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

New Treatment for Scabies – and even bad Rosacea, Blepharitis, and Scalp Folliculitis

Scabies has become increasingly resistant to Nix and Kwelleda leaving people with attempts to get Ivermectin orally by emergency release from the US (not easy – they kept sending me repeated letters with more questions to answer). It is easy for animals as it is a de-worming agent though. A work around is the finding that topical ivermectin 1% has real potential to work. It is now clear that some Roseacea, Blepharitis, and scalp folliculitis is actually an infestation of Dermodex “mange” mites that are ubiquitous in humans but excessive in some.

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Pamidronate in Severe Knee Pain

Filling in my contention that pamidronate is very useful in Complex Regional Pain Syndrome, is an older article using it for CRP of the kneecap.

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Posted in complex regional pain, Drugs, Knee | Leave a comment

Inflammatory Back Pain (IBP) – MRI’s Use depends on when you do it.

In IBP – MRI could be negative or positive at one point and then the opposite later on. Make MRI imaging more dubious than people think.

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Posted in arthritis, Back Pain | Leave a comment

Are You Sick of Health Web Sites?

I am sick of health websites that:
- don’t give links to what they discuss
- are filled with commercial ads
- make you go though multiple pages, each with various ads
- just repeat what you see elsewhere.

It is thought that health sites will be filled with commercial interests and I am seeing that already.
see:
Health websites could be overrun by commercial interests, experts fear
http://www.cbc.ca/news/health/health-websites-could-be-overrun-by-commercial-interests-experts-fear-1.2779128?cmp=rss

Everything on this site is referenced and on one page. I have no ads nor commercial interests.

I think people should tell some of these sites that they are not worth scrolling through…

opinions?

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Desimpramine For Neuropathic Pain a Myth

Use of  Tricyclic antidepressants (TCA)’s for neuropathic pain was based on an article for diabetic neuropathy where, through frequent phoning and support, authors were able to get patients up to 150 mg. No one has succeeded in getting people up to these doses since and success with TCA has been less. Now, in the case of desipramine, Cochrane has come out and said it – “This review found little evidence to support the use of desipramine to treat neuropathic pain. There was very low quality evidence of benefit and harm, but this came from studies that were methodologically flawed and potentially subject to major bias. Effective medicines with much greater supportive evidence are available.”
I have written how Nortriptyline is of little use in Neuropathic pains:
Is Nortriptyline Any Good? – Maybe – but Maybe Only a Bit
http://painmuse.org/?p=3316

neuropathicp

I wish speakers would stop extolling the virtues of TCA’s when their effects are poor at best. – use better drugs.

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Autosomal Dominant Polycystic kidneys – avoid or keep Estrogens to low dose

Recent review of Polycystic Kidneys states “Because of the proliferative effect of estrogen on hepatic cysts, oral contraceptives containing estrogen and menopausal estrogen therapy should be administered at the lowest effective dose or avoided in patients with ADPKD (autosomal dominant polycystic kidney disease)“

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Acetaminophen (paracetamol) does not work in acute Back Pain

Double blind study found Paracetamol (acetaminophen) at average dose of 3500 mg/day in week 1 and 2800 mg/day in week 2 for the regular group was not better than placebo.  It had `no eff ect on pain, disability, function, global symptom change, sleep, or quality of life.`

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No Evidence of Hypervigilance in Fibromylagia (FM)

Implications have been made that victims of FM are nuts and think too much of their pain. Now it seems that subjects with FM are no better in awareness of changes in tactile stimulation – suggesting hypervigilance is not present.

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Serum Lipase Should Be Test For Pancreatitis

Serum lipase has a sensitivity of 91% while amylase had sensitivity of 61%. Specificity was 92% for lipase and 93% for amylase.  Testing lipase and amylase together changed sensitivity very little - was 93%.

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Bell’s Palsy Treatment Algorithm

Latest algorithm suggests you make sure of diagnosis

Use of antivirals doesn’t work

Prednisone 1 mg/k x 7 days (why does one need to taper though?) useful

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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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Posted in Hip Pains | Leave a comment

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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Posted in breast cancer, cancer | Leave a comment

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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Posted in Fibromyalgia, pain mechanisms | Leave a comment

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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