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.
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Appearances
70 kilo person. Thank you. And we get four and a half. And so when people ask me that, I'm like, wow, it does make us sound pretty smart, doesn't it? There's no difference between four and a half and five.
Complex regional pain syndrome, very tragic pain condition that is a neuropathic pain condition we see a fair amount of. I've got a clinical trial I'm just wrapping up on that using low-dose naltrexone funded by the RSDSA Association. Another is actually multiple sclerosis they've used it in, and they found some reduction in reoccurrences of MS. I think they did that at UCSF or UCLA.
But it's in these weird neurodegenerative-type conditions where they're seeing some help. Now, I've had some wacky, really wacky patient responses. I can share one. He is dysarthric. He can't speak. He's got weakness. He has hemibody pain, burning pain. This is that central pain.
So he comes to me several years later, can barely speak at all.
No, no, no, no. He has a speech therapist. It's not getting any better. He's a couple of years out. Stroke is stabilized. Okay, so it's this burning pain. Burning pain. On half his body. Half his body. I trial him on four and a half milligrams of LDN. He goes away. He comes back a couple months later. Pain has improved.
But not only that, he's now speaking and throwing a few words together for the first time since his stroke. I'm like, what the hell? I bump up his dose. You cannot hurt yourself on this drug. I know you know this. So I go to nine. Why not 10? Well, because it's easy to take two capsules. He comes back a few months later. He's now talking in sentences. I said, are you sure?
This isn't due to your speech therapist. And they swear up and down. Absolutely not. I go up to 13 and a half, and now he's having conversations. And how's his pain? Massively better on this. Really remarkable effect. The only way I can explain these things is, you know, in a stroke, you've got dead tissue, you've got live tissue, you've got these intermediate zones. And
Somehow, with reducing maybe inflammation, you end up with more functional brain.
drug is the only side effects I see. 20, 30% of people get vivid dreams. They get technicolor dreams, not bad dreams, not nightmares. Their dreams just take on a more colorful nature. Every once in a while, I'll see somebody who they say it activates them. We tell them to take it two hours before bedtime. And if it activates them a little bit, take it in the morning instead.
It's a good thing after injury and after an infection because it mobilizes all of those repair cells to come in and clean up the mess. The problem that we think is going on in pain, the switches don't turn off and go back to normal. And indeed, that, Peter, which you did a beautiful intro, is one of the things we think is playing a role in fibromyalgia.
They got an insult, activation of this neuroinflammatory system. In a healthy state, it turns off. And fibromyalgia never turned off.
I think the short answer is yes. A little bit of the longer answer is, you know this, everything we do is weighing risk and benefits. This is one drug I am hard-pressed to come up with significant risks. We have decades and decades and decades of experience with this drug in people with addiction.
Yeah. The problem is, as all the addictionologists know, is that it's hard to keep people on this because they can just stop it and go back and use.
You have to want to be off. They have injectable versions of this. It's not called Vivitrol, is it? It's an injectable under the skin that lasts X number of days, months. But yeah, we've got a lot of long-term data on this.
And from a pilot standpoint, with informed consent, obviously, and just I would view that as a novel treatment in patients that one could try out, monitor, do some objective measures, see what you get. I want to be careful. I wouldn't say that for a lot of the things that we do, because there's real risks with a lot of the medications that we provide, a lot of the procedures we do.
Not only that, there's big costs that come with them. Whereas this, I'm going to make a plug here I have no relationship to, but we get our stuff out of Balmar Pharmacy in Colorado. Why? They're a compounding pharmacy. They've got all the certifications. The reason is you can't go to Safeway or Costco and get this.
And so we go through this pharmacy because they've got good customer service. They take patients' credit cards over the phone, and they will ship it to you immediately, and they're very responsive. You can probably find it in your local area at other compounding pharmacies. It usually runs about $30 a month.
Insurance doesn't often cover it. They consider it experimental, but it's basically a free drug. It's a buck a day. Yeah. So it's one that I use more and more and more because of its safety profile and its potential for getting me a home run.
It is. And I need you to, just as ideally a good scientist, tell you that not everybody buys in to the microglial model that I'm describing. There are friends and colleagues at Michigan, Dan Claw, brilliant, brilliant guy who is very much in disagreement with me, who believes that even at these low doses, you are antagonizing the opiodergic system and in essence kind of resetting it
in these chronic pain states so that you're normalizing the endogenous tone. And you know what? That's the fun thing about science and why we try to keep our egos out of it. The truth will come forward.
Showing 301–320 of 373 · page 16 of 19
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