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.
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Now, imagine if you're doing that day after day after day and not getting sleep. That really messes up your central nervous system and that modulation around pain. What happens is it changes your set point and it impairs that prefrontal cortex and its ability to modulate pain. When you went through, Peter, your bad episode of back pain, did it impact your sleep?
You're human. That impact on sleep ultimately further amplified your pain. On top of it, how did you feel during that? And outside the pain, how was that affecting your overall life and your thoughts and your emotions? Total disaster.
Yeah. That's a terrible story. And I have to imagine one that has probably shaped you moving forward and had a big impact on your life and what you've been doing.
Yeah. Well, I hope we can come back to that and talk about it more and the influence of all this other stuff that was probably contributing to your experience of pain and the bad stuff going on as a consequence of it. And it plays a role in everybody else's life out there. And I think there's some key messages there. What would you like to segue to?
These medications are cyclooxygenase inhibitors. What they do is a couple of things. They reduce some of the inflammation. They're anti-inflammatories. So I was alluding very briefly that there are substances that can be released down in the periphery during injury that wind up that nociceptor and amplify it. Prostaglandins, histamines, cytokines, interleukins, all of that.
This inflammatory soup that occurs after every single surgery, every single injury that we experience. You get this inflammatory soup, and it's classically mediated by swelling, redness, temperature increases, and aspirin and a COX-2 inhibitor NSAIDs do a nice job in reducing that inflammation. Now,
This is where medical science, you're going to probably be much more informed than I am on this, but medical science has been slowly shifting in its view of this. We have historically thought, take these medications in an acute injury, it knocks down that inflammation, and all is well and good.
Well, some of the data was coming out in the orthopedic literature decades ago that people who were taking NSAIDs during total joint replacements were getting non-fusion of that joint to the bone. They were getting failures.
And then more recently, there's been some question as to whether knocking down the inflammation is a good thing after all, that maybe that inflammation is part of the healing process. And that by giving an NSAID aspirin, we're delaying the natural healing effect and causing more problems. So where's the truth? This is tough. One, I don't think we have the whole story yet on the NSAIDs.
Two, I'm a gray guy, meaning I don't live in black and white. And I'm also appreciated that every medical field has their own lens that they look at in the world.
And I think we have to appreciate the complexity of the patient, meaning if it's perhaps something minor and they can get by without the NSAID and it's not going to change significantly their level of function, then maybe not taking it will improve healing. They can't get out of bed. They can't go to work.
but a naperson helps them to do that thing so that they can engage with their family, with their friends, with work, well then, heck yes, take the NSAID if it's helping with that level of functional improvement.
A little of both. But I think through chronic pain, we start to introduce all the longer-term negative consequences of this. Impact on blood pressure, your heart, impact on your kidneys with long-term NSAIDs, particularly if you're older. I remember, I think it was in your book, you took Vioxx. Yes. I loved Vioxx.
I stockpiled it. I wish I did. I called up all the drug reps I knew because they couldn't like give it out. And I'm like, can you just hook me up? So I ran out a stockpile of that for a long time and cut this if it's too tangential, but Every field looks at the problem through their own lens. Here, you had a drug that was causing heart attacks.
Stop using the 50 milligrams. Use the 25s. And you're right. Don't give it to insusceptible people.
We all do this. We look at the world through our own particular field. It's like with the latest blood pressure guidelines, the cardiologists want it really low, but it screws up the kidneys. And well, the cardiologists say, save the heart, screw the kidney. So great drug. Wish it was still around.
So NSAIDs nuance around taking the verdict.
Make sure.
Food in the stomach, fluids. If you're either older, you've got kidney issues, you've got GI issues, talk to your doc first. Don't just go into this stuff blindly.
I mean, the ERs see people with acetaminophen, Tylenol overdoses, and it's a cause of, well, you know this. Liver failure.
Showing 141–160 of 373 · page 8 of 19
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