Treatment of Resistant Osteitis pubis with Pamidronate

Posted on March 20, 2014 by admin

Back in 2001, 3 subjects with resistant osteitis pubis had monthly infusions of 60 mg pamidronate – one for 3 months and 2 for 6 months. Two had no known cause and one had inflammatory arthritis. All recovered and had no recurrence of symptoms and in the 2 with bone scan changes- these changes resolved. Now this study has be replicated – cases with bone marrow edema were infused with 60 mg over 60 kg size and 30 mg under 60 kg size. Sadly, they were given one infusion initially and maybe a repeat at 3 months – a study I call “one shot wonders” – hardly sufficient to work well. Nonetheless, 5/8 were significantly improved and returned to sports and 1/8 was some improved. This confirms in my mind that it should be used in resistant osteitis pubis.

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Osteoarthritis – Does Sierrasil Work? – No

Posted on February 11, 2014 by admin

One of my patients started on Sierrasil and said there was literature on its effectiveness – it does not say that it helps pain though.. Continue reading →

Posted in Drugs, Knee | Leave a comment

Cytokine Storm – Treatment with Etanercept – Could it Stop Influenza Death?

Posted on February 9, 2014 by admin

Mild cytokine reactions give you a flu like situation where achy all over and malaise. Cytokine storm occurs with certain viral infections and can kill. Etanercept (Enbrel) can block that effect some in the mouse model infected with H1N1.

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Posted in Drugs | 1 Comment

Hip Labral Tear or Impingement – Steroid Injection Not Good

Posted on February 6, 2014 by admin

Steroid injection into hip with impingement or labral tear only gave relief for 10 days.

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Posted in Hip Pains | Leave a comment

Some Supplements May Aid Cancer Growth – A Few Might Stop

Posted on February 1, 2014 by admin

One would naturally assume keeping in good health through supplements would help your fight with cancer. Turns out, cancers may like supplements too…

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Posted in breast cancer, cancer | Leave a comment

Aphthous Ulcer/Canker Sore – Pepto-Bismol Treatment

Posted on January 31, 2014 by admin

Simply applying pepto-bismol to a canker sore with a q-tip or “swish and spit”  for multiple sores can soothe irritated area within minutes

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Fibromyalgia – Part of “Software Malfunction” is Dopaminergic/GABAergic Neurotransmission Disruption

Posted on January 23, 2014 by admin

Excessive pain due to brain central sensitization has been called a “software malfunction”. Part of that appears to be of Dopa/GABA circuits.

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Posted in Fibromyalgia, pain mechanisms | Leave a comment

Sacrococcygeal (SC)Ligaments Look Like Facet Ligaments And May Be Source of Pain

Posted on January 18, 2014 by admin

On anatomical study “small nerve fibers were observed adjacent to the ventral aspect of the SC intercornual ligament and piercing the ligament in one specimen” – similar to what is seen in facet joints. Commentary on article speculated they could be a source of pain and perhaps treated similarly to facet joints.

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Posted in coccygodynia | 1 Comment

Post Herpetic Neuralgia (PHN) Treatments – Lots More Than Just Pills

Posted on January 13, 2014 by admin

Pregabalin helps 1 in 4.93 while lidocaine patch helped 1 in 2.. Still, reliance on meds only helped 1/2 then…- there are plenty of alternatives though

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Followup Guidelines For Early Breast Cancer

Posted on January 12, 2014 by admin

Primary Care Physician (PCP can do much of followup. Here are guidelines:

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Chemotherapy Neuropathy – Prevent and Treament

Posted on January 12, 2014 by admin

Use of agents to reduce chemotherapy induced peripheral neuropathy confounded by issues of decreased anti-cancer effectiveness. L-Acetyl Carnitine during chemotherapy, and Venlafaxine or Duloxetine after are my choices.  Tricyclics, gabapentin, lyrica, and topical agents did not rate well and belie the idea neuropathy can be treated as a”group” process.

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Bruxism (Teeth Clenching) – At Last a Treatment

Posted on January 7, 2014 by admin

Electrically stimulating a masster muscle should pulse go over 110% during night helps suppress bruxism.

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Fibromyalgia (FM) Recommendations Vary By Country

Posted on January 4, 2014 by admin

Canada has no alternative (CAM) FM treatment recommendations but Isreali and German Recommendations do..

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Monotherapy Mediocre in Treating Fibromyalgia (FM)

Posted on January 3, 2014 by admin

New Acceptance and Commitment therapy – 8 sessions of 2.5 hours reduced pain by 20% in 1/2 cases but only 50% in 1/48 cases. Fairly maximal drug therapies with pregabalin +/- Duloxetine alone was not great

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Posted in Fibromyalgia, psychology | Leave a comment

High Dose Metoclopramide (20 mg IV over 15 min) Beats Subcut Sumitriptan (Imetrix) 6mg For Acute Headache

Posted on January 3, 2014 by admin

Metoclopramide 20 gm IV was VAS pain score  0.55/10 better on VAS than Sumitriptan injectable 6 mg. However, the later needed starting an IV and slow infusion over 15 minutes to avoid extrapyramidal oculogyric crisis (0.2% incidence with the 10 mg)

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Applying Sleep Hygiene Questionnaire to Chronic Pain Subjects Comes Out With Two Factors

Posted on January 2, 2014 by admin

Irregular Sleep -Wake Schedule and Sleep Disturbing Behaviour and Environment factor out as two main sleep issues in chronic pain.

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Posted in Sleep | 1 Comment

In Unilateral Chronic Episodic Headaches – Should Prolactin Levels Be Done?

Posted on January 2, 2014 by admin

Recently a series of patients with Prolactinomas (a pituitary prolactin – secreting tumor in brain) was published. They found they often presented with either one sided migraines (often orbital) or SUNCT (short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing). They felt prolactin levels should be done in those with with trigeminal autonomic cephalalgias like SUNCT. Cabergoline, a dopamine agonist, worked well.

prolactinoma

 

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Hip/Knee Arthritis – Not Satisfied With Acetaminophen? – Using Arthritis Pills (NSAIDs) Instead Helps

Posted on January 2, 2014 by admin

When Osteoarhtritis patients were allowed to try NSAID instead of acetaminophen,  “proportion of patients on acetaminophen treatment during the study decreased from 74.8 % at baseline to 23.9 %, while the proportion on non-steroidal anti-inflammatory drugs (NSAIDs) increased from 59.8 to 85.8 %.”

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Posted in arthritis, Hip Pains, Knee | Leave a comment

Hypnomanic Checklist

Posted on January 1, 2014 by admin

Once had a psychiatrist phone me very irritated because I had diagnosed a teeanger as potentially bipolar. Fortunately, I had seen her hypomanic, and run a hypomanic questionnaire at time – adequate documentation despite his hostility (guy needed a holiday). Chronic depression and a history of suicide in family helped as well. Here is a simple checklist taken from the 15 point checklist:

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Posted in Depression, psychology | Leave a comment

Taping Elbow Reduces Tennis Elbow Pains 50% – But Maybe Use a Band?

Posted on December 31, 2013 by admin

Taping around a tender tennis elbow can reduce pain from 4/10 to 2.2/10

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Remarkable New Treatment – Injecting Over Tenderized Skin Nerves With Plain 5% Dextrose

Posted on December 31, 2013 by admin

For year I felt the main expression of chronic pain was through activation of myofascial knots – now it looks like tenderized skin nerves is a front runner. Merely injecting D5W overtop tenderized nerve tracts an average of 6 weekly times can settle down even recalcitrant back pains.

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Posted in Back Pain, Injection, Leg Pains, Neck | 4 Comments

T Wave Inversion in AVL Could be Important – Don’t Always Rely on ECG Computer Diagnosis

Posted on December 30, 2013 by admin

In an acute coronary syndrome situation in emergency, ALV inversion had significance.  84.8% of patients had > 50% obstruction of the mid-segment left anterior descending (MLAD) artery.  In subjects with >50% obstruction, 84.9% had T wave inversion in one other lead – mostly lead I. In subjects with no significant obstruction, finding another lead inverted was only half as likely (42.1%).  It had a 76.7% sensitivity and 71.4% specificity.

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Posted in chest pain | 1 Comment

New Daily Persistent Headache Lasting Over 1 Year Responding to Nimodipine (Nimotop)

Posted on December 29, 2013 by admin

Case of thunderclap (severe sudden onset) headache associated with inability to do calculations (acalculia) that persisted for 13  months despite interventions.  Nimodipine 30 mg, initially bid, then od, relieve headache. It was felt that cytokines and vasospasms persisted the headaches.  Nimodipine is a TNF/interleukin inhibitor as well as an antispastic drug used in subarachnoid hemorrhage cases – which is why it was thought to miraculously work.

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Extensor Digitorum Brevis Manus as Cause of Dorsal Hand Pain Myalgias – Botox Rx

Posted on December 28, 2013 by admin

This  anomalous hand muscle presents as a a “fusiform, soft prominence” between the 2nd and 3rd extensor tendons near the wrist to hand. It can become sore as it is compressed against the extensor retinaculum and possibly irritates the posterior interosseous nerve.  Botox injections helped one case.

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Unresectable Painful Bone Cysts – IV Zoledronic acid For Adults and IV Pamidronate For Children Gives Rapid Relief

Posted on December 28, 2013 by admin

Painful large and unresectable bone cysts responded rapidly to IV biphosphonate therapy within first cycle in 88% of cases. Adults received 4 mg of Zoledronic acid (Zometa®, Novartis), and children got IV pamidronate 1mg/kg.  Zoledronic acid, if more than one was needed, was cycled every 1-2.7 months; pamidronate was cycled every 2.7 – 6 months.

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Posted in Back Pain, children, Drugs, Hip Pains, IV therapy | Leave a comment