Vitamin B12 Injections For Chronic Pain

Below is a study poster presented to the Canadian Pain Society showing benefits of frequent B12 Injections. Unfortunately, a study found men with smoking history have a 3 times lung cancer rate so I have now restricted B12 injection use to women.

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Office Ketamine For Chronic Pain Poster

here is poster in pdf format:

Poster CPS 2017 ketaminefinal (2)

in word format:
Pilot Study

 

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Welcome to Painmuse

ALTHOUGH I WILL NOW UPDATE THIS SITE, FOR PAST 6 MONTHS, BLOG NOTES (about 50) WERE PUBLISHED AT :
newpainmuse.org

visit me there!

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

Thanks admin

Hit     CTRL  +   to make things larger

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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 | 9 Comments

Commonly Missed Problems in Chronic Pain

Back in 2006, Janice Montbriand  and I wrote a poster about “Often Missed Treatable Co-Morbidities in Patients with Treatment Resistant Chronic Pain”. They included Bipolar disease, B12 and Vitamin D deficiencies, and sleep disorders.  Each one of these is still an important issue today.

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Finger pressure can relieve many migraine headaches

Over three minute pressure to occipital arteries can greatly relieve migraine pain in over 1/2 of cases; almost sounds too good to be true. Continue reading

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Vitamin D in Dogs – are we missing the boat? – Arthritis and Itching

Dogs cannot make vitamin D – not even from sun and hence are totally dependent on diet. Osteoarthrtis in humans is only  protected in humans with HIGH vitamin D levels. Might this apply to my dog as well?

Below article discusses the potential need for Vitamin D. Deficiencies were common:

Thirty-three dogs (71·7 %) had 25(OH)D values below the previously reported minimum concentration indicating sufficient vitamin D status of 100 ng/ml”

Young, Lauren R., and Robert C. Backus. “Oral vitamin D supplementation at five times the recommended allowance marginally affects serum 25-hydroxyvitamin D concentrations in dogs.” Journal of nutritional science 5 (2016).

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/FFBAD4E956A376301E5DFC12F0E1C252/S2048679016000239a.pdf/oral-vitamin-d-supplementation-at-five-times-the-recommended-allowance-marginally-affects-serum-25-hydroxyvitamin-d-concentrations-in-dogs.pdf

Importance of Vitamin D in dogs so far:

In veterinary medicine, many investigators have reported associations between low serum 25(OH)D concentrations and canine mast cell tumour(16) , chronic kidney disease (17), congestive heart failure(18) , inflammatory bowel disease (19) and cancer (10)

16 Wakshlag JJ, Rassnick KM, Malone EK, et al. (2011)
Cross-sectional study to investigate the association between vitamin D status and cutaneous mast cell tumours in Labrador retrievers. Br J Nutr 106, S60–S63

17 Gerber B, Hassig M & Reusch CE (2003) Serum concentrations of 1,25-dihydroxycholecalciferol and 25-hydroxycholecalciferol in clinically normal dogs and dogs with acute and chronic renal failure. Am J Vet Res 64, 1161–1166

18 Kraus MS, Rassnick KM, Wakshlag JJ, et al. (2014) Relation of vitamin D status to congestive heart failure and cardiovascular events in dogs. J Vet Intern Med 28, 109–115

19 Gow AG, Else R, Evans H, et al. (2011) Hypovitaminosis D in dogs with inflammatory bowel disease and hypoalbuminaemia. J Small Anim Pract 52, 411–418.

10 Selting KA, Sharp CR, Ringold R, et al. (2014) Serum 25-hydroxyvitamin D concentrations in dogs – correlation with health and cancer risk. Vet Comp Oncol (epublication ahead of print version 8 July 2014).

 

ARTHRITIS BIG ISSUE and NEED FOR HIGH VITAMIN D LEVELS

What is little known in human studies is only high levels fully protect people

only HIGH levels fully protect mono sufferers from getting MS:
Munger, Kassandra L., et al. “Serum 25-hydroxyvitamin D levels and risk of multiple sclerosis.” Jama 296.23 (2006): 2832-2838.
https://jamanetwork.com/journals/jama/fullarticle/204651/

“HIGH circulating levels of vitamin D are associated with a lower risk of multiple sclerosis.”

HIGH levels fully help protect subjects from heart disease:

J Prev Med Public Health. 2017 Jul; 50(4): 278–281.
The Big Vitamin D Mistake
Dimitrios T. Papadimitriou
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5541280/pdf/jpmph-50-4-278.pdf

HIGH  levels are helpful in lupus:

Pakchotanon, Rattapol, et al. “Randomized Double-Blind Controlled Trial To Evaluate Efficacy Of Vitamin D Supplementation Among Patients With Systemic Lupus Erythematosus.” Journal of Southeast Asian Medical Research 4.1 (2020): 24-32. https://www.jseamed.org/index.php/jseamed/article/view/57

 

AND Most importantly, only HIGH levels gave best protection against Osteoarthritis.

In a Framingham study of osteoarthritis only subjects in the Upper 1/3 blood levels of vitamin D were protected from osteoarthritis progression: Relation of Dietary Intake and Serum Levels of Vitamin D to Progression of Osteoarthritis of the Knee among Participants in the Framingham Study Timothy E. McAlindon et al Ann Intern Med. 1996;125(5):353-359.

http://annals.org/article.aspx?articleid=709914

“Risk for progression increased threefold in participants in the middle and lower tertiles for both vitamin D intake (odds ratio for the lower compared with the upper tertile, 4.0 [95% CI, 1.4 to 11.6]) and serum levels of vitamin D (odds ratio for the lower compared with the upper tertile, 2.9 [CI, 1.0 to 8.2]).”

This is huge with “normal” and low levels getting THREE times the osteoarthritis rates. However, where I live vitamin D deficiency is rampant and there seems to be no understanding that knee replacement might be in part related to low vitamin D levels.

 Suspect same seems to go with canines.

Dogs carry huge risk of osteoarthritis yet there is little research into need for vitamin d.

Initial article used:

2·3 μg vitamin D 3 /kg BW exp 0·75

Exponenting the weight comes from studies:
Sidhu KS. Basis for body weight exponent (0.75) as a scaling factor in energy metabolism and risk assessment. J Appl Toxicol. 1992 Oct;12(5):309-10
https://pubmed.ncbi.nlm.nih.gov/1447474/

1 mcg vitamin D is equal to 40 IU

10 kg exp 0.75 comes to 5.6 kg

Results work out to 560 u/day for a 10 kg dog (400 u = one drop pediatric – so one drop for 3 days and 2 drops on forth day)

 

Gave my 10 k cocker spaniel his first drop today….  More heavy set dogs are going to need it more…

addendum – vit d supplementation might help itch in dogs:

Klinger, Christoph J., et al.
Vitamin D shows in vivo efficacy in a placebo‐controlled, double‐blinded, randomised clinical trial on canine atopic dermatitis.
Veterinary Record 182.14 (2018): 406-406.
https://www.rxvitamins.com/rxvitaminsforpet/wp-content/uploads/2018/03/Vitamin-D-Study.pdf

“After eight weeks of treatment, patients who received cholecalciferol showed significantly less pruritus than patients from the placebo group (P<0.0001)” – actually cut it in half! I’m hoping my dog will scratch less…

 

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Emotional and Physical Pain Might Be a Memory Engram and How to Prevent It

Dr. AV Apkarian has pioneered the idea that brain changes occur following pain injury that leaves a pain memory.

Mansour, A. R., M. A. Farmer, M. N. Baliki, and A. Vania Apkarian. “Chronic pain: the role of learning and brain plasticity.” Restorative neurology and neuroscience 32, no. 1 (2014): 129-139.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4922795/

“We argue that the definition of chronic pain can be recast, within the associative learning and valuation concept, as an inability to extinguish the associated memory trace”

Perhaps early use of steroids can prevent this pain memory as seen in whiplash and more recently, in a PTSD like situation.

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Vitamin B12 in Chronic Pain

Since it was found that high dose B12 shots can almost double life expectancy of victims with ALS, the use of B12 shots has taken a new life

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Anger Issues in Chronic Pain

There can be a significant depression issue in chronic pain in which, if you scratch the surface, you find significant underlying anger is actually the issue. Inability to deal with the anger leads to significant depression and self-flagellation and increase suffering. I attempt to suggest to patient to say out loud “I forgive you” in regards to others but finds subjects choke up on that. Now it look like a way in, is to do loving kindness meditation (Tong Len taking and giving). This involves meditation plus imagining breathing in the black “pain” of others while breathing out an aura of happiness to others. My feeling is that doing that to ones you hate could help the issue and give you a sense of relief.

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Making Methotrexate Work in Ankylosing Spondylitis/ Inflammatory Back Pain

Methotrexate is a fairly safe medication but studies of it solo have failed to help Ankylosing spondylitis. Chinese study found when used with methylprednisolone had a therapeutic effect and improved inflammatory markers.

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Gut Hazard – Commercial Dishwasher Soap

Alcohol ethoxylates, which stick to dishes and prevent water adhering after drying, are shown to damage gut cells or render them permeable.  This is considered toxic to gastrointestinal tract and could flare gut symptoms at levels used by such cleaners. So, what does one do with stomach problems? – Either don’t use a dishwasher or clean dishes off with an alcohol-based hand sanitizer/ hand wipes as compound not that water soluble…

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Spinal Stimulation Not Working For Pain – Option of Adding Dorsal Root Stimulation to Save the Day

Spinal cord stimulation is often used as a last resort. To start with, that is a mistake.

Dr. K Kumar pioneered efforts to use spinal stimulation:

Here is a list of some of his articles:
https://scholar.google.ca/scholar?q=Kris+Kumar+spinal+cord+stimulation&hl=en&as_sdt=0&as_vis=1&oi=scholart

I have been practicing long enough in his town to hear him speak and one thing always stuck with me. He bemoaned how long it took for subjects to get to him for treatment as he felt early intervention improved results. Some years ago at a conference, spinal stimulation was discussed but the neurosurgeon was unaware of Dr. Kumar’s 22+ years of experience culminating in that revelation. I was shocked.

So, subjects are seen late, and fail to achieve adequate relief with spinal stimulation even with new modes being used- then what do you do? I try IV pamidronate, ketamine and even methadone might have a place. Now, it looks like adding a stimulator more externally to the outlet of the spinal cord where the dorsal root ganglion is, could make the difference.

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Cytokine Pain Diseases

Chronic diseases with negative “blood work” might in fact be  a cytokine inflammation disease. Moderate fibromyalgia has now be found to be a cytokine inspired disease.

I wrote about importance of cytokines 12 years ago:
Cytokine Inflammation Diseases Will Be the Diseases of the 21st Century
http://painmuse.org/?p=361

Then connection to multiple diseases were seen (headaches, irritable bowel, diabetes, alzheimer’s, chronic pancreatitis, chronic fatigue, depression and now depression.

Back in 2013 I wrote a draft that was never published:
“Could Elevated Cytokines Become a Test For Fibromyalgia (FM)?” Now it has.

Below is an update on tests in Fibromyalgia and cytokine relation

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Mouse Explains Why Some Marijuana Products Not Work Well

I have found for years that pure cannabinoid (CBD) seemed to have little impact in significant = more likely neuropathic pain.  I tired to get subjects to at least have 1/4 portion of THC but elderly subjects would have nothing to do with spacing out meds. Now the animal model has shown that pure CBD has little impact on neuropathic pain. Marijuana sites pride themselves in regulating cannabis doses as they consider doctors  idiots when it comes to that. However, when you look at their titrations, it is very down-scaled and not likely to have impact for 3-6 weeks. Due to expense, many of my trial users give up on the med.

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Chronic Back Pain – Antibiotics and Pamidronate +/- Steroids

Now that it looks like Rheumatoid Arthritis could be infection driven, the benefits in a study of Clavulin (amoxicilin + clavulanic acid) needs revisiting. It has been know for a long time that certain antibiotics have “anti-inflammatory properties”. Now it might be interpreted that they control bacteria that could augment inflammation. A study of plain amoxicillin did not work.

Does that mean that Clavulin controls this inflammation by having wider antibiotic spectrum and should it engender new respect? Could certain antibiotics work like they do in rheumatoid arthritis and reduce inflammation?

Anti-inflammatories “NSAID’s” work poorly in ankylosing spondylitis. Methotrexate does not seem to help.

Prednisone helps but high dose is needed to get any initial response and cannot be used long-term by self especially related to osteoporosis.

Pamidronate is a game changer in chronic back pains particularly where inflammation is missed.  Mixing with prednisone/steroid is possible.

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Bacteria at Heart of Rheumatoid Arthritis?

Recent Study found a strain of previously unrecognized strain of Subdoligranulum in gut was associated with Rheumatoid arthritis (RA) autoantibodies. This bacterium, if introduced into guts of mice, replicated the arthritis seen in humans. This strain is only seen in RA victims.

 

So, both gut bacterial and periodontal disease can potentially trigger antimmune responses. This leads to new implications on prevention and treatment of Rheumatoid arthritis.

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My College is a Pain in the Ass – My Reply to Them and Why They No Longer Call Themselves “Educational”

Our medical college has taken upon themselves the task of antagonizing doctors to point many clinic will no longer even prescribe opioids. They called their program “educational” but demanded doctors respond to them is 2 weeks or else face discipline. No where else in Canada is it that short – BC has 2 “working” weeks which ends up 3 weeks. Some 20 years ago I went to see The then Registrar, Dr. Kendel, and told him 2 weeks was too short but he seemed more concerned that doctors did not take the letter seriously. I got in trouble over that and retired over it.

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Buprenophine and Pregabalin Combo For Chronic Back Pain

Most drugs have little effect on back pain or back pain with sciatica. Surprisingly, a combination of Buprenophine and Pregabalin did seem to make a difference in milder back pain cases.

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Testosterone Effective in Widespread Pains/ Fibromylagia

I have tested testosterone levels in my chronic pain female patients and found none of them had any detectable levels; they should have some. Supplementation helps.

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Pamidronate Works Again in the Back – This Time For the Worst – Spinal Stenosis

Spinal stensois is a horrible disease often thought that surgery is the only outlet (though steroid blocks might have some “limited” effect).  Now again pamidronate has been shown to stem tide of pain with a mean improvement of 40%. Not a controlled trial; but still encouraging. Old study but new to me…

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Chronic Diarrhea – Stool Testing For Ova and Parasite Gone Bad and “Plan B”

People who come in with recently developed chronic diarrhea are a challenge. Reliance on stool tests might be suspect if just relying on Ova and Parasite micro exam. Given excretion is episodic, O&P testing by microscopy  would miss 39% of amebiasis and 25% of giardiasis. Even the antigen tests could miss 10+%. This leads to plan B –  Metronidazole treatment as a viable option but could still not help up to 30% of cases.

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Moron Studies in Pain

Studies of too little, too short or too narrow a scope are associated with poor outcome and I am accumulating a list of poorly done studies as I am just fed up. I hope authors take note. I will take me awhile to go thru a compilation of studies I have.

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Malassezia Fungus Makes News Again With Peptic Ulcers

Malassezia seen in brains of Alzheimer’s:
Front Aging Neurosci. 2018 May 24;10:159. doi: 10.3389/fnagi.2018.00159
Infection of Fungi and Bacteria in Brain Tissue From Elderly Persons and Patients With Alzheimer’s Disease.
Alonso R et al.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5976758/
“the fungal genera more prevalent in AD patients were Alternaria, Botrytis, Candida, and Malassezia”

and, in abundance, in pancreatic ca:
Aykut, Berk, Smruti Pushalkar, Ruonan Chen, Qianhao Li, Raquel Abengozar, Jacqueline I. Kim, Sorin A. Shadaloey et al.
The fungal mycobiome promotes pancreatic oncogenesis via activation of MBL.
Nature (2019): 1-4.
https://www.researchgate.net/profile/Wei_Wang439/publication/336224053_The_fungal_mycobiome_promotes_pancreatic_oncogenesis_via_activation_of_MBL/links/5d95fff6458515c1d3919a55/The-fungal-mycobiome-promotes-pancreatic-oncogenesis-via-activation-of-MBL.pdf

“Here we show that fungi migrate from the gut lumen to the pancreas, and that this is implicated in the pathogenesis of PDA [Pancreatic Duct Cancer].  PDA tumours in humans and mouse models of this cancer displayed an increase in fungi of about 3,000-fold compared to normal pancreatic tissue.

Now, seborrheic dermatitis, related to it, increases chance of peptic ulcers by 1.6 times.

 

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Why is Metformin’s Magical Effects on Chronic Pain a Secret?

Selecting people with mildly abnormal hemoglobin A1C (prediabetic), authors found the introduction of Metformin 500 mg twice daily could dramatically relieve widespread pains. Article had to be pulled because consents were iffy and they didn’t have enough in “control group” to prove it didn’t work in non-diabetics. This was May 2019; I have been waiting for them to get consents and a big enough control group but treatment study was never republished. This has remained a secret.

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What is Time Course of Vertebral Fracture Pain?

At least in low back, it looks like after 3 months, it gets as good as it gets.. Almost 1/3 might end up poorly so thoughts of IV pamidronate or vertebro/kypho plasty might need consideration.

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Failed Post-Cervical Laminectomy Fusion Pains -What can you do?

Failed cervical laminectomy/fusions are considered a difficult situation. Epidurals are difficult. and rhizotomies might fail. Usually a cervical spinal cord stimulator is considered impossible due to scarring. However, in this case. a cervical spinal cord stimulator was much easier placed than thought and cut pain 80% . In one of my cases, chronic infection was considered and treatment achieved 36+% improvement in pain.

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New Genetic Determinant of Neuropathic Pain – Chromosome 12q23.1

We are all faced with patients that have pain are above what they should have and have pondered genetic causes.  Genetic Variant at Chromosome 12q23.1 increases chances by odds ratio 1.68 of neuropathic pain. Is a mitochondrial phosphate carrier and calcium binding gene, expressed in brain and dorsal root ganglia. The plot thickens.

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What Mattress Works Best to Prevent Back Pain?

Review of multiple studies found no surprises: “a medium-firm mattress promotes comfort, sleep quality and rachis alignment.”

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Methadone – Is It Better Than Morphine?

Brazilian study compared morphine 47.4 +/-  57.6 to methadone 62.1 */- 15.5 and suggested methadone was 20% better. However, there are some problems with study.

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Treating Tooth Infection Early

I have had my share of tooth infections and this is what I have learned so far:

1) Once it’s abscessed nothing works but a root canal or extraction
2) early on, regular dosed antibiotics do nothing.

There are options – loading doses and topical

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