Welcome to Painmuse

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

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

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

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

Finger pressure can relieve many migraine headaches

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

Posted in Headaches | 11 Comments

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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Posted in Headaches, Insurer issues, Uncategorized | Leave a comment

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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Posted in skin, Topical Pain Treatments | Leave a comment

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

Posted in Leg Pains, skin | Leave a comment

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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Posted in Drugs, Headaches, Uncategorized | Leave a comment

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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Posted in Depression, Drugs | Leave a comment

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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More Painful Bladder Syndrome Non-invasive Treatments

I have painful bladder victims that do not want instillations – multiple allergies that would make infections impossible to treat is one issue. There are some other options mentioned in a recent review that are not common.

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Posted in Interstial Cystitis/Gynecologic, Uncategorized | Leave a comment

Topical Clonidine or Capsaicin For Diabetic Neuropathy and Mannitol

Both clonidine 0.1% gel and capsaicin 0.75% cream three times daily can drop pain by 40% in 12 weeks though clonidine causes less skin irritation.

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Frozen Shoulder – Just a Little Cortisone But More Blocks Help

Study found 20 mg Kenalog worked as well as 40 mg and another found you don’t even need to hit the joint. I supplement suprascapular and quadrilateral space blocks as well as subscapularis working out.
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Posted in Injection, myofascial pain, shoulder | Leave a comment

Prostate Cancer – Does Early NSAID (Arthritis Pill) Use Help?

Early NSAID use in prostate cancer could potentially cut death risk to 1/3 though high dose late use, thought related to bone pain use, shows opposite.

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Twin Chronic Pain Study – Low DHEA Metabolite and High BMI and ?Cortisone

Twin study shows low Epiandrosterone, a metabolite of dehydroepiandrosterone (DHEA). Could supplementation help?

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Posted in Fibromyalgia, pain mechanisms | Leave a comment

Morphine Does Not Facilitate Breast Cancer in Animal Model

Frequent concern is whether meds someone is taking is making their cancer worse. In the animal model, morphine does not help breast cancer.

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Hurt until Pain = Overdoing; Avoiding Things That Hurt = Avoidance – Can’t Win

Study found many overdo things resulted in significant pain flareups after. However, if they have periods where they avoid things that hurt, they are then categorized as avoidant – can’t seem to win though a paced life would be obvious.

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Bruxism – How do You Treat 2015 Besides Splints

Review on Bruxism Rx suggests splints, particularly mandibular advancement splints, clonidine or clonazepam, maybe botulinum, and nocturnal clenching biofeedback.

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Posted in ENT, TMJ | 1 Comment

Suffering is a Distinct Pain Feature

Simple study zapping volunteers drew distinction between unpleasantness ratings and suffering to point it considered it a distinct pain factor. This is not new news to anyone whose life has been changed by pain.

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Posted in psychology | 1 Comment

Celiac is More Painful Than Thought – and What Does That Mean?

In seeing new pain patients, I became painfully aware that Celiac or at least gluten sensitivity has a definite presence- so much so that I always looked for it. Now, it looks like “anybody is fair game” now that even gluten intolerance without Celiac can potentially have their pain better off gluten for 6 months. What makes things clearer, is the finding of neuropathy in established celiac varies from 0.7% up to 23% with even more -  39% of celiac, having neuropathic symptoms. The latter might reflect how small fiber neuropathy is impossible to diagnose without biopsies – something not done where I live.

Another startling  finding is that sensory Chronic Demyelinating Inflammatory Neuropathy (sensory CIDP) is increased in Celiac. Sensory CIDP is hard to diagnose because of the lack of muscle weakness early on yet is potentially treatable with IV gamma globulin, Plasmaphoresis and pulse steroids. This leaves a subgroup of people with widespread pain treatable which one study in Fibromyalgia found when subjects responded to IV gamma globulin. I find it disturbing that there could be a subgroup of widespread pain Celiac victims that have treatable disease.

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Posted in Abdominal pain, celiac, Fibromyalgia, Leg Pains, neuropathic | 1 Comment

Severe or Neuropathic Groin Pain – Obturator Neuropathy

Have and elderly fellow that just persevered with severe left groin pain as was just something he should put up with. He had not been sleeping and daughter noted cognitive decline with it. Exam of hip was a bit sore but when I let go of the leg, you could see this expression of searing pain in his face. Turned out to be Obturator Neuralgia. I have trouble picturing the obturator nerve so I have included many pics…

obtur_neuropathy

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Posted in groin pain, Hip Pains, Injection, neuropathic | 1 Comment

Migraine – How much Help From Herbals

The top 3 herbals I recommend for migraines include B2 400 mg/day, Coenzyme q10 >120 mg and magnesium.  Now a proprietary med has put in all 3 and got 30% less headache days.

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When Irritable Bowel is not Irritable Bowel Syndrome (IBS)

Had patient in today with dark blood stools previously diagnosed with Irritable bowel but more much likely now colitis. Had another case recently worked up by a gastroenterologist with nothing organic found – yet fact subject eats  a lot of fruit was not factored in.

1/6 IBS cases have something significant even with out warning features -causes: crohn’s,  celiac, and microscopic colitis. Then there is the fructose malabsorption that will be more apparent this summer with increased fruit consumption.

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Why are Pain Severity Readings Omitted From Recent Fibromyalgia(FM) Studies?

Two important studies on approaches to help Fibromyalgia (FM) have omitted changes in Visual Analog Scale (VAS) readings in their results. Giving reading of skin tenderness adds differences with each muscle site tested and can exaggerate total difference. Suspicion is, there were not significant changes as this is the hardest measure to show benefit – yet the most important.

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Posted in Fibromyalgia, Manual Med | Leave a comment