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
Because we think you're depressed. You're depressed.
Not FDA approved drug. Approved for pain is what you meant. Yeah. Thank you. Thank you for that correction. FDA approved for something else. You're absolutely right. Okay. Well, this brings us to opioids, which I saved for last because of, well, there's actually more drugs I want to talk about, but in terms of the off the shelf, typical stuff that people think about.
So a lot of hay has been made over this. There's no question that opioids have been overused and abused. And there's no question that illicit use of these things has had a devastating impact on our society. But it would be difficult to say that the field of medicine would be better off having never had an opioid. We just talked about surgery, for example.
Very challenging to deliver medical care in a hospital without opioids. So the question becomes, what is the most responsible case for oral opioids, which by definition are meant to be used outside of a hospital, not inside a hospital? And as a pain specialist, I would imagine few people are better equipped to navigate the nuance of that question.
By the way, the perfect analogy to this is the mortgage crisis in 2006 to 2008. If you took a zeroth order view, it would be really easy to blame one of the entities, but it is actually a perfect storm.
Just one thing, you are not taking care of somebody in the acute phase of expected pain typically, is that correct? In other words, that guy that just had a knee replacement, he's being managed by his surgeon, correct?
When is the big gun of your team's expertise being brought in for a post-surgical routine case versus not?
You know, when we brought pain in for every case when I was in residency, anytime we did a thoracotomy, It was a non-negotiable. Pain was consulted before the case, just for people listening, a thoracotomy. We didn't do these often because a lot of times by the time I was in residency, we did minimally invasive surgery in the chest.
But sometimes you had to actually make a huge incision under the ribs. And that's a very painful, you just know this from experience, that that's such a painful experience. You cut this huge incision in the intercostal muscles, you put rib spreaders in, you crank these things open so you can do this big operation.
We just know those patients are going to need an epidural catheter and we want that in before surgery, not after. And it makes all the difference in the world. So pain was a part of that response. I don't remember us routinely bringing pain in regularly. otherwise, but things have changed, I'm sure, in 20 years.
So today, for a general abdominal case or a general orthopedic case, are you brought in preoperatively?
If someone's listening to us and they're going to have elective surgery at some point, I want to plant a seed in their head for someone who's going to have the knee replacement, the hip replacement, the cholecystectomy, the API, whatever. Should they be requesting this of their surgeon? Should they say, hey, I want to be diligent about my recovery. I want to minimize my use of narcotics.
Do you mind calling in a pain consult so that I can just have a team of docs who are exclusively thinking about my pain? Because let's be honest, the surgeon, I got enough to worry about. I got to make sure you didn't leak, that that anastomosis is fine, that you're not getting a wound infection.
Your pain is literally like third or fourth on the list of my concerns for you to have the best outcome.
How ubiquitous is the patient-controlled analgesic device, the PCA that we use?
Okay. So people are still typically getting fentanyl through a PCA in the immediate post-operative phase?
And the goal is we want to get you off an opioid, even oral, before you go home. Is that generally the stated objective of the medical system now is whatever opioids you're going to need, let's try to deliver that to you in the hospital?
So how are you thinking about that? How are you thinking about extracting the value of the opioid and minimizing the risk of long-term dependence?
So if you have someone who just suffers from, not that anhedonia is anything but unpleasant, but if they're only experiencing anhedonia but no self-loathing, you would say, well, the risk isn't as high.
Yeah, especially with that randomization, because what you really would like to be able to see is you take a whole bunch of people in, you get their incoming metrics of anhedonia, dysthymia, self-loathing, you categorize all the arms and tentacles of depression, and then you randomize within each of those to with and without opioid strategies.
Showing 1101–1120 of 5,258 · page 56 of 263
← Previous
Next →