Fibromyalgia, it's real and you can treat it. We'll prove it to you on this episode.

Welcome to the Curb Siders, the Internal Medicine podcast that uses expert interviews to bring you clinical pearls and practice changing knowledge.

I'm your host, Dr. Matthew Wato. On this episode, I won't be joined by my normal co-host, Dr. Tony Sideri and Dr. Stuart Brigham. They were on call at Cashlack Memorial, so they weren't around for this interview.

But I had a great conversation with our guest, Dr. Daniel Klaw. Dr. Klaw is a professor of anesthesiology, medicine, and psychiatry from the University of Michigan.

He attended undergrad in medical school at Michigan and then did his internal medicine residency and rheumatology fellowships at Georgetown University, where he eventually held roles including the Chief of Rheumatology and the Vice Chair of Medicine.

While at Georgetown, he assembled an interdisciplinary team who began to study the Central Nervous System contributions to a number of chronic pain disorders, including fibromyalgia, interstitial cystitis, low back pain, and Gulf War illnesses.

This group of investigators, the Chronic Pain and Fatigue Research Center, moved to the University of Michigan in 2002.

Dr. Klaw remains very active in institutional and departmental translational research training programs, and is very active and recognized as a mentor of clinical and translational researchers.

Many of his mentees are producing research aimed at helping better understand how to best diagnose and treat acute and chronic pain.

Dr. Klaw now has over 300 peer-reviewed publications and has been the PI of more than $100 million in federal grants.

Needless to say, we are thrilled to have him on the show today. We made a connection over Skype, so some of the audio is a little bit choppy in spots, but I feel the content is really good, and I wanted to get it out to you guys, so rather than spend 100 hours on editing, I'm just going to ask you guys to deal with some of those spots.

On this episode, we get really deep into chronic pain and fibromyalgia going through in part one, the diagnosis, the epidemiology, the pathophysiology of chronic pain, part two is more geared towards the actual treatment, both pharmacologic and non-pharmacologic therapies that are available.

I think there's a lot of great clinical pearls in here for our listeners. I think you guys are going to love the episodes, so without further ado, here is Dr. Klaw.

Hi, Dr. Klaw. How are you? I'm doing great. Thank you so much for coming on the show. My pleasure.

You've done lots of research in chronic pain, and I've heard you say that you have a very high pain threshold, and it doesn't seem like you have chronic pain yourself, so how did you get so interested in this topic of all topics?

Well, I'm trained as a rheumatologist, and even though almost all of what rheumatologists see is chronic pain, or at least people present with chronic pain, I was always sort of fascinated by how little we understood about the underlying mechanism of pain.

I saw a lot of patients with fibromyalgia during my rheumatology fellowship, and although the people that were mentoring me didn't know what the pathophysiology was, they actually believed it to be a real entity, and I thought it was just a fascinating condition, so I began working in fibromyalgia pretty early in my career.

And you know, that's great that the people you were working with believed in it, because I had mentioned to you, and pre-recording there, that I really, until the past few years knew very little about this until I was kind of thrown into the fire as a primary care doctor, and sort of like realizing that I did not know enough about this, and the topic of fibromyalgia had been almost like a taboo subject when I was in medical school and residency, so I didn't even know if I should talk to patients about it.

And that's not uncommon. We've learned a lot about fibromyalgia just in the last 10, 15 years or so, and the medical knowledge in the general medical community has not caught up yet.

And a lot of the advances in fibromyalgia and even more broadly in chronic pain could only occur after the advent of research techniques like functional neuroimaging and chemical structural neuroimaging, so that really has been a boon to neuroscience research in general, but also pain research more particularly.

And I definitely want to talk about your research a little later on, but before we get into some of that stuff, I just wanted to ask you, what sort of habits or skills do you think you had to allow you to get so heavily involved and be so successful as a researcher?

I think I'm naturally inquisitive. I think that's one of the reasons that I went into rheumatology, rheumatology sees a lot of the patients that other people can't really figure out what's wrong with them, but yet it's still a subspecialty that looks at the entire body.

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