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Category Archives: Back Pain
One study demonstrates that chronic back pain is associated not so much with plain disc degeneration but with disc degeneration combined with end plate or vertebral body schmorl nodes. Another study found that people with back pain and modic type … Continue reading
4000 u/d vitamin D lessening Chronic Musculoskeletal Pains
With a recent negative American view, it is nice to have a more encouraging German perspective. Though 2/3 go to surgery, 1/3 can be managed with physiotherapy, cycling exercise, psychotherapy, and injections – epidural, paraspinal, facet and sacroiliac.
It has been suggested just going thru sacrococcygeal ligament is enough to get into epidural space. Imaging shows it works 68% of time, while advancing up 1 cm works 95.8% of time. However, intravascular injection occurred 25% of time where … Continue reading
Methylene blue injections were an exciting option after a Chinese article was published in PAIN glowingly detailed great responses to intradisc injections. Dr. N. Bogduk, at time, wrote an editorial suspicious that Chinese patients might be reluctant to admit they … Continue reading
Epidural injections can reduce pain from spinal stenosis but fact is, very little of the effect is from the steroid. It can reduce pain from 6.6-6.7 to lower 4’s in 3 and 6 weeks – this is a drop of … Continue reading
In IBP – MRI could be negative or positive at one point and then the opposite later on. Make MRI imaging more dubious than people think.
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 … Continue reading
Unresectable Painful Bone Cysts – IV Zoledronic acid For Adults and IV Pamidronate For Children Gives Rapid Relief
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 … Continue reading
I have recently achieved (previously unattainable) control in some of my chronic pain subjects using recent innovations – but to acheive this required use of multiple modalities at once.
Recently, nortriptyline has been touted as good anti-neuropathic drug but thoughts of its use have extended into use for chronic pain in general. Well, it doesn’t work for back pain, sciatica or migraines so that might need reanalysis.
Use of sorbothane insoles cut back pains by 38%, foot pains by 37% and knee pains by 38%. Relief in back pain did not mean relief in another areas. Wonder if antifatigue covers would help more.
Five cases of groin pain that refused deliniation and had NO back pains. They all turned out to be L4/5 or L5/S1 disc pain found on discogram/discoblock. They all got relief with anterior intrabody fusion.
Chronic Back Pain May Be a Pamidronate Infusion Treatable Disease – And Why Did It take 10 Years to Replicate That?
For Chronic back pain – Pamidronate 90 mg diluted in 250 mls saline and given over 4 hours – initially and in 4 weeks resulted in 85% getting 100% relief at 6 months versus very little response in the placebo … Continue reading
I had a recent personal experience of back pain that showed me conditions that would multiply pain several times or more. I have patients on opioids that have complained their meds no longer “cuts it” – and I have been able … Continue reading
About 30 years ago, I attended a course given by Drs. Travell and Simon. Dr. Simon was discussing interscapular pains and Dr. Travell mentioned – don’t forget the scalenes – something that Dr. Simon replied he was getting … Continue reading
Effectiveness of Kyphoplasty has been disputed, and other are left without it; this leave a proportion wondering what to do. Medial branch rhizotomy (like a facet rhizotomy) has been found helpful.
Steroid Epidurals Results Might Be Minimized By Fact Steroid Mineralcorticoid Effects are Pro-Inflammatory and Nociceptive
Steroids effect two processes/receptors – a glucocorticoid pathway, and a mineralcorticoid one. The glucocorticoid pathway has strong anti-inflammatory and immunosuppressive effects. The mineralcorticoid pathway works more on retaining salt. The latter has been found to have pro-inflammatory effects which might have … Continue reading
Midazolam Effective For Back Pain – Safe as Kenalog Because Same Benzyl Alcohol Perservative – As Long as Ph Balanced and Benzyl Alcohol Diluted to 0.07%
Midazolam has been shown to have powerful effects similar to steroid epidurally, but there are concerns about its perservative. However, it is the same Benzyl alcohol preservative seen in Kenalog which is widely used in epidural injections. Recent animal vitreous … Continue reading
Since 2001, there have been case studies showing you can grow low grade anaerobes out of damaged discs; these ignored as contamination or incidental because some studies did not find any infection. Now it appears that those with positive cultures are 5.6 times … Continue reading
In a Quebec analysis (if one looks is actually the drug company’s), it has been suggested that Duloxetine might be more cost effective for patients over 65 where the heart disease and stomach bleed risks of NSAID arthrtis pill might … Continue reading
Will MRI Localize the Site of Back Pain? – Epiduroscopic Study Suggests No – What this means for Insurers
Cases of chronic back pain with or without non-radicular leg referrals (in leg but not classic sciatica) were examine clinically, with MRI and by using a “keyhole” scope instrument in the spine called an Epiduroscope. Scoping and probing area during … Continue reading
In 2006, My Daughter, Janice Montbriand, published a poster called Commonly Missed Factors in Chronic Pain. Vitamin D deficiency was one of them. Since the there have been a variety of confirmatory studies – with some negative ones as well. I … Continue reading
Got a recent enquiry of what to do if you are an enbrel failure. I will go over what I can.
Case reports have found lithium carbonate an effective in chronic pain but these results have been ignored because of lack of a reliable study, Now a a double-blind, randomized, placebo-controlled clinical trial was done and showed benefit in Chronic Spinal … Continue reading