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.
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” test for neck radiculitis
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 for it despite the theoretically “dangerous high levels” which would probably not be a problem if they avoided chinese imports. There was no effort to have a control group to see how many more deaths there were in the “dangerously high” group.
I have not had much luck tapering opioids and a recent analysis explains why. They claim opioids are integrated in mood, energy, motivation, social functioning and personality systems and withdrawing doses will effects all of it. Above study was successful because they started with 5% reductions in the first month and upped it to 10% every 2 weeks in the second month.
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 I suspect more not diagnosed. In a mixed state, a pain patient gets little sleep and is in considerable distress with agitation and will inadvertently be put on significant doses of tranquilizers to deal with this “pain” when tolerance to atypical anti-psychotics is limited. March is a good time to see it and I have seen a couple cases already this year. After the mixed state subsides, they end up continued to take them because they can contend it helped them.
It is also easy to put pain patients that don’t sleep and have restless legs, on Clonazepam which is some cases is dangerous, particularly if subjects are obese and subject to sleep apnea.
Pain became the 5th vital sign and doctors were initially told to take tabs on severity through scales out of 10 testing. Now, out of fear severity analysis will over-treat pain with opioids, doctors in USA are being encouraged not to question pains severity and stick to level of function. There is evidence that, removed from placebo effect, opioids only reduce pain by 1/10 on average. For clinicians that are not trained in orthopedic medicine, opioids, and now marijuana, are the main tools to control pain. This is what fuels the opioid epidemic. I did an analysis of my practice and find other measures I do drops pain by 2/10 bringing pain to more acceptable levels. Those with 7/10 of more can be often dropped in pain by 3/10 for 3 days at a time by ketamine shots done 1-2 times a week and control depression. Regular treatments using alternatives written in this blog, can do more.
Article starts by mentioning how up to 33% of cholecystectomy patients can have persistent abdominal pain so taking out Gallbladder (GB) is a serious decision. Indications however include frequent attacks, large stones, older age, inflamed GB attack(cholecystitis), and pancreatitis from gallstones.
Although the question of whether one is dealing with hip bursitis or is this referred from back is important, I wanted to clarify what steroid injection would do for seemingly glutues medius bursitis. One study suggests it was good in 72% of cases at one month while another suggested it was good up to 6 weeks. Thereafter however, is problematic with PRP injection outshining it after 6 weeks. Problem is and I quote “an isolated passive intervention cannot hope to address the often complex mix of pre-existing and subsequent impairments”.
A Canadian study on full thickness tears found the no-op subgroup did well over 5 years. A Netheraland study found removing bursa (B) and taking off acromium(A) not any better than just removing bursa alone in chronic subacromial shoulder pain. Tear progression was not statistically different though at trend for A+B. Both suffer from not examining the patient subsequently to see what troubles they did actually have. British study found no clinically relevant benefits to Arthroscopic sub-acromial decompression
People who were given botulinum for migraines found coincidentally that phobia and dry eye symptoms improved as well.
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 of Amyloid Neuropathy which proved very resistant to treatment but responded “immensely” well to intrathecal drug delivery system with infusion of hydromorphone.
3 cases submitted where the anterior tongue was sore because of the Sodium Lauryl Sulphate in toothpaste
Literature reviews suggest neuropathic pain in 1/4-1/3 of post breast cancer surgery patient. A review of the effectiveness of neuropathic pain found only 23.7% achieved any significant relief from usual pyramid schemes of treatment for neuropathic pain
Severe Neuropathic Pain – Only 1/4 Respond to Standard Drug Protocols – What Else Is There? http://painmuse.org/?p=2640
I was always suspicious that soft knee sleeves just cover up the pain area without helping. However multiple studies show benefit and presence of “stay” supports does not add any benefit.
Looking for cheap and easy techniques to treat pain, I came across a treatment for back pain using the slump test. Sitting with legs out straight and your feet flat against a wall, you slump forward and put your head down. If your back pain radiates into the buttocks this would suggest that your dural spinal lining is irritated and doing the slump regularly can “floss” free any adhesions and help the back pain..
metanalysis of studies shows positive effects of cervical traction.
For years people were told they needed 400 u/day; Now it looks like 8000 is more like it. There are all sorts of cures for disease’s with taking vit d which is probably just making up for deficiency.
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 circuits do undergo tolerance.
I have a patient with psoriatic arthritis that had widespread pains. His rheumatologist told him it was “fibromyalgia” He developed such bad bronchitis I had to put him on steroids – at which point his “fibromyaglia” pains went away. He was so mad he went back to his rheumatologist and told him what he thought of his diagnostic ability. Enthesitis is inflammation where tendons, ligaments and capsules attach to bone. Psoriatic arthritis is thought to start there.
35% could bring on their SVT by flexing trunk – a sign they called “sign of lace-tying.”
At a recent conference, it was stated that the Infraspinatus muscle was key to all pain in the upper quadrant. He advised rolling a lacrosse ball back and forth it over it. You either sit or stand against a wall or lie down and roll it. Now a study on elderly with nonspecific shoulder pain shows it is involved.
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.
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 widespread abdominal nerve block called the transversus abdominis plane (TAP) block – bilaterally if need be – and finds it generate significant pain relief. This could be a major milestone for abdominal pain relief.
Brings up the question of why it took so long to understand bad chronic abdominal pain could be part abdominal wall and treatable…
Spinal stimulators are often used in resistant pain cases. Where there is a peripheral source like CRPS of knee, a dorsal root ganglion stimulator was much preferred over spinal stimulator Continue reading
Diffuse idiopathic skeletal hyperostosis (DISH) is were you get extensive ossification of ligaments and entheses(endings of tendons and ligaments). It is relatively common (10% of people over 50). If you get boney bridging of vertebrae you can get a very stiff spine.Treatment options are limited.
A vegetarian who develop Sjogren’s has zerostoma and sicca treated with B12 and Vit D without effect for 1 year. Adding bovine clostrium Lactobin improved things gradually.
