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 how do you predict patient comes to you and they're experiencing some pain? What are the clues that would tell you, I think TENS is going to be successful here? In other words, I think that activating A-beta fibers is going to be a tool that will reduce your perception of pain because that's what we're doing. Everything that you do is, how do I reduce your perception of pain?
I can't necessarily take away. I mean, if they have an injury that needs to be resolved, they shouldn't be seeing you. They should be seeing the surgeon or whoever fixes the physical injury, right? In short, yes.
So who is the, I hate to use the word poster child, but who's the patient that when you see them, your intuition says TENS is going to really work for this person?
Can I put a bow on the gait control thing to make sure I understood it? Yeah. It seems like a very important idea, but I also think I might be missing the juice. Is the idea that 10 people could experience the exact same peripheral injury, if you could map the action potentials, they would look identical.
You could even see identical perceptions, but they could have 10 different gating channels within the spinal cord and therefore perceive pain differently. I just want to make sure I've captured what the gating theory states. You are right.
Yep.
So here's another experiment that you won't be able to do unless you get to teach this class on multiple days, but it's to go one step further, which is to do the same thing every day and see how they compare their score from day to day. I'll tell you my experience with that. I do love to use a cold plunge. So my cold plunge is at 42 degrees with circulating water.
So I don't know what that makes it feel like, but it feels like it's somewhere in the 30s. There are days when I can spend 10 minutes in there and feel like nothing is wrong. There are days when, I'm not kidding, 30 seconds in, my ankles hurt so bad I want to scream. And I think, what's different? It can't be the circulation in my ankles is better one day to the next.
They're a relatively avascular part of my body. Why is it that one day I can spend 10 minutes and not know I'm in this water? I mean, I know that I'm cold, but it's more like my core temp, but my joints don't hurt. And on another day, the throbbing in my joints feels like somebody's hitting them with a hammer. And I'm the same person.
So in other words, your point is well taken, but I would say there's a second dimension to it, which is even as individuals, we can experience things differently from day to day.
There seems to be kind of, I guess I should ask this. I'm not asserting this is the case. Is there kind of a moral judgment that comes to this at some level? Like, don't we as a society just tend to look more favorably at people that have a very high pain tolerance?
So when you go through that experiment you just did with the medical students, if everybody's being brutally honest, aren't they kind of looking at the people who score 0, 1, 2 more favorably than those that score 8, 9, and 10? Absolutely. Why do you think that is? If I'm being truthful, I do it.
I just think it's like a compatibility thing. Like I know when I do that type of an exercise compared to others, I tend to just feel less pain. I also know my wife does as well. And so I almost wonder if that's a compatibility. We both just have a high threshold for that when we're exercising, when we're doing anything, even recreationally, that doesn't matter.
So what is the consequence of this? So we're acknowledging that it is an attractive trait to have a high tolerance of pain. Society rewards it. And yet by definition, a significant subset of the population, call it a third, call it a quarter if it's a normally distributed function, are going to be a standard deviation on the other side.
They're going to be on the side relative to people who have a high tolerance for pain. These are people who are going to really perceive pain And if we just did this through the lens of the responsibility of the medical community, there's a pretty significant consequence to that. Indeed.
So just because you have a high threshold for cold, you could completely flip it on hot or pressure or pinprick or whatever the other modality is.
I was going to say, is there any way to put together a set of experimental lab versions of this to basically generate predictive models of how people will respond to real world pain? I think where you're going with chronic pain is even more relevant.
So for example, why do some people have a disc herniation that leads to manageable pain, whereas for others, the exact same injury by every metric available to us produces a totally different set of consequences? And what do we do about that?
What about other things? You talked about sleep deprivation. Any other physical things, exercising, not exercising, insulin resistance, non-insulin resistance? What are the other things that might factor into this?
How much sleep deprivation does one need for there to be an increase in pain perception?
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