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
Linda Watkins, Mark Hutchin did some really nice work in that and showed people have had some difficulty in replicating it. But I have a hard time. We know the mechanism, I think, seems pretty solid. But when I look at the clinical conditions that it has been applied to and shown benefit, I mentioned multiple sclerosis, ulcerative colitis, I believe is another one.
and these weird neurodegenerative things, I have a hard time understanding why mild antagonism of opioids is going to have an impact on those conditions.
Well, it's another one of these weird degenerative... Through a central effect? Yeah. Yeah, I don't have a good answer for you on that. I'm just spouting off some of the headline in the studies that I've read where it's been used. I will have to go and look just for kicks when I get back to the hotel room and just see about the whole mild cognitive impairment, Alzheimer's aspects of it.
I clearly don't treat these patients, but it is an intriguing idea, isn't it?
About 10 to 12 people in it. This is all the physicians and nurses, the trainees. It was tiny, tiny, tiny. And we were in this small little clinic. And today? Probably 130, 150. We have a factor of 10 or more. And we've grown to be, I think, the largest academic pain center west of the Mississippi. One of the top in NIH fund. It's really come a long way.
It's been really exciting to see the growth and the careers and the people we've helped out.
Did it do anything?
That's a great story. I listened to that and in one hand, I remember it. And another hand, it's been so many years. Yeah, it's one of a million stories. You could have been talking about Bob as the doc. And I'm listening to this and I'm like, well, yeah, that is the kind of thing I would have done late at night and just try to get it under control.
Yeah. Just spray the hose. Yeah. Because normally, to be clear to the audience, I would never approach that in a chronic situation like that. It lacks all specificity. You can't learn anything from it. But I remember you just being an extremist and we had to do something to help you.
What I usually look at, I usually think of it as, I'm confident we can really help them. I don't know what help means. Curing is such a strong word. Every once in a while, we can cure, just eliminate, make it go away, never comes back.
Like your case, which honestly, I didn't even know about until recently. I was lost to follow up. Lost to follow up. I'll tell you maybe in just a little bit, like how I did find out. I don't use the word cure maybe like a surgeon would use the word because I don't want to set unrealistic expectations with patients. But I don't give up.
I've never hit a point in my career with a patient where I've ever said, we're done.
I got nothing. We've got so many tools available to us now. Back when we first met, we had a handful of procedures. We had a handful of medications, gabapentin, the new kid on the block, opioids, NSAIDs. some tricyclics, but that was about it. And by the way, that also, that notion contributed to the opioid crisis because we didn't have tools.
Now, there's over 200 medications that have shown to have analgesic properties. We have over 200 procedures that we do for pain, scores of mind-body therapies. scores of complementary alternative therapies and physical rehabilitative approaches. The toolbox that we can draw upon is so much larger. Often the problem is not with all the tools we have.
It's trying to figure out the right tool for the right patient, the right context. I frequently focus on getting people back to a good quality of life and giving them control of their life and their pain rather than a promise to eliminate pain.
In the acute setting, often it's eliminating pain because in an acute perioperative or acute injury situation, you need to eliminate or significantly reduce it before you can get people moving, which was kind of in your case. I got to tell you, I was tempted. My memory of this was a little vague. I almost, for a moment, I thought maybe I just look up my records on Epic and just see what's what.
And I'm like, no, man, that's what gets you fired. And so I didn't. I'm glad you filled in the memory gaps. I'm literally just so happy for you. Can I ask you some questions about it all? Sure. Maybe build on some of the things we've been talking about. So some of the stuff that's going on when you were in this is you were in distress.
Clearly there was a lot of catastrophizing going on, if I can draw upon that term. You cut me off if I'm going off in tangents. Catastrophizing is this concept that was introduced by Albert Ellis in 1962. He was a psychologist and he also liked neologisms. So he created catastrophizing. He created the word awfulizing. Awfulizing didn't stick around.
Catastrophizing was not related to pain, but got used for pain, has three factors to it. Amplification of pain, rumination or repetitive thoughts about pain, and a sense of helplessness or loss of control over your pain. Check, check, check. It's natural. We get a lot of controversy in the field on this term because it has such a pejorative impact.
And unfortunately, some of the docs have weaponized it against patients. Oh, you're a catastrophizer. Tragic. But it has real neurobiologic consequences because when people catastrophize, when they have a loss of self-control, when they have rumination, it negatively impacts these prefrontal cortical circuits that I mentioned, these cognitive circuits.
Showing 321–340 of 373 · page 17 of 19
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