Does Musculoskeletal Pain Cause Stress or Stress Cause the Pain -Studying People over time

Posted on June 3, 2015 by admin

A longitudinal – study – studying people before and subsequent to pains is the most reliable study format for figuring out what is going on.. What this study found was that it was the Musculosketal pain that caused the stress and not visa versa in most cases

Continue reading →

Posted in pain mechanisms, psychology | Leave a comment

Metformin is Mitochondrial Enhancer and Helps Bipolar Depression

Posted on June 3, 2015 by admin

A 25 yr old bipolar patient of mine was put on metformin and a weight loss program prior to hip surgery. Her mood was more stable and she noticed particularly fewer manic episodes. There is evidence in literature for metformin helping bipolar cases. Bipolar, particularly those inherited from mother, could be more likely a mitochondrial disease, and recent developments suggest metformin with weight loss is a mitochondrial metabolic enhancer. Given metabolic syndrome is almost universal in bipolar, should metformin be universally used? Day after I wrote this up, I had a Bipolar victim come in refusing to take any stabilizing meds because she would put on 30 lbs. Metformin  then became a serious option.

Continue reading →

Posted in Depression, Drugs | 2 Comments

Hives with Nonspecific Gut symptoms – Consider Blastocystis

Posted on June 2, 2015 by admin

Blastocystis is a protozoan thought commensal (normal flora) but actually shown to cause disease in humans. Now a particular subtype is linked to urticaria/hives.

Continue reading →

Posted in Abdominal pain | Leave a comment

Endometriosis – Continuous Birth Control Pills- Does it Help?

Posted on June 2, 2015 by admin

Review article covered recent literature and found what one would expect – of course.

Continue reading →

Posted in gynecologic | Leave a comment

Fibromyalgia (FM) – Mitochondrial Dysfunction Helped by Metformin and Weight Loss

Posted on June 1, 2015 by admin

Adenosine Monophosphate activated Protein Kinase (AMPK) regulates cell metabolism  i.e “AMPK has a central regulatory role in cell metabolism, mitochondrial biogenesis and oxidative stress response”. Recent study of FM fibroblasts found AMPK downregulated.”AMPK down-regulation [is] at least in part responsible for the impaired oxidative stress response and mitochondrial dysfunction observed in Fibromyalgia”. AMPK activation can be obtained by metformin.  Also perhaps by weight loss as serum from weight loss restricted mice activates it. Implications are that weight loss and metformin can set one’s metabolism some straight. FM subjects are susceptible to oxidative stress potentially leading to cell deaths and above measures help contain that as well.

Continue reading →

Posted in Depression, Drugs, Fibromyalgia | 1 Comment

Topical B12 helps Canker Sore Pain and what this means for Shingles –

Posted on June 1, 2015 by admin

Triamcinolone 0.1% topical oral ointment with 500ug B12/2 mg ointment outperformed plain triamcinolone adding credulance that frequent B12 injections into active shingles area helps. Question is whether it needs to be methylcobalamin  – B12 bioactive form for best topical effect.

Continue reading →

Posted in ENT, post herpetic neuralgia | Leave a comment

Pine Bark for Migraine?

Posted on June 1, 2015 by admin

Only study on Pine bark for migraine I could find used 1200 mg/day and did get impressive results on resistant migraines. But the best price I could get for that was $4/day..

Continue reading →

Posted in Drugs, Headaches | Leave a comment

Migraine in Adolescence – Abortive Treatment -But in Canada you’ll Need a Pill Splitter

Posted on June 1, 2015 by admin

In the US, a drug combination for treatment of migraines has been released called  Treximet – sumatriptan (Imetrix) 10 mg and Aleve (Sodium Naproxen) 25  mg. It has been approved for use in adolescents 12-17. In Canada you’d have to cut sumatriptan 25 mg and Aleve 220 mg tablets or take liquid of latter.

Continue reading →

Posted in Drugs, Headaches | Leave a comment

Diabetic Neuropathy – B12 Helps While Vegan Diet Minimal Effects

Posted on May 31, 2015 by admin

Though 20 week vegan diet touted as helping diabetic neuropathy, its pain levels were no different than the B12 control and the foot skin conductance was not different. Only diffence was in McGill Pain questionnaire in the sensory fields. Unfortunately, these fields are not mutually exclusive so the same thing could be added up several times eliminating their p=0.04 significance. A difference in neuropathy scale would suffer from same issue. Yet if you look in the free press, vegan diet may be the next best thing for DM neuropathy..

http://consumer.healthday.com/diabetes-information-10/diet-diabetes-news-178/vegan-diet-might-ease-diabetic-nerve-pain-699793.html

I have written the author for clarification.

Continue reading →

Posted in Deficits, neuropathic | Leave a comment

Neck Pains From Atlanto-Occipital Joints

Posted on May 31, 2015 by admin

Top joint C0-1 refers to upper neck, face and upper shoulder tips. Exam requires you to grip c1 transverse processes and nod neck sideways. Certain manual techniques might help.

Continue reading →

Posted in Headaches, Injection, Manual Med, Neck | Leave a comment

Diabetic Neuropathy: Duloxetine Mediocre Results

Posted on May 30, 2015 by admin

For Diabetic Neuropathy – Recent study in China showed statistical significant drop of pain on Duloxetine but not clinically significant. – Have a look.

Continue reading →

Posted in Drugs, neuropathic | Leave a comment

Coccygodynia = Tender Coccyx – Inject Ganglion Impar

Posted on May 29, 2015 by admin

One Ganglion Impar injection achieved over 50% improvement for 82% of cases that lasted an average of 6 months.

ganglion_impar Continue reading →

Posted in coccygodynia, Injection | 3 Comments

DN4 Outperforms In Diagnosis of Cancer Neuropathy

Posted on May 29, 2015 by admin

Douleur Neuropathique in 4 Questions (DN4) proved more sensitive to neuropathic pain in cancer than the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) – 87.5% for DN4 versus 68.1% for LANSS in sensitivity. However LANSS had slightly better specificity – 93.4% for LANSS versus 88.4% for DN4 – not that much difference though. I have always like the LANSS but this suggest the DN4 might be a better tool.

Continue reading →

Posted in cancer, neuropathic | Leave a comment

Widespread Pain and Dizzy – Ear Canalithiasis? (rocks) and Repositioning Them Helps Whiplash, TMJ, and Fibromylagia

Posted on May 18, 2015 by admin

Study suggests dizzy whiplash and widespread pain cases could respond well to middle ear grit repositioning measure.  This is being able to see way outside the box…

Continue reading →

Posted in Fibromyalgia, Manual Med, Neck, TMJ | Leave a comment

Benign Positional Vertigo? – Modified Canalith Repositioning Maneuver (CRP)

Posted on May 18, 2015 by admin

Effectiveness of Treatments for Benign Paroxysmal Positional Vertigo of the Posterior Canal
Helen S. Cohen, Kay T. Kimball
Otol Neurotol  26: 1034–1040, 2005

Modified  Canalith  Repositioning  Maneuver  (CRP)  technique:

The head was held in each position as follows:

  • The subject sat on the long side of the mat table.
  • The investigator turned the subject’s head 45 degrees away from the involved side and tilted the patient en bloc into a side-lying position through the coronal plane, with the nose pointing upward.
  • Ten seconds after the cessation of vertigo, the subject was tilted nose-down toward the uninvolved side and held there until 10 seconds after the cessation of vertigo.
  • Keeping the head turned toward the uninvolved side, the patient was assisted to sit up and remained in that position for 10 seconds after the cessation of vertigo.
  • This variation from the original description, eliminating the premedication and shortening the interval between head movements, is associated with significant reductions in vertigo

repositioningComment – this is a companion article to one showing treating dizziness helps TMJ, whiplash and Fibromyalgia. canada goose pas cher canada goose pas cher

Posted in Uncategorized | Leave a comment

Duloxetine For Fibromyalgia – Mixed Results

Posted on May 17, 2015 by admin

Initial study showed benefit only in first 6 weeks more than placebo and not after: Study glowingly mentions early effects but fails to mention lack of lasting effects

duloxetine fm1Comment – I recently reviewed a back study that cleverly disguised their lack of effectiveness. Having said that. it is suggested 2/10 might active an moderate effect.

I will need to insert other studies when I have time.

Posted in Drugs, Fibromyalgia | Leave a comment

Fibromyalgia – Responses to Methotrexate and Steroids

Posted on May 17, 2015 by admin

Old McGill study found initial impressions of doctors and rheumatologist were wrong 2/3 of time and in particular inflammatory arthritis cases are missed.

Fitzcharles, M‐A et al. “Inaccuracy in the diagnosis of fibromyalgia syndrome: analysis of referrals.” Rheumatology 42.2 (2003): 263-267. http://rheumatology.oxfordjournals.org/content/42/2/263.full

This leaves a reservoir of inflammatory cases classified as Fibromyalgia and responding to methotrexate and prednisone.

Continue reading →

Posted in Fibromyalgia | 2 Comments

Amitriptyline – Not Much For Neuropathy Really

Posted on May 17, 2015 by admin

The initial study of use of Amitriptyline was a study with diabetic neuropathy where patients were subject to impressive coaching (calls from nurse and pharmacist) . That way doses of 75-150 mg were obtained. They were able to show benefits. Over half of recent studies, using 25-75 mg which is what patient ordinarily tolerate, failed to show much benefit. The most recent study is one on HIV neuropathy; doses of 25-50 mg failed to show any benefit. Two studies using it in Chemotherapy neuropathy failed to show benefit. However, the myth it is good for all neuropathy persists. In some cases exaggerated benefits persists because of a lack of control group which would expose lack of benefit. Some clue to its ineffectiveness comes from a study showing you need 300 mg/dl in blood to get any clinical effectiveness – 2/3 reach that with 75 mg but many studies just used 50 mg.

Continue reading →

Posted in Drugs, neuropathic | Leave a comment

New Help for Some Fibromyalgia (FM) – Gluten Sensitivity Management

Posted on May 10, 2015 by admin

Over the past couple years there is growing evidence that maybe 1/3 of Fibromyalgia patients with IBS actually suffer from non-celiac gluten sensitivity and respond to gluten free diet – some within a few month, and some “gradually… over many months”. Gluten free diet could be life changing with remission of symptoms and back to work.

Continue reading →

Posted in Fibromyalgia | 3 Comments

Algorithm For Post Hernia Pains

Posted on May 10, 2015 by admin

Concise choice selections for what to do with nerve damage level post hernia pains. I love algorithms – they are so practical.

Continue reading →

Posted in neuropathic, Post Hernia | Leave a comment

Uncontrolled Post-Herpetic Neuralgia (PHN) in Elderly subject – New Measures

Posted on May 10, 2015 by admin

Using 6% gabapentin, 4% amitriptyline,  ketoprofen 10%,  lidocaine 5%, and ketamine 10% probably in Lipoderm could give some relief topically.  Ketamine 100 mg/ml with 0.1 ml spray nasally could give additional relief.  30% mannitol might be good here.

Continue reading →

Posted in Drugs, Pain Dystrophy, post herpetic neuralgia, Topical Pain Treatments | Leave a comment

Patellofemoral (PF) pain – New Hope – Femoral Nerve Stretching Helps Half

Posted on May 9, 2015 by admin

Another looking out of the box study. Supposed part of PF pain is neurologic and stretched femoral nerves. In cases that tested as having “tight” femoral nerves (positive femoral slump test) which was about 1/2 of cases, treatment resulted in over 50% improvement of pain – often immediate

Continue reading →

Posted in Knee | Leave a comment

Needling Lower Trapezius Helps Unilateral Neck Pains

Posted on May 9, 2015 by admin

Needling the lower trapezius muscle was found beneficial in chronic neck pain. I was so taken with the approach then had to injecting lower trap(with muscle relaxed rather than stretched) that I had to include a pic of actual treatment approach. There are so few controlled studies in myofascial pain that this is exemplary.

lowertrap

Continue reading →

Posted in Manual Med, Mechanical aids, myofascial pain, Neck, Thoracic | Leave a comment

Resistent Post Herpetic Neuralgia Treatments – IV Magnesium for Neuropathic Pains

Posted on May 9, 2015 by admin

Three IV Magnesium  1mg /k in 100 mls saline  infusions over 1 hour – one every other day or Three 1 mg/kg Ketamine in 100 mls saline infused in over 1 hour ketamine  one EOD resulted in 7/15 magnesium and 10/15 ketamine patients having >/= 50% improvement in pain .  Both had Midazolam 0.1 mg/kg to render them unconscious though in actuality only some would be needed for ketamine to treat the dysphoria achieved at higher doses..

Continue reading →

Posted in central & spinal, complex regional pain, Drugs, IV therapy, neuropathic, Pain Dystrophy, post herpetic neuralgia, radiculitis | 1 Comment

Fibromyalgia Hypervigilance May Exist – and My Model

Posted on May 6, 2015 by admin

With help of  EEG (scalp)sensors, one can measure a brain response to a stimulus- often auditory.  Often the brain reaction diminishes with a repeat stimulus – called sensory gating. If one were hypervigilant, you would expect the brain response to not get less – one study says no, another, maybe better done, says yes

Continue reading →

Posted in Fibromyalgia | Leave a comment