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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

Topical Clonidine or Capsaicin For Diabetic Neuropathy and Mannitol

Both clonidine 0.1% gel and capsaicin 0.75% cream three times daily can drop pain by 40% in 12 weeks though clonidine causes less skin irritation.

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Frozen Shoulder – Just a Little Cortisone But More Blocks Help

Study found 20 mg Kenalog worked as well as 40 mg and another found you don’t even need to hit the joint. I supplement suprascapular and quadrilateral space blocks as well as subscapularis working out.
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Posted in Injection, myofascial pain, shoulder | Leave a comment

Prostate Cancer – Does Early NSAID (Arthritis Pill) Use Help?

Early NSAID use in prostate cancer could potentially cut death risk to 1/3 though high dose late use, thought related to bone pain use, shows opposite.

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Twin Chronic Pain Study – Low DHEA Metabolite and High BMI and ?Cortisone

Twin study shows low Epiandrosterone, a metabolite of dehydroepiandrosterone (DHEA). Could supplementation help?

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Posted in Fibromyalgia, pain mechanisms | Leave a comment

Morphine Does Not Facilitate Breast Cancer in Animal Model

Frequent concern is whether meds someone is taking is making their cancer worse. In the animal model, morphine does not help breast cancer.

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Posted in breast cancer, cancer | Leave a comment

Hurt until Pain = Overdoing; Avoiding Things That Hurt = Avoidance – Can’t Win

Study found many overdo things resulted in significant pain flareups after. However, if they have periods where they avoid things that hurt, they are then categorized as avoidant – can’t seem to win though a paced life would be obvious.

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Bruxism – How do You Treat 2015 Besides Splints

Review on Bruxism Rx suggests splints, particularly mandibular advancement splints, clonidine or clonazepam, maybe botulinum, and nocturnal clenching biofeedback.

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Suffering is a Distinct Pain Feature

Simple study zapping volunteers drew distinction between unpleasantness ratings and suffering to point it considered it a distinct pain factor. This is not new news to anyone whose life has been changed by pain.

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Celiac is More Painful Than Thought – and What Does That Mean?

In seeing new pain patients, I became painfully aware that Celiac or at least gluten sensitivity has a definite presence- so much so that I always looked for it. Now, it looks like “anybody is fair game” now that even gluten intolerance without Celiac can potentially have their pain better off gluten for 6 months. What makes things clearer, is the finding of neuropathy in established celiac varies from 0.7% up to 23% with even more -  39% of celiac, having neuropathic symptoms. The latter might reflect how small fiber neuropathy is impossible to diagnose without biopsies – something not done where I live.

Another startling  finding is that sensory Chronic Demyelinating Inflammatory Neuropathy (sensory CIDP) is increased in Celiac. Sensory CIDP is hard to diagnose because of the lack of muscle weakness early on yet is potentially treatable with IV gamma globulin, Plasmaphoresis and pulse steroids. This leaves a subgroup of people with widespread pain treatable which one study in Fibromyalgia found when subjects responded to IV gamma globulin. I find it disturbing that there could be a subgroup of widespread pain Celiac victims that have treatable disease.

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Posted in Abdominal pain, celiac, Fibromyalgia, Leg Pains, neuropathic | Leave a comment

Severe or Neuropathic Groin Pain – Obturator Neuropathy

Have and elderly fellow that just persevered with severe left groin pain as was just something he should put up with. He had not been sleeping and daughter noted cognitive decline with it. Exam of hip was a bit sore but when I let go of the leg, you could see this expression of searing pain in his face. Turned out to be Obturator Neuralgia. I have trouble picturing the obturator nerve so I have included many pics…

obtur_neuropathy

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Posted in groin pain, Hip Pains, Injection, neuropathic | Leave a comment

Migraine – How much Help From Herbals

The top 3 herbals I recommend for migraines include B2 400 mg/day, Coenzyme q10 >120 mg and magnesium.  Now a proprietary med has put in all 3 and got 30% less headache days.

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When Irritable Bowel is not Irritable Bowel Syndrome (IBS)

Had patient in today with dark blood stools previously diagnosed with Irritable bowel but more much likely now colitis. Had another case recently worked up by a gastroenterologist with nothing organic found – yet fact subject eats  a lot of fruit was not factored in.

1/6 IBS cases have something significant even with out warning features -causes: crohn’s,  celiac, and microscopic colitis. Then there is the fructose malabsorption that will be more apparent this summer with increased fruit consumption.

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Why are Pain Severity Readings Omitted From Recent Fibromyalgia(FM) Studies?

Two important studies on approaches to help Fibromyalgia (FM) have omitted changes in Visual Analog Scale (VAS) readings in their results. Giving reading of skin tenderness adds differences with each muscle site tested and can exaggerate total difference. Suspicion is, there were not significant changes as this is the hardest measure to show benefit – yet the most important.

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Does Musculoskeletal Pain Cause Stress or Stress Cause the Pain -Studying People over time

A longitudinal – study – studying people before and subsequent to pains is the most reliable study format for figuring out what is going on.. What this study found was that it was the Musculosketal pain that caused the stress and not visa versa in most cases

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Metformin is Mitochondrial Enhancer and Helps Bipolar Depression

A 25 yr old bipolar patient of mine was put on metformin and a weight loss program prior to hip surgery. Her mood was more stable and she noticed particularly fewer manic episodes. There is evidence in literature for metformin helping bipolar cases. Bipolar, particularly those inherited from mother, could be more likely a mitochondrial disease, and recent developments suggest metformin with weight loss is a mitochondrial metabolic enhancer. Given metabolic syndrome is almost universal in bipolar, should metformin be universally used? Day after I wrote this up, I had a Bipolar victim come in refusing to take any stabilizing meds because she would put on 30 lbs. Metformin  then became a serious option.

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Posted in Depression, Drugs | 1 Comment

Hives with Nonspecific Gut symptoms – Consider Blastocystis

Blastocystis is a protozoan thought commensal (normal flora) but actually shown to cause disease in humans. Now a particular subtype is linked to urticaria/hives.

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Endometriosis – Continuous Birth Control Pills- Does it Help?

Review article covered recent literature and found what one would expect – of course.

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Fibromyalgia (FM) – Mitochondrial Dysfunction Helped by Metformin and Weight Loss

Adenosine Monophosphate activated Protein Kinase (AMPK) regulates cell metabolism  i.e “AMPK has a central regulatory role in cell metabolism, mitochondrial biogenesis and oxidative stress response”. Recent study of FM fibroblasts found AMPK downregulated.”AMPK down-regulation [is] at least in part responsible for the impaired oxidative stress response and mitochondrial dysfunction observed in Fibromyalgia”. AMPK activation can be obtained by metformin.  Also perhaps by weight loss as serum from weight loss restricted mice activates it. Implications are that weight loss and metformin can set one’s metabolism some straight. FM subjects are susceptible to oxidative stress potentially leading to cell deaths and above measures help contain that as well.

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Topical B12 helps Canker Sore Pain and what this means for Shingles -

Triamcinolone 0.1% topical oral ointment with 500ug B12/2 mg ointment outperformed plain triamcinolone adding credulance that frequent B12 injections into active shingles area helps. Question is whether it needs to be methylcobalamin  – B12 bioactive form for best topical effect.

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Posted in ENT, post herpetic neuralgia | Leave a comment

Pine Bark for Migraine?

Only study on Pine bark for migraine I could find used 1200 mg/day and did get impressive results on resistant migraines. But the best price I could get for that was $4/day..

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Posted in Drugs, Headaches | Leave a comment

Migraine in Adolescence – Abortive Treatment -But in Canada you’ll Need a Pill Splitter

In the US, a drug combination for treatment of migraines has been released called  Treximet – sumatriptan (Imetrix) 10 mg and Aleve (Sodium Naproxen) 25  mg. It has been approved for use in adolescents 12-17. In Canada you’d have to cut sumatriptan 25 mg and Aleve 220 mg tablets or take liquid of latter.

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Diabetic Neuropathy – B12 Helps While Vegan Diet Minimal Effects

Though 20 week vegan diet touted as helping diabetic neuropathy, its pain levels were no different than the B12 control and the foot skin conductance was not different. Only diffence was in McGill Pain questionnaire in the sensory fields. Unfortunately, these fields are not mutually exclusive so the same thing could be added up several times eliminating their p=0.04 significance. A difference in neuropathy scale would suffer from same issue. Yet if you look in the free press, vegan diet may be the next best thing for DM neuropathy..

http://consumer.healthday.com/diabetes-information-10/diet-diabetes-news-178/vegan-diet-might-ease-diabetic-nerve-pain-699793.html

I have written the author for clarification.

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Neck Pains From Atlanto-Occipital Joints

Top joint C0-1 refers to upper neck, face and upper shoulder tips. Exam requires you to grip c1 transverse processes and nod neck sideways. Certain manual techniques might help.

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Posted in Headaches, Injection, Manual Med, Neck | Leave a comment

Diabetic Neuropathy: Duloxetine Mediocre Results

For Diabetic Neuropathy – Recent study in China showed statistical significant drop of pain on Duloxetine but not clinically significant. – Have a look.

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Coccygodynia = Tender Coccyx – Inject Ganglion Impar

One Ganglion Impar injection achieved over 50% improvement for 82% of cases that lasted an average of 6 months.

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