Contemporary Approaches to Treating Chronic Pain

Daniel Clauw, M.D.
Professor, Anesthesiology, Medicine & Psychiatry
Director, Chronic Pain & Fatigue Research Center
University of Michigan

[@Gpacharlie]

Thank you for your endorsement of the VA model of stepped care. I returned to the VA 3 years ago saying to myself if anyone can figure out trauma based chronic pain and collate the data and test drive the therapy it will be the VA. It looks like they are finally going to take leadership in doing that. Stay tuned.

[@EDD519]

DAMN IT , were hurting , suffering , and your talking on the y-tube ,and the gov. has locked up the pain meds ? so who`s dieing ? PEOPLE IN CHRONIC PAIN !

[@saicopathy]

I don't understand what everyone in the comments are critical about, to a point where you're insulting his knowledge? He ADMITTED that opioids were prescribed prematurely because it reflected the knowledge we had. If we have better knowledge and pproaches then shouldn't we try and engage the new therapies that come along with it? Just because you disagree on the logistics of transition it doesn't mean you've actually shown that he is wrong about the causes and prognosis of chronic pain conditions.

[@pida9669]

The reason people are upset with doctors like Daniel Clauw is that they are most likely dependent on opioids, and they don't want their drug supply taken away. I can understand that. However, if someone is taking opioids and they *still* regularly experience chronic pain, they should own up to the fact that these drugs are just not working as advertised. To clarify, opioids may certainly ease pain for a few hours, but then the pain typically comes back between doses. Increasing the dose or the frequency of dosage only temporarily solves this issue, and then tolerance sets in and the between-doses pain comes right back. *No* long-term studies have shown opioid treatment to be better than not taking opioids in the long term. Cheers...

[@johnathanabrams8434]

Myofascial pain syndrome is alot more common than fibromyalgia and it is treatable through a process called dry needling. Takes a long time to fix a long time of pain.

[@shkpra2365]

Given what was shared in one of the slides with the substances that increase/decrease pain, has Seretonin on the side of the pain enhancers, does it mean that sSRIs might increase fibro pain ?

[@camshoemaker9802]

Interesting question

[@EDD519]

your words make pain worse !!

[@dansmith9724]

Fibro is such a wide spread term these days. It was first used in pts with post viral issues. If fatigue was the main symptom you copped chronic fatigue syndrome. If your main symptom was pain you copped fibro. But both would fit into cfs category, and also have abnormal immune markers such as low natural killer cell function, increased cytokine studies and a high prevalence of very high herpes viral titres indication chronic or reoccurring viral reactivation. Not just a positive igg test meaning life long protection, instead much higher indicating an active infection. As for the treatments outlined and saying exercise is the most important, just isnt true in the group i mention above. An expensive study done by the psychology group in the UK on cfs pts using cbt/get supposedly showed large improvements in these patients. After alot of legal fence jumping by an advocacy group to obtain all the data used. It showed these scientist/psychologist lied through their teeth and the data actually showed mosts pts went backwards. It showed they had poor understanding of cfs and one of the main hallmark symptoms backed up by many studies on post exertional malaise. The most telling studies on PEM are the 2 consecutive day treadmill studies. The pharmacological treatments in this video that are supposedly effective are very poor for managing pain in the above group. Looking on any cfs forum and the vast majority dont only find these treatments ineffective but instead have adverse reactions to them even on doses much smaller then recommended. So if some has fibro and a proper diagnosis of cfs/me with immune abnormalities, theres very little that consistently works on treating pain. Sleep abnormalities is a very very common finding and treating sleep with benzos seems to help more people with pain ie if they dont have any adverse reactions to benzos. If being honest theres not much that really does help symptom management. Im ranting about this as cfs and cfs/fibro pts dont fit into the 3 groups mentioned and probably need even more individualized care. With long covid exploding in numbers, they are basically post viral cfs pts and will probably be very hard to manage also.

[@mbtvalli]

LDN didn’t do anything for me. All the other drugs for Fibromyalgia had intolerable side effects.

[@jmc8076]

FWIW I know some with fibro who take CBD in diff forms and works well. Also diet changes.

[@butterflyfields314]

How much research has your university done with environmental toxicity of the many chemicals or plastics inadvertently consumed by us and other life, which is bioaccumulating in most of life on the planet? The chemicals and plastics are not being regulated by the FDA, USDA, and EPA? Is your university studying the effects of micro and nano plastics/particles in human tissue and blood? Maybe the plastic and chemical environmental pollution is effecting health leading to lots more diseases, which current doctors do not know how to treat with US western style health care. There seems to be some correlation with the US population with the introduction of certain types of chemicals and polymers. Did you wonder why maybe there is a connection to the uptick in fibromyalgia diagnoses? We now know glyphosate type of chemicals does lead to Parkinson’s and Cancer type of diseases. Does your university ignore this information and research due to private interest money research?

[@terryglenweaver]

Why don't these people STOP THEIR BULL CHIT? Let me have that guy for ten minutes alone and in one day he will stop continuing his line of chit. But for the rest of his life he will have first hand knowledge of Severe Chronic Pain.

[@Gpacharlie]

I get your anger. So you know I have cred, I have had severe pain every day for 20 years now. I gave suffered with over 20 of the 30+ other associated symptoms. It has taken just about everything from me. Here is the deal. This doctor is describing where our top healthcare people are right now regarding chronic pain therapy and the diagnosis is now “Central Sensitization.” There are few options other than this functional rehab approach and the stepped care model. Oh you can try ketamine infusions and tens units and pain pumps and surgeries and some will swear by them but those are pretty drastic interventions.

[@sarak6860]

@@Gpacharlie Is Central Sensitization a real thing? Is it the same as Hyperalgesia?

[@bluecrueful]

Why? Is your over the top rage a function of your chronic pain?

[@elizabethandrew3903]

Still amazed with the immediate healing i received from Dr Ojiezele , now i'm free from herpes permanently and i say only god will reward you for all the good works you putting out for people

[@jmc8076]

@@bluecrueful We don’t know what we don’t know about their life or situation. Maybe they have a right to it.

[@kathleenwharton2139]

Pain is caused by TMS.

[@jmc8076]

I read Sarno’s book and he himself explained no not all. Some on YT and MDs using his theory and approach try to say diff. More dx = more $. You maybe surprised how much some who talk about Sarno’s theory/pgm make. It’s now a big industry. Any YT channel at ~100K-500K subbs and enough views can earn $10-15K per mth (and more) incl plus ebooks, talks/seminars/courses/consulting, sponsors (even hidden ones) etc. Im waiting for more objective data and longterm independent studies.

[@kathleenwharton2139]

@@jmc8076 I Believe You! I really just put my Trust in God..anyway! I have stopped listening to the TMS people. I get it!

[@kathleenwharton2139]

@@jmc8076 I should have said..Pain Can be caused by TMS.

[@sandypanos1647]

No!!!! It is not an exiting course for everyone!!!

[@diannecoil7284]

This kind of therapy is certainly yields far better results than what you get from a pain clinic. I don't agree with removing all opioids. But they should be used as last resort and not on a daily basis.

[@dennisd1906]

This guy cannot be a real physician. If he is he most definitely didn't take his Hippocratic oath seriously. I would pay GOOD money for the chance to be alone with him for 10 minutes - I can 100% guarantee to give him a need for pain management moving forward.

[@edwarddunlap7344]

I always wondered about that word "HIPPOCRATIC" ,maybe it should be hipocrit ?

[@terryglenweaver]

He needs to be sued. He knows nothing. (The first dude as I will not watch the rest of the video... Its just too stupid.)

[@2004marmar]

Blah blah blah…