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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

Widespread Pain and Dizzy – Ear Canalithiasis? (rocks) and Repositioning Them Helps Whiplash, TMJ, and Fibromylagia

Study suggests dizzy whiplash and widespread pain cases could respond well to middle ear grit repositioning measure.  This is being able to see way outside the box…

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Posted in Fibromyalgia, Manual Med, Neck, TMJ | Leave a comment

Benign Positional Vertigo? – Modified Canalith Repositioning Maneuver (CRP)

Effectiveness of Treatments for Benign Paroxysmal Positional Vertigo of the Posterior Canal
Helen S. Cohen, Kay T. Kimball
Otol Neurotol  26: 1034–1040, 2005

Modified  Canalith  Repositioning  Maneuver  (CRP)  technique:

The head was held in each position as follows:

  • The subject sat on the long side of the mat table.
  • The investigator turned the subject’s head 45 degrees away from the involved side and tilted the patient en bloc into a side-lying position through the coronal plane, with the nose pointing upward.
  • Ten seconds after the cessation of vertigo, the subject was tilted nose-down toward the uninvolved side and held there until 10 seconds after the cessation of vertigo.
  • Keeping the head turned toward the uninvolved side, the patient was assisted to sit up and remained in that position for 10 seconds after the cessation of vertigo.
  • This variation from the original description, eliminating the premedication and shortening the interval between head movements, is associated with significant reductions in vertigo

repositioningComment – this is a companion article to one showing treating dizziness helps TMJ, whiplash and Fibromyalgia.

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Duloxetine For Fibromyalgia – Mixed Results

Initial study showed benefit only in first 6 weeks more than placebo and not after: Study glowingly mentions early effects but fails to mention lack of lasting effects

duloxetine fm1Comment – I recently reviewed a back study that cleverly disguised their lack of effectiveness. Having said that. it is suggested 2/10 might active an moderate effect.

I will need to insert other studies when I have time.

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Fibromyalgia – Responses to Methotrexate and Steroids

Old McGill study found initial impressions of doctors and rheumatologist were wrong 2/3 of time and in particular inflammatory arthritis cases are missed.

Fitzcharles, M‐A et al. “Inaccuracy in the diagnosis of fibromyalgia syndrome: analysis of referrals.” Rheumatology 42.2 (2003): 263-267. http://rheumatology.oxfordjournals.org/content/42/2/263.full

This leaves a reservoir of inflammatory cases classified as Fibromyalgia and responding to methotrexate and prednisone.

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Amitriptyline – Not Much For Neuropathy Really

The initial study of use of Amitriptyline was a study with diabetic neuropathy where patients were subject to impressive coaching (calls from nurse and pharmacist) . That way doses of 75-150 mg were obtained. They were able to show benefits. Over half of recent studies, using 25-75 mg which is what patient ordinarily tolerate, failed to show much benefit. The most recent study is one on HIV neuropathy; doses of 25-50 mg failed to show any benefit. Two studies using it in Chemotherapy neuropathy failed to show benefit. However, the myth it is good for all neuropathy persists. In some cases exaggerated benefits persists because of a lack of control group which would expose lack of benefit.

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New Help for Some Fibromyalgia (FM) – Gluten Sensitivity Management

Over the past couple years there is growing evidence that maybe 1/3 of Fibromyalgia patients actually suffer from non-celiac gluten sensitivity and respond to gluten free diet – some within a few month, and some “gradually… over many months”. Gluten free diet could be life changing with remission of symptoms and back to work.

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Algorithm For Post Hernia Pains

Concise choice selections for what to do with nerve damage level post hernia pains. I love algorithms – they are so practical.

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Uncontrolled Post-Herpetic Neuralgia (PHN) in Elderly subject – New Measures

Using 6% gabapentin, 4% amitriptyline,  ketoprofen 10%,  lidocaine 5%, and ketamine 10% probably in Lipoderm could give some relief topically.  Ketamine 100 mg/ml with 0.1 ml spray nasally could give additional relief.  30% mannitol might be good here.

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Posted in Drugs, Pain Dystrophy, post herpetic neuralgia, Topical Pain Treatments | Leave a comment

Patellofemoral (PF) pain – New Hope – Femoral Nerve Stretching Helps Half

Another looking out of the box study. Supposed part of PF pain is neurologic and stretched femoral nerves. In cases that tested as having “tight” femoral nerves (positive femoral slump test) which was about 1/2 of cases, treatment resulted in over 50% improvement of pain – often immediate

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Needling Lower Trapezius Helps Unilateral Neck Pains

Needling the lower trapezius muscle was found beneficial in chronic neck pain. I was so taken with the approach then had to injecting lower trap(with muscle relaxed rather than stretched) that I had to include a pic of actual treatment approach. There are so few controlled studies in myofascial pain that this is exemplary.


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Posted in Manual Med, Mechanical aids, myofascial pain, Neck, Thoracic | Leave a comment

Resistent Post Herpetic Neuralgia Treatments – IV Magnesium for Neuropathic Pains

Three IV Magnesium  1mg /k in 100 mls saline  infusions over 1 hour – one every other day or Three 1 mg/kg Ketamine in 100 mls saline infused in over 1 hour ketamine  one EOD resulted in 7/15 magnesium and 10/15 ketamine patients having >/= 50% improvement in pain .  Both had Midazolam 0.1 mg/kg to render them unconscious though in actuality only some would be needed for ketamine to treat the dysphoria achieved at higher doses..

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Posted in central & spinal, complex regional pain, Drugs, IV therapy, neuropathic, Pain Dystrophy, post herpetic neuralgia, radiculitis | Leave a comment

Fibromyalgia Hypervigilance May Exist – and My Model

With help of  EEG (scalp)sensors, one can measure a brain response to a stimulus- often auditory.  Often the brain reaction diminishes with a repeat stimulus – called sensory gating. If one were hypervigilant, you would expect the brain response to not get less – one study says no, another, maybe better done, says yes

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Multiple Sclerosis (MS) Help – Biotin (Vitamin B7) High Dose – and What More Could You Take?

In MS cases, 1/6 noted clinical improvement over 2-8 months with Biotin 300 mg/day This is exciting not just for the improved people but potentially for a group that might not further deteriorate. Suggestion was to take 100-300 mg/day which might be tough considering commercially available Biotin comes in 10 mg (10,000 mcg). Vitamin D has promise to help, particularly since deficiency is so common and it helped to prevent relapses in pregnant women in a study this year. B12 helped nerve regeneration in Bell’s palsy and ulnar nerve transfer surgery so might be important to take at least 1000 mcg/day of it as well – though by self failed to help MS (though deficiency makes MS worse)

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Post-Herpetic Neuralgia – Transforaminal Epidural Steroid Injection Might “Cure” And New Injection Rules

Several case studies have shown that transforaminal steroids could relieve Post Herpetic neuralgia (PHN) but that procedure is under heavy scrutiny because of rare strokes, paralysis and death so use of soluble dexamethasone has been edicted.
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Sacroiliac Joint Injection Proposal

Given that I do not have Ultrasound (got rid of old one – filled a room), I have developed a SI joint technique and would like opinion re such. Also I will refer to article using SI injections.

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Posted in Back Pain, Injection | Leave a comment

Chronic Back Pain Is a Painful Vertebral Body Problem

One study demonstrates that chronic back pain is associated not so much with plain disc degeneration but with disc degeneration combined with end plate or vertebral body schmorl nodes. Another study found that people with back pain and modic type I  bony  changes benefit from vertebroplasty (hot cement pumped in) of their painful vertebral bodies.

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Posted in Back Pain, Injection, Insurer issues, pain mechanisms | Leave a comment

Is Sensitive Skin Neuropathic?

Study in Dermatology journal suggests 1/5 of subjects test positive with quiz DN4  for neuropathy

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Posted in mast cell disease, neuropathic | Leave a comment

Pseudofolliculitis cutis – ingrowing facial hair Treatments

Ok this is not a pain  condition but I wanted to put advice where patients can find it.

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Complex Regional Pain Syndrome (CRPS) – Finding Immune Mechanims Offers New Treatments

Finding high levels of  beta2 adrenergic receptor autoantibodies in CRPS cases might explain why steroids, tumour necrosis factor (TNF)-alpha antagonist
Adalimumab, IV Immmunoglobulins, and in present article Plasmapheresis can help in selected cases. In present study, these antibody titres fell with treatment at same time as pain levels fell.

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Posted in Botox, complex regional pain, Drugs, Injection, IV therapy, neuropathic, Pain Dystrophy, Stimulation | Leave a comment

Headache Just At Night – Try Indomethacin

Hyponic (night only) solely headaches are uncommon. In some ways they are distinct from migraines as the drug of choice is Indomethacin 50 mg twice daily. Continue reading

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Low Dose Neuropathic Pain Drugs Only Work in Combo – and then only a Bit

Neuropathic pain drugs by self have mediocre effects – often dropping pain by </= 2/10 points. At low dose Imipramine 75 mg/day and Pregabalin 300/day did not have significant benefit but the combo dropped VAS by One more than placebo – nothing to write home about however.

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Irritable Bowel – Hypnosis helps

Hypnosis is a useful adjunct to IBS treatment.

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Posted in Abdominal pain, psychology | Leave a comment

Chronic Scrotal Pain Algorithm

Chronic scrotal pain can be an enigma – this new article gives detailed options for investigation and treatment. I have spent a great deal of time trying to give a clear view for people -  let me know if you find it helpful…

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Posted in groin pain, prostatitis / prostatism, Uncategorized | Leave a comment

Fibromyalgia Look Alike – Myotonia Congenita

Myotonia Congenita is a rare neuromuscular disease manifest by “painful muscle cramps or myalgia as well as transient muscle weakness following myotonic stiffness”. Article describes 2 cases – one that got worse with pregnancy which is what Fibromyalgia also does. The transient weakness after cramping can be easily missed though EMG does pick up the problem.

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Vitamin D – Could High Doses Help Pains?

4000 u/d vitamin D  lessening  Chronic Musculoskeletal Pains

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Posted in Back Pain, Deficits, Drugs, Fibromyalgia, myofascial pain, pain mechanisms | Leave a comment