Sean Mackey, M.D., Ph.D.
speaker
373 appearances
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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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systems so that they can no longer downregulate your pain. They have abnormal connections to hypothalamic regions, which are key in hypothalamic pituitary adrenal axis, your HPA axis, which I know you're very familiar with. And so In an acute situation, you get a release of cortisol for stress response. You know this is a surgeon. It's great. It keeps us alive. Chronically, terrible.
And so you get this allostatic overload, and it starts to thin out that brain region. You're no longer able to modulate, and it's this worsening cycle that you get deeper and deeper in. A lot of what we do in pain... is we try to break those cycles. And it's not one thing. I use the interventions, the procedures to help break an immediate cycle to get you on a path.
We do this with other patients similarly. And then it's learning skills.
Yeah, that's exactly it. And you had the resources to do this. I was reflecting in your book in the early chapter, you described a friend's mother, I think Sophie, and you told the story and maybe it was in the original version of it. It got trimmed out and edited. But when I read that story of this woman who shoulder injury and then went down this bad path.
And it doesn't get mentioned in the book. Again, may have been left out of the editorial, but all I'm thinking of is pain. All I'm thinking of is this poor woman probably had severe, severe pain that was untreated, and it put her down a spiraling path. And what happens in these situations? Well, one of the things we're learning more and more is social functioning.
So we call pain a biopsychosocial model, but we tend to skip over the social, small s. But it turns out we've done a lot of data analysis on our own patients. Social isolation, social functioning plays a key role in your overall pain and quality of life. And you talk about this in your book from a social functioning standpoint. My guess is she invariably withdrew. She became deconditioned.
She may very well had a lot of fear avoidance around moving her shoulder, which sets you up on a worsening spiral. And what I think about, and when I think of Sophie, and I think about people as they get older, We need to manage your sleep. We need to manage all the things you put beautifully in your book.
But I think we also need to help them better manage their pain so that they can have the function and do all the things that you say so nicely in your book. I don't know what your thoughts are.
Yeah, yeah. The data on elderly people who get a hip fracture spiral immediately downhill to death.
Oh, and I'm sorry if I'm repeating things. No, no, no, no, no.
Yeah, and I just keep thinking if we could better help get their pain under control and address them from that holistic standpoint and just get them back to a level of functioning, would this story be written differently? I'd like to believe it would. I hope it will.
When you went through all of this, you get through the rehab, did you feel a greater, one, understanding of your pain, what was causing it, and the nature of your back and what you could do and its safety?
Yeah, that's a great story and it's helped you be a better doc and help people. I listened to your story and everybody's story obviously is very different and personal. I have my own variant of this and I don't talk about this much because I tend to be a little private with these things. I suffer from cluster headaches and all my life, as far as I can remember, I would get these headaches.
It was like a bomb going off in my brain. How often? Every two years. Every two to three years. It's a classic fall-spring cycle. And all through my teens, my early adulthood, I'd get these two weeks being just terrible, the most insane pain I've ever had. I've broken a lot of bones in sports. Nothing trivial compared to that. And nothing I would do would work.
I'd occasionally go to the emergency department and they'd say it's a sinus headache and they'd give me antihistamines and they'd prescribe them. And sure enough, they worked because it always went away in a couple of weeks. I remember in residency getting one of these in the midst of a cardiac anesthesia rotation and barely able to get the patient to the recovery room.
And I just went into a call room and I just hung out. The thing is, nobody knew what they were. I didn't know what they were, but I was scared. Every time these came on, I thought I had a brain tumor. I was convinced. I thought this was going to kill me. And you get really scared that it's never going away. I catastrophized.
After the end of like a couple of weeks, I'm like, what the hell am I going to do? I can't work like this. I can't live like this. Then I become a pain doc. And I'm like, well, shit, I got cluster headaches.
First of all, just to let people know, what a cluster headache is, it typically manifests as headaches that last anywhere from upwards of a couple hours. They can occur eight times a day to every other day. They tend to have these weird characteristics. They're under a class of trigeminal autonomic cephalages. Fancy term for simply meaning that you get eye tearing, redness in your eye.
I get what I refer to as a sticky eye sensation, like my eyelid gets heavy and it droops. I get my nasal congestion. But one of the major characteristics is extreme agitation. Extreme agitation. Meaning Beth would say, well, you better to lie down. I'm like, no, it doesn't matter. And I just pace. You pace and you pace and you pace until it goes away.
So what I did in the period of all this fear, I learned every damn thing I can learn about cholesterol headaches. Every single thing.
Showing 341–360 of 373 · page 18 of 19
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