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Category Archives: neuropathic
What Does One Use For Worst Topical Pains – Lidocaine2.5% /Prilocaine 2.5%
I remember lidocaine/prilocaine mix as Emla – used to put on sites for those terrified of needle pokes. It didn’t have “poison prevention packaging” and was removed from market though generics are available or compounding pharmacy can make up. Was … Continue reading
Posted in Drugs, neuropathic, skin, Topical Pain Treatments, Uncategorized
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New Genetic Determinant of Neuropathic Pain – Chromosome 12q23.1
We are all faced with patients that have pain are above what they should have and have pondered genetic causes. Genetic Variant at Chromosome 12q23.1 increases chances by odds ratio 1.68 of neuropathic pain. Is a mitochondrial phosphate carrier and … Continue reading
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Capsaicin 8% Patch in Peripheral Neuropathy Not Diabetic but at a Cost…
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 … Continue reading
Posted in neuropathic, Topical Pain Treatments
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Upper Facial Pain Treatment- Home Based Sphenopalatine Block
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.
Posted in ENT, neuropathic
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Post Craniotomy Headache Local Treatments
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.
Posted in Headaches, neuropathic
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What can One Do For Severe Limb Pain? Epidural Motor Cortex Stimulation
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 … Continue reading
Posted in complex regional pain, neuropathic, Stimulation
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What are the Causes of Polyneuropathy?
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 … Continue reading
Posted in neuropathic
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Does Small Fiber Neuropathy Progress?
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.
Posted in neuropathic
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Nasal Neuralgias – What to Do
A Nose pain issue with pain out of control could represent a nasal neuralgia with a treatable injection regimen.
Posted in ENT, neuropathic, Uncategorized
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Lateral to Upper Eyelid Lacrimal Neuralgia
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.
Posted in eyes, neuropathic
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Cheek Pain – New Zygomaticofacial Neuralgia
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
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” … Continue reading
Posted in Neck, neuropathic
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Want Do You Do For Desperate Neuropathy? – Implantable Pain Pump
Some years ago, Neuropathic study demonstrated meaningful reduction in neuropathic pain occurred in only 23.7% of cases. Severe Neuropathic Pain – Only 1/4 Respond to Standard Drug Protocols – What Else Is There? http://painmuse.org/?p=2640 Subject of present article was case … Continue reading
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Chronic Severer Abdominal Pain – Why Has It taken So Long To Realize it’s Partly the Abdominal Wall and Treatable?
Early last year I wrote about my experience chronic severe abdominal pain as it being from the abdominal wall: Chronic Severe Abdominal Pain is a Skin Nerve Pain http://painmuse.org/?p=4840 Now, someone has taken it a step further by doing a … Continue reading
Posted in Abdominal pain, Injection, neuropathic
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Median Nerve Flossing for Neck- Arm Pains
Several years ago I listened to a talk on using nerve “flossing” mobilizations to help victim with hypermobility issues. This would stretch the nerve in their “tracts” and help reduce pain. They were taught to do a routine -repeated like … Continue reading
Posted in arm, Neck, neuropathic, radiculitis
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New Ion Channel Abnormality Found in Diabetic Neuropathy
Hyperpolarization-activated cyclic nucleotide-gated (HCN2) channels have been found to cause issues in animal models of diabetic neuropathy and the rush is on to find a drug safe to use to block them. An Ion Channel That Perpetuates Pain in Diabetic … Continue reading
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Neuropathic Treatment Failure -The Greatest Issue In Treatment of Chronic Pain
I was asked to put a letter in a time capsule for my great nephew. I reflected over the near 40 years I have been working on chronic pain and my wishes for 2034. The treatment of neuropathic pain is … Continue reading
Posted in neuropathic
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Imipramine and Pregabalin – Little correlation Effect with plasma concentration
Imipramine drops polyneuropathy pain by one and has no increasing effect with dosage suggesting most effect is placebo. Pregabalin drops pain by 0.4 and marginal/not significant drug dosing effects suggesting neither is much use alone.
Posted in Drugs, neuropathic
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Supratrochlear Neuralgia
This is a newly described condition. Ignored as a possible cause of head pain (astoundingly, 6/15 had a prior supraorbital nerve block but not trochlear). Tip off is it’s near midline location. Pressing or … Continue reading
Posted in Headaches, neuropathic
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Peripheral Neuropathy Pain Unresponsive to Creams – Try 5% Doxepin
Child cancer case where chemotherapy induced peripheral neuropathy pain was not helped by usual topicals was helped by 5% doxepin cream
Posted in neuropathic, Topical Pain Treatments
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Buttock-Posterior Thigh Neuropathic Pain – Posterior Femoral Cutaneous Nerve Injury and Treatment
Pain in butt and hamstring is not uncommon and usually involves hamstring. However, neuropathic level pain in areas can happen after surgery or injection suggesting nerve damage to Posterior Femoral Cutaneous Nerve. Present article used cryoablation successfully to treat.
Posted in neuropathic, Uncategorized
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Refractory Burning Mouth – Try Clonazepam and Venlafaxine
Venlafaxine (300 mg/d) and Clonazepam (5 mg/d) in Refractory Burning mouth – All responded with a reduction in pain from 8.6/10 to 3.2/10 after 3 months
Posted in Drugs, ENT, neuropathic
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Burning Mouth Syndrome – Remarkable Improvement with Botulinum Injections
“16 units of incobotulinumtoxinA (100 units diluted in 2 mL of saline), 4 units into each side of the lower lip and 4 units into each anterolateral side of the tongue” – “The beneficial effects lasted up to 16 weeks … Continue reading
Posted in Botox, ENT, neuropathic
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Neuropathic Pain – Phenytoin Topical Augments Ketamine or Baclofen
It is all very well to say a drug works topically. However it is easy to assume they work on similar mechanisms so one does not add to the other. Phenytoin (Dilantin) augmented both ketamine or Baclofen so might be … Continue reading
Multiple Sclerosis (MS) Pain Treatment Options
I have an MS patient who was in bad shape when I started to see her – was using a walker. With various measures, she was much better. What worked? Vit D2 50,000 u weekly, B12 injections 1000 mcg subcut … Continue reading