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]

@hoss_tagge Cannabis and cocaine too

[Ajay Manhapra @AjayManhapra]

@gavinnixon7 No mostly anxiety

[Ajay Manhapra @AjayManhapra]

Only 5% of people who present to hospital with chest has something like a heart attack or PE. The rest get better by themselves in a day or two.

[Gavin Nixon D.O. @gavinnixon7]

"Acute low back pain" is a diagnosis in the same way "chest pain" is a diagnosis.
It's true, and it tells you nothing. It names a location and a duration, not a pain generator: disc, facet joint, SI joint, endplate, muscle, nerve root. Imagine walking into an ER with crushing chest pain and being told "acute chest pain, rest and ibuprofen." Nobody would accept that, because we know chest pain could be a heart attack, a clot in the lung, a torn aorta, or reflux. Back pain has just as many sources, yet we label 90% of it "nonspecific" and send people home.
A diagnosis that can't change the treatment isn't a diagnosis. It's a shrug

[Ajay Manhapra @AjayManhapra]

What?!!! I got to go back to med school to learn how to palpate the lower cervical disc?!!!😃

[John McFadden, M.D. @drjohnhaiti]

@Retlouping Pain in the neck and trapezius area is often from a cervical disc. Are students being taught to palpate the lower cervical discs?

[Ajay Manhapra @AjayManhapra]

Mathew Perry understood his lived experience and was talking about it with the language he had. What he is calling as “allergy of the body” is the opponent effect which is a homeostatic adaptation to the effect of alcohol and not alcohol. Hitchens was ignorant and dickish

[James Spiro @JamesSpiro]

This exchange was the first time I had listened to Peter Hitchens, who at the time I thought was obnoxious, naive, and insensitive.

13 years later my view has completely reversed. Of course he is correct.

I didn’t notice how much Perry was already slurring his words here, and relying on anecdotal evidence to defend his inability to control his actions.

Sadly it cost him his life.

[Ajay Manhapra @AjayManhapra]

@marklewismd It’s just a car that farted a not strong that it stayed up for few seconds. 😆

[EP Lab Digest @EPLabDigest]

After failed PFA, how much ablation is too much? In a 2026 @westernafib roundtable, @rranjanMD urged EPs to think beyond lesion sets: eliminating AFib matters, but so does preserving atrial function.

Join #WAFIB2027, Feb 25–27! https://t.co/ATabxMhpqF
@nmarrouche

[Ajay Manhapra @AjayManhapra]

@JPDeAquinoMD @APAPubJournals @IsmenePetrakis @YalePsych @Gabriel_PACosta @YaleADM That link for the manuscript is not working
Can you send me the correct one please

[Ajay Manhapra @AjayManhapra]

@sanilrege Then there’s the issue of self fulfilling prophecy after being diagnosed with ADHD

[Dr Joanna Moncrieff @joannamoncrieff]

Neurologist, Suzanne O'Sullivan on how giving a diagnosis such as ADHD is not a neutral act. It may look like a solution, but it defines people 'by what they cannot do...lowers ambitions' and stops people from learning how to manage everyday challenges. https://t.co/DArDhcJ0ai

[Ajay Manhapra @AjayManhapra]

@sanilrege Agree, but individual risk benefit analysis rarely happens in practice and the risk benefit analysis process is rarely defined in guidelines as with opioids. So everyone has their own method. Worsening of ADHD symptoms due to addictive properties is rarely mentioned as risk

[Ajay Manhapra @AjayManhapra]

@GregLehman @DerekGriffin86 Framingham data mostly. It’s a well established fact. Inflammatory mediators are part of normal tissues. Inflammation is absent. Structural changes can cause pain but is not the reason for pain in CP syndromes where pain is not a symptom of a physical disease

[Ajay Manhapra @AjayManhapra]

@GregLehman @DerekGriffin86 The prevalence of mod to severe pain is about 50% in PTSD, 35% in any psych disorder and 25% in SUD. None of it is explained by physical diseases. Is OA or mental illness a more likely “cause” of chronic pain? Makes one wonder

[Ajay Manhapra @AjayManhapra]

@GregLehman @DerekGriffin86 In X-ray proven SEVERE “OA”, prevalence of any pain is about 20%. That means about 5% have moderate to severe pain that requires treatment and 95% don’t. The “itis” in osteoarthritis indicates inflammation which is absent in most. You tell me how the “OA” causes pain.

[Ajay Manhapra @AjayManhapra]

The practice of medicine is to help the patient make sense of their lived experience and thus help them to change it to a better experience, using available scientific knowledge and skills

[Phillip Kirschberg @RushmoreExt23]

"Rethinking Lived Experience" via @TheLancet
https://t.co/9JqNjJSSTM

[Ajay Manhapra @AjayManhapra]

Looks like brain surgeon must learn difference between correlation and causation

[Doctor Wizzy @DoctorWizzy]

Simple habits like quality sleep, strength training, socialising, and learning new skills support overall well-being.

[Ajay Manhapra @AjayManhapra]

Patient outrage re: antidepressant withdrawals is understandable. But, why do clinicians/experts act surprised as if this a new discovery??!! Withdrawals are normal expected responses when long term stimulation of reward/motivation system with any intervention is suddenly stopped

[Christopher Lane Author @christophlane]

The whitewashing of Paxil withdrawal was not so different from the whitewashing of withdrawal from all SSRIs.

In the archive, you can see the language being softened, the timelines shortened, the dependence reframed.

Paxil was where that tactic was perfected. Not where it ended.

The newly searchable archive makes that pattern visible across files. Explore at https://t.co/NirRgVNIWH

#PaxilPapers #SSRIs #ChristopherLane

[Ajay Manhapra @AjayManhapra]

There goes another myth in pain

[Nature Portfolio @NaturePortfolio]

Pain may not increase linearly with age, with the sharpest rises occurring before the age of 55, according to a global analysis of more than 6 million people published in Nature Medicine. https://t.co/mZHV1nvpQs

[Harlan Krumholz @hmkyale]

We don't ask whether a model touched their prose. We ask authors to own every word.

@JACCJournals parted w/ICMJE & doesn't require disclosure of AI writing help: the rule is unenforceable, biased, & not good for medical communication.

My Editor's Page: https://t.co/veMMajWOzJ