Medication overuse (not opioids in this study) is implicated in chronic daily headaches. A simple screening questionnaire has been devised to suggest this is a problem.
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.
Vity D deficiency was seen in in 17.6% of patients with Parkinson Disease versus 9.3% of controls. Deficient cases had higher parkinsonism severity ratings.
Subject treated for acromegaly developed peripheral neuropathy and could not tolerate oral meds. Though pain was 9/10; 5% baclofen once daily, profoundly reduced pains in legs.
Sumatriptan (Imetrix) 85 mg plus Sodium Naproxen (like Aleve or Anaprox) 500 mg gave 29% – 2 hour painfree response and 24% sustained 24 hour painfree response yet 62% were satisfied/very satisfied.
82% of cases diagnosed as sinus headahces will respond significantly to tryptans.; but take heart – I think it could be a double crunch
Non-diabetic painful numbness in hands/feet is often caused by inflammatory neuropathy. Tremor is common in these disorders and does not respond to usual treatments
Two cases of cluster headahces with drropy eye. Droopy eye rapidly disappeared with occipital nerve block confirming association of cervical and trigeminal systems
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 group…..Initial good results of this nature were known 10 years ago – why is it just coming out now?
Neck and/or arm pain/numbness with progressive disability and many negative evaluations is typical of the disease. Emotional decompensation from pain and poor treatment from others, forms an integral part of the disease. Evaluation is actually quite simple – treatment often only palliative. Situation reminds me of people laughing at a joke – when they hear it, when they tell it, and when they finally get it. I had plenty of knowledge on TOS but the perspective and wisdom from Dr. Togut made it all clear (went to his talk twice)…
I found PLO gels irritating but not Lipoderm. At a recent conference they bragged about their ability which can be seen at:
http://www.pccarx.com/pcca-products/pcca-exclusives/bases/lipoderm
Disclaimer – don`t get squat from anybody
You can get abut 1/3rd reduction in pain on 2 weeks of Naproxen 500 mg bid. Continue reading
Combo pill with ibuprofen 800 mg and 26.6 mg famotidine when given tid has 50% Stomach bleed reduction – marketed in US as Duexis. In Canada probably famotidine (pepcid) 20 mg tid with ibuprofen 800 tid would make a good combo. Think now – many patients won`t touch NSAID`s because of stomach trouble but most have taken ibuprofen/advil so might be will to try that combo.
When pain becomes severe, constant, and unremitting – chances are high the pain has imprinted on the brain and centralized. This is a tragic disease with poor treatment options. In those that persisted with treatment (failures may have dropped out?) all had permanent reduction in pain with HCG use making it the only agent to actually remit chronic centralized pain.
I had a recent question on treatments for PHN…I felt I needed to add more info on Botox for PHN. (Using equivalents) Putting equivalent of 6 units Botox INTRADERMAL per 3.56 cm diameter (1.4 of an inch) diameter area, could result in 35% drop in pain (like 8 to 5.2/10 VAS). The benefits are apparent by 2nd day and lasting 7.4 weeks. I would consider it an adjunct to other treatments but 35% is as good or better as one would get from painkillers.
Patient with abdominal wall pain and no distinct triggers had bilateral pulse radiofrequency to T10 and 11. This brought pain levels down from 6/10 to 1/10 at 10 weeks by procedure and still relief after 10 months. Though their case was neurogenic type of pain, one wonders if it would help other abdominal pains
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Series of 3 simple eyebrow, just below eye and bottom of skull posterior injections can give long-lasting relief of headaches. Now, just to get family doctors to pick up a syringe…
Lidocaine patches can drop pains by 1.5-2 points on the pains scale – which is about as much as you get from painkillers.
Some 6-11% of recurrent abdominal pains in children are protozoan infections. Those cases “did not show a characteristic presentation when compared with patients with other causes of abdominal pain” – so you can’t tell by looking at them.
Factors such as pain on light touch (allodynia) and excessive pain on pinprick (hyperpathia) were strong indicators of pain severity. “Female gender, age, and history of serious mental disorders were found to be weaker indicators.” Psychological factors are played up as being the prime indicator of chronic pain – much to the delight of insurers who would like to be off the hook for compensation if they could deem client’s problem as psychological and hence of their own doing. This has always been rubbish – pain severity has always been the unmost important factor and each victim has a breaking point where psychological decompensation will be evident. That does not mean that coping strategies don’t help – its just that it still is a pain problem, not a psychological one. Recent review of Fear Avoidance Model states it has not worked out well and needs to be re-vamped with multidimensionality.
Good pic on how neck, scalp, occipital nerves, trigeminal nerves and face all impact on migraines and lady with nummular headache in posterior scalp ended up activating this convergence.
Though Thoracic Outlet Syndrome (TOS) with vascular findings can be more easily resolved by disappearance of pulse, neurogenic TOS remains more controversial. Now there has arrived a concensus of opinion on diagnositic criteria.