Sean Mackey, M.D., Ph.D.

That's exactly it. It's remarkable through modern medicine that we get people through all this as a reflection of advancements in surgery, advancements in anesthesiology, advancements in post-operative care. But it is no different than a controlled injury. It's done in a nice sterile environment, but it is a massive injury that people are undergoing.

That's exactly it. It's remarkable through modern medicine that we get people through all this as a reflection of advancements in surgery, advancements in anesthesiology, advancements in post-operative care. But it is no different than a controlled injury. It's done in a nice sterile environment, but it is a massive injury that people are undergoing.

They're just not awake, and it's nice and clean and sterile. But there is a stress response associated with that. Most people recover well. One of the hot topics of research these days is why do most people recover, but a certain percentage of people go on to have persistent pain after surgery? That's an area that I used to research years ago. Many others are doing some great work in that space.

They're just not awake, and it's nice and clean and sterile. But there is a stress response associated with that. Most people recover well. One of the hot topics of research these days is why do most people recover, but a certain percentage of people go on to have persistent pain after surgery? That's an area that I used to research years ago. Many others are doing some great work in that space.

Turns out that a lot of the factors we're going to get to this is what people bring to your operating room table, meaning early life events, levels of emotional health, cognitive health, and everything else. So to answer your question and getting back to it, no, I don't believe there is the perception of pain without a conscious brain. There's all sorts of nuances to that.

Turns out that a lot of the factors we're going to get to this is what people bring to your operating room table, meaning early life events, levels of emotional health, cognitive health, and everything else. So to answer your question and getting back to it, no, I don't believe there is the perception of pain without a conscious brain. There's all sorts of nuances to that.

So what does that mean? That's where it gets muddy. And there's smarter people than I that would probably be more articulate, but This is why I think on first principles, you have to define the thing that you're talking about. When we typically talk about pain, we're talking about it from a uniquely human standpoint. Does a dog experience pain? Easier to accept. Easier to accept. I'm a dog person.

So what does that mean? That's where it gets muddy. And there's smarter people than I that would probably be more articulate, but This is why I think on first principles, you have to define the thing that you're talking about. When we typically talk about pain, we're talking about it from a uniquely human standpoint. Does a dog experience pain? Easier to accept. Easier to accept. I'm a dog person.

They experience pain. You move on down the evolutionary. At what point?

They experience pain. You move on down the evolutionary. At what point?

You see how muddy it gets. You go down rabbit holes pretty quickly, which is why I tend to stay with humans, which is hard enough by the way.

You see how muddy it gets. You go down rabbit holes pretty quickly, which is why I tend to stay with humans, which is hard enough by the way.

So we have different ways of categorizing pain, putting it into different buckets, if you will. One is nociceptive pain. And you'll note that That word nociceptive sounds very similar to nociceptors, and it's by design. It means that it is pain caused by activation of primary nociceptors, whether it be in your skin or soft tissues or viscera. and it tends to have certain qualities.

So we have different ways of categorizing pain, putting it into different buckets, if you will. One is nociceptive pain. And you'll note that That word nociceptive sounds very similar to nociceptors, and it's by design. It means that it is pain caused by activation of primary nociceptors, whether it be in your skin or soft tissues or viscera. and it tends to have certain qualities.

It's very easy to localize. You know exactly where it is. It has a certain intensity. That nociceptive pain tends to be time-limited, responds well to short-term use of analgesic agents, acetaminophen, NSAIDs, COX-2 inhibitors, opioids, and it tends to go away. And this is the kind of pain that occurs after typically acute injuries. You then have visceral pain,

It's very easy to localize. You know exactly where it is. It has a certain intensity. That nociceptive pain tends to be time-limited, responds well to short-term use of analgesic agents, acetaminophen, NSAIDs, COX-2 inhibitors, opioids, and it tends to go away. And this is the kind of pain that occurs after typically acute injuries. You then have visceral pain,

which as a former general surgeon, you understood this. This is due to activation of those primary nociceptors in our viscera. Now, the difference and why we bring up the distinction with visceral pain that is either in our thoracic viscera or abdominal or pelvic viscera is that the receptive fields, that means where those nociceptors serve and what we perceive are very diffuse and wide.

which as a former general surgeon, you understood this. This is due to activation of those primary nociceptors in our viscera. Now, the difference and why we bring up the distinction with visceral pain that is either in our thoracic viscera or abdominal or pelvic viscera is that the receptive fields, that means where those nociceptors serve and what we perceive are very diffuse and wide.

When you get a stomach ache, you can't put your finger exactly where it hurts. You tend to put your whole hand over it and say, it hurts here, it's diffuse. That's because the spinal cord and the brain have these diffuse receptive fields which expand the area. The viscera don't typically respond to the same type of stimuli that nociceptive pain does.

When you get a stomach ache, you can't put your finger exactly where it hurts. You tend to put your whole hand over it and say, it hurts here, it's diffuse. That's because the spinal cord and the brain have these diffuse receptive fields which expand the area. The viscera don't typically respond to the same type of stimuli that nociceptive pain does.