Differential Diagnosis of Neurogenic Thoracic Outlet Syndrome (NTOS)

Posted on June 8, 2013 by admin

Tenderness is supraclavicular fossa, numbness patterns, tinel’s sign either supraclavicular, axillary or elbow cubital areas all point to NTOS. Triggers in trapezuis, rhomboids and levator scap are common in NTOS as well.

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Prevent Chemotherapy Neuropathy With L-Acetyl Carnitine (LAC) – Please Take

Posted on June 1, 2013 by admin

Peripheral Neuropathy can limit the extent of chemotherapy and hence have a direct effect on survival; L-Acetyl Carnitine at a dose of 3-5 gm/day can prevent that.

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Posted in breast cancer, Drugs, neuropathic | 2 Comments

Fibromyalgia Helped by Music Therapy – Confirmed

Posted on May 31, 2013 by admin

1 hour/day of classic music mixed with salsa music resulted in a 24% reduction of pain over placebo.  this is a confirmation of a different study finding relief with regular music listening:
Music Therapy in Chronic Pain May Drop Pains by 50% 0ver 2 Months
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Trigeminal Neuralgia – New Treatment For Drug Resistant Cases

Posted on May 29, 2013 by admin

A simple infusion of lidocaine 100 mg and Magnesium sulphate 1.2 gm over 1 hour –  weekly for 3 weeks, gave good results in 9 trigeminal neuralgia resistant cases.

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What Causes Hand Tingling in Computer Terminal Operators – More Myofascial Than You Would Think

Posted on May 26, 2013 by admin

The causes of hand tingling in computer operators were : myofascial pain syndrome, 68%;  cervical radiculopathy (arm sciatica), 27%;  shoulder rotator cuff syndrome, 11%;   forearm tenosynovitis, 8%;  and carpal tunnel syndrome, 5%.

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Posted in arm, myofascial pain, Thoracic | Leave a comment

Bolulinum Works as Well as Steroid in Frozen Shoulder – Isn’t it About Time We Think About Combining The Two?

Posted on May 26, 2013 by admin

A recent article shows that botulinum  and steroid have similar durations of action in adhesive capsulitis – ie Frozen Shoulder. I have given both triamcinolone and botulinum (at separate times) into knee joints and noticed the combination can cause a profound improvement.  Why not use both?

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Posted in Botox, Injection, shoulder | Leave a comment

Severe Neuropathic Pain – Only 1/4 Respond to Standard Drug Protocols – What Else Is There?

Posted on May 24, 2013 by admin

Presentation at Canadian Pain Society Winnipeg 2013 found only 23.7%  of severe neuropathic pain victims responded to Canadian Pain Society drug protocols for neuropathic pain. It is time to look outside the box for treatment measures.

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Posted in Drugs, Fibromyalgia, Injection, IV therapy, Manual Med, myofascial pain, neuropathic, Pain Dystrophy, piriformis | 9 Comments

Unilateral Interscapular Pains – Dorsal Scapular Nerve Entrapment – Forgotten and Now Rediscovered

Posted on May 20, 2013 by admin

 

 

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 to – as a cause of unilateral interscapular pains. Now, discussion of Dorsal Scapular Nerve entrapment as a cause of interscapular pains has returned, and has helped to highlight a couple cases I am having trouble with. Have you got rhomboid triggers that won’t settle? – Better think of this.

 

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Posted in Back Pain, myofascial pain, Neck, Thoracic, thoracic outlet syn | 7 Comments

Varizig – Zoster Immune Globulin – Forgotten in Severe Zoster

Posted on May 15, 2013 by admin

An older study found zoster immune globulin single early infusion could reduce shingles symptoms by 50% at day 42 but this appears to be forgotten. It appears in Canada to be readily available through public health as Varizig – manufactured in Winnipeg by Cangene.

 This lady deserves Varizig.

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Posted in post herpetic neuralgia | Leave a comment

Hip Blocks Help Pain For Up to 3 Months – But Used Steroid So More Likely That Effect – And How to Block a Hip

Posted on May 7, 2013 by admin

Injecting articular branches femoral nerve and obturator nerve can give some relief for up to 3 months. However, results are more likely from the steroid used.

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Posted in Hip Pains | 2 Comments

Alcohol Blocks Versus Radiofrequency Thermocoagulation For Post-Herpetic Neuralgia

Posted on May 4, 2013 by admin

Given that Post shingles pain is restricted to certain nerve root Level(s),  nerve destructive measures could be an option. Cure rates for both were about 85% but thermocoagulation had more adverse events.

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Quick Questionnaire For Cluster Headache

Posted on May 1, 2013 by admin

Three simple questions have a  sensitivity of 53.8%  and a specificity  of 88.9% for cluster headache.

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Intercostal Nerve Blocks For Shingles / Herpes Zoster

Posted on May 1, 2013 by admin

I have written extensively on how nerve root blocks are a necessary part of treatment of shingles. Came across two Chinese articles stating effectiveness – one stating you can get “markedly effective” results in 75% of cases.

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Posted in post herpetic neuralgia | 1 Comment

Post-Herpetic /Shingles Neuralgia – Benefits of Local B12 Injections

Posted on April 29, 2013 by admin

Two separate chinese articles discuss use of B12 in the period immediately after shingles  and also, in a separate study, later. Each shows benefit. Note should be made that they used methylcobalamin – the bioactive form of B12

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Posted in Injection, post herpetic neuralgia | Leave a comment

Early Fix For Herpetic Zoster/Shingles – Inject the Spots With Local and Steroid

Posted on April 28, 2013 by admin

Injecting shingles lesion in acute stage with local and steroid  reduces pain, improves sleep and purportedly reduces post-herpetic neuralgia.

NOTE TO MY CHINESE VIEWERS – I only have access to the chinese abstract translation – if you could fill in gaps from articles it would be appreciated…. Continue reading →

Posted in post herpetic neuralgia | 1 Comment

The Missing Aspects of Tennis Elbow Treatment – Axillary and Scapular Triggers to Treat Segmental Hypersensitivity

Posted on April 28, 2013 by admin

Chinese article claims adding injections to “dorsal scapula” triggers and sore spot in axilla can allow lateral epicondyle injections to work 100% of time.

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Post Herpetic Neuralgia / Shingles – Micro-knifing Tender Areas (Acupotomy) Reduces Pain 60% and Persists over Course of 6 – 12 Months

Posted on April 28, 2013 by admin

Previously, there was a technique involved producing 2nd degree frost burns in tender post-herpetic neuralgia areas –  as a means to reduce pains.
Suzuki H, Ogawa S, Nakagawa H, et al. Cryocautery of sensitized skin areas for the relief of pain due to post-herpetic neuralgia.
Pain 1980;9:355–362
http://www.ncbi.nlm.nih.gov/pubmed/7208080

Now it looks like areas can undergo micro-knifing with an acupuncture needle with a knife on the end instead.

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Posted in Injection, post herpetic neuralgia | Leave a comment

Vertebral Compression Fracture Pain And Nothing Helped – Other Option

Posted on April 27, 2013 by admin

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.

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Posted in Back Pain, osteoporosis | Leave a comment

Herpes Zoster/Shingles – Can You Tell What Nerve Level Affected?

Posted on April 27, 2013 by admin

The back can have a wide distribution in shingles; and according to a study, is not relable at determining nerve level, as is the front distribution. I will inject dorsal nerve roots in order to shut the back distribution off; often I have to inject several levels.

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Neuropathic Features Seen In Osteoarthritis

Posted on April 22, 2013 by admin

Neuropathic feature – electric shocks pain,  burning pain,, radiating pain with increased touch sensitivity to an area were commonly seen in joints.

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Posted in Knee, neuropathic | Leave a comment

Steroid Epidurals Results Might Be Minimized By Fact Steroid Mineralcorticoid Effects are Pro-Inflammatory and Nociceptive

Posted on April 22, 2013 by admin

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 a pain increasing effect, blunting benefits of steroid injections. This might explain the lackluster effects and duration of epidural injections.

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Posted in Back Pain, Injection | Leave a comment

Is TMJ Issues a Problem of Same Side Chewing?

Posted on April 18, 2013 by admin

Subjects with TMJ were asked to chew almonds to see how a splint worked – 16/20 chewed on affected side leading author to dub it the “Habitual Chewing Side Syndrome”

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Posted in TMJ | 1 Comment

Might Anxiety Be A Form of Pain?

Posted on April 18, 2013 by admin

Recently, a dose of Acetaminophen (Tylenol) has been shown to reduce anxiety responses to a surrealistic film. Previously, it had been shown to reduce MRI evidence of the effects of social rejection. Together, it suggests anixety/social rejection is another form of pain.

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Top 10 Pain Web Sites

Posted on April 12, 2013 by admin

Recent article scanned the web and catalogued the best pain sites. I’m not on it but I’m not bitter (much)…

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Endometriosis and Painful Bladder Syndrome: Evil Twins in Regard to Chronic Pelvic Pain

Posted on April 10, 2013 by admin

In chronic pelvic pain,  61% will have painful bladder syndrome, 70% will have endometriosis, and 48% will have both. They do indeed seem to be evil twins often  operating together.

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Posted in gynecologic, Interstial Cystitis/Gynecologic | Leave a comment