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Reaching “Critical Mass” to Achieving Pain Control – Procedure Pearls

I have recently achieved (previously unattainable) control in some of my chronic pain subjects using recent innovations – but to acheive this required use of multiple modalities at once.

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Posted in arm, Back Pain, Botox, complex regional pain, Drugs, Fibromyalgia, Headaches, Injection, IV therapy, Leg Pains, Manual Med, myofascial pain, Neck, neuropathic, Pain Dystrophy, piriformis, post herpetic neuralgia, radiculitis, shoulder, Uncategorized | 3 Comments

Finger pressure can relieve many migraine headaches

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

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TMJ – Upper Joint Injection Technique

I had always thought injecting the TMJ laterally in upward direction would be best. A posterior approach was found more effective in the swine equivalent.

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Post Lobectomy Persistent Chest Pains Prevented by Kinesiology Taping(KT)

Presently there is a battle in attempt to find measures to prevent persistent post-operative pain.  Persistent pains after chest surgery can approach up to 50%.  Post-operative, Kinesiology Taping (KT) was done over  three areas: at the chest access site pain trigger point; over the ipsilateral deltoid/trapezius; and lower anterior chest. In control group 30 day persistent pain was 30% versus only 7% in the KT group.

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New Acute Headache – ? Cause

Eliminating chronic headaches and “cephalic illnesses” (stroke, seizures, cranial lesions, sinusitis, or central nervous system infections” left a group with new moderate- severe headaches that attended emergency. These people could have comorbid serious health issues such as heart failure, worsening asthma or  emphysema, hypertension and pneumonia or something as trivial and an acute viral illness.

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Foot Morton’s Neuroma – New Treatment – Capsaicin Injection

Mortons’s Neuroma can cause severe foot pains often between the bases of the 3rd-4th toes. Cortisone injection may lead to atrophy of tissues and more rubbing of area as result so options are needed. Injection 0.5 mls of 0.1% Capsaicin lead to pain reduction from 5.9 to 2.4/10
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Gabapentin Fails to Help Back Pain With or Without Sciatica

Not all that long ago, Canadian Indian Affairs mandated that native pain sufferers had to try  gabapentin/cymbalta like drugs first before certain opioids. I wrote about how poorly cymbalta worked:
http://painmuse.org/?p=2179

Now even gabapentin failed to help back pain with or without sciatica. One wonders about the ethics of such sweeping proclamations.

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Posted in Back Pain, Drugs | Tagged | 1 Comment

Chronic Severe Abdominal Pain is a Skin Nerve Pain

Lidocaine freezing, administered rectally, can eliminate bowel pains temporarily. Having done that in a case of severe chronic abdominal pains, I found very tender nerve tracts from back to lower abdomen and pelvis on right side, explaining most of the pain.

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Does Etanercept Nerve Irritation Limit Use?

Many years ago I was injecting enbrel paraspinously near the nerve exit of sciatica nerve location. I was using a full 25 mg and found it had minimal effects. I wrote E. Tobinick at times and wondered if it was irritating the nerve. He wrote back “Who are you?” and that was the end of it. Now they have found that any more than 0.5 mg injected near nerve transforaminally gave reduced benefits for treatment of sciatica. This irritative effect of higher doses could explain reduced effects in some studies.

transforaminal

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Pregnancy Gone Badly – needs Quick Diagnosis and Treatment

Came across this while searching pain. It is so deadly, I had to write it up.

Catastrophic antiphospholipid syndrome (CAPS) is a rarely occurring condition leading to death in up to to 1/3 of cases. It can be confused with several other conditions like hemolysis   elevated   liver enzymes low platelets syndrome (HELLP), thrombotic thrombocytopenic purpura(TTP), and hemolytic uremic syndrome (HUS); so easily missed. It can present with generalized malaise,  abdominal  pain,  chest  pain,  shortness of breath and  hypertension,  altered mental status and seizures. Immediate  triple treatment with heparin, IV methylprednisone, and  IV immunoglobulins or plasmaphoresis can save lives.

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Finger Bruising – Recurrent Spontaneous

There is a subgroup of people who will spontaneously develop bruising in the palm side fingertip of a finger. It is a known syndrome – so don’t think you are crazy..

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Sleep Bruxism Temporarily responds to repetitive Transcranial Magnetic Stimulation (rTMS)

Stimulating the primary motor cortex representation of masseter muscle “bilaterally for 20 min per side each day for 5 consecutive days”  significantly reduced bruxism and opened up a new avenue of treatment.

bruxism_rTMS

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Scar Pains – More Injections to Cure Than Think

I was taught that a simple intradermal injection of local could eliminate scar pains. Now it is becoming clearer that repeated injections are often needed and the addition of cortisone is often necessary for results.

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Center Disease Control 2016 Recommendations For Using Opioids

CDC 2016 has put out a checklist for opioid use. It does not emphasize much on  use of injection, manual medicine and other alternative techniques but does give some guidelines.

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Missed Back Pains Especially in Elderly – Kissing Spinous Processes – Baastrup’s Disease

Touching spinous processes in back can elicit pain, and may coexist with other problems so be easily missed. Cortisone injection is the first line treatment. I might have seen one lately that was puzzling that it was so localized – in an elderly patient that I was more concerned about rib impingement.

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Chronic Prostatitis – Are Gut Germs Involved?

People with Chronic prostatitis have much less diversity of gut flora and particularly lack Prevotella – enough so, researchers think it is a biological marker.

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Post Breast Surgery Pains – Nerve Blocks Help

Post breast cancer surgery Pains are often do to injury to the Intercostobrachial nerve. Up to now, there has been little literature on whether blocking nerve actually helps – now a pilot study suggests pain can be cut in half.

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Chronic Headache Tragically Missed Cause – Intracranial Hypotension – And Poor Imaging Issues

New cases series of patient twith chronic headache that oft went thru a litany of doctors without success with a clearly treatable disease. Each gave a history of  headache on arising and relieved by lying down that was discounted because intracranial hypotension is so rare.

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Calcinosis Cutis – Under Skin Painful Deposits and Ulcers

Calcinosis Cutis is a disease of abnormal calcium skin deposits. Found in Connective tissue diseases like Dermatomyositis and CREST syndrome, in some  cancers, in genetic disorders,  and with infections and injury.  It presents with hard nodules that can be painful, ulcerated and non-healing. Therapy can be problematic but a recent study showed topical 25% sodium metabisulfite could be effective.

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Lipoedema – Pain Relief With Liposuction

With Liposuction, Lipoedema pains dropped from moderate to near none and relief persisted, on 8 year followup.lipoedema Continue reading

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Predicting Response to SSRI Antidepressants (Not SNRI’s though)

Less than 30% patients respond to antidepressants. Study cataloged depression scale and other features and came up with predictors of depression response particularly to Escitalopram. They included Demographics like black, unemployed, and uneducated; Depression severity and persistence all day ; Longstanding issues with depression;  PTSD symptoms; Anxiety attack fear avoidance; Sleep issues, and some miscellaneous issues like Insight into depression, Energy issues, Psychomotor agitation, and widespread aches and Pains.  People with those features would respond to SSRI’s like Escitalopram. Otherwise SNRI’s like venlafaixine or mirtazepine would be more effective.

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Rash under Breasts -Swoobie helps

Have a lady use hemp pads under her breasts to wick away moisture and relieve under breast rashes with considerable success. The are called Swoobies and pink lady in Regina have them

swoobie

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Could Marijuana Help Headaches?

With Medical Marijuana,  migraine frequency dropped from 10.4 to 4.6 headaches per month.

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Arthritis /NSAID Allergy – Want Can You Take?

Odd as it sound people allergic to aspirin and arthritis pills can tolerate Sodium salicylate and is non- acetylated. Pharmacy College assures me it is still available as Dodd’s sodium salicylate which is still available through pharmacy suppliers so pharmacy can get in – It is over the counter. Come in 500 mg – maybe start with 500 mg twice daily and work up to four times daily. Full dose in Rheumatoid Arthritis is 4 gm/day.

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Resistant Depression – Does Folic acid Prevent Lamotrigine From Working?

Recent study added lamotrigine to depressed subjects already under treatment. Folic acid supplementation appeared to prevent any improvement versus those not on supplementation.

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Canadian Marijuana Presciption Steps

I am trying to put together a list of steps for prescribing Marijuana. This is version 1.1 – please provide additional steps. Our province dos not cover this drug even for palliative care patients (yes, we are in a bible belt…). However, the military will cover cases for PTSD. Please add advice/comments. I am using Cannimed – a local supplier as an example but could sure use something cheaper… Step are included below:

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Nocturnal Rib Impingment

rib_imping_sleeping

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