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I’ve upgraded WordPress to include a twitter account where we can discuss blog entries. Hope to see you there.. http://twitter.com/painmuse
I hope to be active there this year.
I have a program that tracks where users are from – pain is worldwide:
Thanks admin
Presentation at Canadian Pain Society Winnipeg 2013 found only 23.7% of severe neuropathic pain victims responded to Canadian Pain Socieity drug protocols for neuropathic pain. It is time to look outside the box for treatment measures.
About 30 years ago, I attended a course given by Drs. Travell and Simon. Dr. Simon was discussing interscapular pains and Dr. Travell mentioned – don’t forget the scalenes – something that Dr. Simon replied he was getting to – as a cause of unilateral interscapular pains. Now, discussion of Dorsal Scapular Nerve entrapment as a cause of interscapular pains has returned, and has helped to highlight a couple cases I am having trouble with. Have you got rhomboid triggers that won’t settle? – Better think of this.
An older study found zoster immune globulin single early infusion could reduce shingles symptoms by 50% at day 42 but this appears to be forgotten. It appears in Canada to be readily available through public health as Varizig – manufactured in Winnipeg by Cangene.
This lady deserves Varizig.
Injecting articular branches femoral nerve and obturator nerve can give some relief for up to 3 months. However, results are more likely from the steroid used.
Given that Post shingles pain is restricted to certain nerve root Level(s), nerve destructive measures could be an option. Cure rates for both were about 85% but thermocoagulation had more adverse events.
Three simple questions have a sensitivity of 53.8% and a specificity of 88.9% for cluster headache.
I have written extensively on how nerve root blocks are a necessary part of treatment of shingles. Came across two Chinese articles stating effectiveness – one stating you can get “markedly effective” results in 75% of cases.
Two separate chinese articles discuss use of B12 in the period immediately after shingles and also, in a separate study, later. Each shows benefit.
Injecting shingles lesion in acute stage with local and steroid reduces pain, improves sleep and purportedly reduces post-herpetic neuralgia.
NOTE TO MY CHINESE VIEWERS – I only have access to the chinese abstract translation - if you could fill in gaps from articles it would be appreciated…. Continue reading
Chinese article claims adding injections to “dorsal scapula” triggers and sore spot in axilla can allow lateral epicondyle injections to work 100% of time.
Previously, there was a technique involved producing 2nd degree frost burns in tender post-herpetic neuralgia areas – as a means to reduce pains.
Suzuki H, Ogawa S, Nakagawa H, et al. Cryocautery of sensitized skin areas for the relief of pain due to post-herpetic neuralgia.
Pain 1980;9:355–362
http://www.ncbi.nlm.nih.gov/pubmed/7208080
Now it looks like areas can undergo micro-knifing with an acupuncture needle with a knife on the end instead.
Effectiveness of Kyphoplasty has been disputed, and other are left without it; this leave a proportion wondering what to do. Medial branch rhizotomy (like a facet rhizotomy) has been found helpful.
The back can have a wide distribution in shingles; and according to a study, is not relable at determining nerve level, as is the front distribution. I will inject dorsal nerve roots in order to shut the back distribution off; often I have to inject several levels.
Neuropathic faeture - electric shocks pain, burning pain,, radiating pain with increased touch sensitivity to an area were commonly seen in joints.
Steroids effect two processes/receptors – a glucocorticoid pathway, and a mineralcorticoid one. The glucocorticoid pathway has strong anti-inflammatory and immunosuppressive effects. The mineralcorticoid pathway works more on retaining salt. The latter has been found to have pro-inflammatory effects which might have a pain increasing effect, blunting benefits of steroid injections. This might explain the lackluster effects and duration of epidural injections.
Subjects with TMJ were asked to chew almonds to see how a splint worked – 16/20 chewed on affected side leading author to dub it the “Habitual Chewing Side Syndrome”
Recently, a dose of Acetaminophen (Tylenol) has been shown to reduce anxiety responses to a surrealistic film. Previously, it had been shown to reduce MRI evidence of the effects of social rejection. Together, it suggests anixety/social rejection is another form of pain.
Recent article scanned the web and catalogued the best pain sites. I’m not on it but I’m not bitter (much)…
In chronic pelvic pain, 61% will have painful bladder syndrome, 70% will have endometriosis, and 48% will have both. They do indeed seem to be evil twins often operating together.
Study of 2940 Obstructive sleep apnea subjects over 3 years found a 3.7 times risk of having IC/PBS.
Midazolam has been shown to have powerful effects similar to steroid epidurally, but there are concerns about its perservative. However, it is the same Benzyl alcohol preservative seen in Kenalog which is widely used in epidural injections. Recent animal vitreous injections of benzyl alcohol have found 0.071% benzyl alcohol does not cause retinal toxicity – easily achieve with IV Versed if given caudally in 15 mls dilutant that has some bicarbonate to ph balance the formulation. Even then, that does not consider that the solution will be diluted even more caudally.
Recent article did not find orthotics by self made a difference, but when combined with dorsiflexion calf stretching night splint reduced pain by 50% in 8 weeks.
Article finds self massage can reduce pains potentially by 1/2. Massage instructions are free to anyone.
Analysis of 41 cases of juvenile widespread pain found “definite SFPN (small fiber polyneuropathy) in 59%, probable SFPN in 17%, and possible SFPN in 22%. Steroids or IV gamma globulin subjectively helped 80% of those that tried them.
