Sean Mackey, M.D., Ph.D.
speaker
373 appearances
1 recordings
1 series
first heard Apr 2025
last heard Apr 2025
Sean Mackey, M.D., Ph.D.’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
If you're using the term dry needling from an intramuscular standpoint, I don't know if that's where you're going.
Well, it's an acupuncture point. It is a Chinese medicine list of acupuncture points. I'm way out of my wheelhouse here, folks. When I think of dry needling, I tend to think of that in the context of trigger point injections, which we do, physicians do. And that we're taking typically like a 30 or 27 gauge needle. We're putting it intramuscularly into a trigger point muscle.
It's where you get those knotty muscles. Yep. And you can do dry needling. And what that does is it causes relaxation of the muscle. Acupuncture is really quite different from that.
Very nuanced. This is another one where I'm liable to get some hate mail on either side of this. Here's what I'll tell you. One, the verdict is still way the heck out there. You look at well-controlled, randomized trials. There's very few of them, by the way, but some in neuropathic pain that show analgesic benefit over a short period of time with cannabis. You look at population-level studies.
Australia did one. They did not show benefit with cannabis. We collect data. One of my other areas of both research, but also clinical care is I built a learning health system that captures high quality data on every patient that comes in. And so we deeply characterize or phenotype them. And we looked at people coming in on cannabis, not on cannabis.
Bottom line, people coming in on cannabis into Stanford are worse off and they stay worse off. Now, there's all these limitations to observational studies, no matter how well you conduct them. Let me distill it down to some talking points. There's a huge number of cannabinoid receptors in the human brain that are playing a role in analgesia.
So I'm absolutely convinced that cannabinoids are playing a role in pain relief. One. Two, the forms of cannabis that we take are dirty, meaning we don't know the dose. We don't know the ratios. They've not been well studied and they've not been studied in different groups.
A major part of that is because it's a schedule one drug, which means that the DEA says basically high abuse potential and no medical benefit. And it takes basically an act of Congress to study cannabis. I don't prescribe it at Stanford. I don't screen people for it at Stanford. If I did and if we kicked them all out, I wouldn't have anybody in the clinic. I mean, we're in Northern California.
You can study it with federal dollars. NIDA will support funding of cannabis. The regulatory controls you have to go through are crazy.
We used to make jokes. UCSF did some nice cannabis research. And the word on the street was that they would deliver the cannabis... doobies in a Brinks armored truck with guys carrying M16s. Now, I think it's gotten better, but it's just been challenging to study this. I'm firmly of the opinion, here's where I'm going to upset people.
I firmly believe we should make it a Schedule II or Schedule III drug.
Yeah. Yeah. What was historically a garbage bag definition. Fibromyalgia is a condition of widespread bodily pain that impacts people above and below the waist, the diaphragm. It's associated with early morning stiffness, fatigue, mental fog, often some GI problems.
It was historically, based on American College rheumatology definitions, based on tender points in 11 out of 18 places, but that's been replaced.
by now criteria which involves multiple body sites affected and a symptom severity score the key thing when the audience hears well first of all it's fibromyalgia syndrome and whenever the audience hears syndrome what they should translate that to the definition of a syndrome is a constellation of signs and symptoms that define a disease but we don't understand the mechanism
So, fibromyalgia is a syndrome. We do not understand its mechanisms. We know that historically, it tended to affect women more than men, about 80%-ish or so women. With the newer definition, we're picking up a lot more men. The cognitive aspects of it are really a problem. It's also associated, as I alluded to, with sleep disturbances.
They get this weird, what we call alpha wave intrusion into their EEG, which means alpha waves are typically in light awakefulness. So when you're supposed to be in deep sleep or REM sleep, your brain is in kind of a light alert state instead. And so they're not getting a restful sleep. This is a syndrome that's caused untold problems, particularly for women.
I should know how many millions there, Pete. I should know how many millions and I don't. I can tell you just to give a frame of reference. Chronic pain, we think there's 50 to 100 million Americans with chronic pain. That's a huge range and it depends on the way you ask the question. If you ask it more stringently, it's 50 million. If you ask it more liberally, it's 100 million.
We know that there are about 8% of the population or a little over 20 some odd million with something called high impact chronic pain. This is a big one and this is where I spend a lot of my research and policy work on. These are the people that have substantial restrictions to their pain in activities of daily living. These are the really challenging people.
Of that 50 to 100 million, the most common chronic pain is low back pain at about 28%, neck pain 16%, headaches around 16%. Societal burden of chronic pain is terrifying. It's astounding. We spend over half a trillion dollars a year and chronic pain. And the reason why, in part, it's not more appreciated is because we have parceled it out. We've broken it into different categories.
With heart disease, we lump it into heart disease, cardiovascular disease, even though it's all these different subcomponents. With pain, instead, we categorize it as it's either back pain, it's musculoskeletal pain, it's migraines, it's abdominal pain, and it gets diluted out But when you put it all together, you're dealing with a half a trillion dollars.
Showing 261–280 of 373 · page 14 of 19
← Previous
Next →