does everything you just said differ or overlap with neuropathic pain or that sort of burning pain that I'm sure some people are familiar with? Certainly I was familiar with it for several years. Yeah. Is that simply a subset of this? Are there various different types of pain that don't have a clear cause-effect relation to tissue damage?
Showing 981–1000 of 5,258 · page 50 of 263
← Previous
Next →