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.
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And by the way, on visceral pain, what is the response to treatments with respect to the way we saw in noceptive pain where, hey, great response to these NSAIDs or opioids or whatever?
Yeah, I was about to say, before you gave your examples, I was going to say nociplastic pain must be a huge bucket because it's everything for which we don't understand. It's sort of the all else bucket, which is enormous, especially for chronic pain, right?
Now, there's no objective way to measure pain, correct?
Sorry, you're capturing these through what modality?
Let's just start with standard understanding. If you put me into an fMRI machine and I said to you, hey guys, I'm not feeling any pain right now, I feel great. And then you scan me and then someone came out and took a hammer to my thumb and I went through the classic response that you described earlier, what would my fMRI show?
And to be clear, this is distinct from the part of my cortex that is the homunculus for my thumb.
Yeah. Okay. So let's go back to the story of these four branches of pain, or at least the first three, and then how the sensory component is impacting the perception.
Give me a little bit more.
Okay. So we go back to nociceptive pain. So tissue injury occurs. I think where I derailed us was in classifying all the different types of pain, but you had signal comes up, two signals coming up, the C fiber, the A delta fiber. The immediate response is to get you out of pain. There's an evolutionary logic to that. The C fiber is not there to get you out of pain because the A delta did that.
Is the C fiber there to remind you not to go back and do that again? Perfect. Perfect.
By the way, do we have any evidence, Sean, that there was enough genetic heterogeneity around this that there were 200,000 years ago, there were members of our tribe who simply didn't feel pain and therefore did not pass on their genes because they made poor decisions?
I find it amazing to just sit around and dream about how little convergence must have existed a quarter of a million years ago in terms of things that ended up not being good for our species, like people who didn't experience pain the same way or didn't have certain filters within themselves. There'd been lots of talk about people who couldn't socialize. You couldn't evolve alone.
So if you didn't have the right set of genes that allowed you to at least be part of some sort of social tribe. And of course, we still probably have people today that have escaped. We clearly have some antisocial folks among us, but they're the exception and not the rule.
So anyway, I just wondered if today we're much more homogeneous in terms of what a human's response to pain is versus what it might have been. Probably.
And I also think about certain things like childbirth prior to any anesthetic was obviously brutal, both in terms of the pain and the mortality. And yet there's no evidence that people were deciding, yeah, maybe we ought not to do this. In other words, the drive for procreation somehow overcame what must have been brutal.
Those are the two things that I joke about with my friends, which is I still don't really understand how our species is here for two reasons. One, women had to continually go back to the well. Because remember, if your reproductive rate isn't in excess of two, the species collapse. So on average, every woman must be able to do this. And back then it had to be reproductive rate of north of three.
Right. Every woman had to do this three times. How she did it the second two times after how bad the first was blows my mind. The second thing is just looking at how stupid adolescent males are. I'm sure you can relate to this. I was one. Yes, as was I. And I look at my boys. I don't understand why males all didn't die from just doing stupid.
stupid, stupid things before the age of 20 or even before the age of like 15. Those two things are a miracle to our species, that all the males didn't die and that all the females were willing to have at least three kids.
We'll link to them in the show notes, some of my favorites.
Sometimes trying to create a distraction. Okay. Okay. Sometimes, though, probably illogical trying to keep whatever humor is in there that's hurting isolated like a tourniquet. Right. Right. Obviously, if I'm using cold, especially if it's one of my kids that hurt themselves, we'll put cold on hoping to anesthetize the area, presumably slow the circulation, take down the swelling.
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