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

Gabapentin, I think you've had perhaps some experience with. Turns out it's a lousy anti-seizure drug. Terrible. But it's a pretty good anti-nerve pain drug. Four grams a day. Four grams a day. Yeah. Drowsy though. You know who gets credit by the way? I give credit to making gabapentin the blockbuster drug. George Clooney. How? You ever watched ER? Yeah. He was a pediatric ER doc.

Gabapentin, I think you've had perhaps some experience with. Turns out it's a lousy anti-seizure drug. Terrible. But it's a pretty good anti-nerve pain drug. Four grams a day. Four grams a day. Yeah. Drowsy though. You know who gets credit by the way? I give credit to making gabapentin the blockbuster drug. George Clooney. How? You ever watched ER? Yeah. He was a pediatric ER doc.

Kid comes into the ER with a skateboarding injury. George Clooney puts the kid on gabapentin. Now, where that had all started was a case report from a couple of ED docs who had noted by putting people on gabapentin that their acute pain got better. So,

Kid comes into the ER with a skateboarding injury. George Clooney puts the kid on gabapentin. Now, where that had all started was a case report from a couple of ED docs who had noted by putting people on gabapentin that their acute pain got better. So,

I felt like beforehand when I was practicing medicine, around the time I saw you practicing pain medicine, that I'd look like a genius if I put somebody on gabapentin because nobody heard of it. And then after that came out, floodgates opened, primary care docs started using it. Now everybody's tried it. And it's a very safe medication.

I felt like beforehand when I was practicing medicine, around the time I saw you practicing pain medicine, that I'd look like a genius if I put somebody on gabapentin because nobody heard of it. And then after that came out, floodgates opened, primary care docs started using it. Now everybody's tried it. And it's a very safe medication.

I should also make a mention when I'm talking about these meds or any treatments. I have zero industry relations with anybody. Nobody. I don't take any industry money. You can go look me up on Open Payments CMS, which is a public database. Okay. Neuropathic pain. There's another one. There's a new kid on the block called nociplastic pain. I don't know if this one has made much traction yet.

I should also make a mention when I'm talking about these meds or any treatments. I have zero industry relations with anybody. Nobody. I don't take any industry money. You can go look me up on Open Payments CMS, which is a public database. Okay. Neuropathic pain. There's another one. There's a new kid on the block called nociplastic pain. I don't know if this one has made much traction yet.

This is a newly introduced category of pain, which is thought to represent dysfunction in the central pain processing system. And I'm not precisely defining it, but that's the gist of it. It means that in the absence of an identifiable peripheral cause, There is dysfunction in the brain and the spinal cord that is causing pain, perpetuating and amplifying pain. Nociplastic pain.

This is a newly introduced category of pain, which is thought to represent dysfunction in the central pain processing system. And I'm not precisely defining it, but that's the gist of it. It means that in the absence of an identifiable peripheral cause, There is dysfunction in the brain and the spinal cord that is causing pain, perpetuating and amplifying pain. Nociplastic pain.

And it has been tied in with conditions like fibromyalgia, temporomandibular disorders, some aspects of chronic low back pain, irritable bowel syndrome, interstitial cystitis, and more. It's slowly starting to get traction. When we talk about pain, both to study it, but also ideally to treat it, we put them in these categories that we just described.

And it has been tied in with conditions like fibromyalgia, temporomandibular disorders, some aspects of chronic low back pain, irritable bowel syndrome, interstitial cystitis, and more. It's slowly starting to get traction. When we talk about pain, both to study it, but also ideally to treat it, we put them in these categories that we just described.

You're absolutely right. And I think the verdict is still out. In the end, does nociplastic pain stick around? Or is the problem that in these conditions that we associate with nociplastic pain, medical science hasn't caught up to identify a specific peripheral driver? I'm of the opinion it's that latter. I think we're going to find peripheral drivers for fibromyalgia.

You're absolutely right. And I think the verdict is still out. In the end, does nociplastic pain stick around? Or is the problem that in these conditions that we associate with nociplastic pain, medical science hasn't caught up to identify a specific peripheral driver? I'm of the opinion it's that latter. I think we're going to find peripheral drivers for fibromyalgia.

There's some controversy right now as to whether fibromyalgia represents a small fiber neuropathy. And just because we may not be able to identify a lesion doesn't mean that there's not something there. But, as in all things, the truth will weigh out. We'll see how the story plays.

There's some controversy right now as to whether fibromyalgia represents a small fiber neuropathy. And just because we may not be able to identify a lesion doesn't mean that there's not something there. But, as in all things, the truth will weigh out. We'll see how the story plays.

Oh, the last 15 years of my career has been spent on doing that very thing. And where do you think we are in that regard? Much further along than I ever would have predicted. So a large chunk of my research early on, my early research was in neuroimaging of pain. It was opening up windows into the brain to see where people were thinking, processing, perceiving, magnifying pain.

Oh, the last 15 years of my career has been spent on doing that very thing. And where do you think we are in that regard? Much further along than I ever would have predicted. So a large chunk of my research early on, my early research was in neuroimaging of pain. It was opening up windows into the brain to see where people were thinking, processing, perceiving, magnifying pain.

And I spent much of that publishing work to understand the mechanisms of that. And we haven't yet actually finished our story of pain going up to the brain and what's going on. And we'll get there. Over the years, I migrated into the space of developing objective biomarkers of pain. So I love working with young, smart people. I bet against it.

And I spent much of that publishing work to understand the mechanisms of that. And we haven't yet actually finished our story of pain going up to the brain and what's going on. And we'll get there. Over the years, I migrated into the space of developing objective biomarkers of pain. So I love working with young, smart people. I bet against it.