Ajay Manhapra

Our new manuscript- Free download: authors.elsevier.com/a/1hy6jbXYirDph 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 🧵 sciencedirect.com/science/articl…

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 acrabstracts.org/abstract/resul…

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

@AjayManhapra That is simply wrong what you wrote

Interesting, by now the majority answered NO. This makes one wonder why so many lead researchers in the field of pain field are convinced that the answer is YES?

@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

@AjayManhapra Not conflating anything. Primary pain is non-specific pain, which is the most prevalent form of pain. The logic in the question is not my logic, it is the logic of prominent leaders in the pain field

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

@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

@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!

@AjayManhapra @alvaropint What does Traumatic Brain Injury have to do with what I said? And thanks for the figure that demonstrates how BPS guided thinking has led to ignoring the primal unpleasant sensation at the heart of the experience of pain.

When a patient comes to the doctor and uses the WORD- PAIN -indicating he/she has an unpleasant somatic manifestation(anywhere in the body), the pain is ALWAYS -SPECIFIC -to an activation of the nociceptive apparatus. Sometimes the activation is structurally related, and sometimes the activation itself is the problem. However, it is always SPECIFIC!

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

@GhanaboyPharmd Congrats

10 years!! #anniversary #marriage

@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

@AjayManhapra @alvaropint If so I guess the 2021 Nobel prize for the discovery of PIEZO and TRPV should be returned and the McGill pain questionnaire be discarded

@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

@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.

@AjayManhapra @JohnWarePT How has “holism” advanced pain medicine?

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

@alvaropint Yes

@AsafKlaf @JohnWarePT Your reductionism is interesting

@JohnWarePT This is ironic because the label “non specific” created exactly that. The future if pain relief will be targeted nociceptive modulation based on the understanding of personsl neuro-immune, epigenetic and genetic profiles of patients

@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.

@PainNewsNetwork there’s a reason the hysteria kicked into overdrive in 2017 is #DrDebbieDowell loaded up with millions of taxpayer money aggressively campaigned to have the guidelines implemented in every aspect of the medical system. I’m not surprised @AjayManhapra doesn’t understand the difference between “opinions” and “facts”. All they ever had is strong opinions without a shred of scientific evidence. @Surgeon_General “Turn The Tide” campaign has been completely scrubbed from the web, the link goes straight to a 404. No worries, it’s just more wasted taxpayer money. Now they’re weaponizing DSM V authored by them. More eminence-based slanted theories from the psychiatric fringe claiming it’s proof. Do they have amnesia? I don’t. I remember everything they’ve done and can recognize when they’re starting up the same playbook. What drug “wave” are we on now? 6? 7? Oh, remember Kolodny did have a chance to speak for himself at the SOHO debate with @dr4liberty, he bailed sending another @supportprop member instead. He blocks everyone on social media. I have to @AjayManhapra some credit for interacting, the rest of them are too cowardly to face the people they’ve malicious harmed.

@LarsLarsonShow @DrIanWeissman @slsatel @PainNewsNetwork @JacobSullum @LIBMedicine @GavinPrestonMD @drjohnhaiti @jacobjamesrich @JamesGierach @YancyKm @slsatel  @PainNewsNetwork @jacobjamesrich @kevinfolta @BoomertarianN @GeneticLiteracy  @RyanMarino @BobTwillman @US_ASP @IASPpain @StefanKertesz @maiasz @LynnRWebsterMD #StephenENadeau @TheDailyRemedy  @center4inquiry

Another unhelpful piece in chronic which talks about everything other than IASP accepted science of pain and it’s treatment nytimes.com/2025/01/12/mag…

@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

@machall2110 Supporting the myth? Most evidence on placebo point at an effect on subjective symptoms only. I have yet to have seen someone cured from cancer, Parkinson’s, autoimmune diseases etc from placebo. It’s not a myth

Saying its “a myth” on this one is a huge statement. Where is the evidence refuting this myth?

@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

@AjayManhapra @kirsten_klang @PainNewsNetwork @ACSHorg @LarsLarsonShow @DrIanWeissman @slsatel @jacobsullum @LIBMedicine @GavinPrestonMD @drjohnhaiti @jacobjamesrich @JamesGierach @kevinfolta @BoomertarianN @GeneticLiteracy @RyanMarino @BobTwillman @US_ASP Why did you choose 2012? Because... SAMHSA - 2013 "Deaths involving 𝐩𝐫𝐞𝐬𝐜𝐫𝐢𝐩𝐭𝐢𝐨𝐧 𝐚𝐧𝐝 𝐢𝐥𝐥𝐢𝐜𝐢𝐭 𝐨𝐩𝐢𝐨𝐢𝐝𝐬...data are challenging to analyze and difficult to interpret, and thus form a poor basis for crafting effective responses." tandfonline.com/doi/pdf/10.108…

@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.

@AjayManhapra @kirsten_klang @ACSHorg @LarsLarsonShow @DrIanWeissman @slsatel @jacobsullum @LIBMedicine @GavinPrestonMD @drjohnhaiti @jacobjamesrich @JamesGierach @yancykm @kevinfolta @BoomertarianN @GeneticLiteracy @RyanMarino @BobTwillman @US_ASP There was no "public health emergency" due to opioids of any kind until 2017. That was likely done by HHS to counter the backlash against the 2016 CDC guideline. You really need to check your posts for accuracy before making them.

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

@AjayManhapra @PainPtFightBack @maiasz Well that just makes it sound like all treatment could be described as a "use disorder" making everyone a target for those who stand to profit off such 'disorders'. Relief is much more than the reward system. Sometimes it's just the absence of distress.

yeah, that article made no sense. how can you have an opioid use disorder without misusing opioids? if you aren't misusing them, aren't compulsive, aren't having negative consequences & they relieve pain for you, in what world is that a "disorder"?

@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

@AjayManhapra @kirsten_klang @PainNewsNetwork @ACSHorg @LarsLarsonShow @DrIanWeissman @slsatel @jacobsullum @LIBMedicine @GavinPrestonMD @drjohnhaiti @jacobjamesrich @JamesGierach @kevinfolta @BoomertarianN @GeneticLiteracy @RyanMarino @BobTwillman @US_ASP Yet the huge push against opioid prescribing still happened (down since at least 2012) and these deaths still haven't wavered much. Kinda odd, ya think? x.com/yancykm/status…