Office Ketamine For Chronic Pain Poster

here is poster in pdf format:

Poster CPS 2017 ketaminefinal (2)

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Posted in Drugs | 2 Comments

Welcome to Painmuse



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

Thanks admin


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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 | 5 Comments

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

Posted in Headaches | 11 Comments

Post Craniotomy Headache Local Treatments

Post-Craniotomy Headaches are annoyingly common – “Headaches following craniotomies are reported in up to 91% of neurosurgical cases”.  Injecting craniotomy edge defect triggers,  scar neuromas, and botulinum to temporalis muscle are local treatment options.

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What can One Do For Severe Limb Pain? Epidural Motor Cortex Stimulation

Severe limb pain unresponsive to treatment ends up a surgical problem with spinal or ganglion stimulation becoming more common. A pain pump is an option. Motor cortex stimulation is as well, if pain is localized.  This is technically more difficult to do on a leg but a  Japanese study shows it can be done.


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Using the Pain System to Treat Depression – Buprenorphine

I have published on the use of ketamine to treat pain/depression/suicidality. Now a weak painkiller / partial painkiller blocker has been shown to help depression, not with one study, but with findings from twelve studies.

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Dental Nerve Injury

Yanking out a 3rd molar can damage the associated nerve, but done inferiorly, this just seems to create a numb chin most of the time. Dental implants however, can damage the nerve and leave persistent pain. Article found that early surgical exploration and perhaps nerve  resuturing could significantly improve things.

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Does Gargling with Probiotic Align Help Persistent Sore Throat?

Had one patient with persistent sore throat gargle with Align Probiotic with rapid improvement in pain – just used it once/day, Would be interested in anyone with similar response.

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Fibromyalgia and Going For Surgery Advice.

This advice is being circulated and I’m putting it here so it won’t be lost in ensuing weeks.

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Chronic Abdominal Pain in Children – Are They Suffering Unnecessarily?

I recently wrote about how they are only now finding certain abdominal wall injections work for chronic abdominal pain in adults – confirming source is the abdominal wall – what already???

I suspect it is even worse with children in which 30% of chronic abdominal pain is thought originated from the abdominal wall and amenable to injection.  Study in press documents features and treatment.

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What are the Causes of Polyneuropathy?

Recent study gave a breakdown of what they found re cause. Frank diabetes was eliminated from selection as the cause would be obvious? Top 4 were Idiopathic 47%, Chronic Demyelinating Inflammatory Polyneuropathy(CIDP) 38%, Pre-diabetes 16%, and Charcot Marie Tooth syndrome (CMT) 9%.

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Does Small Fiber Neuropathy Progress?

Approximately 40% of “Fibromyagia” cases are actually small fiber neuropathy (SFN). There is now evidence of how this type of neuropathy progresses. 75% remain stable and 25% progress into large fibers.

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Intramuscular Stimulation (IMS) Works Even in Rats

Intramuscular Needle electrical needling of trigger knots in rat gastrocnemius(calf)  results in less irritable sites. I use IMS for areas I wish to avoid use of local (neck, about hip where need to be able to walk after etc.).  I couple it with massage techniques to remove any residual triggers and find it helpful.  Nice to have some basic science showing it works.

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

Plantar Fasciitis – New Helps – Simple PRP and Nerve Ablation

Results from simple measures such as heel cup and ankle dorsiflexion night splint are not vigorous so am forced to look further. Steroid injection in the 21st century is out because it thins the heel pad making further problems more likely. I came across this protocol for PRP that is simple and could be done by anyone with a centrifuge. All PRP studies of plantar fasciitis only talk about long term results so I suspect immediate gratification like one gets from steroids, is not likely. It uses small amounts (from 10 mls blood) weekly x3.

Nerve radiofrequency abaltion of Inferior Calcaneal nerve gives spectacular results and so could chemical ablation

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Does Ritalin Help Traumatic Brain Injury Mental Fatigue and Mental Functioning? -Yes

Two year study found methylphenidate, average 60 mg /day, improved mental functioning in TBI.

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Masseter Facial Myofascial Pain – Botulinum Treatment

Treatment of Masseter Mysofascial pain with botulinum was successful in 64% of cases.

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Nasal Neuralgias – What to Do

A Nose pain issue with pain out of control could represent a nasal neuralgia with  a treatable injection regimen.

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Lateral to Upper Eyelid Lacrimal Neuralgia

Poorly known pain condition affecting outer eyelid and temple area. Such conditions I thought no one would care about but have had thank you’s in past so here it is.

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Posted in eyes, neuropathic | 1 Comment

Might Need Magnesium to Make Vit D Work Well – and Great Effects on BP.

Vitamin D is helpful in pain control and reduces cancer esp colorectal cancer – and recurrence rates.  Article makes a plausible case for magnesium needed for  Vitamin D to work.

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Cheek Pain – New Zygomaticofacial Neuralgia

The  Zygomaticofacial Foramen  is 2 cm lateral and 2 cm inferior to the lateral canthus  (edge)  of the eye. A case of neuropathic pain from there that responded well to injection is documented.

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New Test for Neck Radiculitis

I have now seen 2 cases of idiopathic cervical “sciatica”/radiculitis with stickingly bad pains in triceps. This arm muscle pains can help distinguish this from intrinsic shoulder pains and one author some years ago came up with the arm “squeeze” test for neck radiculitis

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Cutting Opioid Dose Does What? And Why is Tapering so Difficult?

Opioid deaths seem to be fueling more by Chinese derived illicit fentanyl. However, massive efforts are made to lower opioid dose. One study was successful at getting opioid consumption down  from 288 mg to 150 mg. They weren’t any better for it despite the theoretically “dangerous high levels” which would probably not be a problem if they avoided chinese imports. There was no effort to have a control group to see how many more deaths there were in the “dangerously high” group.

I have not had much luck tapering opioids and a recent analysis explains why. They claim opioids are integrated in mood, energy,  motivation,  social functioning and personality systems and withdrawing doses will effects all of it. Above study was successful because they started with 5% reductions in the first month and upped it to 10% every 2 weeks in the second month.

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Opioid and Tranquilizer Deadly Mix- How Did We End Up That Way? – Bipolar and/or PTSD

It has been said Opioids and tranquilizers can increase risk of overdose death five fold.
In my population, there is a subgroup of cases with bipolar disorder. Indeed, a meta-anlysis found 21 – 25% of Fibromyalgia disorder have it and I suspect more not diagnosed.  In a mixed state, a pain patient gets little sleep and is in considerable distress with agitation and will inadvertently be put on significant doses of tranquilizers to deal with this “pain” when tolerance to atypical anti-psychotics is limited.   March is a good time to see it and I have seen a couple cases already this year.  After the mixed state subsides, they end up continued to take them because they can contend it helped them.

It is also easy to put pain patients that don’t sleep and have restless legs, on Clonazepam which is some cases is dangerous, particularly if subjects are obese and subject to sleep apnea.

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Doctors Told To Skip Pain Severity Questions

Pain became the 5th vital sign and doctors were initially told to take tabs on severity through scales out of 10 testing. Now, out of fear severity analysis will over-treat pain with opioids, doctors in USA are being encouraged not to question pains severity and stick to level of function. There is evidence that, removed from placebo effect, opioids only reduce pain by 1/10 on average. For clinicians that are not trained in orthopedic medicine, opioids, and now marijuana, are the main tools to control pain. This is what fuels the opioid epidemic. I did an analysis of my practice and find other measures I do drops pain by 2/10 bringing pain to more acceptable levels. Those with 7/10 of more can be often dropped in pain by 3/10 for 3 days at a time by ketamine shots done 1-2 times a week and control depression. Regular treatments using alternatives written in this blog, can do more.

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Indication For Gallbladder Removal

Article starts by mentioning how up to 33% of cholecystectomy patients can have persistent abdominal pain so taking out Gallbladder (GB) is a serious decision. Indications however include frequent attacks, large stones, older age, inflamed GB attack(cholecystitis), and pancreatitis from gallstones.

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Gluteus Medius Tendonitis Injection Treatment and more

Although the question of whether one is dealing with hip bursitis or is this referred from back is important, I wanted to clarify what steroid injection would do for seemingly glutues medius bursitis. One study suggests it was good in 72% of cases at one month while another suggested it was good up to 6 weeks. Thereafter however, is problematic with PRP injection outshining it after 6 weeks. Problem is and I quote “an isolated passive intervention cannot hope to address the often complex mix of pre-existing and subsequent impairments”.

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Posted in Back Pain, Hip Pains, Injection | Leave a comment

Shoulder Operation -More Confusion

A Canadian study on full thickness tears found the no-op subgroup did well over 5 years. A Netheraland study found removing bursa (B) and taking off acromium(A) not any better than just removing bursa alone  in chronic subacromial shoulder pain. Tear progression was not statistically different though at trend for A+B. Both suffer from not examining the patient subsequently to see what troubles they did actually have. British study found no clinically relevant benefits to Arthroscopic sub-acromial decompression

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Botulinum Helps Photophobia and Dry Eyes

People who were given botulinum for migraines found coincidentally that phobia and dry eye symptoms improved as well.

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