Ajay Manhapra

Specialist in recovering people with pain, NOT A PAIN SPECIALIST. People with pain have a lot more than pain and I’m interested in the other things!

[Ajay Manhapra @AjayManhapra]

Our new manuscript- Free download: https://t.co/fuZ9gkZICm
Is psychiatric diagnostic remission associated with reduced prevalence of moderate to severe pain interference (PI) and improved functioning ....?

Yes! PI ⬇️es from 35% ➡️ 22%- Remarkable!!
A 🧵
https://t.co/S7p1PVg0Qh

[Ajay Manhapra @AjayManhapra]

Why do we do steroid injections for knee pain? Somebody explain …..
Results of Large Multi-Site Pragmatic Clinical Trial Comparing Corticosteroids or Blinded Lidocaine-only Injections in Treating Osteoarthritis of the Knee https://t.co/Zo3OvJ5s7V

[Ajay Manhapra @AjayManhapra]

@AsafKlaf Which part? The chronic primary pain or non-specific pain

[Ajay Manhapra @AjayManhapra]

@AsafKlaf Chronic primary pain has clear diagnostic criteria and has no mechanistic assumptions whereas “non-specific” pain has no clear definition but has implied mechanisms involved in it which is not nociceptive or neuropathic

[Ajay Manhapra @AjayManhapra]

@AsafKlaf By definition, nociplastic mechanisms are likely the dominant mechanism in chronic pain. Fear would be a nociplastic driver of pain

[Ajay Manhapra @AjayManhapra]

@AsafKlaf I think you are conflating two different things
Chronic primary and secondary pain diagnoses are agnostic of mechanisms of pain (fear, nociceptive etc). It’s just based on symptoms and history. In both, pain is considered a disease of its own and not a symptom of other diseases

[Ajay Manhapra @AjayManhapra]

@AsafKlaf @alvaropint BPS means that the sensation of pain is experienced by the person and not by just an organ. So, several factors that affect the whole person beyond what affects the organ are contributing to the knee pain. These factors can be grouped into sense making categories- BPS
That’s it!

[Ajay Manhapra @AjayManhapra]

@AsafKlaf @alvaropint I think you’re so pain sensation focused that you don’t see the person with pain sensation or other coexisting sensations.

[Ajay Manhapra @AjayManhapra]

@GhanaboyPharmd Congrats

[Ajay Manhapra @AjayManhapra]

@AsafKlaf @alvaropint The figure on right is what our patients describe as “pain”- a complex experience of pain, several non-pain symptoms, distress, debility, and all the mess in their life. What’s studied in lab is just a response to nociceptive stimulus, a type of this complex experience

[Ajay Manhapra @AjayManhapra]

@AsafKlaf @alvaropint They’re great scientific discoveries pertaining to pain but don’t matter much in treating people with chronic pain, at least for now

[Ajay Manhapra @AjayManhapra]

@AsafKlaf @JohnWarePT I am guessing you mean whole person perspective. I don’t know what you mean by holism.
A whole lot if we are treating patients but not so in labs. There’s a huge difference between treating a patient with pain and treating pain.

[Ajay Manhapra @AjayManhapra]

@AsafKlaf @alvaropint Maybe this works in lab
It definitely does not work in clinics

[Ajay Manhapra @AjayManhapra]

@AsafKlaf @JohnWarePT Your reductionism is interesting

[Ajay Manhapra @AjayManhapra]

@ACSHorg @PainNewsNetwork @kirsten_klang @LarsLarsonShow @DrIanWeissman @slsatel @jacobsullum @LIBMedicine @GavinPrestonMD @drjohnhaiti @jacobjamesrich @JamesGierach @yancykm @kevinfolta @BoomertarianN @GeneticLiteracy @RyanMarino @BobTwillman @US_ASP To be fair, the popularity of opioids in chronic pain was established in the opinions of few palliative care doctors without experience in chronic non-cancer pain and support of Purdue. There was not a shred of evidence.

[Ajay Manhapra @AjayManhapra]

Another unhelpful piece in chronic which talks about everything other than IASP accepted science of pain and it’s treatment

https://t.co/djQxadcfHF

[Ajay Manhapra @AjayManhapra]

@AsafKlaf @machall2110 Another way to look at it is that placebo effects modified the illness experience in people with a particular disease but there’s no evidence that it modifies the molecular pathway pathologies

[Ajay Manhapra @AjayManhapra]

@yancykm @kirsten_klang @PainNewsNetwork @ACSHorg @LarsLarsonShow @DrIanWeissman @slsatel @jacobsullum @LIBMedicine @GavinPrestonMD @drjohnhaiti @jacobjamesrich @JamesGierach @kevinfolta @BoomertarianN @GeneticLiteracy @RyanMarino @BobTwillman @US_ASP It’s easy to ascertain opioids as the cause of death among those receiving opioid infusion in death chambers but in real life death among those using opioids therapeutically or non-therapeutically is almost always multifactorial. It’s futile to pin it one thing

[Ajay Manhapra @AjayManhapra]

@PainNewsNetwork @kirsten_klang @ACSHorg @LarsLarsonShow @DrIanWeissman @slsatel @jacobsullum @LIBMedicine @GavinPrestonMD @drjohnhaiti @jacobjamesrich @JamesGierach @yancykm @kevinfolta @BoomertarianN @GeneticLiteracy @RyanMarino @BobTwillman @US_ASP I can’t argue with belief systems that there was no public health emergency emerging in 2013. Most physicians familiar with this problem think that the problem started way before 2012. The events in 2017 was just a downstream consequence of things that started way back.

[Ajay Manhapra @AjayManhapra]

@PardonMyPain @PainPtFightBack @maiasz It’s difficult to experience relief without the involvement of reward system- fact.

[Ajay Manhapra @AjayManhapra]

@yancykm @kirsten_klang @PainNewsNetwork @ACSHorg @LarsLarsonShow @DrIanWeissman @slsatel @jacobsullum @LIBMedicine @GavinPrestonMD @drjohnhaiti @jacobjamesrich @JamesGierach @kevinfolta @BoomertarianN @GeneticLiteracy @RyanMarino @BobTwillman @US_ASP These opinions do not make much sense with awareness of the history of prior opioid crises. It always starts off as one things and transforms into something else that is related but sufficiently different to raise doubts