Below is a study poster presented to the Canadian Pain Society showing benefits of frequent B12 Injections. Unfortunately, a study found men with smoking history have a 3 times lung cancer rate so I have now restricted B12 injection use to women.
here is poster in pdf format:
in word format:
ALTHOUGH I WILL NOW UPDATE THIS SITE, FOR PAST 6 MONTHS, BLOG NOTES (about 50) WERE PUBLISHED AT :
visit me there!
I have a program that tracks where users are from – pain is worldwide:
Hit CTRL + to make things larger
I have recently achieved (previously unattainable) control in some of my chronic pain subjects using recent innovations – but to acheive this required use of multiple modalities at once.
Back in 2006, Janice Montbriand and I wrote a poster about “Often Missed Treatable Co-Morbidities in Patients with Treatment Resistant Chronic Pain”. They included Bipolar disease, B12 and Vitamin D deficiencies, and sleep disorders. Each one of these is still an important issue today.
Over three minute pressure to occipital arteries can greatly relieve migraine pain in over 1/2 of cases; almost sounds too good to be true. Continue reading
Spinal cord stimulation is often used as a last resort. To start with, that is a mistake.
Dr. K Kumar pioneered efforts to use spinal stimulation:
Here is a list of some of his articles:
I have been practicing long enough in his town to hear him speak and one thing always stuck with me. He bemoaned how long it took for subjects to get to him for treatment as he felt early intervention improved results. Some years ago at a conference, spinal stimulation was discussed but the neurosurgeon was unaware of Dr. Kumar’s 22+ years of experience culminating in that revelation. I was shocked.
So, subjects are seen late, and fail to achieve adequate relief with spinal stimulation even with new modes being used- then what do you do? I try IV pamidronate, ketamine and even methadone might have a place. Now, it looks like adding a stimulator more externally to the outlet of the spinal cord where the dorsal root ganglion is, could make the difference.
Chronic diseases with negative “blood work” might in fact be a cytokine inflammation disease. Moderate fibromyalgia has now be found to be a cytokine inspired disease.
I wrote about importance of cytokines 12 years ago:
Cytokine Inflammation Diseases Will Be the Diseases of the 21st Century
Then connection to multiple diseases were seen (headaches, irritable bowel, diabetes, alzheimer’s, chronic pancreatitis, chronic fatigue, depression and now depression.
Back in 2013 I wrote a draft that was never published:
“Could Elevated Cytokines Become a Test For Fibromyalgia (FM)?” Now it has.
Below is an update on tests in Fibromyalgia and cytokine relation
I have found for years that pure cannabinoid (CBD) seemed to have little impact in significant = more likely neuropathic pain. I tired to get subjects to at least have 1/4 portion of THC but elderly subjects would have nothing to do with spacing out meds. Now the animal model has shown that pure CBD has little impact on neuropathic pain. Marijuana sites pride themselves in regulating cannabis doses as they consider doctors idiots when it comes to that. However, when you look at their titrations, it is very down-scaled and not likely to have impact for 3-6 weeks. Due to expense, many of my trial users give up on the med.
Now that it looks like Rheumatoid Arthritis could be infection driven, the benefits in a study of Clavulin (amoxicilin + clavulanic acid) needs revisiting. It has been know for a long time that certain antibiotics have “anti-inflammatory properties”. Now it might be interpreted that they control bacteria that could augment inflammation. A study of plain amoxicillin did not work.
Does that mean that Clavulin controls this inflammation by having wider antibiotic spectrum and should it engender new respect? Could certain antibiotics work like they do in rheumatoid arthritis and reduce inflammation?
Anti-inflammatories “NSAID’s” work poorly in ankylosing spondylitis. Methotrexate does not seem to help.
Prednisone helps but high dose is needed to get any initial response and cannot be used long-term by self especially related to osteoporosis.
Pamidronate is a game changer in chronic back pains particularly where inflammation is missed. Mixing with prednisone/steroid is possible.
Recent Study found a strain of previously unrecognized strain of Subdoligranulum in gut was associated with Rheumatoid arthritis (RA) autoantibodies. This bacterium, if introduced into guts of mice, replicated the arthritis seen in humans. This strain is only seen in RA victims.
So, both gut bacterial and periodontal disease can potentially trigger antimmune responses. This leads to new implications on prevention and treatment of Rheumatoid arthritis.
My College is a Pain in the Ass – My Reply to Them and Why They No Longer Call Themselves “Educational”
Our medical college has taken upon themselves the task of antagonizing doctors to point many clinic will no longer even prescribe opioids. They called their program “educational” but demanded doctors respond to them is 2 weeks or else face discipline. No where else in Canada is it that short – BC has 2 “working” weeks which ends up 3 weeks. Some 20 years ago I went to see The then Registrar, Dr. Kendel, and told him 2 weeks was too short but he seemed more concerned that doctors did not take the letter seriously. I got in trouble over that and retired over it.
Most drugs have little effect on back pain or back pain with sciatica. Surprisingly, a combination of Buprenophine and Pregabalin did seem to make a difference in milder back pain cases.
I have tested testosterone levels in my chronic pain female patients and found none of them had any detectable levels; they should have some. Supplementation helps.
Spinal stensois is a horrible disease often thought that surgery is the only outlet (though steroid blocks might have some “limited” effect). Now again pamidronate has been shown to stem tide of pain with a mean improvement of 40%. Not a controlled trial; but still encouraging. Old study but new to me…
People who come in with recently developed chronic diarrhea are a challenge. Reliance on stool tests might be suspect if just relying on Ova and Parasite micro exam. Given excretion is episodic, O&P testing by microscopy would miss 39% of amebiasis and 25% of giardiasis. Even the antigen tests could miss 10+%. This leads to plan B – Metronidazole treatment as a viable option but could still not help up to 30% of cases.
Studies of too little, too short or too narrow a scope are associated with poor outcome and I am accumulating a list of poorly done studies as I am just fed up. I hope authors take note. I will take me awhile to go thru a compilation of studies I have.
Malassezia seen in brains of Alzheimer’s:
Front Aging Neurosci. 2018 May 24;10:159. doi: 10.3389/fnagi.2018.00159
Infection of Fungi and Bacteria in Brain Tissue From Elderly Persons and Patients With Alzheimer’s Disease.
Alonso R et al.
“the fungal genera more prevalent in AD patients were Alternaria, Botrytis, Candida, and Malassezia”
and, in abundance, in pancreatic ca:
Aykut, Berk, Smruti Pushalkar, Ruonan Chen, Qianhao Li, Raquel Abengozar, Jacqueline I. Kim, Sorin A. Shadaloey et al.
The fungal mycobiome promotes pancreatic oncogenesis via activation of MBL.
Nature (2019): 1-4.
“Here we show that fungi migrate from the gut lumen to the pancreas, and that this is implicated in the pathogenesis of PDA [Pancreatic Duct Cancer]. PDA tumours in humans and mouse models of this cancer displayed an increase in fungi of about 3,000-fold compared to normal pancreatic tissue.
Now, seborrheic dermatitis, related to it, increases chance of peptic ulcers by 1.6 times.
Selecting people with mildly abnormal hemoglobin A1C (prediabetic), authors found the introduction of Metformin 500 mg twice daily could dramatically relieve widespread pains. Article had to be pulled because consents were iffy and they didn’t have enough in “control group” to prove it didn’t work in non-diabetics. This was May 2019; I have been waiting for them to get consents and a big enough control group but treatment study was never republished. This has remained a secret.
At least in low back, it looks like after 3 months, it gets as good as it gets.. Almost 1/3 might end up poorly so thoughts of IV pamidronate or vertebro/kypho plasty might need consideration.
Failed cervical laminectomy/fusions are considered a difficult situation. Epidurals are difficult. and rhizotomies might fail. Usually a cervical spinal cord stimulator is considered impossible due to scarring. However, in this case. a cervical spinal cord stimulator was much easier placed than thought and cut pain 80% . In one of my cases, chronic infection was considered and treatment achieved 36+% improvement in pain.
We are all faced with patients that have pain are above what they should have and have pondered genetic causes. Genetic Variant at Chromosome 12q23.1 increases chances by odds ratio 1.68 of neuropathic pain. Is a mitochondrial phosphate carrier and calcium binding gene, expressed in brain and dorsal root ganglia. The plot thickens.
Review of multiple studies found no surprises: “a medium-firm mattress promotes comfort, sleep quality and rachis alignment.”
Brazilian study compared morphine 47.4 +/- 57.6 to methadone 62.1 */- 15.5 and suggested methadone was 20% better. However, there are some problems with study.
I have had my share of tooth infections and this is what I have learned so far:
1) Once it’s abscessed nothing works but a root canal or extraction
2) early on, regular dosed antibiotics do nothing.
There are options – loading doses and topical
Raloxifen is a estrogen look alike used for osteoporosis. Is is similar to tamoxifen so helps to prevent breast cancer. Like birth control pills, has a slight stroke risk.
I have a relative who had been on raloxifen for Osteoporosis. It, in combination with other meds has been relatively effective. Her sister has had a fracture, worse hearing loss, and was at one point diagnosed with Fibromyalgia.
It turns out, and article with no referencing to, described raloxifen as a treatment for fibromylagia pain and fatigue in a double blind trial. The study was never repeated and came on it by accident. Pain was cut to more than half in 4 months and fatigue helped as well.
Techniques involving post isometric relation stretching of Quadratus Lumborum clinic use.
(Travell & Simon) Continue reading
While gabapentin might work in post herpetic neuralgia and diabetic neuropathy, it does not work well in spinal pains/sciaticas and so forth. Now it has been shown not to work in chronic pelvic pains as well.
Usually when subjects brux (teeth clench) of antidepressants, one has to stop antidepressants as the alternative is higher dose clonazepam (1 mg)
Bruxism – How do You Treat Besides Splints
Quetiapine 25-50 mg helps considerably as well.
Even Opioids, if placebo is removed, can only give you 1/10 reduction in pain. Want to push it for more? Well, I suspect some opioid deaths are included here. From what I have seen, various approaches ( Tai Chi, acupuncture, Cognitive- behavioural, exercise, journaling,etc) can do some effect in studies but only help temporarily or a bit because of human nature and poverty. Can’t afford long term CBT or acupuncture, quit exercise in cold weather etc.
People who do well do several approaches at one. Doing that will allow you to reach what I call critical mass. Once you reach a certain point of betterment, improvement is much more than can be expected from the culmination of the three – you reach critical mass and improvement in activities of daily living flourishes.
People who try one thing at a time often say it didn’t help that much and end up being discouraged. Don’t do that!