Chronic indigestion “dyspepsia” is a frequent medical problem and gets bad when ulcer pills fail to work. Now nighttime - bile reflux (regurgitation bile into stomach) may account for some. This is helped by agents that help bowel motility like Domperidone (motilium) Read the rest of this entry »
Popularity: 1% [?]
I had a patient come in and ask if Reishi mushroom - “Lingzhi” Ganoderma Luciderma is helpful. The answer is maybe… Read the rest of this entry »
Popularity: 4% [?]
I recently had the following letter:
“I am doing research on use of botulinum toxin type-a in trigeminal neuralgia.so, I will be highly obliged if you will send me some details with references about dosage and techniques used in injecting different facial muscles.”
Interestingly, the use of botulinum in neuropathic pain appears to be often intradermal(injected into skin so bleb blanches skin)… Read the rest of this entry »
Popularity: 5% [?]
It has been known for some time that taking vitamin C 500 mg twice daily following a wrist fracture can significantly reduce the chances of developing Complex Regional Pain / Reflex Sympathetic Dystrophy in that arm. Now it has been found that people with Post Shingles Pain are more likely to have low vitamin C levels and giving IV Vitamin C on three alternate days can reduce “spontaneous” pain in 62% cases by over 50%. Read the rest of this entry »
Popularity: 6% [?]
The first question I ask a shingles / herpes zoster patient is whether they would mind if what pain they currently had persisted. This is because efficacy of anti-virals could be limited…They are still fighting over whether anti-virals prevents post-herpetic neuralgia as late as November 2009 - in the Journal of the American Medical Association (JAMA):JAMA, November 4, 2009—Vol 302, No. 17, p1862:
“I stand by my statement that “[p]revention of PHN is a major concern because antiviral drugs alone do not reliably prevent this complication.” The US Food and Drug Administration (FDA), using the definition of PHN cited by Zhou et al, concluded that although treatment may decrease the median duration of pain (as a continuum), the data from well-controlled clinical trials did not provide evidence of reduction of PHN for any of the licensed drugs: acyclovir,1 valacyclovir,2 or famciclovir.3 The FDA refused to grant this indication based on its analyses and input from advisory committees. ”
So to make an impact on a potentially quality of life changing disease, nerve blocks appears to be the ticket. I can only assume those who feel there is not enough evidence , have never done one - the relief is immediate and often sustained. Fortunately, there is now a controlled trial of blocks versus anti-virals Read the rest of this entry »
Popularity: 8% [?]
Someone wrote:
“I came across this while searching the web. I have bilaterial shoulder impingement, tendonosis, tendonitis, etc etc so they say. I have been in pain since 2002. I have had 2 MRI’s that show nothing. The surgeon says there is nothing wrong but a little arthritis. I cannot sleep at night because if I roll on either shoulder it hurts and I wake up. Sometimes the pain is so bad I go for days without sleeping. It feels as if my shoulders are pulling out of the sockets. I have stabbing pains that sometimes go to the elbows. The surgeon only suggests more physical therapy or more injections….neither of which have done any good. I take pain pills constantly that I am sick of taking because at this point in time they only take the edge off and I refuse to take anything stronger. I am extremely frustrated and don’t know what to do. There IS something wrong…I can’t imagine having to live like this the rest of my life. I was a massage therapist for 10 years and injured them doing 12 massages a day. I keep telling the surgeon that just because he can’t see something doesn’t mean it doesn’t exist. Any suggestions? I’m desperate.” Read the rest of this entry »
Popularity: 8% [?]
I have compiled a simple list of measure known to help depression that can be given to patients. It was initially compiled with pregnancy in mind but concerning herbals, there are Pregnancy issues. However here are suggestions from a recent obstetrical review:
Obstet Gynecol Clin North Am. 2009 Dec;36(4):789-807,
Update and critique of natural remedies as antidepressant treatments.
Mischoulon D abstract here
Below is the list: Read the rest of this entry »
Popularity: 7% [?]
Over the years, I have had patients come in with severe one-sided regional pains with no good reason for it to be there. In each case, I have suspected Herpes Zoster prodrome and initiated antivirals with resolution without rash. I could never know for sure if I was right, but the patients have all been happy with outcome… Read the rest of this entry »
Popularity: 8% [?]
One of the problems defining chronic pain as a psychological condition, is the fact that psychological treatments have somewhat mediocre results. So when I find an article claiming results, I am suspicious. Here is an example: Read the rest of this entry »
Popularity: 9% [?]
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What is the worst pain imaginable? Neurogenic pain of course…
What is the worst non-neurogenic pain? – acute headache of course…
Now combine the two in a condition where it is guaranteed you will be
Over the years of my practice, I have seen three cases of this disease and find myself horrified and ashamed to be a part of a medical system that can do that to some people.
Can anyone guess the condition? stay tuned – I hope to have this written up soon…
Popularity: 14% [?]
Recent study of “disability pensioners” given vocational advice and brief cognitive behavioural program found it only got “negligible” amounts of people back to work. Terminating disability coverage, because vocational advice was given, is nothing more than a scam. Read the rest of this entry »
Popularity: 16% [?]
Brain damage in certain areas has been seen in chronic back pain, Complex Regional Pain Syndrome, Fibromyaglia, and so on. The question is whether the damage causes the pain or visa versa. In hip pain patients, the at least partial resolution of this atrophy following successful hip surgery suggests the pain causes the damage. Read the rest of this entry »
Popularity: 12% [?]
The following is a verbatum copy of an article in the Canadian Pain Coalition Newsletter with permission from Mr. Wheeler, and contains some useful Canadian info. Read the rest of this entry »
Popularity: 15% [?]
I’ve had questions if Savella/Milnacipran available in Canada. It is not. Checking the Health Canada site offers that info. Read the rest of this entry »
Popularity: 13% [?]
A weeks worth of patch wear was associated with a significant relief of neck pain though the deeper trigger knots were still sore Read the rest of this entry »
Popularity: 15% [?]
Retroviral Image
Read the rest of this entry »
Popularity: 19% [?]
I get the impression some car accident victims get an eye rolling response to claims of multiple injuries. Here’s an example of low back and upper thoracic (high chest) back fractures while wearing a three point seat belt. Read the rest of this entry »
Popularity: 18% [?]
Sacroiliac instability is common and contributes to back pain and maybe even headaches. Where can you get good SI supports? Read the rest of this entry »
Popularity: 17% [?]
Having a load of steroid response “Fibromyaglias” (as diagnosed by rheumatologists), I have been accumulating a list of anti-inflammatory agents. Omega 3 appears to have some promise. Read the rest of this entry »
Popularity: 17% [?]
First Seen in Banff, The character has been making appearances worldwide… Read the rest of this entry »
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Pain Clinics are becoming very big into psychological coping - well, they better teach patients to swear more - as swearing has now shown to alleviate pain.
Popularity: 19% [?]
Waiting for a knee replacement and the quality of life is poor? Most often the inner knee cartilage wears out first. Measures to take the load off the inner knee are helpful. Read the rest of this entry »
Popularity: 21% [?]
I have found home ultrasound helpful in chronic back pain but there has been little research in its effectivenesss. Now there is a study in low back pain combining it with exercise that found it useful. TENS worked well to but I find if there is any instability, TENS might aggravate the problem so ultrasound is safer. Read the rest of this entry »
Popularity: 21% [?]
DEMS - dry eyes and mouth syndrome; SAPS - sicca asthenia polyalgia syndrome
These cases do not qualify for sjogren’s syndrome but have “Sicca [dryness] symptoms and “nonspecific musculoskeletal pain”. They were found to have 59.2% thyroid peroxidase antibody rate compared to 20.4% controls P= .0009. Read the rest of this entry »
Popularity: 21% [?]
As a male doctor, I have trouble imparting all the info needed for someone with vulvodynia. Fortunately, Corrie Anne Goldfinger did her Master’s thesis at Queen’s University on the subject. It is available
free here (~2+ MB)
Since it is openly posted, I extracted the self help sections (16 pages) and have posted it as a doc file. This could be printed for patients or at least the link given….
There is a brochure included which was the hard work of Evelyne Gentilcore-Saulnier which I neglected to credit - good work there….
word file free here
let me know if this was useful!
Popularity: 21% [?]
I have mentioned previously how IV pamidronate could be useful here and IV Magnesium here
Now it looks like repeated 4 hour magnesium 70 mg/kg infusions repeated over 5 days can have some lasting effects. Read the rest of this entry »
Popularity: 21% [?]
Botox reduced pain in chronic neck pains (average 9.1+ years) for at least 2 month versus placebo -randomized and blind !! 150 - 300 unit was used per sesssion. Read the rest of this entry »
Popularity: 21% [?]
Injectable “lubricant” hyaluronan gives some relief of Carpal-metacarpal OA Thumb. One ml was injected weekly over 3 weeks. Read the rest of this entry »
Popularity: 21% [?]
Due to lack of rheumatists in Regina, I have been forced to deal with complex pain cases that in part have an inflammatory nature. Some fit a PMR profile that requires more difficult management than I am used to. Below is a summary of articles (one German) which creates a new picture of the disease for me: Read the rest of this entry »
Popularity: 25% [?]
Much of the work I do is treating the “peripheral sensitization” - the tissues that become locally sensitive and knotted. Working these areas allows me to get a feel for how much is coming from the spine or other sources, and how much is being generated locally. On average, about 50% is local and 50% is “referred” - plus or minus some. Following is a tragic case of hip pain treated vigorously without looking for local causes. Read the rest of this entry »
Popularity: 22% [?]
I received the following message:
“Very interesting read, i’m on 4 days after left side inguinal hernia repair with incision and mesh. No full anesthesia. 2 mornings after surgery, after waking up the 2nd time, the back of left knee was in pain, could not straighten or bend over 90 deg. Called in to doc in morning and went back to hospital for a venus doplar check for a blood clot. It was negative. Now 4 days later and this afternoon, pain persists, but additional pain above the left knee cap, extremely painful, tender to the touch, and a bit inflamed. Doc never mentioned any to these type pains, just take some extra aspirin. So next move?……dunno” Read the rest of this entry »
Popularity: 28% [?]
Let me first apologize to those with good books I have not mentioned. Please let me know and I will add them to the list: Read the rest of this entry »
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A New England Journal Medicine article several years ago demonstrated that compared to placebo not much by pills worked well for OA knee. This leaves one looking for options. Read the rest of this entry »
Popularity: 27% [?]
Failed back sydrome - post-laminectomy syndrome has multiple origins. Now it appears some sympathetic overload is present as well. Read the rest of this entry »
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Lon-term bone building meds intravenously (like Pamidronate) are associated with occasional oseonecrosis of jaw. Now there appears to be some hysteria that this can occur with oral medication. What are the facts? Read the rest of this entry »
Popularity: 28% [?]
In the neck, imaging can be next to useless in many cases of unresolved neck pain. Incredibily, some people are told nothing showed on imaging so it has to be in their head. Now functional (multipositional) upright MRI is demonstrating some abnormalities. Read the rest of this entry »
Popularity: 27% [?]
Having come across a case of resistant rotator cuff (supraspinatus) impingment syndrome, I have been looking for answers. Some treatments include: Read the rest of this entry »
Popularity: 40% [?]
Cervical (neck) disc disease can mimic or cause Fibromyalgic symptoms. Certain porportion of post whiplash “Fibromylagia” will fit here. Read the rest of this entry »
Popularity: 28% [?]
In Ankylosing Spondylitis, the The Bath Ankylosing Spondylitis Disease Activity Index (BASDAI) and Spinal Pain Visual Analog Scale (VAS) are used to obtain coverage for Etanercept.
These forms are available here unprotected. Read the rest of this entry »
Popularity: 27% [?]
Seat adjustments that take the pressure off the ischial tuberosities help relieve back pain sitting
Popularity: 30% [?]
Your body has a set of circuits to shut off pain - your endophin circuits, except in the spinal cord the endophins are called “enkaphalins” and are chemically built a bit different. The pain inhibiting spinal circuits i.e. the “descending pain modulatory pathway” go from the brainstem rostral ventromedial medulla (RVM) via the dorsolateral funiculus (DLF). Now it appears cells in this RVM can either prevent or facilitate pain. Read the rest of this entry »
Popularity: 32% [?]
Certain anti-depressants are used in chronic pain because of their painkiller effects.
Women with prior Ca. of Breast can end up on a drug called tamoxifen to help prevent recurrences. Tamoxifen has to be convered in the body by a system called cytochrome CYP2D to a drug called endoxifen. Certain anti-depressants inhibit this conversion. A recent article suggests this is can make tamoxifen more ineffective. Read the rest of this entry »
Popularity: 32% [?]
Article states “there has been a belief that DD initially causes pain because of the penetration of fluid nuclear material through annular fissures, and that pain eventually resolves as the nucleus becomes fibrotic and can no longer penetrate the fissures”. These old discs image “black” and a felt to be more painfree - yet the reverse is true. Read the rest of this entry »
Popularity: 33% [?]
Diabetics are 1.6 times more likely to have chronic musculoskeletal complaints yet in non-diabetics, a high random glucose is associated with less complaints. Read the rest of this entry »
Popularity: 33% [?]
I have seen cases of severe Irritable Bowel, combined with allergies and hives, that require multiple medications to control and are disabled from symptoms. These cases are discarded by gastroenterologists yet might represent a systemic disease called Mastocytosis. Read the rest of this entry »
Popularity: 57% [?]
Listened to talk by Dr. Anthony Kaufman.He does probably the largest amount of Trigeminal nerve microvascular decompressions in Canada (~50/year) and helps run the Winnipeg Centre for Gamma Knife Surgery.
He has a web site with detailed descriptions here
Here are some points made: Read the rest of this entry »
Popularity: 44% [?]
Afraid the “College” will get on your back for giving opioids to someone with chronic headaches? Can’t get your doctor to listen that you have no quality of life with your headaches? Well here are some guidelines (Not rules - so can be stretched) that might help you in selected cases Read the rest of this entry »
Popularity: 33% [?]
(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? Read the rest of this entry »
Popularity: 34% [?]
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: 36% [?]
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: 37% [?]
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: 34% [?]
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: 40% [?]
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: 50% [?]
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: 34% [?]
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: 35% [?]
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: 48% [?]
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: 35% [?]
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: 35% [?]
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: 34% [?]
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: 35% [?]
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: 39% [?]
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: 34% [?]
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: 35% [?]
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: 40% [?]
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: 42% [?]
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: 37% [?]
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 »
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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: 36% [?]
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: 35% [?]
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: 35% [?]
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 »
Popularity: 48% [?]
I have found inflatable neck traction very useful for neck radiculopathy cases. A cheap source is available on ebay Read the rest of this entry »
Popularity: 40% [?]
I recommend good support bras for some of my female patients but have had complaints about $200-300 dollar price tags on some of them. One of my patients, suggested I give this link for decently priced bras. They do have some with posture and back support. Read the rest of this entry »
Popularity: 35% [?]
Testing MRI/CT imaged Sacroilitis versus clinical testing and comparing it to positivity of tests with Low back pain came up with low sensitivities and specificities. Read the rest of this entry »
Popularity: 54% [?]
Study finds in cases that meet the criteria for actual osteoarthritis in TMJ responded equally as well to Diclofenac and splint althought the former worked faster Read the rest of this entry »
Popularity: 37% [?]
Candida-related denture stomatitis is an annoying chronic concern. Comparison of “topical application of miconazole three times per day for 30 days” versus “upper denture microwaved IN WATER (650 W per 6 min) three times per week for 30 days”. The microwave group was effective treatment - the other not Read the rest of this entry »
Popularity: 35% [?]
A blood clot in a hemorrhoid can cause extreme pain. Caught early, it can be surgically evacuated. Once several days old, there is no advantage in doing so. Now it looks like an intrasphincteric injection of 0.6 ml of a solution containing 30 units botulinum toxin can give dramatic relief of pain within 24 hours. Read the rest of this entry »
Popularity: 36% [?]
A new wonder of technology has created a new suboccipital stimulator at 1/12th the size of previous! It has been found useful for chronic one sided headache called chronic hemicrania for which indomethacin has been the mainstay of treatment Read the rest of this entry »
Popularity: 36% [?]
Recent article found both regimens below equal efficacy:
prochlorperazine 10 mg and diphenhydranate 25 mg intravenously
metoclopramide 20 mg and diphenhydranate 25 mg intravenously
“Three quarters of subjects in both arms would want the same medication for their next migraine.”
Popularity: 36% [?]
In Burn Cases, both Pain and Sleep Onset Insomnia predicted pain chronicity and their model suggested that the sleep problem was beyond what one would expect from the pain Read the rest of this entry »
Popularity: 34% [?]
Recent metanalysis of studies suggests recovery is not great after 3 months Read the rest of this entry »
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Phantom limb pain is suprizingly resistant to treatment and some articles on the subject have concluded “put them on opioids - perhaps methadone”. Now come two different approaches to treating the leg version of this - memantine and pulsed radioifrequency. Read the rest of this entry »
Popularity: 35% [?]
In 2006, my daughter, Janice Montbriand, and I did a pilot study on selected chronic pain patients looking for sleep apnea. We found a high incidence of nocturnal oxygen desaturations in these cases. Methadone classically has also been known to induce sleep apnea. Now a cases series of people on other opioids has been published:
Popularity: 35% [?]
Certain sore kneecap cases will benefit from foot orthotics. Read the rest of this entry »
Popularity: 35% [?]
The subscapularis muscle is the key muscle in shoulder pain. It is strong and pulls the shoulder up to impinge “better”. It is a principle muscle involved in frozen shoulder. The best trigger / Botox injection would perhaps hit the most motor points (where the nerve ends into the muscle). A block with phenol has recently been shown to help spastic shoulders in cervical injury patients. Read the rest of this entry »
Popularity: 36% [?]
In osteoarthritics, Doxycycline, a tetracycline, was found to reduce knee joint space narrowing by 40% at 16 months and 33% at 30 months compared to placebo. In another study, after noticing a rapid reduction of inflammation in an OA case on Sulfa-Trimethoprim (Cotrimoxazole), a case series was done which again noted “high improvement in pain, joint limitation, and patients’ global assessment of disease activity” in 6/10 cases. Read the rest of this entry »
Popularity: 37% [?]
Are these legitimate arguments?
1) One shot should fix it and if it doesn’t then that’s it (I call this the “one shot wonder” attitude). I think the only person who could be sure to fix things at one go would have to be God and I know I’m not him/her…
2) Steroid injection rots the cartilage from joints and accelerates osteoarthritis. If steroid injections are used to treat symptomatic mensicial tears, I would not think repeated injections would not be the best idea as accelerated deterioration would be happening anyway.
But evidence do we have? Read the rest of this entry »
Popularity: 40% [?]
A Recent Framingham study has demonstrated on MRI:
Popularity: 37% [?]
Recently, there was a workshop on muscle energy techniques. I know the name sounds corny but it is a gentle postitional push- release-stretch technique that has become one of the principle manual spinal techniques now taught to physiotherapists and besides Maitland techniques has become the standard. A recent application was made for family physicians to have credit for taking this course in Manitoba and word was received back that family docs don’t need to know this stuff.
Not only does this show incredible ignorance, as 30% of Canadians live in chronic pain, it sends the message that doctors don’t need more than the 11 hours of training (see other blog article re this) they receive in medical school when it comes to treating pain. Not only is this physiotherapy technique a treatment technique - it is a diagnostic process for spinal problems that would allow doctors to converse with physiotherapists. Read the rest of this entry »
Popularity: 34% [?]
Diverticulosis can exist with segmental colitis - have an older patient who had bad diarrhea on a trip and was diagnosed with such. Not something I was aware of. Read the rest of this entry »
Popularity: 35% [?]
Achilles Tendonitis is one condition I hate and any treatment program is welcome. This is an upgraded eccentric program that does not involve dorsiflexion (foot pushed up from normal) Read the rest of this entry »
Popularity: 35% [?]
I hate the term Fibromyaglia (FM) - not because it doesn’t exist but because it stops people looking for potentially treatable issues as well. “It’s all just Fibromyalgia” is just too convenient. Here is an example of a subject with FM and a dural leak (leaking spinal fluid at some level in the spine) that would have had a zero life if it had gone undetected Read the rest of this entry »
Popularity: 35% [?]
I have a picture that portrays my view of fear-avoidance:My perspective is that, in a good many of cases, everything is controlled by pain intensity. Some articles try to avoid the issue by saying “they just thought they were in a lot of pain” and that in itself was a psychological problem (oh brother).
Now it appears controlling the pain with opioids can facilitate exercise rehab without having to tell the patient to suck it up and say “It’s just pain”. Read the rest of this entry »
Popularity: 36% [?]
A recent article found a relationship of low zinc levels and tender point counts, and low magnesium and fatigue Read the rest of this entry »
Popularity: 42% [?]
There is alot of confusion of what amounts to optimal fentanyl patch use. Many patients contend it only lasts 2 days. How does one adjust the dosage? Read the rest of this entry »
Popularity: 38% [?]
Given there is little evidence medications work well for chronic radiculitis, It is encouraging to note that Spinal Cord Stimulation might give 50% relief in failed back patients. Read the rest of this entry »
Popularity: 36% [?]
Angiogensis and its accompanying nerves are evident in disc disease with the formation of neurovascular growth in the High Intensity Zone facing the spinal cord. Similarly, I have written how chronic tendonitis is associated with neurovascular growth. Now it appears arthritis pain may be angiogenesis related as well. Read the rest of this entry »
Popularity: 34% [?]
Facet injection appeared to be superior to medial branch block of SPECT scan positive facet joints Read the rest of this entry »
Popularity: 36% [?]
6% Gapapentin in Lipoderm is helpful in vulodynia. Interesting how they made it up. Read the rest of this entry »
Popularity: 39% [?]
Dorsal wrist impingement is pincing of dorsal wrist capsule between the extensor carpi radialis brevis and the dorsal ridge of the scaphoid. It’s diagnosis is strictly clinical. Read the rest of this entry »
Popularity: 42% [?]
After a sciatic nerve as accidentally injected, gabapentin and tramadol helped the pain until some recovery came about. Read the rest of this entry »
Popularity: 45% [?]
Disposable insulated needles are not readily available but a 20 gauge cannula is easy enough to find… Read the rest of this entry »
Popularity: 34% [?]
Children in a chronic pain clinic respond significantly to massage. The laying on of the hands also has a significant effect on distress. This is an under-utilized resource that needs to be taught to parents.
Popularity: 37% [?]
Chronic daily headahces has to be the bane of most doctors frustrated by fact use of painkillers will potentially only make things worse. Now it looks like Mexiletine may help but …the patient has to be prepared to accept side effects. Read the rest of this entry »
Popularity: 37% [?]
I am used to 75-150 mg doses of pregabalin but doses of 300 mg BID are being used for diabetic peripheral neuropathy. Read the rest of this entry »
Popularity: 37% [?]
Two cases resistant to any treatment responded to Duloxetine suggesting complex origin. Read the rest of this entry »
Popularity: 35% [?]
Recent Japanese article hilights spinal sensitization in neuropathic pain suggesting lidocaine and ketamine maybe should play bigger role Read the rest of this entry »
Popularity: 36% [?]
Hypnosis helps chronic pain and should be part of a chronic pain program, if not managed by mindfulness meditation. Read the rest of this entry »
Popularity: 34% [?]
Arthritis pills longterm, particularly in the elderly, is a risky business. Stomach bleed have been reported to cause more deaths than car accidents and other injuries. These stats are now relatively old and comments from doctors has been that they are not seeing as much. Question is why:
1) Use of selective Cox 2 celebrex agents - well maybe- but if they are on any aspirin, you can forget any benefits.
2) Use of proton pump inhibitors - omeprazole, pariet (Rabeprazole), pantaloc, prevacid, nexium and so on… It does reduce gastritis problems and might explain reduction seen.
3) Now it appears eradication of Helicobacter pylori helps Read the rest of this entry »
Popularity: 35% [?]
http://ard.bmj.com/cgi/content/full/67/6/758
“Cervical interspinous bursae lie anteriorly in C6–C7 interspinous spaces (arrows). B. Median sagittal section through L3–L5 of the vertebral column. Lumbar interspinous bursae lie posteriorly in L3–L5 interspinous spaces (arrows).”
These are inflamed bursas between the posterior neck (and back) spines (the bumps on the spine you can feel. Not only will it heighten the suspicion of PMR, it should be treatable by local injection (in a hospital setting). Read the rest of this entry »
Popularity: 35% [?]
In 2006, a US military study did a GOOD perspective study on MS that involved taking blood samples some 4-5 years prior to the start of their MS. In subjects under 20, high vitamin D levels offered a high rate of immunity form the disease Odds ratio = 0.09 which means perhaps 1/11th less likely to get it. A March 2008 good perspective study found a susceptible gene type with persistent Epstein Barr (mono) high titers had a wooping 9 times risk of getting MS later. Read the rest of this entry »
Popularity: 35% [?]
Nerve blocks combined with tricyclic antidepressants gave rapid relief of pain in 80% cases in one Japanese report. I feel nerve blocks or epidural blocks are manditory for any cases of shingles in which the current acutely infected pain would be too high to live with long-term. Read the rest of this entry »
Popularity: 59% [?]
The Common Drug Review is part of the Canadian Agency for Drugs and Technologies in Health. It is a national program that determines what drugs are worth putting on formularies in the province. They decided that Lyrica should not be used just because a comparison with amitriptyline was not forthcoming. I wrote them this letter:
——————–
It is disgusting that we are paying a government agency to be soul-lessly scientific and immoral.
Make your own views known
site:
http://cadth.ca/index.php/en/cdr/cdr-overview
just use contact us at the top.
Popularity: 34% [?]
A Canadian Pain Society Survey found medical students only get on average 11 hours training in pain education. A vet, however, gets on average 98 hours education. This might explain why patients are treated poorly by some doctors. Read the rest of this entry »
Popularity: 34% [?]
Traditional treatments for referred nerve pain of neck and back have been inadequate. As mentioned previously, opioids and other pain modifying medications work poorly in radiculitis, leading to an American summation that there is no proved drug treatment for radiculopathy. Now, a simple, non-destructive pulsed radiofrequency could give relief for 6 months. Read the rest of this entry »
Popularity: 37% [?]
Post- stroke victims with central pain can be left with excruciating pain, often one whole side. If their vestibular system is intact (absence of “marked post-stroke disequilibrium.”), then one cold water ear irrigation can drop pain scale levels by more than 2.58/10, lasting 1- 4 weeks or more. Its effects seem primarily for face and arm pains where pain can be replaced by numbness. Read the rest of this entry »
Popularity: 54% [?]
A recent study found doctors had a poor knowledge of the features of Ankylosing Spondylitis (AS) which is why only 6% of women with this disease are properly diagnosed by GP’s. This will mean women with active spinal arthritis might have to wait 7 years to be diagnosed. Men with concomitant back injuries can suffer the same fate Read the rest of this entry »
Popularity: 48% [?]
Arthritis of the joint in the wrist down from the thumb can be common and in some cases eludes successful treatment. Recent article published in the prestigious medical journal, Pain, describes one application of leeches to the area can reduce pain 60% for more than 60 days. Read the rest of this entry »
Popularity: 50% [?]
In a prospective study, 26.3% of elderly subjects developed hip pain before their fracture. Study concluded that people should be questioned about appearance of new symptoms. “A better recognition of “prefracture” pain in the elderly may allow adequate management and treatment of patients, in order to avoid a proportion of hip fractures.” Question is, what could one do? Read the rest of this entry »
Popularity: 34% [?]
11/220 cases of whiplash, examined medico-legally for non-resolution, had comorbid subacromial impingment, many of which had been missed. This adds to the growing legion of real problems missed in whiplash cases. Read the rest of this entry »
Popularity: 37% [?]
Article in press found injection of Botox into aphthous ulcers not only gave relief of pain in three days but freedom of recurrence for more than 6 months Read the rest of this entry »
Popularity: 34% [?]
In January, published report found evidence of persistent enteroviral infection in the stomach of people with chronic fatigue.
Similarly, duodenal ulcers were found to be due, in part, to a stomach germ, helicobacter pylori. Many carry this germ harmlessly but others can’t heal the irritation created by the germ presence so well. One factor is stress which can slow down healing because it can cut blood flow to stomach and the stress induced cortisone excess impairs wound healing. Now one wonders if chronic fatigue is a persistent stomach infection. Read the rest of this entry »
Popularity: 43% [?]
The use of a SINGLE application of a 8% (vs 0.025 - 0.075 usually used) capsaicin patch (NGX-4010) resulted in significant relief for over 12 weeks in HIV neuropathic pain. Given the old technique (4 X/day gel application for two weeks just to see any benefit) was messy and labor intensive, this new approach could be a godsend. Read the rest of this entry »
Popularity: 37% [?]
At the Canadian Pain Society Meeting in Victoria, it was announced that (National) Action of People with chronic pain has a new chapter in Regina. Terry Bremner, President of Action Atlantic, negotiated transition of the Fibromyalgia support group in Regina to an Action chronic pain support group. They have a series of video tapes discussing a variety of pain concerns to help with pain discussion and education.
Regina contact: Elaine Torrie ph - 306 - 522-8686
I hope to get more information.
Popularity: 34% [?]
Most NSAID’s (arthrtis pills) have a GI bleed (stomach bleed) rate of 10%. Diclofenac is 7%. Celebrex is 5% but only if they are not taking ASA. I have cases that cannot tolerate any NSAID’s or due to major GI bleeds are ill advised to take any. Now it looks like SAMe (a health food store supplement) might be an alternative. Read the rest of this entry »
Popularity: 37% [?]
Some years ago, I came across a graph, that explained some migraine treatments options. I found it handy to show patients but have upgraded it. The original graph was this:
Therapeutic gain of migraine prophylaxis compared to placebo. Graph shows the percentage of patients with a 50% decrease in attack frequency during active drug treatment minus the percentage with 50% decrease during placebo therapy.Article found here
I have upgraded it but categorized effectiveness as more vaguely.
Popularity: 35% [?]
While much is written about gimped NMDA receptors in chronic pain, the innocuous support tissues in the spinal cord, the “glial cells”, turn out to be a big player. An inhibitor of these cells, clopidogrel - known as Plavix - (an anti-platelet drug used in some instead of aspirin to prevent stroke) - surprisingly works to prevent this in animal studies Read the rest of this entry »
Popularity: 36% [?]
Controversy abounds over whether People with dyspepsia should have H. pylori colonization treated. Recent article concludes “The main therapeutic strategy for managing dyspepsia in patients under the age of 45 years is ‘test and treat’. H. pylori eradication is recommended in patients with dyspepsia and no other gastroduodenal abnormalities than H. pylori induced gastritis.” Now to get our drug plan to come on board with that… Read the rest of this entry »
Popularity: 39% [?]
Startling findings from gene deletion mice experiments implicate mast cells and histamine receptors in IC. It is also implicated that other peripheral sensitizations might follow that process. Read the rest of this entry »
Popularity: 34% [?]
I have had some pleas about how to deal with case workers. Worker’s advocate, media, and politicians are impotent because of thier lack of medical knowledge. There is potentially some loose end they don’t know about that could make all the criticism go away… I have tried to include information on potential letters to case workers and some resources for treatment.
Popularity: 52% [?]