Pain Medical Musing

Raloxifen is a estrogen look alike used for osteoporosis. Is is similar to tamoxifen so helps to prevent breast cancer. Like birth control pills, has a slight stroke risk.

I have a relative who had been on raloxifen for Osteoporosis. It, in combination with other meds has been relatively effective. Her sister has had a fracture, worse hearing loss, and was at one point diagnosed with Fibromyalgia.

It turns out, and article with no referencing to, described raloxifen as a treatment for fibromylagia pain and fatigue in a double blind trial. The study was never repeated and came on it by accident. Pain was cut to more than half in 4 months and fatigue helped as well.

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Techniques involving post isometric relation stretching of Quadratus Lumborum clinic use.

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While gabapentin might work in post herpetic neuralgia and diabetic neuropathy, it does not work well in spinal pains/sciaticas and so forth. Now it has been shown not to work in chronic pelvic pains as well.

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Usually when subjects brux (teeth clench) of antidepressants, one has to stop antidepressants as the alternative is higher dose clonazepam (1 mg)
Bruxism – How do You Treat Besides Splints
http://painmuse.org/?p=4547

Quetiapine 25-50 mg helps considerably as well.

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Even Opioids, if placebo is removed, can only give you 1/10 reduction in pain. Want to push it for more?  Well, I suspect some opioid deaths are included here. From what I have seen, various approaches ( Tai Chi, acupuncture, Cognitive- behavioural, exercise, journaling,etc) can do some effect in studies but only help temporarily or a bit because of human nature and poverty. Can’t afford long term CBT or acupuncture, quit exercise in cold weather etc.

People who do well do several approaches at one. Doing that will allow you to reach what I call critical mass. Once you reach a certain point of betterment, improvement is much more than can be expected from the culmination of the three – you reach critical mass and improvement in activities of daily living flourishes.

People who try one thing at a time often say it didn’t help that much and end up being discouraged. Don’t do that!

This is such a trying condition that when I came across this poster abstract I felt I needed to post it here.

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Would opioid guidelines always work on cancer patients?The answer is NO. –  13.7% do not respond to usual doses and only half of those will get any benefit from increasing the dose. If one were to extrapolate, this would mean 7% of opioid users would need higher than usual doses of opioids to respond.  I guess this is why the new rules are only suggestions and not hard and fast regulations. Now, if only College regulators could handle these implications… Opioid induced hyperalgesia might be helped by switching opioid.

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Injecting skin nerves where constricted in the skin can significantly relieve pain in Complex Regional Pain Syndrome – a secret as is only published as a letter

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Below is a study poster presented to the Canadian Pain Society showing benefits of frequent B12 Injections. Unfortunately, a study found men with smoking history have a 3 times lung cancer rate so I have now restricted B12 injection use to women.

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Post-thoracotomy pains are the worst post-operative pains, occurring in high frequency and can be severe. Surprisingly, asthma beta-adrenergic stimulants greatly reduce any neuropathic pain, though not muscular pains, postsurgery. It suggest beta-adrenergic circuits, thought to be involved in descending inhibition, might be important.

I wrote about how beta-adrenergic agents might be involved in downward inhibition:
Antidepressants Just Don’t Work on Descending Inhibition
http://painmuse.org/?p=3241

The fact beta-adrenergic agents prevent post thoracic neuropathic pains here:
Eur J Pain. 2015 Nov;19(10):1428-36. doi: 10.1002/ejp.673. 
Effects of β2 agonists on post-thoracotomy pain incidence.
Salvat E et al
https://www.ncbi.nlm.nih.gov/pubmed/25766791

“The chronic use of β2 -agonists was an independent predictor of thoracic neuropathic pain (but not of non-neuropathic pain) and was associated with a five-fold decrease in the relative incidence of neuropathic pain [OR = 0.19 (0.06-0.45)].”

beta adrenergic agents were found to work as well as antidepressant in animal model of diabetic neuropathy:
Choucair-Jaafar, Nada, et al.
The antiallodynic action of nortriptyline and terbutaline is mediated by β2 adrenoceptors and δ opioid receptors in the ob/ob model of diabetic polyneuropathy.
Brain research 1546 (2014): 18-26.
https://www.sciencedirect.com/science/article/pii/S0006899313015631