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

You'll remember when you were taking a bovie to the bowel, the small intestine, patients wouldn't normally move because the nociceptors don't respond to that. But if you tug on it, if you pull that- Or inflate it. Or inflate it. Boy, oh boy. Blood pressure goes up, heart rate goes up.

You'll remember when you were taking a bovie to the bowel, the small intestine, patients wouldn't normally move because the nociceptors don't respond to that. But if you tug on it, if you pull that- Or inflate it. Or inflate it. Boy, oh boy. Blood pressure goes up, heart rate goes up.

Interesting characteristics with visceral pain is there's something called viscerosomatic convergence, meaning that the afferents, the information coming in from the gut, from the thorax, converge with the same sensory systems from the rest of our different parts of our body. So you may remember the old medical school adage, C345 keeps the diaphragm alive. Okay. We all had these in med school.

Interesting characteristics with visceral pain is there's something called viscerosomatic convergence, meaning that the afferents, the information coming in from the gut, from the thorax, converge with the same sensory systems from the rest of our different parts of our body. So you may remember the old medical school adage, C345 keeps the diaphragm alive. Okay. We all had these in med school.

Well, that means that the third, fourth, and fifth cervical nerve roots subserve our diaphragm, which help us breathe. When the general surgeons or others are operating and they get blood under the diaphragm, it irritates the diaphragm. And what patients will typically complain of, shoulder pain. because the shoulder is subserved by the fourth and fifth cervical areas.

Well, that means that the third, fourth, and fifth cervical nerve roots subserve our diaphragm, which help us breathe. When the general surgeons or others are operating and they get blood under the diaphragm, it irritates the diaphragm. And what patients will typically complain of, shoulder pain. because the shoulder is subserved by the fourth and fifth cervical areas.

And so when they had shoulder pain, the answer wasn't something's wrong with their shoulder, it's they had some irritation of blood under there. It's why when people have a heart attack, pain radiates out into the arm because you've got the upper thoracic nerves subserving the heart that overlap the with the nerves that go down your arm and the nervous system gets confused.

And so when they had shoulder pain, the answer wasn't something's wrong with their shoulder, it's they had some irritation of blood under there. It's why when people have a heart attack, pain radiates out into the arm because you've got the upper thoracic nerves subserving the heart that overlap the with the nerves that go down your arm and the nervous system gets confused.

And that's how it's expressed. And if you like the neurosciences, it's all pretty cool. If you're experiencing it, not so cool. Let's get to neuropathic pain.

And that's how it's expressed. And if you like the neurosciences, it's all pretty cool. If you're experiencing it, not so cool. Let's get to neuropathic pain.

Typical analgesics can be helpful, but identifying visceral-specific anti-nosusceptive drugs is still an area of hot research. These days, it's more about trying to identify the causes of visceral pain and reducing substances that are winding those nosusceptors up. Neuropathic pain, another bucket. Neuropathic pain means injury to either the peripheral or the central nervous system.

Typical analgesics can be helpful, but identifying visceral-specific anti-nosusceptive drugs is still an area of hot research. These days, it's more about trying to identify the causes of visceral pain and reducing substances that are winding those nosusceptors up. Neuropathic pain, another bucket. Neuropathic pain means injury to either the peripheral or the central nervous system.

The nerves out in the body, it's either injury or dysfunction too. Nerves out in the body or the nervous system in your spinal cord or in your brain. Classic, you get nerve injury from a trauma from surgery. Classic qualities people describe burning, sharp, lancinating, stabbing, shock-like. This is the kind of pain that some people tragically get after a thalamic stroke in their brain.

The nerves out in the body, it's either injury or dysfunction too. Nerves out in the body or the nervous system in your spinal cord or in your brain. Classic, you get nerve injury from a trauma from surgery. Classic qualities people describe burning, sharp, lancinating, stabbing, shock-like. This is the kind of pain that some people tragically get after a thalamic stroke in their brain.

Half their body's just like terrible burning pain and there's nothing going on out here. It's all central. This is the kind of pain that you get and you experienced. with radicular pain. And radicular pain means, in this case, injury to a nerve root coming out of your spine.

Half their body's just like terrible burning pain and there's nothing going on out here. It's all central. This is the kind of pain that you get and you experienced. with radicular pain. And radicular pain means, in this case, injury to a nerve root coming out of your spine.

It's this sharp radiating pain, if you've got it in your lower back, that radiates down your leg, typically below your knee into your foot. This can be very challenging to treat with common analgesics. We tend to draw upon different categories of medications for this. These are, broadly speaking, anti-neuropathic pain drugs. And here, in our field, we steal from everybody.

It's this sharp radiating pain, if you've got it in your lower back, that radiates down your leg, typically below your knee into your foot. This can be very challenging to treat with common analgesics. We tend to draw upon different categories of medications for this. These are, broadly speaking, anti-neuropathic pain drugs. And here, in our field, we steal from everybody.

There's only a few FDA-approved medications for pain, like a handful. So what we've learned to do is to steal, borrow drugs from the neurologists, their anti-convulsants, their anti-seizure medications. The gabapentinoids, the tegratols and their derivatives, their other anti-seizure medications, because they tend to have mechanisms of action that also work on nerve pain.

There's only a few FDA-approved medications for pain, like a handful. So what we've learned to do is to steal, borrow drugs from the neurologists, their anti-convulsants, their anti-seizure medications. The gabapentinoids, the tegratols and their derivatives, their other anti-seizure medications, because they tend to have mechanisms of action that also work on nerve pain.