Understanding Pain: Origins, Mechanisms, and Treatment Options

Added: Jan 16, 2024

Defining Pain

Dr. Mackey explains that pain is a complex and subjective experience that serves a crucial role in keeping individuals away from injury or harm. It is both a sensory and emotional experience, and it is highly individualized. Pain can have a significant impact on society, with approximately 100 million Americans experiencing chronic pain, leading to substantial medical expenses.

Origins of Pain

Pain originates from sensory stimuli in the body, such as temperature, pressure, and inflammation, which are detected by nerve fibers called nociceptors. These signals are then transmitted to the brain, where they are processed and integrated with emotional and cognitive factors to create the subjective experience of pain. Dr. Mackey emphasizes the distinction between the sensory signals from the body and the subjective experience of pain in the brain.

Brain Pathways for Pain

While there is no single "pain center" in the brain, pain is represented by a distributed network of brain regions, including the insular cortex, cingulate cortex, and amygdala. These regions contribute to the experience of pain, and ongoing research is uncovering additional brain networks involved in pain processing.

Pain Medications

The discussion delves into the use of pain medications, particularly nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen. These drugs act as anti-inflammatory agents and can reduce sensitization in the body, but they are not technically painkillers. Dr. Mackey emphasizes the importance of balancing the benefits of pain relief with the potential impact on the body's healing process. Individual variability in response to these drugs is also highlighted, with considerations for factors such as stomach irritation and liver function.

Mechanical Interventions

The conversation touches on mechanical interventions for pain, including the "gate theory" of pain proposed by Melzack and Wall. This theory suggests that rubbing or massaging an injured area can activate neural pathways that reduce the perception of pain. Dr. Mackey acknowledges the role of mechanical interventions in pain management and emphasizes the need for a holistic approach to treatment.

He delves into various mechanistic interventions for pain, including massage, acupuncture, and the use of heat and cold. He explains that these interventions can have chemical consequences on the nervous system, affecting the transmission of pain signals. He emphasizes the importance of understanding the neural pathways involved in pain modulation and how different interventions can impact these pathways.

Pain Thresholds and Gender Differences

The discussion then shifts to pain thresholds and gender differences in pain perception. Dr. Mackey explains that men generally have higher pain thresholds than women, but individual variability within each gender is significant. He highlights the role of psychological factors, early life experiences, and anxiety in shaping pain thresholds. He also addresses the impact of social and cultural influences on pain perception.

The Use of Heat and Cold for Pain Management

Dr. Mackey provides insights into the use of heat and cold for pain management. He explains that cold can reduce inflammation and slow down nerve signals, while heat increases blood flow and relaxes muscles. He emphasizes the importance of using these interventions within safe limits and based on individual preferences. He also discusses the potential benefits of cognitive training and exercise in changing pain thresholds over time.

Meeting the Pain and Cognitive Approaches

The podcast explores the concept of meeting the pain versus distracting oneself from the pain. Dr. Mackey discusses attentional distraction and the engagement of specific brain networks in reducing pain perception. He also highlights the role of mindfulness-based approaches, such as non-judgmental acceptance of pain, in managing chronic pain. Additionally, he emphasizes the importance of cognitive reframing and cognitive behavioral therapy in addressing the meaning of pain and reducing catastrophizing.

Understanding Pain and Injury

Dr. Mackey emphasizes the importance of understanding the difference between being hurt and being injured. He shares personal experiences from sports and highlights the anxiety that arises when determining the severity of pain and potential injury. He discusses the significance of distinguishing between temporary pain and actual tissue damage, as well as the role of cognitive appraisal in managing pain and injury.

Understanding Different Types of Pain

Dr. Mackey explains the different types of pain, including somatic pain, visceral pain, and neuropathic pain. Somatic pain refers to pain from injuries to the body's surface, while visceral pain originates from the internal organs. Neuropathic pain results from damage to the nerves and can manifest as shooting, stabbing, or burning sensations. He also discusses referred pain, where pain is felt in a different location from the actual source of the problem, such as in the case of a bulging disc causing pain in the hip and leg.

The Role of Nutrition in Pain Management

The conversation shifts to the role of nutrition in pain management. Dr. Mackey shares his personal experience of developing abdominal pain after a bout of food poisoning, which led to an intolerance to foods in the onion family. He emphasizes the importance of identifying triggers through an elimination diet and the impact of nutrition on pain. He also mentions the potential for microbiome characterization to further understand the relationship between food sensitivities and pain.

The Influence of Psychological Factors on Pain

Dr. Mackey delves into the influence of psychological factors on pain, particularly the concept of hurt versus harm. He explains how chronic stress and emotional distress can contribute to the experience of pain, citing examples of people experiencing back pain or headaches due to stressful job or relationship situations. He highlights the interconnectedness of psychological and physical pain, emphasizing the need to address stressors and emotional well-being in pain management.

The Power of Love in Pain Relief

The podcast explores the fascinating study conducted by Dr. Mackey and his colleagues on the impact of romantic love on pain perception. They recruited couples in the early phase of a romantic relationship and measured their response to pain while viewing pictures of their beloved. The study found that thinking about their partner significantly reduced the participants' experience of pain, with the level of pain relief correlating with the intensity of their passionate love.

Endogenous Opioids and Prescription Opioids

Dr. Mackey explains the concept of endogenous opioids, which are natural substances in the body that act as painkillers. He also discusses the use of prescription opioids, such as morphine, oxycodone, and fentanyl, in pain management. He emphasizes the need for a nuanced approach to opioid use, acknowledging both the positive and negative effects of these medications. He also addresses the overprescription of opioids and the challenges faced by physicians in managing pain effectively.

Katum and Cannabis

The discussion shifts to katum, a natural substance with opioid-like properties, and its use in managing pain. Dr. Mackey acknowledges the anecdotal evidence of katum helping individuals reduce their reliance on prescription opioids but highlights the need for further research to understand its safety and effectiveness. He also addresses the controversy surrounding cannabis and its potential role in pain management. Dr. Mackey advocates for more research on cannabis and suggests reclassifying it to facilitate scientific studies.

Biological and Psychological Aspects

Dr. Mackey explains that pain is a complex and adaptive response that serves as a protective mechanism for the body. He describes the biological processes involved in pain signaling, including the transmission of pain signals from the periphery to the brain. He also highlights the role of psychological factors in shaping the experience of pain, such as emotional processing and coping strategies. Dr. Mackey emphasizes the need to address both the biological and psychological aspects of pain in order to effectively manage and treat it.

Acupuncture and Chiropractic Care

Dr. Mackey discusses the potential benefits of acupuncture and chiropractic care in managing pain. He explains that acupuncture has been shown to engage different brain regions and may have a central effect on pain modulation. He also acknowledges the potential benefits of chiropractic care for certain types of pain, particularly low back pain. However, he emphasizes the importance of seeking high-quality practitioners and being cautious about potential risks associated with these treatments.

Role of Physical Therapists in Pain Management

Dr. Mackey highlights the crucial role of physical therapists in the treatment of chronic pain. He emphasizes the importance of physical rehabilitation and functional approaches to pain management. He discusses the concept of pacing, which involves setting small goals and gradually increasing activity levels to avoid the negative cycle of overexertion and subsequent inactivity. He emphasizes the need for collaboration between different healthcare providers, including physical therapists, to develop comprehensive and individualized treatment plans for people with chronic pain.

Non-Prescription Compounds and Supplements

Dr. Mackey discusses the potential benefits of non-prescription compounds and supplements in managing pain. He highlights several over-the-counter agents, such as acetyl-L-carnitine, alpha-lipoic acid, and fish oil, that have been shown to have positive effects on pain conditions. He emphasizes the importance of understanding the potential side effects and interactions of these compounds and advises individuals to seek education and guidance before using them. Dr. Mackey acknowledges the potential of supplements in providing additional support for pain management, particularly when used in conjunction with other treatment modalities.

Psychological Treatments for Pain

Dr. Mackey emphasizes the importance of psychological treatments in managing pain. He discusses the role of pain psychologists and behavioral therapists in teaching skills such as cognitive behavioral therapy, mindfulness-based stress reduction, and acceptance and commitment therapy. He highlights the importance of addressing maladaptive thought patterns and coping strategies related to pain.