Newer Treatment For Ingrown Toenails - Once Spicule Out and Healed, Metal Brace It Straight = Orthonyxia
March 16th, 2010Spicule removal and later, metal bracing nail straight, has been shown equivalent to partial matrix excision
Popularity: 1% [?]
Latest in Skin Piercings
March 16th, 2010Not to Miss in the Trend For Body Piercing, I Offer This Technique of Nail Piercing Read the rest of this entry »
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Determining If Veretbral Compression Fracture
March 15th, 2010Various new approaches help define vertebral compression fracture so can be earlier diagnosed. Read the rest of this entry »
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Anterior Shoulder Dislocation - Putting It in Yourself
March 15th, 2010Recent article describes how to relocate your own shoulder dislocation using modified Milch technique
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Shingles Vaccine Finally Available in Regina
March 15th, 2010Zostavax vaccine has to be held frozen at -15 degrees C and only set in batches of 5. Now, Lakeshore Drugs (584-0717) has gotten in a Fridge specially set and so it is available there. Catch is, it cannot be held at room temperature for more than 30 minutes so have to keep cool when taken to doctor Read the rest of this entry »
Popularity: 1% [?]
Article: A sterile, simple, effective & pain free method of removal of adhesive dressings
March 15th, 2010OK - I’ll bite - how does one do that?… Read the rest of this entry »
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Renal Colic? - Try Desmopressin Nasal Spray Plus NSAID Suppository
March 14th, 2010Combination Desmopressin Nasal Spray (DDAVP nasal) and diclofenac Suppository brought prompt relief renal colic in 62.7% cases vs 30.7% in the group with suppository alone Read the rest of this entry »
Popularity: 1% [?]
Intra-Bladder Lidocaine Freezing to Diagnose Bladder Pain Syndromes and Lidocaine Treatments for Bladder Pain
March 14th, 201020 mls of 2% Lidocaine Intravesically (into bladder) wil cause over a 50% relief of pain in patients with bladder pain syndromes - distinguishing it from other pelvic pain diseases. Read the rest of this entry »
Popularity: 1% [?]
New Measures For Treatment of Chronic Pancreatitis - Anti-oxidant Micronutrient Therapy and Spinal Cord Stimulation
March 14th, 2010Combination of Selenium 300 - 600 mcg, Vitamin C 540 - 600 mg, Beta Carotene 12 - 54 mg, Vitamin E 100 - 188 mg, and perhaps methionine 1.6 - 2 gm can lead to considerable reduction in chronic pancreatitis pain and attacks. It had lead to a new theory of pathogenesis of chronic pancreatitis pain. Spinal cord stimulation can result in good relief of pain in chronic pancreatitis. Read the rest of this entry »
Popularity: 1% [?]
Lower Dose Gabapentin and Imipramine work in Neuropathic Pain
March 13th, 2010Tested in Cancer Neuropathic pain, Gabapentin 200 mg and Imipramine 10 mg every 12 hours was found to be a superior combination Read the rest of this entry »
Popularity: 1% [?]
People with Multiple Functional Somatic Symptoms May Had Defunct Pain Modulating Circuits
March 13th, 2010People with multiple sensitivities and somatic complaints may actually be experiencing untoward pains from what others would not find painful. Recent article finds this may be do to inability to muffle these sensory stimuli due to defunct pain muffling system Read the rest of this entry »
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What Does One Do To Prevent Post Surgery Pains?
March 13th, 2010Significant numbers of people are surprized to find themselves living in chronic pain after surgery. There are a growing number of options found helpful Read the rest of this entry »
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Good Free Review of Testicular Pain Management
March 13th, 2010This new article in press:
Urol Int. 2010;84(2):125-131. Epub 2010 Mar 4.
Clinical Management of Chronic Testicular Pain.
Kumar P, Mehta V, Nargund VH.
Karger, the publisher, is allowing free access Read the rest of this entry »
Popularity: 1% [?]
New Tennis Elbow Treatment - Inject Lubricant (Hyaluronate)
March 12th, 2010New Study form London, Ontario: Subjects with 3 month + tennis elbow. Injection of 1% Hyaluronate into “into the subcutaneous tissue and muscle 1 cm. from the lateral epicondyle toward the primary point of pain” twice a week apart led to persistent improvement. Read the rest of this entry »
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Post-Chest Surgery (Post - Thoracotomy) Shoulder Pain Cure But Only in Those With Sore Shoulder Muscles - Suprascapular Block and New Way to Do Block
March 11th, 2010Of 92 cases of post-thoracotomy muscular only shoulder pain, 83.5% obtained satisfactory pain relief from suprascapular nerve block Read the rest of this entry »
Popularity: 2% [?]
Frozen Shoulder Simple Test - Coracoid Tenderness
March 11th, 2010People with frozen shoulders have more sore coracoids versus with rotator cuff tear, calcifying tendonitis, glenohumeral arthritis, acromioclavicular arthropathy and asymptomatic subjects Read the rest of this entry »
Popularity: 2% [?]
Prior Motor Vehicle Accident (MVA) Doubles Chance Persistent “Troublesome Neck Pain” .
March 11th, 2010A Saskatchewan Study found people with previous MVA had twice the rate of persistent neck problems. Insurers like to play down this association but in fact this is real. Read the rest of this entry »
Popularity: 2% [?]
New Cure For Untreatable Warts - Inject Them With MMR vaccine
March 11th, 2010Study involving treatments of warts- some multiple and recalcitrant (mean ~8 months), found a 81% cure rates (versus 27.5% in control saline injection group) with intralesional injections of measles-mumps-rubella vaccine. Read the rest of this entry »
Popularity: 2% [?]
Botulinum For Scalene Based Thoracic Outlet Syndrome (TOS)
March 10th, 2010After a car accident, TOS can pinch nerves in the neck and cause neck and arm pain with arm/hand numbness that nobody can seem to find a reason for. A simple injection into the anterior scalene muscle can prove the source and Botulinum injection some relief Read the rest of this entry »
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Platelet Rich Plasma(PRP) Treatment Takes a Hit - Doesn’t Work For Achilles Tendonopathy
March 9th, 2010Recent Study in JAMA found PRP didn’t work more than saline injections for Achilles midportion tendonopathy. Read the rest of this entry »
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New Hope For Uncontrolled Visceral Abdominal Pain
March 7th, 2010One out of eight people with abdominal pain are uncontrolled with medication. This can be debilitating and affect quality of life. 66 out of 70 people had substantial symptom relief with spinal cord stimulation.
Read the rest of this entry »
Popularity: 2% [?]
Post Hernia Surgery Pain Protocol and Other Options
March 6th, 2010Recent Article gives a flow chart for dealing with post hernia pains - all leading to a surgical nerve removal procedure called Endoscopic retroperitoneal neurectomy. Read the rest of this entry »
Popularity: 2% [?]
Yes, Virginia, Steroid Caudal Blocks Are Effective (At least For Spinal Stenosis)- and So Older People With Back Pain After Two Blocks Walking Are Better.
March 6th, 2010Article in Press Finds Caudal Epidural Steroid injection work for degenerative lumbar spinal stenosis. This condition is the bane of older individuals that can’t walk more than a 2-3 blocks without getting back - leg pain. The pain remits with rest - especially with sitting, which opens up the spinal canal. Surgery is an option; so is steroid injections given through the tailbone. Read the rest of this entry »
Popularity: 2% [?]
Is Cervical Spondylotic Myelopathy Genetic?
March 4th, 2010Old age change in the neck leading to narrowing of the spinal canal is the bane of older subjects. A Chinese study suggests, in their population, it is related to Vitamin D receptor polymorphisms Read the rest of this entry »
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? Sciatica Option - Drug For Pulmonary Hypertension Gives Relief
March 4th, 2010Case study of patient on Sitaxsentan, a selective endothelin-A antagonist used in pulmonary hypertension, found his sciatica got better while on the drug and worse when off. Read the rest of this entry »
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Telling If Your Cat Is Using Opioids
March 4th, 2010Cashing in on recent opioid phobia, I offer this synopsis on how you can tell if your cat is using drugs… Read the rest of this entry »
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Thoracic Intra-Articular Meniscoid Folds - A Plaisable Pain Generator
March 4th, 2010Detailed dissection of Thoracic Facets has found 62% of them hold and intra-joint mensicoid fold(s) - some with blood vessels. The addition of craggy clefts, cartilage damage, ulcers and hemmorhage all suggest they could be pain generators. Read the rest of this entry »
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Does Chronic Pain Cause Cancer? - The Answer is NO
March 2nd, 2010Article in press found no increase in cancer in chronic pain patients Read the rest of this entry »
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Prolotherapy to Mid Tendon Achilles Tendonopathy - Only Mildly Better Results When Compared to Eccentric Loading Exercises - How Could That Be Better?
March 1st, 2010Article in Press found at 12 months, Relief scores were 73% for Eccentric Loading Exercises (ELE), 79% for prolotherapy and 86% for combined treatment in treatment of achilles tendonitis. Read the rest of this entry »
Popularity: 3% [?]
Surgery For Diabetic Peripheral Neuropathy - Another Option Not Available Here
February 28th, 2010Diabetic peripheral neuropathy with pain, and numb feet and toes could be the result of an entrapment like carpal tunnel and hence potentially treatable. However considerable controversy follows it. Read the rest of this entry »
Popularity: 4% [?]
Diabetic (DM) Neuropathy - Think B12 Deficiency and More so if on Metformin
February 26th, 2010According to one article, low B12 (<200 mcg) occurs in 1/2 of non-metformin using diabetics. According to another recent article, "Chronic metformin use results in vitamin B12 deficiency in 30% of patients". This could eventually lead to B12 deficiency neuropathy which unlike DM neuropathy is treatable. Read the rest of this entry »
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New Painkiller for Back & Knee Pains - Raloxifene (Evista) - a drug for Osteoporosis
February 23rd, 2010There is a connection between osteoporosis and arthritis with arthritis settling in more in osteoporotic joints. Now an osteoporotic drug can not only help that but seems to have analgesic properties to back and knee pains if used regularly. Read the rest of this entry »
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Patients with Irritable Bowel (IBS) Should Avoid Shift Work
February 22nd, 2010Irregular hours are hard on people with IBS according to one nursing study Read the rest of this entry »
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Groundbreaking News - A “Cure” For Chronic Discogenic Back Pain??
February 22nd, 2010A simple procedure injecting 1 ml of 1% methylene blue followed by 1 ml 2% lidocaine into damaged disc has achieved unprecedented results Read the rest of this entry »
Popularity: 4% [?]
New Chronic Pain Gene Identified - Beta2-Adrenergic receptor (ADRB2) - and Genes For Achilles and ACL Knee Ligament Problems
February 22nd, 2010Using a British Cohort born in March 1958, over 8000 individuals were blood sampled and nucleotide polymorphism sequenced for ADRB2 and COMT (Catecholamine-O-methyltransferase), the latter previously implicated in pain genetics. Only ADRB2 of certain gene types were associated with increased widepread pain (by 1.39-1.83 the OR risk) and by increased pain extent (by 1.24-1.58 the OR risk) Read the rest of this entry »
Popularity: 4% [?]
Immunoglobulin Infusion Improves Complex Regional Pain
February 19th, 2010Longstanding Complex Regional Pain can be incredibly difficult to treat. Now Immunoglobulin Infusions have been shown to drop pains scores by 1.55 units. Read the rest of this entry »
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Opioid Phobia Takes Hit - “Iatrogenic opioid addiction… rare” According to Cochrane Library
February 19th, 2010With all the courses and Physician college emphasis on opioid addiction detection one would think addiction was highly likely on opioids - a Cochrane review finds quite the opposite. Read the rest of this entry »
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Severe Chronic Pain Kills
February 15th, 2010One thing that is never considered in an insurance settlement is the fact that 10 year survival may be less in people with severe pain. A recent article plots a survival decay curve Read the rest of this entry »
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Breast Cancer Help - Soy helps prevent recurrences and Free Maid Service
February 13th, 2010JAMA article finds 4 yr mortality rates were 10.3% and 7.4% in low and high soya users and 4-year recurrence rates were 11.2% and 8.0% as well. There is a free maid service for breast cancer victims in certrain communities. Read the rest of this entry »
Popularity: 5% [?]
New Hope For Chronic Daily Headaches - Continuous Infusions of Dihydroergotamine
February 13th, 2010Repeated IV infusions of DHE (dihydroegotamine) is the standard treatment for breaking transformed migraines (into chronic daily headaches). Unfortunately, arranging patient to be seen every 8 hours is just not viable in our community. Now a continuous infusion protocol may make this procedure more available. Read the rest of this entry »
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Oxycodone and St. John’s Wort - a bad combination and Oxycodone and Death Rates
February 13th, 2010St. John’s wort may reduce oxycodone (oxycontin, oxy-IR, etc.) levels by 50%. Read the rest of this entry »
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Indigestion - when ulcers Pills don’t work - Think Nocturnal Bile Reflex - Helped by Domperidone
February 4th, 2010Chronic 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: 6% [?]
Is Ganoderma Lucidum herbal any Use?
January 16th, 2010I 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: 9% [?]
Botulinum / Botox for Neuralgia/Neuropathic Pain
January 10th, 2010I 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 »
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Helping Prevent and Treat Post Shingles Pain / Post Herpetic Neuralgia - Can It Be as Simple as Vitamin C to Help?
January 4th, 2010It 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 »
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Shingles - For God’s Sake Give a Block Update
December 28th, 2009The 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: 12% [?]
Shoulder Pain Patient Needs Help - Any Suggestions?
December 25th, 2009Someone 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: 13% [?]
Checklist of Simple Treatments For Depression - including in Pregnancy
December 18th, 2009I 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
- If there is significant depression, then traditional antidepressants are necessary
- St. John’s Wort: “One small prospective study found no significant differences in fetal malformations in women exposed to St John’s wort during pregnancy, compared with pregnant women on other antidepressants and pregnant women with no teratogen exposure.49 Studies examining hyperforin and hypericin levels in breast milk have suggested safety for children and mothers,50,51 and one small prospective study suggests no increase in adverse events in children exposed to St John’s wort in mother’s milk, though cases of lethargy and drowsiness were reported.52 The data, however, are scant and long-term studies of safety are required.53 In the absence of safety data, it is recommended that women who are pregnant or intend to become pregnant avoid St John’s wort. “
- SAMe - “As with St John’s wort, there is a lack of data regarding safety during pregnancy and lactation. Some studies have found that pregnancy may result in impaired methylation and lower levels of SAMe,73 suggesting a potential benefit from SAMe administration in pregnant women. SAMe supplementation in pregnant women with intrahepatic cholestasis has been associated with beneficial effects.74 Although SAMe seems to be a mostly safe over-the-counter agent (ie, a chemical that humans already manufacture,with no drug-drug interactions, and minimal and mild adverse effects), consideration for SAMe administration in selected cases may be reasonable. ” [but if significant depression then traditional better]
- Omega 3 - beneficial in pregnancy [but it is not safe to leave a lady depressed in pregnancy that could otherwise be better on traditional antidepressants.]
Below is the list: Read the rest of this entry »
Popularity: 12% [?]
Severe New Pain With No Right to be There - Zoster Sine Herpete?
December 17th, 2009Over 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: 12% [?]
Does “Success” of Psychological Treatments of Chronic Pain Need to be Taken With a Grain of Salt?
December 8th, 2009One 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: 13% [?]
Some Canadian Car / Motor Vehicle Accident Insurance Claim Resources
November 30th, 2009- I would like to compile resources for Car Accident Victims to help deal with their claims.
- In this province, there is “no-fault” really meaning it’s the victims fault for being in chronic pain. They have to deal with case workers who are poorly trained and subjected to scams meant to block their claim.
- They have to shell out of their own pocket any defense that doesn’t get to go to court, but is subject to a review committee that is, in my opinion, poorly educated as well (who else in North America uses the AMA Guide [for disability] unaltered?).
- They are also subject to disability settlements that are orcestrated by a SGI physician that in one case I saw did not give any extra for pain level or chronic pain induced depression. The poor fellow with severe back pain, obviously very depressed as well, was subjected to the AMA guide 5% disability rating for his crushed vertebra pain. The ruling physician had not seen the patient. When I tried to object, I was almost kicked out, for I was only an observer.
- If they want to object to this ruling, they would have to get an independent assessment, which in my opinion is impossible to do in this area; assessments seem to have rather an insurance company bias.
- To this end, I am complying self- help links for accident victims Read the rest of this entry »
Popularity: 16% [?]
What is the Worst Chronic Pain Imaginable?
November 15th, 2009What 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
- told you are a liar, faker, and drug addict
- victimized by doctors, insurers, and anyone in the healthcare field
- Have insurers either cut you off or downgrade your coverage with the explicit message that your life really isn’t worth very much and there is nothing you can do about it - you are being exploited and that the way it is…
- Find that not much is found and that medications don’t seen to work at all.
- Have yourself hounded by narcotic controllers (Addiction experts one is forced to see through your doctor or insurer, the provincial doctor licensing body and so forth) as being on painkillers unnecessarily and worse, with the attitude the opioids will only make you worse – again leaving you with the message that you are not worth very much to anyone.
- Finding your life such that, the hope you had, dissolves away; as you live sleepless nights and find your life slipping away - job, family, friends, any hobbies and interests, just gone
- Finding that, with the pain and the persecution, along with the growing poverty, that suicide looks better and better.
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: 17% [?]
Given Vocational Advice to Chronic Pain Patients And terminating Coverage - The “You Could be A Funeral Director Scam”
November 12th, 2009Recent 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: 19% [?]
Chronic Pain Can Cause Reversible Brain Damage
November 9th, 2009Brain 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: 16% [?]
Advice On Long Term Disability Claims
October 28th, 2009The 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 »
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Finding If a Drug Available in Canada
October 26th, 2009I’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: 16% [?]
Diclofenac Patch for Neck Pain - Could One Make Their Own Patches?
October 18th, 2009A 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: 18% [?]
3rd Retrovirus to Infect Humans Found in Fibromyalgia and Chronic Fatigue -Not Confirmed But Possible Because Poor Techniques Used
October 12th, 2009- Previously there were two main groups of retroviruses known to infect humans - HIV, causing AIDS; and human T-cell leukemia virus (HTLV - various types). AIDS can be associated with frank neuropathies and pain. HTLV infections “is endemic in the Caribbean, Japan, South America, and parts of Africa” ref here. Disease may be asymptomatic with” fewer than 5% of those infected develop related disease” (ref here ). Bronchitis and bladder infections are more common, however. (ref here)
- What is most interesting however is that the previously known Retrovirus HTLV - I is associated with a 37% Fibromyalgia rate ( vs 12.9% of “controls”):
Higher prevalence of fibromyalgia in patients infected with human T cell lymphotropic virus type I.
Boris A Cruz, Bernadete Catalan-Soares, and Fernando Proietti
The Journal of Rheumatology November 1, 2006 vol. 33 no. 11 2300-2303
abstract here - Now a third Retrovirus has been found highly associated with Chronic fatigue, Fibromyalgia, and atypical MS
- October 8, 2009 - Whittemore Peterson Institute in Nevada publish undisputable evidence of Xenotropic Murine Leukaemia Virus (XMLV) infection in Chronic fatigue, and furthering their research have found it in over 95% of Fibromyalgia and atypical MS as well
Retroviral Image
Read the rest of this entry »
Popularity: 23% [?]
Car Accident with Multiple Areas Involved - Here’s Proof
September 13th, 2009I 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: 21% [?]
Sacroiliac Supports
September 13th, 2009Sacroiliac 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 »
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Omega 3 - Anti-inflammatory Effects
September 13th, 2009Having 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: 20% [?]
Canadian Celebrity Takes World by Storm - Humor Me
August 16th, 2009First Seen in Banff, The character has been making appearances worldwide… Read the rest of this entry »
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It’s Official - Swearing Helps Pain
August 15th, 2009Pain Clinics are becoming very big into psychological coping - well, they better teach patients to swear more - as swearing has now shown to alleviate pain.
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Medial Knee OsteoArthritis (OA)- What Else Can You Do? - Unload it and more
August 8th, 2009Waiting 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: 24% [?]
Ultrasound and TENS for Back Pain
August 5th, 2009I 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: 24% [?]
Muscle-Joint Pains, Dry Mouth and Eyes? - Maybe You Have DEMS/SAPS with Thyroid Antibiodies
July 17th, 2009DEMS - 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: 24% [?]
Vulvodynia Therapy Patient Resource
July 17th, 2009As 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: 24% [?]
New Hope For Complex Regional Pain Syndrome I - 5 days Magnesium Infusions
July 17th, 2009- Type I CRPS is a vague syndrome of inordinate pain with variable - vague neurologic weakness or numbness features (unlike type II in which the nerve has definely been cut). Typical scenario is after a wrist fracture in patients with low vitamin C levels. Limb can become very painful, tender to touch, cold, and weak - more or less useless. Pains can become overwhelming.
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: 24% [?]
New Hope For Refractory Neck Pain - Botulinum “Botox” - But Not Cheap
July 17th, 2009Botox 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: 24% [?]
Hyaluronan for Base Thumb Osteoarthritis (OA)
July 16th, 2009Injectable “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: 24% [?]
Polymyaglia Rheumatica(PMR) - A New Look - Not as Easy as Seems
July 16th, 2009Due 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: 28% [?]
You Need to Do Local Work to Get a Feel for Pain - Tragic Hip Example
July 9th, 2009Much 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: 25% [?]
Knee Pain After Hernia Surgery - Any Ideas?
June 29th, 2009I 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: 31% [?]
Attenuation of Pain After Spinal Injury May be Possible
June 18th, 2009Microglia spinal support nerves become activated after nerve and spinal injury an greatly potential the pain. Animal experiments show minocycline, a tetracycline antibiotic known to inhibit microglia, can reduce post spinal pain in animal subjects. Read the rest of this entry »
Popularity: 5% [?]
Self Help Book Resources in Chronic Pain
April 18th, 2009Let 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 »
Popularity: 31% [?]
Knee Osteoarthrtis(OA) - Arthritis Pills Don’t Work That Well -What Else?
April 11th, 2009A 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: 29% [?]
Part of Failed Back is Overactivity of Sympathetic Nervous System
April 10th, 2009Failed back sydrome - post-laminectomy syndrome has multiple origins. Now it appears some sympathetic overload is present as well. Read the rest of this entry »
Popularity: 28% [?]
Biphosphonates (bone building meds) and Jaw Necrosis - Not Seen in Oral Doses
April 5th, 2009Lon-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: 30% [?]
Unresolved Shoulder Pain - Look at the neck
April 5th, 2009Bad Neck (and perhaps arm pains)but Normal MRI? - Need a Functional MRI
April 5th, 2009In 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: 29% [?]
Resistant Shoulder Tendonitis Treatments
April 4th, 2009Having 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: 43% [?]
Upper body “Fibromyaglia” Misdiagnosis
April 3rd, 2009Cervical (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: 30% [?]
BASDAI resource
April 3rd, 2009In 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: 29% [?]
Ischial Tuberosity Off - Loading When sitting for pain relief
February 19th, 2009Seat adjustments that take the pressure off the ischial tuberosities help relieve back pain sitting
Popularity: 31% [?]
Pain Inhibiting Circuits - Neuropathic Pain - Good Gone Bad?
December 22nd, 2008Your 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: 33% [?]
On Tamoxifen? Beware of Some Anti-depressants - but only in 7%
December 14th, 2008Certain 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: 34% [?]
Advanced Disc Degeneration Still Very Painful
December 7th, 2008Article 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: 34% [?]
Diabetic Have More Muscle Pains
December 7th, 2008Diabetics 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: 34% [?]
Multiple Allergies, Hives and Abdominal Pain - Think Mastocytosis
December 7th, 2008I 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: 60% [?]
Trigeminal Neuralgia
November 25th, 2008Listened 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: 45% [?]
When to Use Opioids in Chronic Headaches
November 23rd, 2008Afraid 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: 35% [?]
? Obturator Neuralgia Needing Help
November 19th, 2008(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: 35% [?]
Chiari-Syringomyelia Resources
November 16th, 2008This 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: 37% [?]
Calcific Tendonitis Shoulder - Puncture as Good as Puncture/Aspiration
November 16th, 2008Calcification 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: 38% [?]
Migraines More Common in Celiac Disease (Which Could Still Have Normal Biopsy)
November 15th, 20085.5 % 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: 35% [?]
Would Basal Body Temperature Manipulation Help Fibromyaglia(FM)?
November 11th, 2008Subjects 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: 42% [?]
Post-Stretococcus Reactive Arthritis – Poorly Diagnosed Treatable Chronic Pain
November 11th, 2008I 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: 51% [?]
Regina Fibromyaglia Group
November 8th, 2008Monthly 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: 35% [?]
Got Crohn’s? - May Have Spine Arthritis Too
November 7th, 2008Recent 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: 36% [?]
Fibromyalgia (FM) Tragic Misdiagnosis - Myotonic Dystrophy Type 2 and Cervical Spinal Stenosis - New Treatments as Result
November 3rd, 2008Since 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: 49% [?]
Nerve Pain? - 21st Century Gene Therapy
November 1st, 2008
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: 36% [?]
Ounce of Prevention is a Pound of Cure For Neuropathic Pain
October 29th, 2008Chronic 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: 36% [?]
New Arthritis Pain Option - Botox It
October 29th, 2008For 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: 35% [?]
Irritable Bowel - Possible Missed Protozoan Disease With Treatment
October 27th, 2008It 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: 36% [?]
Polymyalgia Rheumatica (PR) - What can Help?
October 27th, 2008Prednisone 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: 40% [?]
Possible Cure for Parkinson and Central Pains - Gamma Knife the Thalamus
October 25th, 2008Gamma 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: 35% [?]
Got a Sinus Infection? Try a Migraine Triptan.
October 25th, 2008Cases 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: 36% [?]
Bacterial Overgrowth causing Chronic Pancreatitis and Rosacea - New treatment? And, for elderly, a quick way to get rid of lactose intolerance
October 25th, 2008Chronic 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: 41% [?]
Hamstring Syndrome of Tethered Sciatic Nerve - Newer Entity With Surgical Treatment
October 21st, 2008
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% [?]
Irritable Bowel (IBS) Involves Excessive Permeability of Gut Membranes
October 21st, 2008
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: 43% [?]
Post-mastectomy Neuropathic Pain Cure - Lymph Node Transplants
October 20th, 2008Pain 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: 38% [?]
Costovertebral Joint Pain Referrals
October 18th, 2008Costovertebral (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 »
Popularity: 37% [?]
Lumbar Facet Osteoarthritis Not Associated With LBP
October 18th, 2008I 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: 37% [?]
Posterior Acromial Injections Need 2″+ Needles
October 15th, 2008Recent 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: 36% [?]
Older Celiacs With Iron Deficiency Anemia Missed
October 13th, 200820% 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: 36% [?]
IV Magnesium Studies
October 13th, 2008There 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: 49% [?]
Neck Cheap Home Cervical Traction
October 12th, 2008
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: 41% [?]
Where Can You Get Inexpensive Support Bras?
October 12th, 2008I 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: 36% [?]
Sacroiliitis Tests Not Great
October 12th, 2008Testing 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: 56% [?]
TMJ Osteoarthritis(OA) - Diclofenac and Splints Work
October 12th, 2008Study 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: 38% [?]
Chronic Mouth Yeast Infection? - Nuke Your Dentures..
October 12th, 2008Candida-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: 36% [?]
Botox For Thrombosed Piles
October 11th, 2008A 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: 37% [?]
New Relief For Chronic One Sided Headaches
October 11th, 2008A 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: 37% [?]
IV meds For Migraine and Approach For Resistant Cases
October 11th, 2008Recent 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: 37% [?]
Sleep Disurbance and Pain Severity Predict Chronic Pain
October 11th, 2008In 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: 35% [?]
Whiplash - When Does “Give It Time” No Longer Apply
October 10th, 2008Recent metanalysis of studies suggests recovery is not great after 3 months Read the rest of this entry »
Popularity: 35% [?]
New Hopes for Leg Phantom Limbs
October 10th, 2008Phantom 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: 36% [?]
Chronic Pain and Sleep Apnea
October 7th, 2008In 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: 36% [?]
PatelloFemoral (Kneecap) Pains - When to Use Orthotics (foot supports)
October 5th, 2008Certain sore kneecap cases will benefit from foot orthotics. Read the rest of this entry »
Popularity: 36% [?]
Injecting Subscapularis - How
October 5th, 2008The 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: 38% [?]
Osteoarthritis Can Improve With Antibiotics - What Does That Mean -and would this prove safer than NSAID’s?
October 1st, 2008In 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: 38% [?]
Steroid Joint Injection - Efficacy and Long Term Cartilage Effects
October 1st, 2008Are 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: 41% [?]
Knee Mensicus Tears - Accelerate Osteoarthrtis or Bistander?
September 29th, 2008A Recent Framingham study has demonstrated on MRI:
- By age 69, 50% have meniscial tears; it is more common in women
- 61% of these tears were asymptomatic
- In cases of Osteoarthritis, those with symptoms 63% had cartilage tears, without symptoms were 60%.
- If no osteoarthritis but symptoms, 32% had cartilage tears; versus 23% tears in those without symptoms. Read the rest of this entry »
Popularity: 38% [?]
Manitoba Family Practice Snubs Physiotherapy
September 29th, 2008Recently, 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: 35% [?]
Segmental Colitis Associated with Diverticulosis (SCAD syndrome)
September 25th, 2008Diverticulosis 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: 36% [?]
Achilles Tendonitis - New Eccentric Program
September 25th, 2008Achilles 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: 36% [?]
I wish I Had Fibromyaglia - Then I Couldn’t Have Anything Else…
September 23rd, 2008I 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: 37% [?]
Rehab - Forget Fear-Avoidance - Give Them Opioids
September 23rd, 2008
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: 37% [?]
Zinc and Magnesium Deficiency Common in Fibromyaglia- and What are Zn and Mg Good For?
September 23rd, 2008A 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: 43% [?]
Optimal Fentanyl Patch Use
September 22nd, 2008There 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: 39% [?]
Hope For Failed Backs - Spinal Cord Stimulation
September 21st, 2008Given 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: 37% [?]
Angiogenesis (new blood vessel growth) the root of all pain?
September 21st, 2008Angiogensis 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: 35% [?]
Is Facet Injection Better Than Medial Branch Block?
September 21st, 2008Facet injection appeared to be superior to medial branch block of SPECT scan positive facet joints Read the rest of this entry »
Popularity: 37% [?]
New Treatment For Vulvodynia - 6% Gabapentin in Lipoderm
September 21st, 20086% Gapapentin in Lipoderm is helpful in vulodynia. Interesting how they made it up. Read the rest of this entry »
Popularity: 40% [?]
Dorsal Wrist Impingement - How to Diagnose
September 21st, 2008
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: 43% [?]
Acute Nerve Injury - Try Gabapentin and Tramadol
September 21st, 2008After 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% [?]
Want a Cheap Nerve Stimulator needle? -Look No More…
September 21st, 2008Disposable insulated needles are not readily available but a 20 gauge cannula is easy enough to find… Read the rest of this entry »
Popularity: 35% [?]
Child in Pain & Distressed - Healing Potential of Massage + some techniques
September 21st, 2008Children 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: 43% [?]
New Treatment for Chronic Daily Headaches - Mexiletine
September 21st, 2008Chronic 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: 39% [?]
Diabetic Peripheral Neuropathy - Pregabalin to 600mg or bust
September 21st, 2008I 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: 38% [?]
Tennis elbow and desperate - try Duloxetine
September 20th, 2008Two cases resistant to any treatment responded to Duloxetine suggesting complex origin. Read the rest of this entry »
Popularity: 36% [?]
Neuropathic Pain More Spinal and there are potentially better treatments
September 20th, 2008Recent Japanese article hilights spinal sensitization in neuropathic pain suggesting lidocaine and ketamine maybe should play bigger role Read the rest of this entry »
Popularity: 37% [?]
Hypnosis in Chronic Pain
September 20th, 2008Hypnosis 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: 35% [?]
NSAID’s and Gastritis - new help
September 18th, 2008Arthritis 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: 36% [?]
Polymyalgia Rheumatica - Back and Neck Pains
August 13th, 2008
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: 36% [?]
For MS Sake, Give Vitamin D to Your Kids
July 29th, 2008In 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: 36% [?]
Fast Fix for Shingles Pain - and Doctors: For God’s Sake - Give a Block!
July 28th, 2008Nerve 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% [?]
Immorality of Canadian Agency for Drugs and Technologies in Health
July 26th, 2008The 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:
——————–
Re decisions made:
Decisions made by your organization would NOT stand ethics board analysis. For example Lyrica is delisted because there has been no adequate comparison with Amitriptyline. This, however, does not claim it is not effective particularly in patients unable to tolerate amitriptyline. Nonetheless, I have had acute herpes zoster elderly subjects unable to tolerate other agents (amitriptyline and other TCA’s and gabapentin) decide to go off lyrica once my samples depleted and live in relative agony. I would suggest your organization be disbanded as provincial formularies will use your conclusions to their advantage without taking intolerances to other agents in mind. The bare minimum you would need is ethics board approval of your recommendations. Shame on you - what would you do if your grandmother developed shingles and was in so much pain, unable to tolerate gabapentin and tricyclics?
Yours disgusted,
———————–
I am sure their decisions are all scientifically based. I am reading a Book Called Contemplative Science by B. Alan Wallace. In it he states:
“It is sobering to note that the twentieth century, which generated the greatest growth of scientific knowledge in the entire course of human history, also witnessed man’s greatest inhumanity to man, as well as the greatest degradation of our natural environment and the decimation of other species. The expansion of scientific knowledge has not brought about any comparable growth in ethics or virtue.”
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: 35% [?]
Want to See a Pain Expert? - See a Vet, not a Doctor
July 21st, 2008A 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: 35% [?]
Pulsed Radiofrequency - New Hope for “Sciatica”/radiculitis of Neck and Back - but where available?
July 20th, 2008Traditional 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: 38% [?]
Post-Stroke Pain - New Hope - Vestibular Stimulation and Maybe for Spinal Pain too
July 14th, 2008
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: 53% [?]
The Pain Diagnosis that Cannot be Made in Women - Spine Arthritis - Ankylosing Spondylitis
July 5th, 2008
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% [?]
New Treatment for Thumb base Arthritis - 60% relief but you won’t like it…
July 1st, 2008
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: 51% [?]
Hip Warning in Elderly
June 28th, 2008
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: 35% [?]
Unresolved Whiplash? - Look for Shoulder Impingment.
June 28th, 200811/220 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% [?]
Are Canker Sores Part Neurologically Driven?
June 28th, 2008
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: 35% [?]
Stomach Enteroviral infection in Chronic Fatigue?
June 19th, 2008In 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% [?]
Super Capsaicin for Neuropathic Pain Control Looks Promising
June 14th, 2008The 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: 38% [?]
Action Pain Support Group Regina New Home
June 5th, 2008At 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% [?]
Can’t Tolerate Arthritis Pills? - Try SAMe But Give It a Month.
May 12th, 2008Most 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: 38% [?]
Migraine treatment options
May 11th, 2008Some 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: 34% [?]
Microglia Key to Neuropathic Pain
May 11th, 2008While 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: 35% [?]
Dyspepsia (Indigestion) Under 45 - Eradicate Hemophilus Pylori
May 11th, 2008Controversy 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: 37% [?]
Mast Cells and Histamine Receptors Cause Pain in Interstital Cystitis (IC) and We Must Deal Better With Peripheral Pain Generators
May 9th, 2008Startling 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: 33% [?]
WCB Suggestions
April 20th, 2008I 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% [?]
Post Vertebral Fracture Pain - Balloon Kyphoplasty Resources - Miraculous Results
April 18th, 2008Post vertebral fracture pain can be disabling and longstanding and spell the beginning of the end for some cases. Almost immediate relief can be obtained by tunneling a balloon into the vertebral body and pumping it up with hot plastic. Regina has lead the way in Canada for starting these sort of procedures. At a recent meeting Dr. Buwembo discussed their statistics. I am including a list of contacts for referral. Read the rest of this entry »
Popularity: 39% [?]
Regina Chronic Pain Self-Management Eduaction Program Open to Public
April 14th, 2008At Wascana Rehab Centre on 23rd Ave., a chronic pain group meets. Formerly, it was only available through invitation from a rehab specialist. Now, it is open to the general public. Your doctor, or another health care professional, can refer you. Referral is to go to Adult Program, Wascana Rehabilitation Centre with notation “Refer to Chronic Pain Group”. Phone is (306) 766-5714. A fax number I have is 766 - 5901.The education program runs for 6 weeks and each session can run three hours.
There is one 3 hour session for family member to learn about chronic pain. [I think non-believers should have to sit on tacks for the three hours and explain why they simply cannot just ignore it…but the educators would be more professional than me…]
I hope to have more information later. Support like this can be very important to sufferers who feel no one understands. It will give you tools to cope. Also may give opportunities to find out how others cope. Don’t miss this free opportunity…
Popularity: 30% [?]
How Should One Investigate Chronic Back Pain and What about the Back Muscles?
April 8th, 2008Exercise programs and biopsychosocial fear-avoidance perspectives abound but what workup should be involved prior to such processes? Despite attempts to talk about “nonspecific chronic back pain”, research has demonstrated that in most many cases, a specific diagnosis can be made and hence specific treatment allotted. Read the rest of this entry »
Popularity: 70% [?]
Manipulation attacked as insufficent by self
April 6th, 2008Whether Manipulation helps is a long held dispute. Despite some positive studies, argument still rages whether this is better than “usual care”. This would have to assume millions of people getting manipulation are crazy.
Read the rest of this entry »
Popularity: 29% [?]
Post Hernia Surgery Helped by TENS and Should Surgeons be Doing Hernia Repairs if They do Not Know How to Deal with the Persistent Pain Afterwards?
April 6th, 2008Pain after hernia surgery is common. Transcutaneous nerve stimulation (TNS) seems to help post operatively and one wonders if it might have lasting effects. I was always taught that one should not do a procedure unless one can deal with the common complications. If a procedure has a “common” risk of pneumothorax, then one better be able to deal with it. It then follows that surgeons should not be doing hernia repairs because they do not know anything about dealing with the pain afterwards.
Popularity: 60% [?]
Estrogenic Effects on Pain Blocked by ACE Inhibitors?
April 6th, 2008Quoted article starts by saying: “Many painful conditions occur more frequently in women, and estrogen is a predisposing factor. Estrogen may contribute to some pain syndromes by enhancing axon outgrowth by sensory dorsal root ganglion (DRG) neurons.” This effect may be blocked by ACE inhibitors
Popularity: 34% [?]
Pamidronate and Clodronate - hope for Reflex Sympathetic Dystrophy (aka CRPS) and Back Pain
April 3rd, 2008Pamidronate can significantly help over 3/4 of RSD and reduce chronic back pain through a series of simple infusions. It is expensive and because of a poorly designed negative study, has not reached full acceptance for the good it can do. Fortunately an IV Clonronate double blind randomized study settled that doubt.
Read the rest of this entry »
Popularity: 38% [?]
Etanercept (Enbrel) for Radiculitis (Sciatica)
March 30th, 2008The common and disabiling pain condition is chronic lumbar radiculopathy (chronic back pain/Sciatica). Despite the widespread promotion of treatments of neuropathic pain a recent analysis of neuropathic pain treatments has concluded the following:
“To date, no medications have demonstrated efficacy in lumbosacral radiculopathy, which is probably the most common type of NP(neuropathic pain).” This was certainly a surprise to me.
Pain 132 (Dec. 2007) 237–251
Review and recommendations Pharmacologic management of neuropathic pain: Evidence-based recommendations Robert H. Dworkin et al
abstract here
This suggests a great need for potential agents. Local injections of Enbrel appears to be one of them with in some cases dramatic responses despite long term misery. This is one of the agents I fear our drug plan will never carry.
Read the rest of this entry »
Popularity: 45% [?]
Cannot treat Chronic Pain in Saskatchewan
March 30th, 2008I am sending out a call for people to help petition the government for coverage of pain medications in Saskatchewan. This is a letter I sent out through the Sask. Pain Network:
To Sask Pain Network:
It seems impossible to treat chronic pain in Saskatchewan. Many of the useful agents are NOT covered by the drug plan and never will be, because they do not demonstrate good effect as a “stand alone” treatment, and are not reliably responsive in groups that are of diverse causes. ( Ex. treating back pain only once with Botox will not hit all the necessary areas to show benefit and treating back pain with Botox may not help a facet and SI joint problem).
Dr. Theil (gynecologist),and I (separately) applied to the drug plan some years ago for coverage for Botox for pelvic pain. I submitted a report of about 20 pages, but got no response. It also seems clear that now the drug plan is more cash -strapped from covering seniors’ prescriptions. I feel nothing of value will ever be covered. People with chronic pain are generally too poor to handle much in the way of drug costs.
I discussed this with Dr. Murray Opdahl (Saskatoon Pain Clinic) and he is similarly frustrated by lack of access to useful treatments. Individually, we have been ignored. As a group, with knowledge in the area of pain, our voice would be one to be reckoned with. Some agents that have shown benefit in select cases include:
Botox as an adjunct to many problems. (~$400.00/bottle - could use 2+)
Pamidronate for Complex Regional Pain Syndrome (aka RSD), and post vertebral fracture ($400.00 x 2-3 for treatment)
Enbrel for radiculitis ( needs TWO shots - not like one one-shot failing remicade study) $250.00 X 2
Lyrica for - Fibromyalgia (recently gained formal approval in USA) and certain neuropathies ~ 150-200/month
Tramadol - especially for pain in elderly or those intolerant to other opioids $150+/month depending
Cymbalta for chronic pain with depression - $150+/month
There is more. We also need a pain clinic in Regina and Dr. Lang (Anesthesia) appears willing to run it (though obviously more multidisciplinary help would be needed).
I would invite all interested parties to submit here. ( I won’t publish your name online unless specifically requested or have comments you wish to make)
Popularity: 27% [?]
WCB ISSUES
March 19th, 2008I have received various concerns about WCB, many angry. There are some precedent judgements passed that may help.
Popularity: 36% [?]
WCB troubles - What Needs to Be Done?
March 16th, 2008I have received a variety of letters condemning high handed techniques by WCB. I read the letter below with a sense of sadness. I can’t imagine the desolation involved in living with chronic pain and dealing with the system. I hope this gives it a voice. It has left me with much to ponder. What is wrong with Saskatchewan and medicine in general? What can be done? Read the rest of this entry »
Popularity: 30% [?]
Exercise Rehab Programs by Themselves Worthless? - Evidence Snuffed?? and How does One Get an Unbiased Appraisal of Disability?
February 2nd, 2008Cochrane reviews withdrew a review on rehab programs that questioned any validity to programs that do not have full multidisciplinary approaches. One wonders if this was pressure from Functional restoration business - who would not like that presented Read the rest of this entry »
Popularity: 36% [?]
New Option For Interstitial Cystitis
January 31st, 2008Pentosan Polysulfate, i.e. Elmiron, is used orally for IC but can take 3 - 6 months to gain effect with 35-40% of subjects having marked improvement of symptoms.
as per here
Now it appears it can be given intravesically (into bladder) “twice a week for 10 weeks and thereafter a voluntary maintenance therapy once a month” with symptoms reduced to half in 5 weeks. Read the rest of this entry »
Popularity: 25% [?]
Restless Legs and Interstitial Cystitis Related to Gut Bacterial Overgrowth?
December 3rd, 2007In those patients with Irritable bowel and restless leg syndrome, significant benefits can occur if therapy to treat bacterial overgrowth is undertaken Read the rest of this entry »
Popularity: 30% [?]
Is Asthma a form of Pain?
December 2nd, 2007Carbamazepine and Valproic acid have been found to be effective in bronchial asthma begging the question whether asthma involves neurological mechanisms similar to migraines or Trigeminal Neuralgia Read the rest of this entry »
Popularity: 24% [?]
Finger pressure can relieve many migraine headaches
November 19th, 2007Over three minute pressure to occipital arteries can greatly relieve migraine pain in over 1/2 of cases; almost sounds too good to be true. Read the rest of this entry »
Popularity: 24% [?]
Mast Cells Implicated in Migraines
November 18th, 2007Recent findings that mast cells may trigger migraines has significant implications on cause and treatment. Mast cells play a key role in Peripheral Sensitization - Neurogenic Inflammation where tissues become overly tender and swollen. They are, however, a cornerstone of allergies as well; which complicates their role and complicates therapy. Read the rest of this entry »
Popularity: 24% [?]
Big disc protrusions gimps facets
November 17th, 2007I have a patient who had a large disc protrusion. These have been shown to have a good chance of recovery (vs disc bulges which very few with sciatica were better a year later). This patient did not improve until facet levels had been thoroughly needled on side of sciatica. Now it appears that facet problems may be common in such a situation and explain some poor epidural steroid responses Read the rest of this entry »
Popularity: 25% [?]
Functional Capacity Accessment for Neck Risky and Unverified
October 6th, 2007In May 2007, was published a review of FCE of the neck. Their analysis found: “At this moment, however, no validated performance based instrument has been described in literature.” They also found various necks tests were not without danger. Read the rest of this entry »
Popularity: 21% [?]
Transformed Dural Leak Headaches - Undiagnosable Here
October 6th, 2007Dural leaks can be following an epidural injection gone subarachnoid, but can occur spontaneously primarily in the Thoracic Spine. The headaches are usually better at night when lying down and worse when one gets up. If the dural leak is high, lets say following skull surgery, the headache may be later on in the day. Generally, laying down improves the headache. However there are variants - one was worse lying down and better when up. When transformed by neurogenic inflammation sensitization of tissues, the headache could just become one of severe disabling chronic daily headaches. Transformed, without Gadolinum enhanced MRI, they will never be diagnosed here Read the rest of this entry »
Popularity: 25% [?]
NMDA receptors are king
October 6th, 2007- NMDA receptors play a vital role in memory
- NMDA dysfunction is of course key to chronic pain, though there are non-NMDA pathways though the thalamus in mice….
- NMDA blockage 2 days in a row with ketamine will cause temporary remission of depression for up to 5 days in 70% of cases meaning NMDA dysfunction also important in depression
Now it appears NMDA dysfuction in involved in borderline personality disorder, thought by some to be a bipolar disease variant. - wonder if they have much more pain…. Read the rest of this entry »
Popularity: 20% [?]
WCB Report Files
August 24th, 2007I made a presentation to the Saskatchwan Workmans Compensation Review Panel. Their report left out much of what I had to say so I am putting it here:
1) Case workers make patients worse and obstruct medical care:
One deadly tactic is to force a patient back to work or to inappropriate rehab just to see what will happen. I call it deadly because one of my patients with MRI evidence of a hot disc lesion was forced into inappropriate rehab and died 2 weeks later of his heart condition. I call this tactic “the Shakedown”.
Family physicians must be allowed to administer medical care without interference.
2) In Chronic Pain as little as 10% of cases are diagnosable by conventional examination, CT and MRI. If one wants to make a diagnosis discograms and selective nerve root blocks are necessary but are not made available to patients. hence patients are regularly terminated because “nothing was found”.
3) MRI’s and CT rarely are of use in CHRONIC pain and do not show the source of pain. Yet negative results are used to conclude the patient is faking
4) WCB recruits doctors who have similar outlooks to themselves. Without discograms, selective facet blocks, and selective nerve root blocks, they are not operating on tangible evidence; they are operating on their “feelings” on the matter. As disability ratings vary by over 30% by doctors, these feeling can be very inaccurate. The tragedy legacy of cancer patient pain undertreatment underscores how poorly doctors rate pain levels. Operating on feelings is a scam.
5) Multiple causes of chronic pain are missed by WCB who are supposed to give the patient the benefit of the doubt but do not.
6) Honesty tests like Waddell signs and consistency testing lack “consistency” and are invalid yet still used. They are as valid as witchhunting.
witchhunt.doc
7) Psychological decompensation is to be expected in certain chronic pain conditions but is used to contend it is all in their head…
8) Computer testing for “suitable jobs” does not take into effect many patients have multiple things the matter with them above their main diagnosis and may be socially and otherwise handicapped. A supreme court case in Quebec made it clear handicap had to include ALL problems. There is no evidence counselling someone on a job possibility makes it happen in disabled cases. Canada Disability pension criteria had to be modified to include not just suitable jobs but AVAILABLE and giving sustantive gainful employment - measures ignored by WCB who will terminate cases for any excuse. I call this the “you could be a funeral director” scam.
9) People who don’t get better can be labelled as “Fibromyalgia” even by specialists. This diagnosis cannot be made in the face or injuries and has a very poor consistency record from doctor to doctor in the literature; it cannot be used to terminate benefits where there is doubt.
10) Several legal precedents have been made in the supreme court re WCB:
- Chronic pain without identifiable cause cannot be treated any different than other patient (Nova Scotia 2001)
- Chronic pain is a valid WCB claim and recompensable. Supreme court 2005
- Handicap includes more than just the original injury Supreme court Quebec
- A worker can refuse rehab s/he deems in inapproppriate without being cut off WCB
In an Alberta WCB Case it was ruled that a patient during appeal had the right to cross examine WCB doctors (who are working on their “feelings”) in the conduct of “natural justice”
11) The AMA Guide for disability is old - made before interventional techniques could more determine the cause of back and neck pains. It does not have ratings for chronic pain and does not take age or occupation into account when determining disability. Various Canadian provinces and for example California have had to make changes to how disability ratings are made; this needs to be legislated in Saskatchewan or will be backward and frankly illegally treat chronic pain patients of underdetermine cause (conveniently made by lack of appropriate testing).
Popularity: 29% [?]
CARP Conference Slides
June 22nd, 2007Presentation at Canadian Association of Rehabilitation Professionals June 2007. Summation (version 1) here:
Power points are here.
1) Disc disease(especially chronic) can often not be imaged and the worst chronic cases just show disc bulges. Disc disease and sciatica is mostly the result of the sectretion of irritating substances by damaged discs effecting the rim of the disc and the nerves at that level.
2) FCE’s are not valid because they do not predict the waxing and waning course of disc disease.
3) Malingering tests are invalid and not accepted in court. Symptom magnification is a manifestation of the ill-treatment chronic pain patients have suffered.
4) Facet syndromes are real and real damage is seen in autopsy cases of whiplash and low back MVA cases. They do NOT have any identifiable signs and Xrays are normal. Without selective injection they will never be properly diagnosed and could easily be treated as potential malingerers.
5) Without discograms or facet selective blocks, 85% of back pains will not have significant diagnosable “objective findings” . However, a consultant deciding this means there is nothing wrong, would be like an obstetrician deciding the sex of a baby by the feel of the abdomen. In the 21st century you can do better than that. Consultants who work for insurers are not necessarily dishonest as much as their philosophy merges with that of the insurers. Given that there is a 34% discordance in disability ratings between professionals, according to the RAND review of the California AMA guide use, patients are entitled to a second opinion.
6) Numerous studies have demonstrated people with chronic pain do not get better after successful litigation, belying the fact people on disability are often malingerers.
7) The link between neurotism and chronic pain is weak and these so called neurotic features have been found to diminish or disappear with treatment of the chronic pain. Attempts to discredit a chronic pain patient on the bases of neurotism (narcissistic, histrionic, anxious etc.) is baseless. Dr Harold Merskey, well known for his research and publishings in this field stated: ” Psychologists should not be diagnosing psychological problems as the major origin of someone’s pain any more than they can prescribe medications for them.” (personal communication 2007 Canadian Pain Society to Dr. M. Montbriand).
8) The association between chronic pain and depression is complex because they share the same pathways. Recent prospective trials suggest the depression results from the pain.
9) fear-avoidance, health anxiety and other psychological factors are driven by the level of pain although some studies obscure that variable by calling it “how much pain they think they are in” or “how disabled they think they are”.
10) There is no scientific basis that TSA vocational couselling leads to job employment in WBC or related chronic pain patients who feel they are not ready for work. On the contrary, A CPP study found the group who left a retraining program because they did not feel well enough, did not go back to work; this was despite the fact they were unique in their desire to return to work by volunteering for retraining. A 1986 study quoted in the CPP report found job advice in itself did not help bring about employment. According to a recent Supreme court decision, “handicap” includes more than just their injury - it includes their age, education, social abilities and so on. These need to be factored into any assessment. According to a 2001 CPP legal decision, re-entering the workforce must consider job availability and whether it could give substantial financial return. If someone can only work for 2 hours at a time before needing a break, no employer would hire such a person so question is moot.
11) In Canada, two supreme court decisions have made it clear that chronic pain without discernable findings is real and requires compensation.
12) The AMA guide is old, made before the day the causes of chronic back pain could be discerned and in their book they still say that 85% of chronic back pain is unknown. Given that it is so dated, it must be used only as a guide and modifications found necessary in California include:
- Age - over 39 gets upgraded disability ratings
-right or left hand concerns
-Occupation concerns - a radio announcer with a larynx injury has a much higher disability
- 3% extra disability is afforded for mild pain and for more pain it is considered “unrateable” so it is “anyone’s game”.
- Chronic pain of undetermined origin - very real if discogram of facet blocks have not been done - in Canada that is compensatable. Given that the AMA guide considers this unrateable, it cannot be used and other measures including occupation have to be considered.
- In Saskatchewan, the pychological disability resulting from the pain, is added to the physical to get a final rating.
13) Fibromyalgia cannot be diagnosed in post trauma cases because the tender points in the injured areas cannot be counted. There is very poor inter-observer agreement into that diagnosis and the use of that to discredit an injured party from receiving benefits is suspect. There is a tendency for some specialists to diagnose all people with widespread pain as having Fibromyalgia, yet only 20% of people with widespread pain actually qualify. True Fibromyalgia, however, might actually be a post-traumatic induced disease. It is a serious affliction with Imaging evidence of excessive appreciation of pain. There is also imaging evidence (from McGill) of progressive gray matter loss in the order of 1 3/4 cm cubed of gray matter loss a year. One study suggested in relation to people with regional pains or no pains, there is twice the death rate.
14) There are multiple “new” chronic pain diseases becoming recognized (eg. femoro-acetabular disease hip). An older one, Thoracic outlet syndrome, though found common after MVA’s in one Canadian study, remains unrecognized because scalene nerve blocks are never done. Only 20% of cases recovered in the Canadian study and in one article written for IME’s it was suggested this is such an intense disease that psychological distress is universal.
Other entrapment disorders and facet disorders remain undiagnosed because of failure to do nerve and facet blocks.
15) Much of chronic pain has now been recognized to have a neurogenic component and the use of a questionnaire like the Leeds Neurogenic Pain scale can help identify these. This might prove valuable in eliciting “objective findings” of disability.
16) People with chronic pain are vicitmized and basically told it is their fault. Many felt they would have been better off with no “help” from adjudicators and rehab people (who use a “try harder” approach to therapy). An effort must be made to be better than “adversarial” help.
Popularity: 22% [?]
Simple Opioid Risk Tool
December 12th, 2006A talk by Dr. Pam Squire recommended a simple opioid risk tool called the ORT
Popularity: 21% [?]
Rotator Cuff of hip causes Greater Trochanter pains
December 11th, 2006Trochanteric side of hip pain is common yet rarely properly diagnosed. Actual Gluteal tears can be a cause and by age 60, 10% of people have them. Twenty Percent of chronic back pains (average age of 54 yrs) have trochanteric pain. Proper treatment depends on extent of tears yet they have eluded recognition up until now. Read the rest of this entry »
Popularity: 25% [?]
Does Abrupt Estrogen Withdrawal trigger Pain?
December 11th, 2006Does sudden withdrawal of Estrogen cause a “aromatase inhibitor pain syndrome” leading to increased musculoskeletal pain? One author thinks so. Read the rest of this entry »
Popularity: 23% [?]
Surface DC Electrode Stim helps Fibromyalgia
December 4th, 2006Skin DC CES (Cranial Electrical Stimulation) has been shown to help central spinal pain (see other post). Now, 5 days of 20 minute daily treatment can drop pain scores from 8.5/10 to 5/10. Placebo effect? - not likely because stim over the wrong brain area had no persistent effect. This highlights how much FM is actually centrally generated pain Read the rest of this entry »
Popularity: 18% [?]
Is Crushed Vertebrae a RSD? - New RX
September 17th, 2006It is not unusual to find asymptomatic compression fractures in the spine, while it has also been demonstrated that the same can cause disabling persistent pain. Now, with evidence of rapid pain response to IV Pamidronate, a drug found helpful in RSD, the question of Vertebral fracture RSD comes to mind. Read the rest of this entry »
Popularity: 24% [?]
Bah to Lyme? - Check out Lichen Sclerosis RX
September 17th, 2006Lichen Sclerosis and its male equivalent balanitis xerotica obliterans can be disabling conditions. It can cause disabling pain, burning, pruritis, and genital lesions. Lyme disease Borrelia burgdorferi have been detected in cases of this, so a recent study used Lyme disease treatments with startling effects. Read the rest of this entry »
Popularity: 21% [?]
CRPS - Peripheral endothelial dysfunction player
September 11th, 2006Evidence of microcirculatory endothelial dysfunction was documented in Complex Regional Pain Syndrome aka RSD. The peripheral changes could help trigger the central sensitization process. Read the rest of this entry »
Popularity: 21% [?]
Zoster Neuralgia -never too late for Anti-virals?
September 11th, 2006IV Acyclovir 10 mg/kg every 8 hours for 14 days followed by oral valacyclovir 1000 mg 3 times per day for 1 month dropped VAS by two in 1/2 cases of post-herpetic neuralgia. Read the rest of this entry »
Popularity: 100% [?]
Chronic cough might be sensory neuropathy
September 11th, 2006Ever have a patient with a chronic cough unresponsive to anti-reflux, allergic rhinitis, and asthma treatment? Sensory Neuropathy might be the problem and Amitriptyline the answer. Read the rest of this entry »
Popularity: 20% [?]
Fibromyalgia no more poor copers than ill public
September 11th, 2006The finding that all ill people can “symptom intensify” and persons with Fibromyalgia(FM) don’t do it any more than any other illness is another nail in the coffin for FM being psychological. There will be a subgroup in FM that is very disabled. These people could have undiagnosed physical problems or could be poor copers - the latter not occurring in any excess to that found in any other medical illness.
Popularity: 14% [?]
Does Pain “Grow” at Tendon injury sites? -and Treatment tennis elbow
September 10th, 2006Studies on Achilles, Patellar and Lateral epicondylar (tennis elbow)tendonitis have demonstrated the ultrasound demonstrable appearance of a “vasculo-neural growth” that corresponds to the site of pain. In long-term resistant cases, treating these lesions with sclerosing agent, polidocanol, under ultrasound guidance; led to “clinically good results” in most cases. Disappearance of the “vasculo-neural growth” corresponded to the improvement. Read the rest of this entry »
Popularity: 29% [?]
Microscopic Colitis - Undiagnosable Pain Generator?
September 9th, 2006There is a growing awareness that colitis can occur without any observable lesions on colonoscopy. Microscopic colitis is occasionally associated with spondylitis and may be associated with myofascial back pain by activating psoas and abdominal wall spasms. How then does one make a diagnosis? Read the rest of this entry »
Popularity: 14% [?]
Glucosamine in RA -pain but not inflammation?
September 7th, 2006Glucosamine 1500 mg/day seemed to help the pain of RA but not signs of inflammation - add on for Acetaminophen in NSAID intolerant along with fluvastatin (Lescol)? Read the rest of this entry »
Popularity: 14% [?]
Sodium Channel effects in Fentanyl vs Morphine
September 6th, 2006Sodiums channels are important in central and peripheral neuropathic pains. Morphine has no effect but Fentanyl (in Duragesic), Tramadol (in Tramacet), and Sufentanil (10 more potent fentanyl) do. This highlights there is a rationale for switching to a different opioid. Read the rest of this entry »
Popularity: 14% [?]
Meditation Reduces Pain’s Thalamic Firing
September 6th, 2006Transcendental Meditation can reduce thalamic response to pain by 40-50% - highlighting how relaxation training needs to be an integral part of chronic pain treatment Read the rest of this entry »
Popularity: 14% [?]
Vulvodynia be gone? Botox study
September 6th, 2006In this small study pain levels dropped from 8.3/10 to 1.4/10 without recurrence over the year of followup. One or two botox injection sessions were needed. Read the rest of this entry »
Popularity: 20% [?]
Varicella shots for shingles but tests ?useless
September 6th, 2006In 2005, a super-potent varicella-zoster vaccine established a 50% reduction in shingles over a 3 year period but left disturbing issues over whether the increased strength was necessary or a marketing ploy. Recent Zoster immunity testing locally cast doubt on test’s validity. Read the rest of this entry »
Popularity: 14% [?]
Opioids “Get No Respect”
September 6th, 2006Opioids for chronic pain: Taking stock - editorial
Pain - in press Sept 2006
Discusses a study finding people on opioids were not better off. I feel they failed to comprehend that poor copers may be the ones that need opioids most and were not better off to start with. Read the rest of this entry »
Popularity: 13% [?]
Knee medial collateral lig calcification painful
September 5th, 2006On occasion, pain and calcification of the medial collateral ligament is reported in symptomatic knee patients. This can be a treatable condition. Read the rest of this entry »
Popularity: 12% [?]
Celiac disease painful and hard to diagnose
September 5th, 2006The malabsortion of celiac disease can cause both osteomalacia and B12 deficiency among other things. These can be painful. Celiac is associated with spondylitis in some cases. A recent blood test result suggested lab testing can be insensitive.
Popularity: 13% [?]
DC Stim Helps Spinal Damage Pain and Cranial Stim for Fibromyalgia
September 5th, 2006Apparently 60-70% of spinal cord sufferers are in pain and 1/3 of these severely. This sort of pain can be very difficult to treat. Yet DC current - enough to be gotten from a nine volt battery could significantly help Read the rest of this entry »
Popularity: 10% [?]
Regina Pain Interest Group - needs input
August 29th, 2006Late August 2006, representative of Pfizer, Dr. Paul Harris and Dr. Mike Montbriand met to discuss putting together a group interested in chronic pain. Input would be appreciated. Read the rest of this entry »
Popularity: 8% [?]
Alzheimer’s- New Anti-inflam RX and Pain
August 29th, 2006TNF-alpha Modulation for Treatment of Alzheimer’s Disease: A 6-Month Pilot Study.
MedGenMed. 2006 Apr 26;8(2):25.
Tobinick E, Gross H, Weinberger A, Cohen H Abstract
full
Comment - Looks like Etanercept (Embrel) works as well as Aricept in a 6 month pilot study in preventing AD progression. This suggests inflammatory disease is involved in AD disease. It has been suggested that some chronic pain involves the same mechanism. Read the rest of this entry »
Popularity: 9% [?]
Gabapentin makes Topical Diclofenac Better
August 28th, 2006Life Sci. 2006 Aug 2; [Epub ahead of print]
Examination of the interaction between peripheral diclofenac and gabapentin on the 5% formalin test in rats.
Picazo A, Castaneda-Hernandez G, Ortiz MI.
Putting 5 capsules of 300 mg gabapentin in a 60 ml bottle of Pennsaid may triple its analgesic power… Read the rest of this entry »
Popularity: 11% [?]