June 2017 Pain News: I put them up as short snaps because not going to blog note them – hope you like. You will probably not find many in news elsewhere.
- No evidence stem cells helps tendon disorders;
Pas, Haiko IMFL, et al.
No evidence for the use of stem cell therapy for tendon disorders: a systematic review.” Br J Sports Med (2017): bjsports-2016.
https://www.researchgate.net/profile/Marinus_Winters/publication/312220371_No_evidence_for_the_use_of_stem_cell_therapy_for_tendon_disorders_A_systematic_review/links/58ca8c4fa6fdcc1d1fea84cc/No-evidence-for-the-use-of-stem-cell-therapy-for-tendon-disorders-A-systematic-review.pdfComment – thank goodness for that because I cannot afford to offer that treatment - Among Fibromylagia subjects: – spinal inflammation sometimes
“Sacroiliitis was demonstrated among 8 patients (8.1%) and ASAS criteria for diagnosis of axial SpA were met in 10 patients (10.2%). Imaging changes suggestive of inflammatory involvement (e.g., erosions and subchondral sclerosis) were demonstrated in 15 patients (17%) and 22 patients (25%), respectively. The diagnosis of axial SpA was positively correlated with increased CRP level and with physical role limitation at recruitment. ”
Ablin, Jacob N., et al.
Prevalence of Axial Spondyloarthritis Among Patients With Fibromyalgia: A Magnetic Resonance Imaging Study With Application of the Assessment of SpondyloArthritis International Society Classification Criteria.
Arthritis care & research 69.5 (2017): 724-729.
http://onlinelibrary.wiley.com/doi/10.1002/acr.22967/full
Comment – I see morning stiffness etc and elevated CRP/ESR regularly in some FM cases – now I know it is inflammatory and prednisone/methotrexate might be useful - Stem cells seemed to help hip – though no control group:
J Hip Preserv Surg. 2017 Mar 19;4(2):159-163.
doi: 10.1093/jhps/hnx011. eCollection 2017 Jul.
Mesenchymal stem cell therapy in the treatment of hip osteoarthritis.
Mardones R et al
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5467400/pdf/hnx011.pdf
“The intra-articular injection of three consecutive weekly doses of ex vivo expanded autologous BM-MSC to patients with articular cartilage defects in the hip and proved to be a safe and clinically effective treatment in the restoration of hip function and range of motion.”
Comment – rats, I won’t be able to afford that - Psychological intervention does not greatly help workplace absences:
Pain. 2016 Apr;157(4):777-85. doi: 10.1097/j.pain.0000000000000434.
Effectiveness of psychological interventions for chronic pain on health care use
and work absence: systematic review and meta-analysis.
Pike A et al
https://www.ncbi.nlm.nih.gov/pubmed/26645543
“Analysis of work loss showed no significant effects of psychological interventions over comparisons, but the use of many different metrics necessitated fragmenting the planned analyses, making summary difficult.”
Comment – only time I’ve ever had a patient want to go back to work was a subject on ketamine therapy which has anti-depressant effects which are hard to achieve in someone in pain - Estrogen new pathway discoveries show it can effect “cognition, depression, homeostasis, pain processing, and other associated neuronal functions”
Neurogastroenterol Motil. 2017 Jul;29(7). doi: 10.1111/nmo.13121.
New roles for neuronal estrogen receptors.
Lu CL et al
https://www.ncbi.nlm.nih.gov/pubmed/28597596Comment – still don’t know how to handle estrogens in chronic pain… - Testosterone replacement can reduce opioid needs
Am J Mens Health. 2017 Jul;11(4):1208-1213. doi: 10.1177/1557988316672396.
The Role of Testosterone Supplemental Therapy in Opioid-Induced Hypogonadism: ARetrospective Pilot Analysis.
Raheem OA et al
https://www.ncbi.nlm.nih.gov/pubmed/28625114morphine equivalent use dropped by 25 mg in testosterone treated group but increased by 2.5 mg in placebo group
Comment – I use testosterone except in heart disease males (females get so little it doesn’t matter). Women require very little (testosterone gel 0.2 ml/day) and get benefits from it. - Much of peripheral sensitization is through TRPV1 pain receptors. Botulinum reduces their protein levels in dorsal ganglion.
Toxicon. 2017 Jul;133:116-122. doi: 10.1016/j.toxicon.2017.05.001.
Botulinum toxin type A reduces TRPV1 expression in the dorsal root ganglion in rats with adjuvant-arthritis pain.
Fan C et al
https://www.ncbi.nlm.nih.gov/pubmed/28480765 Comment – I inject peripheral sensitized tissue in occipital neuralgia etc. Looks like some of that needs to reach dorsal horn - Chronic abdominal bloating and pain treatment approach – lactulose breath test for hydrogen and methane might indicate mild Small intestinal bacterial overgrowth (SIBO) so treatment involved a low-FODMAP diet, antimicrobial botanical therapy, and homeopathic medicine. (I presume homeopathic included probiotics)
Altern Ther Health Med. 2017 Jul;23(4):56-61.
Integrative Treatment of Chronic Abdominal Bloating and Pain Associated With Overgrowth of Small Intestinal Bacteria: A Case Report.
Kwiatkowski L, Rice E, Langland J.
https://www.ncbi.nlm.nih.gov/pubmed/28646815
Comments – both antibiotics cipro and flagyl have been used in Canada because more effective agents are not available here. I used to use neomycin but pharmacists are worried re renal toxicity - Women with sacroiliitis on MRI are more likely to show Pelvic congestion issues as well
Acta Radiol. 2017 Jul;58(7):849-855. doi: 10.1177/0284185116675656.
Evaluation of sacroiliac joint MRI for pelvic venous congestion signs in women
clinically suspected of sacroiliitis.
Cimsit C et al
https://www.ncbi.nlm.nih.gov/pubmed/27799571 - Fibromyalgia subjects experience more pain when included in games rather than when included (the people pleaser issue?)
Clin J Pain. 2017 Jul;33(7):611-619. doi: 10.1097/AJP.0000000000000447.
Impaired Pain Modulation in Fibromyalgia Patients in Response to Social Distress Manipulation.
Canaipa R et al
Clin J Pain. 2017 Jul;33(7):611-619. doi: 10.1097/AJP.0000000000000447.
Impaired Pain Modulation in Fibromyalgia Patients in Response to Social Distress Manipulation.
Canaipa R et al
https://www.ncbi.nlm.nih.gov/pubmed/27841833
Comment – surprised exclusion did not have effect – but I guess the people pleasing stress of being included is the key… - Fat tissues about knee may have direct effect – fat pads in medial joint line area may be inflamed and make knee arthritis worse and fat might have other detrimental effects.
J Cell Physiol. 2017 Aug;232(8):1971-1978. doi: 10.1002/jcp.25716.
Systemic and Local Adipose Tissue in Knee Osteoarthritis.
Belluzzi E et al.
https://www.ncbi.nlm.nih.gov/pubmed/27925193
Comments – should be no surprise when diabetes type 2 is now considered the toxic effects of fat around the pancreas… - Injecting Interstial Cystitis Hunner’s ulcers with triamcinolone cortisone can cut pain at least in half but will need repeat in maybe 4 month
Int Urogynecol J. 2017 Jul;28(7):1027-1031. doi: 10.1007/s00192-016-3213-3.
Pain relief after triamcinolone infiltration in patients with bladder pain syndrome with Hunner’s ulcers.
Mateu L et al
https://www.ncbi.nlm.nih.gov/pubmed/27924374
“Pre- and postreatment VAS was 8 and 2.5 (p < 0.001), respectively. Pre -and postreatment VAS in those with muscular pain was 8 and 5 (p = 0.012), respectively and in those without muscular pain was 8 and 2 (p < 0.001), respectively. Three (15 %) patients required retreatment due to nonresponse and 5 (25 %) patients for pain recurrence after 4 months (3.5-8). Four of them (50 %) were performed with triamcinolone injection again. Seven of ten patients (70 %) followed for ≥8 months required at least one retreatment.”
Comment – need an urologist interested in doing that… - Transcranial DC stimulation tDCS in Fibromyalgia – better results were obtained stimulating DLPFC area rather than C2 motor cortex – former helped pain and fatigue while latter only pain
J Neural Transm (Vienna). 2017 Jul;124(7):799-808. doi:10.1007/s00702-017-1714-y. Epub 2017 Mar 20.
Differential effects of bifrontal and occipital nerve stimulation on pain and fatigue using transcranial direct current stimulation in fibromyalgia patients.
To WT et al
https://www.ncbi.nlm.nih.gov/pubmed/28566169 - In another study tDCS found to help refractory migraines but stimulating motor cortex associated with more side effects – headache, heartburn, and sleepiness
dorsolateral prefrontal cortex (DLPFC) area was better.
J Neurol Sci. 2017 Jul 15;378:225-232. doi: 10.1016/j.jns.2017.05.007.
Transcranial direct current stimulation over the primary motor vs prefrontal cortex in refractory chronic migraine: A pilot randomized controlled trial.
Andrade SM et al
https://www.ncbi.nlm.nih.gov/pubmed/28566169
Comment – tried motor cortex stimualtion on one subject who got bad dreams after so I stopped using it; guess I can try again with DLPFC area. - tDCS over left DLPDC does seem to help attention in FM(fibromylagia) sufferers:
Sci Rep. 2017 Dec;7(1):135. doi: 10.1038/s41598-017-00185-w.
Anodal transcranial direct current stimulation over the left dorsolateral prefrontal cortex modulates attention and pain in fibromyalgia: randomized clinical trial.
Silva AF
https://www.ncbi.nlm.nih.gov/pubmed/28273933