The Art and Science of Easing Pain with Abdul-Ghaaliq Lalkhen, MD
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Why is context essential to understanding physical pain?
At the Nocturinous, we are careful to ensure that all stories comply with healthcare privacy laws. Details may have been changed to ensure patient confidentiality. All views expressed are those of the person speaking and not their employer.
Support for the Nocturnist comes from the California Medical Association. To learn more about the CMA, visit cmadocs.org. Support for the Nocturnist also comes from the Patrick J. McGovern Foundation. You're listening to the Nocturne's Conversations. I'm Emily Silverman. All of us have experienced physical pain at some point in our lives. We've scraped a knee, we've gotten a headache, we've thrown out our back. Yet many of us are unaware of how essential context is to the pain experience. Failure to grasp the complex nature of pain can sometimes lead to harm, especially in medicine, and nowhere is that more evident than in the treatment of those with chronic pain. How is it that something so core to being human can remain such a mystery?
Joining me to unravel some of these complexities is Dr. Abdul Khalik Lalkin. An anesthesiologist and author of An Anatomy of Pain How the Body and the Mind Experience and Endure Physical Suffering.
I am sitting here with Doctor Abdul Lulkin. Abdul, thank you so much for coming on to the Nocturnist to talk about your book.
Thank you very much for having me, Emily. It's a pleasure to be here this afternoon.
I loved this book. Thank you for writing it. I think it's gonna be such a rich conversation. Tell us a little bit about your path to anesthesiology and pain medicine.
I grew up uh surrounded by doctors. Um my dad's a GP, um his sister is a midwife, his older sister is a GP, her children are doctors. Um there we have pathologists and psychiatrists in the family, so I followed in the family tradition and I went to medical school. The most fun course I did at medical school was the first six months where you could choose to do something in the humanities and I did a six month course in comparative religion. And I have to say that intellectually that was probably the best and most challenging aspect of going to medical school.
How did Dr. Lalkhen’s early life and medical training shape his view of pain?
But I think what I like the most is That you could just help people at a very basic level. And when I finished medical school it was quite a turbulent time in South Africa, which is where I'm from originally. So we were transitioning from the apartheid government President Mandela had just been freed. So this was the early nineties. Um, there was a real effort to change the way that had been done from the past where Really, if you had a particular colour skin, then you were given the jobs in the hospitals in the city um where you grew up that was near the beach and if you were of a slightly different colour and a darker shade you got sent to other places. So they wanted to change that system, so it became quite random.
And as part of that random process I got sent to quite a rural part of South Africa. In retrospect, clinically it was probably the happiest year I've ever had. We used to walk um to work in the mornings, and you can imagine miles and miles of unspoilt bush. And the first thing you would hear in the morning is the sound of singing as the nurses sang their morning prayers. For the second year I came back to Cape Town, which was the complete opposite really. It was quite horrible. You know, gang violence, the consequences of first world illnesses, hypertension, diabetes. And I think I think I kinda broke a little bit during that year and I kinda decided that I couldn't see a way forward for myself clinically in South Africa.
At that point I wasn't white enough and I wasn't black enough and so I kinda felt that I'd fallen in the cracks in terms of career progression and so I effectively ran away from home. And I came to England and I started in anaesthetics and anesthesiology, I suppose, as most um Americans would would know it. And I quite liked anesthesiology. It's very controlled. I quite enjoyed it for a while and Then I worked in critical care or intensive care, but I didn't like the fact that that you know, the mortality rate was really high and I I suppose at this point your listeners are probably thinking, Oh god, this guy should definitely not have become a doctor but
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Chapters
8 chapters
1
Why is context essential to understanding physical pain?
0:00–2:28
2
How did Dr. Lalkhen’s early life and medical training shape his view of pain?
2:28–7:03
3
What led Dr. Lalkhen to specialize in pain medicine instead of intensive‑care?
7:03–13:20
4
How does the brain‑spinal cord “gate” model explain chronic pain?
13:20–21:14
5
Why are opioids rarely the best solution for chronic pain patients?
21:14–31:05
6
What is the role of “Carpman’s drama triangle” in pain‑clinic consultations?
31:05–41:48
7
How can spinal‑cord stimulation and other neuromodulation techniques relieve neuropathic pain?
41:48–44:17
8
What societal and philosophical changes does Dr. Lalkhen suggest to reduce chronic‑pain suffering?
44:17–45:40