Pain Medical Musing

(email kept anonymous)

I have had 4 inguinal hernia surgerys an nerves where cut I have chronic pain, all day long . I have burning sharp tender pain where I was cut in my iner thigh. My right testicle is numb and pain runs down my leg. My pain management Dr .  meds  helps a little. I can’t take the pain; is there something I can do ? I need help really bad!!!!

First thing seems to me, to be what nerves are damaged? The usual are either the iilioinguinal or genitofemoral nerves:

However, if the pain is going down the leg more then that would suggest the obturator nerve is affected:

(possible extent down with obturator)

Pain going down the leg further than first picture would suggest obturator neuralgia. This is mentioned here with a possible treatment. If suspected, the first thing would be to freeze the nerve and see if it helped. (obturator nerve block) - anesthetists should do that; although my local one won’t  - so I ended up doing it.

Treatment of Obturator Neuralgia With Laparoscopic Neurolysis . 

The Journal of Urology , Volume 179 , Issue 2 , Pages 590 - 595

J . Rigaud , J . Labat , T . Riant , O . Hamel , O . Bouchot , R . Robert

abstract 

I will write more later..

Popularity: 3% [?]

This is a disorder with brain outlet crowding and cysts in the spinal cord. Having this condition means that you likely will be treated very poorly by the medical community because imaging is poor and people don’t want to believe your symptoms. The signs of myelopathy (spinal damage) that one can have can be very non-specific - gait issues, somewhat hyperactive reflexes etc. which can be discounted. I have on brave soul who was wheelchair bound before she received much help- and only then with help she received from th Chiari Institute in Florida. She put together a list of resources she found helpful and I have included them here verbatum: Read the rest of this entry »

Popularity: 12% [?]

Calcification seen in the Supraspinatus tendon with tendonitis is by tradition treated by puncture and aspiration of the calcific deposits. I never met anyone who did it.  Now, it appears just puncturing the deposit and steroid injection into the deposit is enough to ensure long term benefit. Read the rest of this entry »

Popularity: 11% [?]

5.5 % of children with migraine were found to have elevated tTGA antibodies. They were considered Potential Celiac Disease [CD] despite normal duodenal biopsies. It is suggested “These patients might develop villous atrophy on repeated biopsies performed 1–4 years later and should be followed up closely.” Read the rest of this entry »

Popularity: 23% [?]

Subjects with Fibromyalgia have lower basal body temperatures even though “controls and patients were matched for physical activity level” in one study. Lower free T3 levels, found in some FM subjects in the study, affected pressure pain threshold (p = 0.034). I am left to wonder if bringing the basal body temperature up to “normal” with thyroid would impact pain and fatigue. Read the rest of this entry »

Popularity: 25% [?]

I have become aware of two cases of chronic pain following a Stretococcal infection. This could be a flavour of an Ankylosing Spondylitis with sacroiliits being a prime factor. As a matter of fact in those patients with persistently elevated Antistretolysin titers (ASO titers) suggestive of chronic strep infection, “Most of the subjects with high ASO titer had unclassified or undifferentiated arthritis.” Read the rest of this entry »

Popularity: 41% [?]

Monthly Support Meetings at:

Linda’s Sugar & Nails

Rosemont Shopping Centre

5010 - 4th Ave., Regina
First Thursday every month 7:30 PM

contact # - 522-8686

Popularity: 28% [?]

Recent MRI study of crohn’s colitis patients found 17/44 cases had evidence to sacroiliitis and 11 of these had back pain. HLA B27 is seen in 10% of the population. If present in any of the crohn’s patients (were in 7) - they all had sacroiliitis. This means that 11/44 = 25% of Crohn’s patients will have spine arthritis which is over twice the rate in the normal population. There are significant delays in diagnosis. Read the rest of this entry »

Popularity: 31% [?]

Since they have found the gene for Myotonic Dystrophy, they have found a subgroup not having that gene but having another gene deficit instead that is associated with milder disease. Randomly selecting Fibromyalgia cases found 2/63 cases though none of 200 controls had the gene. Another subgroup of FM patients have been found to have cervical spinal stenosis and surgery helps them. A cervical implanted stimulator is also getting good results in FM. Read the rest of this entry »

Popularity: 52% [?]

Since the early 2000’s experiments gene therapy experiments have been done on rodents using a non-replicating (Not growing) version of Herpesvirus (cold sore virus). The virus’s genetic machinery has been altered so it makes ingredients for enkephalins (spine cord morphine-like produced agent) or similar. When injected into a painful nerve segment, the virus ascends to the spinal dorsal root ganglion where it alters the cells there to make pro-enkephalins leading to significant relief for 3-7 weeks. Now human trials are scheduled for China Read the rest of this entry »

Popularity: 41% [?]

Chronic administration of minocycline (a tetracycline antibiotic) started 7 days prior to nerve injury prevented neuropathic pain in the animal model - This offers exciting possibilities for preventing post surgical pain conditions. Read the rest of this entry »

Popularity: 47% [?]

For some years, they were finding Botox into ankle, shoulder and hip joints was giving pain relief. Now injecting Botox 25 u into a thumb Metacarpal-phalangeal and 50 - 100 units into cervical facet joints gives a similar result. Read the rest of this entry »

Popularity: 53% [?]

It has been known for some time that bacterial overgrowth is a common cause/aggravation of irritable bowel. Now further concern Blastocystis Hominis and Dientamoeba fragilis infections are not being reported because labs are restricting their search for Amoebiasis and Giardiasis - but only with one stool which is suboptimal. Read the rest of this entry »

Popularity: 53% [?]

Prednisone dosage for the PR is a major concern. Initial dosages can be 20 mg daily, decreased 50% at 21 weeks. The accumulative dose is dangerous for osteoporosis, weight gain, hypertension and heart disease. Methotrexate at 7.5 mg weekly failed to reduce this accumulative dose though 10 mg did help. Now Etanercept (Enbrel) shows useful promise. Read the rest of this entry »

Popularity: 57% [?]

Gamma knife (GK) thalamotomy was used in cases of pain with Parkinson disease and other central pains.”A clinical success rate of approximately 80% with negligible complications” was achieved. Read the rest of this entry »

Popularity: 54% [?]

Cases with “sinus headaches” but negative workup were found to respond to tripans used for migraines 82% of time. 31% cases didn’t by into idea migraine and refused to be part of the study from the start - maybe, however, there is a middle ground… Read the rest of this entry »

Popularity: 54% [?]

Chronic pancreatitis is a disease associated with recurrent abdominal pains, and malabsorption with possible steatorhea (fatty looking stools), bloating, intermittent diarrhea. A recent study found Small Intestine bacterial overgrowth (SIBO) in 14/15 cases and suggested treatment would help those symptoms. In another study, SIBO is common in Rosacea and eradication led to “almost complete regression of their cutaneous lesions and maintained this excellent result for at least 9 months.” Half of elderly have lactose intolerance and treating them for bacterial overgrowth can cure it. Read the rest of this entry »

Popularity: 62% [?]

This syndrome comprises of pain in the gluteal region radiating down thigh to the posterior knee popliteal fossa. It is associated with hamstring weakness. A series of 43 cases were found in athletes and surgically rectified. This resulted in a 75% satisfaction rate. Read the rest of this entry »

Popularity: 72% [?]

For years, IBS has been known as a “psychological disease”, an intestinal spastic disease, and a segmental hypersensitivity syndrome (nerves hyperirritable). Now there is increased gut permeability, particluarly in the diarrhea predominant form. This “leaky gut” creates an immune reaction with “increased numbers of T lymphocytes, mast cells and enterochromaffin cells.” This offers new avenues to treatment like probiotics. Read the rest of this entry »

Popularity: 42% [?]

Pain post mastectomy can be an important issue. Associated with the pain is swelling called lymphedema. Now it appears transplanting lymph nodes from the groin can resolve the pain and lymphedema Read the rest of this entry »

Popularity: 64% [?]

Costovertebral (rib) joints are just starting to be recognized as a source of pain. A recent provocative study demonstrated their referral patterns Read the rest of this entry »

Popularity: 67% [?]

I was always bemused by “specialists” that point out facet OA changes and claim to patients these old age changes are responsible for their pains. Now the Framingham study has put a nail in the coffin for that attitude. Read the rest of this entry »

Popularity: 69% [?]

Recent Study did injection by anterior, lateral and posterior portals and checked subacromial penetration arthroscopically. “RESULTS: The mean distance with anterior needle placement was 2.9 +/- 0.6 cm. The mean distance with lateral needle placement was 2.9 +/- 0.7 cm. The mean distance with posterior needle placement was 5.2 +/- 1.1 cm.” Read the rest of this entry »

Popularity: 65% [?]

20% of missed celiac cases are found after age 60 and present with iron deficiency anemia. The gold standard is duodenal scope and biopsy but this might not be the best place to be. Read the rest of this entry »

Popularity: 64% [?]

There was recent mention on using IV Magnsium in acute migraines in a previous blog note. I had used it in combination 1-2 gms Magnesium sulphate with lidocaine 100 – 200mg IV for migraines but was not impressed that it worked for that long. If given too fast, it could also cause some burning in the blood vessels in the arm used which did seem distressing. I was using a small volume that I could give slow push rather than putting it in 250 mls saline so concentration could be the cause. However, this is has encouraged me to review the use of IV magnesium: - in neuropathic, migraine, and regionally. , Read the rest of this entry »