Category Archives: Back Pain

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

Posted in Back Pain, Insurer issues, Neck | 2 Comments

Low Vitamin D and Chronic Pain – What is the Evidence?

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

Posted in Back Pain, Deficits, Fibromyalgia, myofascial pain, osteoporosis, Rheumatic | 1 Comment

Enbrel Failure – So What Else Can You Do For Chronic Back Sciatica?

Got a recent enquiry of what to do if you are an enbrel failure. I will go over what I can.

Posted in Back Pain, neuropathic, piriformis, radiculitis | 7 Comments

Lithium Reduces Spinal Cord Damage Pain by 35% in 6 Weeks

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

Posted in Back Pain, central & spinal, Drugs, neuropathic, radiculitis | Leave a comment

Simple Sciatic Leg Pain Relief – Repeated Simple Knee level Peroneal Blocks

Repeated peroneal nerve blocks can remarkably control sciatica leg pains in most cases and avoid the necessity of surgery .

Posted in Back Pain, Leg Pains, neuropathic, radiculitis | 3 Comments

Sciaitica, Bone Cyst in Ilium, and Gluteal Tight Muscles – down right leg – needs help

Chronic sciatica /buttock pain  – I recently received a request for help…

Posted in Back Pain, Hip Pains, Injection, myofascial pain, neuropathic, piriformis, radiculitis | 1 Comment

Chronic Back Pain Help – Forgotten B12 Injections and What Else Good For…

Double blind, randomised, placebo – controlled trial of daily 1000U IM/day B12 for 14 days found significant benefit for people with chronic Low Back Pain. Cochrane review thought it was not high quality but sounded good to me; and for … Continue reading

Posted in Back Pain, Deficits, Drugs | 7 Comments

Primary Care Back and Leg Neuropathic Pain (thought sciatic) common. – MRI, and Straight Leg Raise Useless.

Recent study of neuropathic pain in leg associated with back pain, in a primary care setting, found MRI evidence of nerve root impingement unlikely and straight leg testing useless. Their conclusion:  “[the] neuropathic pain may be caused by irritation of nervous … Continue reading

Posted in Back Pain, Insurer issues, radiculitis | Leave a comment

Chronic Low Back Pain Injection Spot

Lumbar paraspinous muslces and sacroiliac ligaments all attach to sacrum making it a vulnerable site. Dr. Breck McKay has found injection of these ligments (and the sacrospinous ligament) can give significant results. Poster at IASP congress found a sweet spot … Continue reading

Posted in Back Pain, Injection | 2 Comments

Several Scoliosis Operations and Still Pain – Spinal Cord Stimulation May Help

I have one gentleman with multiple surgical procedures including fusions and Harrington rod placements who is left with chronic pain. He has to stand up most of the time. I’m presuming there is a pseudoarthrosis at one level but there … Continue reading

Posted in Back Pain, Mechanical aids, Stimulation | 1 Comment

Treatment Plan For Fresh Osteoporotoc Compression Fractures

Now that Kyphoplasty has become widespread, these techniques might be outdated. However, there are cases where you cannot do kyphoplasty, and these techniques would apply – they involve caudal or epidural catheter blocks, intercostal nerve blocks, trigger injections, and  near infrared radiation … Continue reading

Posted in Back Pain, Injection, Mechanical aids, neuropathic, osteoporosis, Stimulation | Leave a comment

Bad Thoracic Back Pain and Desperate? -Early Case of Peripheral Nerve Field Stimulation

Some cases of thoracic back pains can get horrendous – partially because there are pain generators coming form both thoracic spine and neck, and because postural and instability effects are rampant there as well. It seems that measures may only … Continue reading

Posted in Back Pain, Mechanical aids, Stimulation, Thoracic | Leave a comment

Accurate Piriformis Injection

ºAlthough I have been happy with Rectal Coupled Piriformis Injections, Ultrasound Guided injections are becomeing more popular. Combined with Botulinum, the results can last 6 months or more.

Posted in Back Pain, Botox, Injection, piriformis | 3 Comments

Epidural Primarily Work on Side Needle Tip is Closer To

At the IASP congress in Montreal, it was stated metanalysis show epidural steroid block do not work. I mentioned the fact putting the bad side down can near double its effectiveness: Steroid Epidurals – Why Some Work And Some Not … Continue reading

Posted in Back Pain, Injection | 1 Comment

People With Longstanding Lumbar Nerve Root Problems Have “MRI Invisible” Lesions

Radiculopathy (sciatica) cases were categorized by their pain diagrams and physical findings. Only 16- 37% of cases showed MRI findings.  If there is an MRI-visible issues – only 22-78 % cases have symptoms (positive  predictive values of MRI-visible nerve involvement).  … Continue reading

Posted in Back Pain, Insurer issues, Neck, radiculitis | 3 Comments

Subcutaneous (Under Skin) Electrical Stimulation For Chronic Back Pain

Back Spinal leads – Spinal cord stimulation (SCS) is useful for leg pains where you can elicit Funny feeling “paresthesias” with implanted leads. Obtaining the same for back pain has been more difficult. In cases where they were unable to … Continue reading

Posted in Back Pain, Stimulation | 1 Comment

Sacral Nerve Root Stimulation Helps Coccygodynia

Sacral Nerve Root Stimulation (SNS) was compared with Peripheral Subcutaneous Field Stimulation (PSFS).  SNS attenuated pain 50 – 60% at low stimulation with good patient satisfaction.

Posted in Back Pain, coccygodynia, Stimulation | 1 Comment

Perineural “Tarlov” Spinal Nerve Outlet Cyst Pains – Overlooked and Treatable

I have a patient with multiple level cysts where the nerves exit the spine in the neck. He also has some mild foraminal stenosis. He is symptomatic with arm and referred upper back pain. Getting his problem taken seriously has … Continue reading

Posted in Abdominal pain, Back Pain, Neck, pelvic | 1 Comment

Lumbar Radiculopathy Paraspinous Blocks Simple and Effective

Author devised a 3.5 cm out for L4-5,  3.5 cm down from there, for L5-S1 –  2 mm down for each model for injections.  Injected 60 mg Depomedrol each level needed for radiculopathy.  Got excellent results without image intensifier in 100 … Continue reading

Posted in Back Pain, Injection | 1 Comment

Confirmed – Intrathecal (Spinal) Midazolam Gives 1-3 Months Relief in Chronic and Failed Back Pain

Those who have epidural steroid injections for back pain know they are limited often to injections every 3 months (except for initial 3 shots). When the pain comes back in 3-6 weeks – what can one do? Now it looks … Continue reading

Posted in Back Pain, Injection | 3 Comments

Sacral Insufficiency Fractures – Hard to Make – a Possible Examination Technique

One elderly lady, I recently saw, fell and multiple fractured her left humerus. Was seen, put in a sling, kept briefly in hospital and discharged. Because she could not walk, she was reassessed and found to have a pubic ramus … Continue reading

Posted in Back Pain, osteoporosis | Leave a comment

Midazolam Augmentation of Lumbar Steroid Injections – Use, in Just Mechanical Back Pain

Recent article demonstrated that a combination of steroid and midazolam worked well for post herpetic neuralgia: Miracle Treatment – Low Back Post Herpetic (Post Shingles)Neuralgia Treated With Epidural Steroid and Spinal Midazolam Without Local Can Give Significant Relief For Over … Continue reading

Posted in Back Pain, Drugs, Injection | 1 Comment

Actonel Improves Osteoporosis Back Pain Without Fracture – on 5 mg/day

In Osteoporosis, not only did Risedronate 5 mg/day cut back pain to 1/3 in 4 months, it cut the disability rating in half – despite the fact there were no fractures.

Posted in Back Pain, osteoporosis | Leave a comment

Smokers 1.5 times More Back Pain – Does Quitting Become An Effective Treatment?

This was a large Canadian study and results demonstrated “this association remained significant after controlling for sociodemographics and any lifetime anxiety or mood disorder.”  If smokers back pain dropped to normal after quitting, this would result in a 33% improvement. … Continue reading

Posted in Back Pain, TMJ | Leave a comment

Steroid Epidurals – Why Some Work And Some Not So Well

Recent findings demonstrate lying patient with bad side down for 15 minutes can almost double its effectiveness.

Posted in Back Pain, Injection | 2 Comments