Please suggest help for this case of post back and post hip back-hip pain

A case in desperate need of help wrote and I have put it in a patient discussion forum:

http://painmuse.org/?topic=post-laminectomy-post-hip-pains/

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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 | 3 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

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Confirmed – Resistant Ulcerative Colitis – Fecal Transplant Works 1/2+ Time

70%  showed clinical response, and “13 of the 30 (43.3%) patients achieved clinical and endoscopic remission.”

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Stabbing Headaches

Rather new entity is the stabbing headache – primary stabbing headache (PSH) – often in occipital area, happening 2-100 times a day and more occipital (back of head) in location.  Treatment is not all what you’d think – its indomethacin, prednisone, gabapentin or tricyclic antidepressants.

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Does Job Rotation Reduce Illness?

Job Rotation reduces wrist and hand pains but doesn’t do much else according to a review. Continue reading

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Sacroiliac Joint – Leg symptoms

SI joints generate significant amount of lateral thigh and inguinal area pains.  About 1/3 will complain of lateral thigh numbness as well.

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Recurrent Aphthous Ulcers – Minocycline 0.5% Mouth Rinse Treatment

Canker sores respond to tetracycline/minocycline rinses – 0.5% minocycline works best

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Burning Mouth Syndrome – Remarkable Improvement with Botulinum Injections

“16 units of incobotulinumtoxinA (100 units diluted in 2 mL of saline), 4 units into each side of the lower lip and 4 units into each anterolateral side of the tongue” – “The beneficial effects lasted up to 16 weeks after injection in all but 1 patient, in whom they lasted up to 20 weeks.”

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Antidepressants Don’t Necessarily Help that Much Re Back Pain

I contend antidepressants help very little in back pain and waiting for it to work before starting painkillers is an unethical abomination. Studies showing any benefit in the last century are laughable because dosages used would not be achievable today. Good studies do show statistical significance but not clinically significant changes. Studies showing benefit used only depressed patients where results might be due to change in depression.

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Greater Occipital Nerve Blocks Help Triptan Overuse Headaches

Triptan overuse can exacerbate and well as signify uncontrolled headaches. Use of Occipital nerve blocks can make transition of limiting triptans easier.
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Advanced Gallbladder Testing Can Miss Disease

Two approaches to gallbladder advanced testing – use of fatty meal (FM) as a substitute for cholecystokinin (CCK) in pain reproduction during hepato-imino-diacetic acid (HIDA) scan in functional gallbladder disorder. – will miss 1/2 of cases

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Back Pain in Crohn’s Colitis is a Spondyloarthritis

Imaging spine in Crohn’s Colitis found evidence of spondyloarthritis (active spine arthritis) in 1/2 of cases. Have a case of “arrested” crohn’s disease (there is usually evidence of continued activity in stool secretion – see http://painmuse.org/?p=374 re that) with chronic back pain. She had depression problems so often labelled as nonspecific. More likely it is spondyloarthritis which would respond to steroid injections to sacroiliac and maybe facets.

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Metformin May Augment Painkillers

Previously I wrote how metformin helps Fibromyalgia and Bipolar. It has anti-cancer properties and diabetics, just on it, live longer. Now in animal model it it cut analgesic needs by 56-73% in regard to ibuprofen, ASA, tramadol, and pregabalin in inflammatory induced pain. Is this drug great?

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Serotonin Syndrome May be Reversed by Famoditine (Pepcid)

Operative case serotonin syndrome induced by Merperidine caused “hypertension, tachycardia, tachypnea, hyperthermia, myoclonus, diaphoresis, retching, nausea, agitation, and semicoma mentality with no pupillary light reflex.”  Incidentally, patient was given famotidine, in this case IV, to prevent aspiration pneumonia. Within 15 minutes condition improved and in 2 hours patient was better.

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Neuropathic Pain – Phenytoin Topical Augments Ketamine or Baclofen

It is all very well to say a drug works topically. However it is easy to assume they work on similar mechanisms so one does not add to the other. Phenytoin (Dilantin) augmented both ketamine or Baclofen so might be good in any mix.

J Clin Anesth. 2017 May;38:154-155. doi: 10.1016/j.jclinane.2017.01.040.
Phenytoin in topical formulations augments pain reduction of other topically applied analgesics in the treatment of trigeminal neuralgia.
Kopsky DJ et al.
https://www.ncbi.nlm.nih.gov/pubmed/28372657

  • case of ablation trigeminal branch left with dysesthesias; 10% ketamine topically helped initially but needed 10 % phenytoin added to maintain benefit
  • another case of post-ablation dysthesias helped initially with baclofen 5% but needed 10% phenytoin to continue benefits.

Comment – given that tolerance to an agent can occur, adding phenytoin makes sense.

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Dysphonia Hoarseness Could be a Myofascial Pain Syndrome

Amazing discovery. While getting  Diagnostic Electrodiagnostic EMG needles stuck in dysphonic vocal cords,  some experienced a sharp pain (like one hitting a muscle trigger point). Subsequently, those that experience that, noted their dysphonia was better. Looking into it deeper, some cases had subtle vocal fold movement abnormalities that suggested they had this underlying trigger point. Hitting spots in these asymmetries could improve phonition suggesting muscle spasm caused the asymmetries. This lead to a diagnosis of laryngeal myofascial pain syndrome (LMPS) as a potential entity.

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Do Estrogen Creams Help Vulvodynia? – Maybe…

Estrogens, in 18-45 age group daily application, reduced dyspareunia 27% versus 3% in placebo though that was not considered statistically better due to small sample size – so answer is maybe…

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Epidural For Back – Particulate Steroids Work Better than Soluble

For Sciatica & spinal stenosis steroid epidurals are used but controversy exists over whether there is any benefit of particulate over soluble steroids. It would seem obvious that a steroid that last weeks would be better than one that last 6 hours. This study demonstrated just that.

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Subtle Cervical Dystonia

Diagnosing early cervical dystonia and using botulinum toxin has been one of the major advances I have seen in my treatment. Sidebend or Rotation to one side can be subtle but very important as one can now get drug coverage for botulinum. Recently, one author noted that the shirt collar was asymmetrical as well.

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Improvements in functioning are dependent or pain relieving measures not mental health – hip and knee replacements

Fear avoidance model makes one consider cause of disability is in the psyche. Normalization of physical functioning despite mental health status with  knee replacement belies that contention and further suggests those with mental health issues can have joint replacements.

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What Determines Depression – A Bad Diagnosis or the Pain? – the Pain of Course

Study did not find a history of cancer affected depression scores – what did was “a painful somatic symptom”. I have always contented that pain was the prime driver in chronic pain where the fear avoidance crowd like to put it all to the psyche. More to my point.

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MRI Back Pain Sciatica Interpretation So Variable Could Effect Patient Outcome

The MRI GOD is struck another blow – interpretation is so variable, the authors states “As a result, the authors conclude that where a patient obtains his or her MRI examination and which radiologist interprets the examination may have a direct impact on radiological diagnosis, subsequent choice of treatment, and clinical outcome.” Now that is a scary prospect.

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Urinary Catheterization Pain – Cut in 1/2 by Attempted Voiding While Implementing

Always feel sorry for male patient being catheterized. Now brilliantly simple maneuver can cut pain in 1/2.

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On Oxaliplatin Chemotherapy for Colon Cancer? Would taking Melatonin Reduce Peripheral Neuropathy?

In rodents, Melatonin helps prevent peripheral nerve damage from Oxaliplatin for colon cancer without reducing its cyotoxic effects on cancer. Doses were large, but I would give it a try..

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Protocol for Treating Polycystic Kidney Disease Pain

Autosomal dominant polycystic kidney disease (ADPKD) can end up with such severe pain that they wish nephrectomy. I’m hoping this protocol reaches kidney societies that can lobby for aggressive pain treatment to keep things under control.

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Multiple Sclerosis (MS) Pain Treatment Options

 

I have an MS patient who was in bad shape when I started to see her – was using a walker. With various measures, she was much better. What worked? Vit D2 50,000 u weekly, B12 injections 1000 mcg subcut injection every day or two, ketamine injections 2-3 times a week, Pramipexole and Sinemet – bedtime dopa  for restless legs, and local injection treatments have helped. Spironolactone may have helped as well.

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