Chronic pain: pathways, treatment, and the path to physical and psychological recovery | Sean Mackey, M.D., Ph.D.

**Peter Attia** (0:11)
Hey, everyone, welcome to the Drive podcast. I'm your host, Peter Attia. This podcast, my website and my weekly newsletter all focus on the goal of translating the science of longevity into something accessible for everyone. Our goal is to provide the best content in health and wellness, and we've established a great team of analysts to make this happen. It is extremely important to me to provide all of this content without relying on paid ads. To do this, our work is made entirely possible by our members, and in return, we offer exclusive member-only content and benefits above and beyond what is available for free. If you want to take your knowledge of this space to the next level, it's our goal to ensure members get back much more than the price of a subscription. If you want to learn more about the benefits of our premium membership, head over to peterattiamd.com/subscribe. I guess this week is Dr. Sean Mackey. Sean is a professor of pain medicine at Stanford University. He also serves as the director of the Stanford Systems Neuroscience and Pain Lab. His research focuses on the neural mechanisms of pain and the development of innovative treatments for chronic pain conditions. In this episode, I talk a little bit about how Sean and I go way back and why it is that I really wanted to have Sean on this episode. In this episode, we discuss the definition of pain as both a sensory and an emotional experience and why it is fundamental as a survival mechanism and the evolutionary purpose of pain, which obviously has been highly conserved across multiple species. We talk about how pain is transmitted through the nervous system, including the different types of fibers that are involved. Talk about the different types of pain, such as nociceptive pain, visceral pain, neuropathic pain, etc. We talk about why pain perception varies so widely from person to person, even in the face of an identical stimulus, how psychological and emotional factors play a role into this. Talk about various approaches to pain management, including NSAIDs, opioids, and anti-neuropathic medications. We talk about the effectiveness of neuromodulation techniques like TENS, and how sleep deprivation affects pain sensitivity, as well as why chronic pain often leads to disrupted sleep cycles. We talk about this and many other things. Again, I share a very personal experience with my own pain and how Sean came to my rescue 25 years ago. So without further delay, please enjoy my conversation with Dr. Sean Mackey.
Sean, thank you so much for making the trip to Austin.

**Sean Mackey** (2:42)
Oh, it's my pleasure. It's really good to see you again after a rather long time.

**Peter Attia** (2:47)
Yeah, I was thinking about it. So this morning, my wife said, oh, what's the topic of the podcast today? And I said, it's going to be pain. And I said, she said, oh, who you have? And I said, Sean Mackey, she goes, her face lit up and she doesn't know you. She's never met you, but she knows your name because she's heard me tell a story. She's heard me tell a story about my own experience through this. I then realized something, which is I haven't seen you since I was in medical school. Yeah. Which is weird.

**Sean Mackey** (3:11)
Yeah.

**Peter Attia** (3:11)
So I'm sure we will get to how you and I met 25 years ago, exactly 25 years ago. Wow. And how you played an unbelievable role in bringing me back from arguably the brink of what could have been the end of my life truthfully. But I want to start with some broader topics around pain. So there's nobody listening to us right now who doesn't know what pain is. There's nobody listening to us right now who hasn't experienced pain. Yet, if you ask for a definition of pain, I think you'd get a lot of using the word to describe the thing, which isn't truly a definition. So if you were trying to explain to a Martian from another planet who doesn't experience pain, what it is, what would you say?

**Sean Mackey** (3:57)
There's the formal definition of pain, which is defined as an unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage. It's a mouthful. If you think of it as it's an unpleasant sensory and emotional experience, it's usually tied to something physically happening, but may not be. I think sometimes what's missing in that definition, one of the things I wish they had put in but never did, is that pain is the great motivator. Pain is one of the most primitive experiences going back to, if you will, single cell organisms. It's either pain or reward. You're either being driven towards oxygen, food, sex, or you're trying to get away from danger.