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.
Trend
recordings per month · last 12 monthsNo recordings in the last 12 months.Older appearances are listed below; set an alert to hear about the next one.
Appearances
And these systems, the prefrontal cortex, the insular cortex, the cingulate cortex, all have those descending projections back down to the spinal cord. So we talked about the gait control theory of pain in the context of rubbing your finger out here, a peripheral neuromodulation. Where it really comes into play is when you introduce brain systems.
The brain and your emotions, your cognitions, your beliefs, your early history, And that influence on pain, that's where it gets really exciting. And that's sending descending pathways down. So I would argue, in part, that your experience of cold water in that moment may have been driven in large part by your mental state before you got in.
And maybe we'll talk more about the intersection of sleep and pain. Huge research in that space. Your state of anxiety, apprehension around this, all sorts of cognitive emotional aspects weigh into your experience of pain. And yes, there's also circadian rhythm aspects related to this from hour to hour fluctuations. But those individual differences are fascinating.
And that is also an area that our group and others, our lab and others are going into is recognizing that one pain score averaged over a week may not give us a lot of information that we need to take into account the within subject, within person daily variations over time and model that.
Yeah. Yeah. That's what society values. That was my home life growing up. That's what my father expected. I come from a very working class. My father had 12 brothers and sisters fighting for whatever scraps of food. And he brought that into my world, our world as kids. And you just suck it up and deal with it. And my father had back pain later in life.
And he would never talk about it, would never ask my opinion. And when I offered my opinion, he would never follow it. Had bad consequences in the end. But we value that. That is just the way our society is. Is that a male thing exclusively? I think you need to get some women on the show and ask them. I think it crosses, actually. I do think there is a masculinity aspects of that.
And I think I could be wrong here. I think that that thing is also attractive for women. I think there's a certain attractiveness because that person may be more likely to be a good provider than somebody who is weak and sensitive. But we're getting a little out of my wheelhouse on that. But you're absolutely right.
My fiance, we're now engaged, is a professor at Stanford, Beth Darnell. She's an ex-ultra marathon runner. And I've always admired the fact that she can sit there in front of a computer or work on something untold hours and not move. And she's just like, listen, I was really good with running with a pebble in my shoe, putting one foot after another and just working my way through it.
And I similarly grew up in an environment where you learn to be tough and you learn to power through life's adversities.
As with all things, it gets a little bit more nuanced. We talked about cold, for instance. It turns out that some of the sensitivities are modality specific.
Somebody who runs a paint lab. I've had everything done to me imaginable. I take heat really well. My son, Ian, takes heat really well. I've had thermal devices on me where I've been there and ended up with second-degree burns to find my 7 out of 10. I hate the cold. I hate it. I'm a wuss when it comes to the cold. So I live in California. I lived in Arizona.
I think there are genetic aspects of this. So we have to be mindful modality specific. On top of it, these experimental protocols probably have little bearing on somebody's experience of chronic pain.
This is now where we move out of that Descartesian model. We appreciate the role of the brain and its modulatory capacity, its ability to turn the amplifier down. And so if you're thinking about a stereo amplifier, we talked about how some people to a certain stimulus might be a zero or one on the dial, some might be a 10.
But what we didn't talk about are people's capacity to now manage their pain, cope with their pain, their level of self-efficacy around their pain. Athletes learn how to manage their pain and suffering. Where they run into problems is when the sports are over. They're retired. That's when I see them. So there are many factors that predict how well somebody is going to do with chronic pain.
They align with a lot of the stuff in your book. So the level of a person's self-efficacy plays a role. There is the presence or absence of whether they've got underlying depression, anger, anxiety, something called catastrophizing. Terrible word, very important concept, probably one of the most predictive of amplified pain.
Yes. One of the biggest predictors of diabetic neuropathic pain is glucose control. So one of the first things we do if we have a person with diabetic neuropathy, which the diabetes, the high blood sugar, as you know much better than I, causes injury to those nociceptive fibers and also causes injury to the A-beta inhibitory fibers. That correlates with glucose control by way of example.
Diet plays a role because if you're eating things that are causing inflammation, we didn't talk about all of this stuff. that amplifies or winds up those peripheral nociceptors. We treated those as a static thing when they're not. They're dynamic. So in the face of inflammation, that causes something called peripheral sensitization.
You've turned up the amplifier on that nociceptor in the periphery. Sleep, huge topic.
We're both out of residency long enough, but we both pulled our old-nighters. How did you feel the next day?
It's a haze, and you're just powering your way through it. And if you think about it, you're kind of feeling a little achy all over. Now, it's not that because of lack of sleep, something has changed in your muscles. I don't think there's good evidence for that. What has changed... is your set point in your brain and your spinal cord for the perception of pain. You feel like crap.
Showing 121–140 of 373 · page 7 of 19
← Previous
Next →