Elderly with Resistant Post Herpetic Neuralgia – What do You Do?

Posted on March 26, 2018 by admin

Not a new study but the benefits  mandated that I include it. Study presented were 2 cases in their 80’s with severe Post Herpetic Neuralgia – one on face, other T8-10 that tried everything including spinal stimulator without effect. Pain level was 10/10. Relief was gradually obtained by increasing doses of Nabilone, starting with 0.5 mg hs and working up over 1 year to 4 mg hs – got pain down to 4/10 without opioids. Having gone generic, cost is not prohibitive .

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Capsaicin 8% Patch in Peripheral Neuropathy Not Diabetic but at a Cost…

Posted on March 25, 2018 by admin

Capsaicin 8% patch was compared to pregabalin (lyrica) for effects on non-diabetic peripheral neuropathy.  A treatment with Capsaicin can cut skin sensitivity (dynamic mechanical allodynia) in half and render 29% free of sensitivity. Was embarrassed to publish this once I found out how much the patch costs ($800/patch in 2012)

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Posted in neuropathic, Topical Pain Treatments | 1 Comment

Trigeminal Neuralgia (TN) Botulinum -Updated Treatment

Posted on March 25, 2018 by admin

When I first started Botulinum injections I just just injecting intradermally the areas where they felt the pain. Then it became clear the trigger zone needed special treatment and subcut was more done. I used to have a researcher repeatedly email me for any updates on TN injections. Now there are some – Injecting the roots (origins) of the affected trigeminal nerve (II  and III anyway), and injecting the muscle in the trigger zone.

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Nonspecific pain in the Little Finger Hypothenar Eminence Hand – Pisiform Instability

Posted on March 25, 2018 by admin

Pisiform instability can cause nondescript pain over lateral hand eminence, and in some cases present with ulnar nerve damage. It is little recognized.

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Colitis Flare-ups Might be Temporary Sensitivity to Gluten Foods

Posted on March 25, 2018 by admin

Growing evidence that some gluten sensitivity is actually sensitivity to the carbohydrates in Gluten Foods rather than to gluten. None the less, avoiding gluten foods during colitis flareups, helps suggesting a temporary sensitivity.

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Posted in Abdominal pain | 1 Comment

Poor Pain Treatment – Here We Go Again

Posted on March 24, 2018 by admin

Back in the 1984, I listened to Dr. John Bonica admonishing Doctors over the poor treatment of cancer pain. I felt ashamed. Now, with the war of Chinese based Fentanyl washing over all use of opioids, cancer patients are again being targeted and living in undo pain. I had one patient with arrested  metastatic cancer having to deal with severe issues over her opioid use. My college actually wrote me about complaints and I sent her cancer clinic report and bone scan and told them that is all they needed to know. Now a human rights group has picked up on fact cancer pain patients  are forced to reduce their opioid doses. This is inappropriate in cancer cases and again I feel ashamed for the medical profession.

You can read about the problem here:
Human Rights Watch Investigating U.S. Pain Treatment
March 15, 2018
Pain News Network
https://www.painnewsnetwork.org/stories/2018/3/15/human-rights-watch-investigating-treatment-of-pain-patients

I have to admit Doctors can be very stupid. It took them years to realize you needed to use sterile technique with deliveries, that a germ caused ulcers, and now it extends to opioid use as well – go for the fad – forget the patient.

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Upper Facial Pain Treatment- Home Based Sphenopalatine Block

Posted on March 24, 2018 by admin

About eye, forehead, and temple pains from headache source, or surgery can be disabling yet responsive to blocks of the back of nose. The description is laid out in an online article at:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5545953/

or you can read my version.

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Post Craniotomy Headache Local Treatments

Posted on March 23, 2018 by admin

Post-Craniotomy Headaches are annoyingly common – “Headaches following craniotomies are reported in up to 91% of neurosurgical cases”.  Injecting craniotomy edge defect triggers,  scar neuromas, and botulinum to temporalis muscle are local treatment options.

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What can One Do For Severe Limb Pain? Epidural Motor Cortex Stimulation

Posted on March 21, 2018 by admin

Severe limb pain unresponsive to treatment ends up a surgical problem with spinal or ganglion stimulation becoming more common. A pain pump is an option. Motor cortex stimulation is as well, if pain is localized.  This is technically more difficult to do on a leg but a  Japanese study shows it can be done.

 

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Posted in complex regional pain, neuropathic, Stimulation | Leave a comment

Using the Pain System to Treat Depression – Buprenorphine

Posted on March 20, 2018 by admin

I have published on the use of ketamine to treat pain/depression/suicidality. Now a weak painkiller / partial painkiller blocker has been shown to help depression, not with one study, but with findings from twelve studies.

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Posted in Depression, Drugs, pain mechanisms | 1 Comment

Dental Nerve Injury

Posted on March 18, 2018 by admin

Yanking out a 3rd molar can damage the associated nerve, but done inferiorly, this just seems to create a numb chin most of the time. Dental implants however, can damage the nerve and leave persistent pain. Article found that early surgical exploration and perhaps nerve  resuturing could significantly improve things.

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Does Gargling with Probiotic Align Help Persistent Sore Throat – and what else you can do.

Posted on March 16, 2018 by admin

Had one patient with persistent sore throat gargle with Align Probiotic with rapid improvement in pain – just used it once/day, Would be interested in anyone with similar response.

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Fibromyalgia and Going For Surgery Advice.

Posted on March 11, 2018 by admin

This advice is being circulated and I’m putting it here so it won’t be lost in ensuing weeks.

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Chronic Abdominal Pain in Children – Are They Suffering Unnecessarily?

Posted on March 11, 2018 by admin

I recently wrote about how they are only now finding certain abdominal wall injections work for chronic abdominal pain in adults – confirming source is the abdominal wall – what already???

I suspect it is even worse with children in which 30% of chronic abdominal pain is thought originated from the abdominal wall and amenable to injection.  Study in press documents features and treatment.

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What are the Causes of Polyneuropathy?

Posted on March 10, 2018 by admin

Recent study gave a breakdown of what they found re cause. Frank diabetes was eliminated from selection as the cause would be obvious? Top 4 were Idiopathic 47%, Chronic Demyelinating Inflammatory Polyneuropathy(CIDP) 38%, Pre-diabetes 16%, and Charcot Marie Tooth syndrome (CMT) 9%.

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Does Small Fiber Neuropathy Progress?

Posted on March 10, 2018 by admin

Approximately 40% of “Fibromyagia” cases are actually small fiber neuropathy (SFN). There is now evidence of how this type of neuropathy progresses. 75% remain stable and 25% progress into large fibers.

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Intramuscular Stimulation (IMS) Works Even in Rats

Posted on March 10, 2018 by admin

Intramuscular Needle electrical needling of trigger knots in rat gastrocnemius(calf)  results in less irritable sites. I use IMS for areas I wish to avoid use of local (neck, about hip where need to be able to walk after etc.).  I couple it with massage techniques to remove any residual triggers and find it helpful.  Nice to have some basic science showing it works.

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Posted in Manual Med, Mechanical aids, myofascial pain | Leave a comment

Plantar Fasciitis – New Helps – Simple PRP and Nerve Ablation

Posted on March 9, 2018 by admin

Results from simple measures such as heel cup and ankle dorsiflexion night splint are not vigorous so am forced to look further. Steroid injection in the 21st century is out because it thins the heel pad making further problems more likely. I came across this protocol for PRP that is simple and could be done by anyone with a centrifuge. All PRP studies of plantar fasciitis only talk about long term results so I suspect immediate gratification like one gets from steroids, is not likely. It uses small amounts (from 10 mls blood) weekly x3.

Nerve radiofrequency abaltion of Inferior Calcaneal nerve gives spectacular results and so could chemical ablation

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Does Ritalin Help Traumatic Brain Injury Mental Fatigue and Mental Functioning? -Yes

Posted on March 8, 2018 by admin

Two year study found methylphenidate, average 60 mg /day, improved mental functioning in TBI.

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Posted in psychology, Uncategorized | Leave a comment

Masseter Facial Myofascial Pain – Botulinum Treatment

Posted on March 8, 2018 by admin

Treatment of Masseter Mysofascial pain with botulinum was successful in 64% of cases.

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Nasal Neuralgias – What to Do

Posted on March 5, 2018 by admin

A Nose pain issue with pain out of control could represent a nasal neuralgia with  a treatable injection regimen.

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Posted in ENT, neuropathic, Uncategorized | Leave a comment

Lateral to Upper Eyelid Lacrimal Neuralgia

Posted on March 3, 2018 by admin

Poorly known pain condition affecting outer eyelid and temple area. Such conditions I thought no one would care about but have had thank you’s in past so here it is.

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Posted in eyes, neuropathic | 1 Comment

Might Need Magnesium to Make Vit D Work Well – and Great Effects on BP.

Posted on March 3, 2018 by admin

Vitamin D is helpful in pain control and reduces cancer esp colorectal cancer – and recurrence rates.  Article makes a plausible case for magnesium needed for  Vitamin D to work.

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Cheek Pain – New Zygomaticofacial Neuralgia

Posted on March 3, 2018 by admin

The  Zygomaticofacial Foramen  is 2 cm lateral and 2 cm inferior to the lateral canthus  (edge)  of the eye. A case of neuropathic pain from there that responded well to injection is documented.

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New Test for Neck Radiculitis

Posted on March 1, 2018 by admin

I have now seen 2 cases of idiopathic cervical “sciatica”/radiculitis with stickingly bad pains in triceps. This arm muscle pains can help distinguish this from intrinsic shoulder pains and one author some years ago came up with the arm “squeeze” test for neck radiculitis

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Posted in Neck, neuropathic | Leave a comment