Welcome to Painmuse

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I have a program that tracks where users are from – pain is worldwide:

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Reaching “Critical Mass” to Achieving Pain Control – Procedure Pearls

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.

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Posted in arm, Back Pain, Botox, complex regional pain, Drugs, Fibromyalgia, Headaches, Injection, IV therapy, Leg Pains, Manual Med, myofascial pain, Neck, neuropathic, Pain Dystrophy, piriformis, post herpetic neuralgia, radiculitis, shoulder, Uncategorized | 2 Comments

Stellate Radiofrequency Neurolysis for upper limb CRPS

Severe pains in various locations in arms can respond to burning the stellate ganglion in the neck.  67.6% of radiofrequency destruction  cases obtained  >50 % pain inprovement for over 2 years while those with just anesthetic block got 21.2% for 2 year results.  Anaesthetic block lasted average or 40.5 days only.

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Case of Wrist Complex Regional Pain (CRPS) Helped by Dextroamphetamine

While dealing with infertility with dextramphetamine, patient’s wrist CRPS pains issues subsided

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Methotrexate for Knee Osteoarthritis

On methotrexate up to 25 mg/week orally, 53% had over a VAS drop of  2.0/10 while only 24% had in control group.

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Venous Leg Ulcer? – Simvastatin 40 mg/day Speeds Healing

With  leg ulcers less that 5 cm size, all healed in simvastatin group versus 50% control. With ulcers over 5 cm, 67% of simvastatin group closed versus none of control group.

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Drugs for Diabetic Neuropathy

 Should we believe these results?  A study on treatment for diabetic neuropathy pretends one treatment is better than onother because on group starts with more severe pain than the other then claims each treatment can virtually eliminate pains with 7 months of continued use. No one else got these results.

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Treatment of Resistant Osteitis pubis with Pamidronate

Back in 2001, 3 subjects with resistant osteitis pubis had monthly infusions of 60 mg pamidronate – one for 3 months and 2 for 6 months. Two had no known cause and one had inflammatory arthritis. All recovered and had no recurrence of symptoms and in the 2 with bone scan changes- these changes resolved. Now this study has be replicated – cases with bone marrow edema were infused with 60 mg over 60 kg size and 30 mg under 60 kg size. Sadly, they were given one infusion initially and maybe a repeat at 3 months – a study I call “one shot wonders” – hardly sufficient to work well. Nonetheless, 5/8 were significantly improved and returned to sports and 1/8 was some improved. This confirms in my mind that it should be used in resistant osteitis pubis.

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Osteoarthritis – Does Sierrasil Work? – No

One of my patients started on Sierrasil and said there was literature on its effectiveness – it does not say that it helps pain though.. Continue reading

Posted in Drugs, Knee | Leave a comment

Cytokine Storm – Treatment with Etanercept – Could it Stop Influenza Death?

Mild cytokine reactions give you a flu like situation where achy all over and malaise. Cytokine storm occurs with certain viral infections and can kill. Etanercept (Enbrel) can block that effect some in the mouse model infected with H1N1.

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Hip Labral Tear or Impingement – Steroid Injection Not Good

Steroid injection into hip with impingement or labral tear only gave relief for 10 days.

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Some Supplements May Aid Cancer Growth – A Few Might Stop

One would naturally assume keeping in good health through supplements would help your fight with cancer. Turns out, cancers may like supplements too…

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Aphthous Ulcer/Canker Sore – Pepto-Bismol Treatment

Simply applying pepto-bismol to a canker sore with a q-tip or “swish and spit”  for multiple sores can soothe irritated area within minutes

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Fibromyalgia – Part of “Software Malfunction” is Dopaminergic/GABAergic Neurotransmission Disruption

Excessive pain due to brain central sensitization has been called a “software malfunction”. Part of that appears to be of Dopa/GABA circuits.

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Sacrococcygeal (SC)Ligaments Look Like Facet Ligaments And May Be Source of Pain

On anatomical study “small nerve fibers were observed adjacent to the ventral aspect of the SC intercornual ligament and piercing the ligament in one specimen” – similar to what is seen in facet joints. Commentary on article speculated they could be a source of pain and perhaps treated similarly to facet joints.

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Posted in coccygodynia | 1 Comment

Post Herpetic Neuralgia (PHN) Treatments – Lots More Than Just Pills

Pregabalin helps 1 in 4.93 while lidocaine patch helped 1 in 2.. Still, reliance on meds only helped 1/2 then…- there are plenty of alternatives though

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Followup Guidelines For Early Breast Cancer

Primary Care Physician (PCP can do much of followup. Here are guidelines:

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Chemotherapy Neuropathy – Prevent and Treament

Use of agents to reduce chemotherapy induced peripheral neuropathy confounded by issues of decreased anti-cancer effectiveness. L-Acetyl Carnitine during chemotherapy, and Venlafaxine or Duloxetine after are my choices.  Tricyclics, gabapentin, lyrica, and topical agents did not rate well and belie the idea neuropathy can be treated as a”group” process.

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Bruxism (Teeth Clenching) – At Last a Treatment

Electrically stimulating a masster muscle should pulse go over 110% during night helps suppress bruxism.

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Fibromyalgia (FM) Recommendations Vary By Country

Canada has no alternative (CAM) FM treatment recommendations but Isreali and German Recommendations do..

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Monotherapy Mediocre in Treating Fibromyalgia (FM)

New Acceptance and Commitment therapy – 8 sessions of 2.5 hours reduced pain by 20% in 1/2 cases but only 50% in 1/48 cases. Fairly maximal drug therapies with pregabalin +/- Duloxetine alone was not great

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High Dose Metoclopramide (20 mg IV over 15 min) Beats Subcut Sumitriptan (Imetrix) 6mg For Acute Headache

Metoclopramide 20 gm IV was VAS pain score  0.55/10 better on VAS than Sumitriptan injectable 6 mg. However, the later needed starting an IV and slow infusion over 15 minutes to avoid extrapyramidal oculogyric crisis (0.2% incidence with the 10 mg)

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Applying Sleep Hygiene Questionnaire to Chronic Pain Subjects Comes Out With Two Factors

Irregular Sleep -Wake Schedule and Sleep Disturbing Behaviour and Environment factor out as two main sleep issues in chronic pain.

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In Unilateral Chronic Episodic Headaches – Should Prolactin Levels Be Done?

Recently a series of patients with Prolactinomas (a pituitary prolactin – secreting tumor in brain) was published. They found they often presented with either one sided migraines (often orbital) or SUNCT (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing). They felt prolactin levels should be done in those with with trigeminal autonomic cephalalgias like SUNCT. Cabergoline, a dopamine agonist, worked well.

prolactinoma

 

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Hip/Knee Arthritis – Not Satisfied With Acetaminophen? – Using Arthritis Pills (NSAIDs) Instead Helps

When Osteoarhtritis patients were allowed to try NSAID instead of acetaminophen,  “proportion of patients on acetaminophen treatment during the study decreased from 74.8 % at baseline to 23.9 %, while the proportion on non-steroidal anti-inflammatory drugs (NSAIDs) increased from 59.8 to 85.8 %.”

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Posted in arthritis, Hip Pains, Knee | Leave a comment

Hypnomanic Checklist

Once had a psychiatrist phone me very irritated because I had diagnosed a teeanger as potentially bipolar. Fortunately, I had seen her hypomanic, and run a hypomanic questionnaire at time – adequate documentation despite his hostility (guy needed a holiday). Chronic depression and a history of suicide in family helped as well. Here is a simple checklist taken from the 15 point checklist:

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