AAPM&R National Grand Rounds: Fibromyalgia - Treating Pain Based on the Underlying Mechanism-Fibromyalgia - Treating Pain Based on the Underlying Mechanism

Video Transcription

Video Summary

Dr. Daniel Claw gave a talk on chronic pain and its underlying mechanisms, emphasizing the role of central sensitization or nociplastic pain in conditions like fibromyalgia. He discussed the use of a fibromyalgia measure to determine the severity of the condition and its correlation with increased opioid requirements and decreased response to knee replacement surgery. Dr. Claw highlighted the importance of phenotyping patients to tailor treatment approaches and mentioned the use of functional brain imaging and quantitative sensory testing to understand neuroplastic changes in chronic pain. He stressed the need for individualized treatment based on underlying pain mechanisms. Dr. Claw also discussed the increasing prevalence of nociplastic pain in the US population and the limitations of traditional drugs in treating fibromyalgia. He mentioned alternative medications like tricyclic antidepressants, SNRIs, and gabapentinoids, as well as non-pharmacologic therapies such as exercise, sleep improvement, and CBT. Dr. Claw mentioned the potential use of low-dose naltrexone and cannabinoids like CBD in pain management, cautioning against high doses of THC. He also briefly discussed the role of neuromodulation and the potential future use of psychedelics in pain management.

Keywords

chronic pain

central sensitization

fibromyalgia

opioid requirements

neuroplastic changes

individualized treatment

nociplastic pain

non-pharmacologic therapies

tricyclic antidepressants

SNRIs

gabapentinoids

pain management