Chronic Pain and Sensitisation

What causes chronic pain? In this video, Dr Mike explores the role of peripheral and central sensitization in chronic pain.
Listen to our podcast for more info: podcasts.apple.com/au/podcast...

[@ahmedhaaqilrifky3531]

What great about a teacher like Dr Mike is you have no idea how complicated of a subject you just understood. Only after going back to my lecture note did I understand that this was actually quite complex. Dr Mike made that way too easy to understand.

[@user-yr1cl4ms7e]

I just love the smile he gave at the last second. Also, thank you so much for making this video!

[@amandacrowe5280]

I have been locked in a mental hospital and given electric shock therapy because my "chronic pain" can't be THAT bad, & I should be HAPPY! (I appreciate the educational video & LOVE the effort.)

[@simplynamur7868]

Wow that was an amazing explanation. Learned more in ten minutes than I did in two hours.

[@CanadaBoarding]

Absolutely brilliant way of explaining this subject. You made that incredibly easy to understand. Thank you!!

[@howtomedicate]

What causes chronic pain? And what keeps it present? Questions we are often struggling with, but the pain avoidance model plays an important role for sure!

[@DrMattDrMike]

How to Medicate yes!!

[@rebeccaoconnor9452]

May I ask what the pain avoidance model is please?

[@crispycruiser4654]

@@rebeccaoconnor9452 A pseudoscientific, crackpot theory that claims that patients who had an injury that "healed" are supposedly in pain because of psychological fear of reinjuring, not because the injury simply didn't heal. It is inherently gaslight-y in nature.

[@DavidZechariah]

​@@rebeccaoconnor9452curious myself

[@MyNameisDianaa]

what a legend!! cant thank you enough!! incredible!

[@kiahgrubb2557]

This explanation was incredible - thanks so much!!!

[@rach3288]

This is the type of simple explanations I need! Thank you so much and love your enthusiasm :)

[@loupolitini7917]

you, my friend, are an absolute legend! that explanation was extraordinary! well done doc ;)

[@benjaminfox7105]

G'day discussion Dr Mike! From a simple pain perspective I knew the basics. However, I hadn't really studied chronic pain. This little lecture was enlightening! I still get amazed at the body that so much of it, is all about voltage! hahaha!

[@01-sudershanapauldrjanmenj4]

Sir, You both deserve felicitations and awards from You Tube . Great work sir

[@TimTrevail]

This is a fantastic explanation, thanks for sharing. My only query would be the inference of nociceptors being referred to as 'pain receptors', which seems to be miss-aligned to current research. I believe pain would be a construct of the central nervous system, rather than something stemming from nociception.

[@mohamedorayith4626]

Nociceptors simply send painful signal to the brain to be perceived as pain, i.e. damage or potential damage to tissue :)

[@crispycruiser4654]

Just because it's a "construct" or originates from the central nervous system, doesn't mean that nocicpetive pain originating from tissue pathology isn't legitimate or that it's "in your head"

[@amandab9973]

Thank you so much for helping us better understand this

[@SheshagiriPai]

99% of videos talking about why and how chronic pain occurs. Nobody talks about a solution. Diarrhoea can be stopped by 2 pills. There seems to be definitely more money in pain management pills for the drug manufacturers, as patients suffer for decades.

[@DS-fi4hf]

That’s how the system was designed

[@simonaliolyte126]

Impressive! Thank you for clarity!

[@madband2009]

the best explanation I've heard! cheers

[@alfredchen71]

Great explanation! Really clear and helpful. Thanks a lot.

[@rr-zf6zm]

You are Amazing! PleAse keep making videos like this. Its so helpful, easier to understand!-from a nursing student

[@laurasafont3229]

Brilliant! What a great teacher you are!

[@sherylislip2285]

Such an uplifting video and certainly gives chronic pain sufferers hope

[@EDD519]

NOT !

[@DrRobertFredrickson]

Great information packed explanations! Thank you

[@QuantumJG90]

This is really interesting. I have had chronic back pain for 5 years, and I have been studying pharmaceutical science for 2 semesters part time now. I’m actually really interested in human physiology, and I’m strongly considering going into drug discovery biology. I’ve always been fascinated with the human body, but I did my first human physiology subject, and looking at chronic pain, I’m starting to understand certain terms in better detail. I want to study more human physiology, and will try full-time next semester. I also really enjoy medical or organic chemistry. This made sense to me.

[@Zinnie988]

Do your best to find an relief for womens pain conditions uterine called endometriosis and adenomyosis. There is no pain the world that can be compared to that one! So debilitating!

[@Truerealism747]

@@Zinnie988 check out tms

[@maximumbrand3181]

So clearly explained

[@summerrose9956]

Thank you Dr Mike😍😍

[@alking_am842]

This is incredible!

[@80expertube]

Amazing Enthusiastic Demonstration!

[@nopretribrapture2318]

ive had multiple traumatic experiences mental and physical since early childhood, im now crippled,going to tribunals soon to try and fight the dwp for stopping my disability payments.

[@devinking6477]

Your amazing god bless you sir

[@malinzetterberg05]

also fantastic job at explaining!

[@MrSuarezno7]

excellent work. what a beast

[@mimispore]

Thanks

[@jackfrith9623]

Thanks mate!

[@edwarddunlap7344]

Chronic= forever, as long as the body lives , you have to have it to know !

[@Override.Health]

And I do! How have you been doing Edward?

[@edwarddunlap7344]

@@Override.Health Doing pretty good because of GOD and kratom !

[@Override.Health]

@@edwarddunlap7344 Have you considered becoming a health and wellness coach? We need more people who have learned to manage their own pain to help others learn to manage theirs. -Hannah.

[@marcusstevens1931]

I have central and peripheral sensitization. It’s a living hell.

[@Truerealism747]

Are you any better have you got Dr TS book it will. Help you to get better then look at TMS Dr schubiner

[@dalailarose1596]

I'm watching this as a spinal cord injury survivor with central pain syndrome & CNS pain syndrome. This was really interesting, & had some new info to me.

[@whome5810]

Me too! Have you found anything that helps?

[@kpip6264]

This is a great overview. I have crps or RSD for over 3 decades. How do we stop chronic pain?

[@jasmineothman3492]

great 🙏🙏 thanks a lot 🌸🌸

[@ebenezerkyndiah8738]

Spot on

[@juddfelsher9708]

Great video!

[@piraveenaabaskaran1394]

Amazing video!!

[@user-py7mz8oj7o]

so how do I make it stop?

[@humblepi3666]

Interesting vid, however... Just me view (and I'm not a medical professional), but... like many other medical pros, you seem to suggest that the causes of, and reaction of, the body to acute pain and the causes of, and reaction of, the body to chronic pain are 'mutually exclusive', in that the pain mechanism 'may' move from the 'acute' phase - for want of a better word - to the 'chronic' phase. I would like to suggest that both may actually continue to work together. So, as an example - which is a very simplistic overview of a complex issue with tons of research papers written on the subject... an Aussie Researcher, Prof HV Crock, back in 1970 and in 1986 discussed an issue with lower back pain which he labelled 'Internal Disc Disruption' (IDD). In this he talks of a disc that has suffered disruption but has not ruptured. The damage is to the annulus fibrosus, where fissures allow leakage of the nucleus pulposus into the annulus fibrosus, which in turn stimulate the nociceptors that usually only innervate the outer third of the annulus. The nucleus pulposus, which is normally contained within the disc, not only antagonises the nociceptors but is seem as a 'foreign body' by the body itself, which kicks off an autoimmune response. This leakage happens over a long period of time - many years - and because it is often overlooked and difficult to diagnose, chronic pain (deep, dull, aching sensations) may well set in, as well as on-going episodes of acute pain (sharp, stabbing sensations) as the nucleus pulposus material continues to slowly leak and antagonise the disc nociceptors and surrounding nociceptors where it is believed damage to the Endplates allows diffusion and leakage of the nucleus material to find its way outside of the disc. Others have done further research in this area, including the renowned Aussie medical researcher, Emeritus Prof Nikolai Bogduk, with findings that back up Crock's work. Wonder what your thoughts are on this.

[@abrouch14]

very very helpful, very clear, thank you so much!!

[@johnathanabrams8434]

How has this helped ?

[@vparakhin]

So nice to hear a man who has absolutely no experience with chronic pain, talk about chronic pain.

[@keshavasavada3415]

Superb sir

[@bismarkbizmark5639]

Super interesting, but could be more leads on what could be done to treat sensitization. Also NSAIDS i think are generally best to avoid, i just read one summary of a recent study showing increased risk for chronic pain for those who consistently took nsaids following a soft tissue injury, and i know there are multiple studies suggesting that nsaids interfere with soft tissue healing. The situation could be different once chronic pain already has set in, but there are more wholesome ways to combat inflammation.

[@sigridruent8631]

Question; I don't understand under first pain response on the synaptic cleft of the dorsal horn. At first, am I correct to say that glutamate and substance P are released but under prolonged peripheral sensitization, we then get CGRP and chemokines and cytokines released . This then activates NMDA receptors as well as AMPA?

[@aswin1690]

Great video. One doubt, isn’t the RMP of nerve -70 and not -90?

[@lolakhalid0504]

Legendary

[@beach_citiesnp7986]

Thank you so....much... NOW I really understand about Chronic pain !!!!

[@PhysioTeachsenthilkumar]

Gud. One Dr mike

[@mingz83]

What about the video that you taught us about pain gate theory? That interneuron sends negative signal to inhibit the 2nd order pain neuron. I am confused at the last part of this video, that you said even fine touch could amplify (not inhibit?) the 2nd pain neuron?

[@alavuddinkurbonboyev6052]

I listened to this topic from a lot of teachers but no one could explain it so clearly. thanks

[@maximiximatosis]

This is such a succinct and helpful breakdown of pain, peripheral, and chronic pain. Thanks!

[@nooks12]

Dr Matt or Mike. Interesting video. Thanks. I noticed here and reading elsewhere that it is noted that this kind of pain persists even when the cause is taken care of or healed. What happens when one does not take care of the cause? I was diagnosed with peroneal tendinitis years after it settled in. Eight years later, an MRI/Ultrasound indicated mild tenosynovitis of the peroneal longus. Ultrasound also showed microtears in the brevis. MRI inconclusive due to hardware in my ankle. I still have pain after all these years and physio. Is the tissue damage still considered to be there? If so, is it causing the pain signals or are the pain signals a result of what you've described in this video? Thanks.

[@lorenzoricco7072]

Hero

[@jennypagliai7259]

NSAIDs have caused kidney disease in myself so not a good treatment for chronic pain.

[@Drstar-rg9wp]

🙏❤

[@deekircher21]

Is there a schedule or calendar for live tutorials? I would like to watch these. I’m from a non science background and really getting into these videos

[@rebeccaoconnor9452]

Is there any way to decrease the level from (the abnormally increased level of -60 or whoever ever it has decided to set its benchmark) back to -90?

[@johnathanabrams8434]

Probably sodium channel blockers but they come with nasty side effects

[@Rachie-nj3oi]

So how can we turn these pain transmitters off. I'm fed up of being in pain. If i could get rid of the pain i could get my quality of life back.

[@itzamazingaxel5773]

What books do you think are best for studying these topics? 🤓

[@crispycruiser4654]

The problem with this explanation is lazy doctors use it right away in lieu of ordering tests. Patients with very real tissue pathology and damage are being denied MRI's and x-rays by doctors who go way too far with this "sensitization" generalization. A lot of forms of chronic pain such as arthritis, tendonosis, scoliosis are degenerative in nature and do NOT heal. The majority of people in chronic pain are suffering from conditions like this, and this whole subsection of people who are imagining their pain because their brain is allegedly overreacting while their tissues are healed or perfectly fine, are a very small subsection but are being treated as an overwhelmingly majority of the pain community - usually accompanied by some form of discrimination (you're too young to be in pain, you're a woman so you're being hysterical, you're a man so just man up). They are extrapolating a tiny subcategory of sensitization patients and stretching it out to the entire parent category of pain patients. It's like treating 100% of the totality of cancer patients as if they had one form of cancer. Would you treat lung cancer exactly as you would prostate cancer?

[@PeterRuppig]

Couldn't have said it better. My GP is one of those people who worked at a pain clinic and now that she is a GP she tells me that there is nothing wrong with my tendon, just some sensitized nerve endings. I always remind her of the fact that MRI shows significant amount of fluid around the tendon and multiple specialists confirmed tendonosis. She always jumps to that conclusion when I tell her that I am still in pain. It's as if she thinks if I am not pain free at this point then it must be a sensitisation problem. No, it's just that the tendon is severely damaged and psysiotherapy can only help so much. I hate this kind of generalisation, I feel like a lunatic everytime she comes up with that bullshit.

[@crispycruiser4654]

@@PeterRuppig Sorry to hear this. She's an absolute fool and it's inexcusable but she has been brainwashed, unfortunately. I haven't spent a day in medical school, and yet I assert that know better than most young medical professionals particularly who have graduated medical school after 2016. That is when the CDC guidelines were revised and the entire curriculum was centered around anti opioid propaganda. They were going to do whatever was necessary to reduce pain scripts to 0, not only by demonizing, exaggerating and lying about opioids (and kratom), but changing the definition of pain so as to gaslight the patient and place all the onus on you to just think your pain away. If it doesn't go away, it's simply that you're not doing it right by meditating hard enough. That justifies not treating the pain, because it's your fault. Where do I get the nerve to assert I know more than they do? By spending a disproportionate amount of time getting 2nd, 3rd, 4th opinions from doctors, surgeons and PT's who DID listen and DID get me results. By having and rehabbing from 10 surgeries. Tendonosis comes from a permanent thickening and degeneration of tendon tissue. Diseased tendon and ligament can grow to 3-5x the size of healthy tissue. Sure, it "heals" per se, but with uneven and painful scar tissue which compress nerves. Think of healthy tendon like a piece of string cheese and an unhealthy tendon like string cheese you've been pulling apart for 10 minutes. You don't simply get to put it back together like it was before. Now, tendonosis is not always a death sentence. It is possible, over time, with things like PT, massage, graston, and shockwave therapy to realign scar tissue close enough to normal tissue so that it no longer hurts. It'll never be 100%, but I've had very bad tendons that healed to 80-90%. The problem is it takes a long time - several months to a few years. And I want to reiterate, the pain is due to TISSUE PATHOLOGY and changes. Yes, the nerve is hurting. Because the nerve is COMPRESSED BY THE DAMAGED TISSUE. The nerve is not free to glide. So it's not simply a case of a perfectly healthy nerve in overdrive. I had a gigantic bone spur in my talus joint that throbbed, 24/7, for 8 months. I was told the same nonsense. As soon as I had the bone spur shaved off, the nerve stopped hurting. The very idea that surgery works well for many orthopedic injuries is stone cold proof that the problem is TISSUE, not nerve sensitization.

[@frede6071]

So true. I have an extra congenital rib pressing on my nerve. They all told me my brain “learned” the pain. Seriously such losers. It’s like THIS IS YOUR JOB, DO BETTER.

[@user-rv2zj8zu5b]

Yup and they just start prescribing antidepressants, Lyrica or gapapentin to “manage” pain. Either lazy or incompetent doctors who don’t have a clue.

[@amandacrowe5280]

I literally was put in a mental hospital because my pain couldn't be THAT bad, poor crazy woman, drug seeking, let's shock some sense into her brain with ECT therapy.

[@fahadbinabdulhalim4024]

Nice

[@malinzetterberg05]

it's hard to see what you've written on the bored my friend

[@EDD519]

same ol stuff ! no pain meds for the suffering , maybe they think words will relieve pain ??

[@petramajernikova3260]

I am having a spinal cord stimulator fitted in couple of weeks, hoping it will help 🙏

[@harrytoyshirt4146]

Good luck. I had one put in 2 mos. ago--------didn't work. If you haven't had the pain a long time, your chances are better than if you have.

[@petramajernikova3260]

@@harrytoyshirt4146 thank you. Yeah had the pain 6 years, SCS in now for 2 months and not doing a damn thing

[@rajivdas8185]

Good

[@ndzeidzerobertfonyuy3594]

What about the dorsal root ganglia? What happens there during chronic pain.

[@johnathanabrams8434]

Myofascial pain is the MOST common form of chronic pain. Not a little, not moderate, THE MOST kzbin.info/www/bejne/nJiom2quoLOUfMUsi=DipHTQi9r1KBeg2V

[@domm165]

Can you have central sensitization in the absence of peripheral sensitization?

[@capresti3537]

No, because the brain does not have pain receptors.

[@aryannaghavi3987]

nice

[@malinzetterberg05]

where do the positive ions come from? 🌸

[@johnathanabrams8434]

G coupled protein receptors or c-fibres

[@larryerb28]

Wow why do none

[@alaaadel8900]

*اللهم صل على سيدنا محمد وعلى اله وصحبه وسلم تسليما كثيرا عدد خلقك و رضا نفسك وزنة عرشك ومداد كلماتك و عدد ما كان وعدد ما سيكون وعدد الحركات والسكون.*

[@Amal-fq1wn]

God knows how much i love u

[@lolasixon2907]

Can you ever heal from this condition?

[@annedean4603]

Go DIY a grounding mat, pillow or sheet to use at home. Earthing is good for almost all health problems including chronic pain.

[@druidofnerium]

Chronic pain is a case by case basis, for the most part it depends on what is the root cause of chronic pain. In many cases it will never be cured, you have to learn how to manage symptoms.

[@danieladenuta8176]

After 4 years I found out this is my diagnostic, I was left with this pain after C section.

[@Override.Health]

How have you been dealing with it Daniela? Would you like to talk about it?

[@kaladharyadhav7697]

Hi

[@andreiadesousafernandes7753]

But what makes the central sensitisation to occur and then cause chronic pain? Not all injuries cause chronic pain...

[@hibahabboushsy4777]

Supeerr

[@lucash8234]

Desperately needs an eli5.

[@paulojustinianookubo]

I was told I have this. I have chronic pain all over my spine, abdomen and pelvic area.I also all kind of burning digestive issues. I'm so depressed as noone cant help me and I am only 33.

[@Truerealism747]

Any luck with TMS therapy

[@arsalanzaidi15]

Builder

[@joellavanderboom4922]

How do we stop the pain? How do we tell the brain its safe? I've been able to over come it twice last year, but for some reason it keeps popping back up.. how can I tell the brain once and for all it can stop sending the signals?

[@smalshani9269]

great but please a little bit slower next time🥺

[@javiera4148]

Question: Can weight training act as a stimulus for chronic pain? I'm not talking about delayed onset muscle soreness..but more like joint and muscle pain associated with a chronic condition.

[@gildog]

Nope. The pain is where it is and if it stops it stops. There is no pain party in your brain that won't end.

[@deekircher21]

Learning medical science is better when the doctor is good looking

[@TonyODonnell]

who is this video aimed at? anybody with chronic pain only wants to know how to get relief from pain and end up in pain clinics, and when you end up in a proper pain clinic, you will receive a lot more detailed information than this video as it should relate to your specific area of pain.

[@cryptonut9732]

This video is not for patients

[@rebekahbrown4052]

What are you even talking about?

[@gauravjoseph4831]

Damn I feel my left eye is sensitized to light flicker!

[@wz5165]

You’re handsome

[@timocuyvers1501]

Why are you talking about skin pain when majority of people have chronic pain at joints ?