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Dr. Sean Mackey Shares Tools to Manage Chronic Pain on The Huberman Lab Podcast

Struggling with chronic pain? Discover what causes pain and how to manage it holistically.
Sean Mackey and Andrew Huberman sitting at a table in a recording studio.
Neuroscientist and podcast host Andrew Huberman hopes this episode will help people understand, manage, and control their pain as well as the pain of others. Image credit: Mike Blabac

In a recent Huberman Lab podcast, Sean Mackey, the Redlich Professor and professor of anesthesiology, perioperative and pain medicine and Chief of the Division of Pain Medicine at Stanford School of Medicine took a deep and broad dive into all things pain: what pain is, what it isn’t, pain management tips, and more. The physician’s clinical and research efforts are also explored, which focus on using advanced neurosciences, patient outcomes, biomarkers, and informatics to treat pain. 

Podcast host Andrew Huberman hopes this episode will help people understand, manage, and control their pain as well as the pain of others. Below is a condensed snapshot of their conversation.

What is chronic pain, and what causes it?

Most people are familiar with the notion of pain from having a physical injury or a headache, but Mackey says the concept of pain is riddled with misunderstanding. So, what is pain really? 

“Pain is this complex and subjective experience that serves a crucial role for all of us to keep us away from injury or harm,” the Redlich professor says. “It is both a sensory and an emotional experience.”

Mackey says the emotional component of pain is lost on people, adding that each person’s pain is completely different. Huberman also brought this key question to the conversation: is pain in people’s brains, bodies, or both? 

Pain is clearly in our brain, Mackey says.

Most pain all starts with some stimulus, whether it be that kink in your neck or your shoulder—and that stimulus is not pain. Instead, these stimuli are tied to nociceptors, which are sensors in our skin, soft tissue, or deep tissues. Nociception is different from the individual experience of pain that people have, Mackey says. Your emotions, cognitions, memories, and actions create a unique pain experience that's different from everybody else's. 

Actual pain is a much more subjective experience. We naturally assume others experience pain the way we do, but their experience is likely very different from our own. Noting pain’s idiosyncratic nature can help us avoid projecting our own experiences with pain onto others. 

Chronic pain and mental health

At the Stanford Pain Management Center, Mackey and his clinical staff promote a philosophy of treating the whole person without distinguishing between psychological pain and physical pain. In his book, differentiating between types of pain leads to putting value judgements on people.

“I don't think it serves us well when we're caring for the person in front of us,” he says. “If they're in pain, I'm addressing the pain.”

Sean Mackey smiling in a black and white photo
Dr. Sean Mackey. Image credit: Mike Blabac

Pain treatment becomes much more complex when anxiety or depression enters the mix, though. Getting angry or catastrophizing can worsen pain significantly.

It goes without saying that managing mental health is key for chronic pain management. Practicing mindfulness can help people address their pain in a non-judgmental, accepting manner. 

“Tell yourself, ‘I'm aware the pain is there, and I am not going to judge it,’ Mackey recommends. ‘I'm not going to put a value on whether it's bad or good. I'm just going to note its presence.’”

Mackey says this kind of self-talk is a direct cognitive reframing about the meaning of the pain. You’re actively considering if the pain is really harming you, or if it just hurts. This practice also serves as a foundation for cognitive behavioral therapy.

Tips for coping with chronic pain

Mackey’s most critical tip for overall pain management is to understand the difference between hurt and harm. To do that, you may consider questions like: “Is this pain something I need to seek medical attention for now or sometime soon? Does continued activity worsen my injury?”

Usually, there’s nothing sinister causing damage. It's more likely that the pain is merely persisting beyond the time of tissue healing, which is treated holistically. Mackey and Huberman discussed six treatment types people can use to cope with chronic pain.

6 treatments for chronic pain

1. Medications

There are over 200 medications available for pain management, ranging from over-the-counter agents to prescription drugs. Examples include NSAIDs like ibuprofen and Naprosyn.

2. Psychological and Behavioral Therapies 

Pain psychology can effectively manage chronic pain. Mackey says it’s key to “meet the pain.” He is a big advocate for Mindfulness Based Stress Reduction (MBSR) in particular, emphasizing that it’s been effective for anxiety, depression, and pain.

3. Physical and Occupational Therapy

These therapies are crucial in improving quality of life and physical functioning. They can help with goal setting, pacing, strength, body mechanics, and endurance.

4. Complementary Alternative Medicine Approaches 

This includes practices like acupuncture and nutraceuticals, or supplements.

5. Self-Empowerment or Increasing Your Agency

This involves education, learning skills, and self-empowerment. The best results typically come from a combination of these six approaches, while the effectiveness of each treatment varies from person to person. 

6. Nerve Blocks and Procedures

These can range from trigger point injections to minimally invasive procedures like spinal cord stimulators and implantation of drug delivery pumps.

A vision for the future of pain care

In addition to his clinical and research work, Mackey also hopes to support those with chronic pain through policy. 

Sean Mackey sitting in the recording studio with a pensive expression.
Dr. Sean Mackey. Image credit: Mike Blabac

A few years ago, he co-led the development of the National Pain Strategy for the United States with the NIH’s Dr. Linda Porter. They brought together 80 national experts in pain research, pain clinical care, pain policy, and people with lived experience with pain. The plan sought to enact a cultural transformation, changing how clinicians assess care for people with pain, how to educate professionals, and how clinicians communicate with the public.

Mackey hopes the National Pain Strategy will be fully implemented in the future, which took a backseat due to being released at the same time as the CDC opioid guidelines.

“It's non-controversial, nonpartisan,” Mackey says of the plan. “It’s motherhood and apple pie. If we just actually implement what we put forward, it'll make a huge difference in the lives of people living with pain.”

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