Category Archives: Drugs

DHEA – for Depression in Elderly – Seemed Like a Good Idea..

Antidepressants are poorly tolerated in elderly and DHEA, found to be low in elderly, has been found to help with depression. I suspect part of its effect is through androgen stimulation as some is converted to such.  I have patients … Continue reading

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Opioid Death Fueled by Illegal Chinese Fentanyl NOT Prescriptions

Recent Article diagrammatically demonstrates where  opioid deaths have been coming from https://aapsonline.org/opioid-overdose-crisis-is-from-illicit-fentanyl/ So spend less time looking at medical opioid prescriptions and more at illicit fentanyl trade. All doctors are now under tremendous pressure to cut their dose of  opioids … Continue reading

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

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 … Continue reading

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Using the Pain System to Treat Depression – Buprenorphine

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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Cutting Opioid Dose Does What? And Why is Tapering so Difficult?

Opioid deaths seem to be fueling more by Chinese derived illicit fentanyl. However, massive efforts are made to lower opioid dose. One study was successful at getting opioid consumption down  from 288 mg to 150 mg. They weren’t any better … Continue reading

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Opioid and Tranquilizer Deadly Mix- How Did We End Up That Way? – Bipolar and/or PTSD

It has been said Opioids and tranquilizers can increase risk of overdose death five fold. In my population, there is a subgroup of cases with bipolar disorder. Indeed, a meta-anlysis found 21 – 25% of Fibromyalgia disorder have it and … Continue reading

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Tolerance to Arthritis Pill Mediated by Opioid Tolerance System

NSAID/arthritis pills have painkilling action centrally and this now appears to be related to its effect on opioid system. Unfortunately it means you can develop tolerance either because you are on an opioid or because its effects on descending inhibitory … Continue reading

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Extra B12 – Lung Cancer Link for Men

I have used frequent B12 shots as an analgesic for resistant pain cases. For men over 40, 10 yr. use of injectable B12 is linked to doubling lung cancer risk.

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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.

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On Methotrexate? – Take Vitamin C

In rat model, vitamin C prevents oxidative stress on liver and kidney

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How Can You Tell If Duloxetine (Cymbalta) or Pregabalin (Lyrica) will Work?

Both duloxetine and pregabalin work by restoring brain down pain inhibition. Hence the work in people who have deficits in this system. There is a simple test to confirm functioning.

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Ibuprofen an Alternative For Preventing High Altitude Sickness

“Severe high altitude headache  occurred in 3% treated with ibuprofen and 10% with placebo”

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Opioids and Tranquilizers/Sedatives Don’t Mix

“Sedative-hypnotic use compared with nonuse was associated with 6.4 times the risk of opioid overdose death. … Even at opioid doses 1-19 mg/d, patients using sedative-hypnotics concurrently had 5.6 times the risk than patients without sedative-hypnotics”. I must admit I have … Continue reading

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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

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Vulvodynia Treatments 2017

New approaches include topical neuromodulation which means “Podophyllotoxin (5 mg/mL) applied locally to tender points of vestibule after 5% acetic acid application. Treated area was covered with a mild estrogen cream and covered with gauze pads until the next day” … Continue reading

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SSRI Antidepressants Work Better Than older TCA Antidepressants in Irritable Bowel

Traditionally, an old antidepressant, amitriptyline, has been used for irritable bowel at doses far lower than its antidepressant level, as an aid to stimulating endophin system etc. Now it appears that more up to date SSRI’s work better. This was … Continue reading

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Office Ketamine For Chronic Pain Poster

here is poster in pdf format: Poster CPS 2017 ketaminefinal (2)

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Antidepressants Don’t Necessarily Help that Much Re Back Pain

I contend antidepressants help very little in back pain and waiting for it to work before starting painkillers is an unethical abomination. Studies showing any benefit in the last century are laughable because dosages used would not be achievable today. … Continue reading

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Advanced Gallbladder Testing Can Miss Disease

Two approaches to gallbladder advanced testing – use of fatty meal (FM) as a substitute for cholecystokinin (CCK) in pain reproduction during hepato-imino-diacetic acid (HIDA) scan in functional gallbladder disorder. – will miss 1/2 of cases

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Metformin May Augment Painkillers

Previously I wrote how metformin helps Fibromyalgia and Bipolar. It has anti-cancer properties and diabetics, just on it, live longer. Now in animal model it it cut analgesic needs by 56-73% in regard to ibuprofen, ASA, tramadol, and pregabalin in … Continue reading

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Serotonin Syndrome May be Reversed by Famoditine (Pepcid)

Operative case serotonin syndrome induced by Merperidine caused “hypertension, tachycardia, tachypnea, hyperthermia, myoclonus, diaphoresis, retching, nausea, agitation, and semicoma mentality with no pupillary light reflex.”  Incidentally, patient was given famotidine, in this case IV, to prevent aspiration pneumonia. Within 15 … Continue reading

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On Oxaliplatin Chemotherapy for Colon Cancer? Would taking Melatonin Reduce Peripheral Neuropathy?

In rodents, Melatonin helps prevent peripheral nerve damage from Oxaliplatin for colon cancer without reducing its cyotoxic effects on cancer. Doses were large, but I would give it a try..

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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 … Continue reading

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Topical NSAID Ketophen or Diclofenac – Poor Showing

Topical anti-inflammatory drug would be the safest way to go in knee arthritis for example. Yet the number of patients needed to treat to help one case was Ketoprofen – one in 6.9 cases Diclofenac (Voltaren) – one in 9.8 … Continue reading

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Burning Mouth Syndrome – Could a Subgroup With Elevated B6 Levels be Helped by Stopping B6?

Recent study paradoxically found elevated B6 levels – up to 4 times normal in 1/6 of burning mouth cases and stopping B6 seemed to help in a case. Could this be of help in others?

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