Pain News – Short Snaps June 2017

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.

  1. 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.  – thank goodness for that because I cannot afford to offer that treatment
  2. 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.

    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
  3. 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
    “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
  4. 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
    “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
  5. 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 –  still don’t know how to handle estrogens in chronic pain…
  6. 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 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.
  7. 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 Comment – I inject peripheral sensitized tissue in occipital neuralgia etc. Looks like some of that needs to reach dorsal horn
  8. 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.
    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
  9.  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
  10. 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
    Comment – surprised exclusion did not have effect – but I guess the people pleasing stress of being included is the key…
  11. 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.
    Comments – should be no surprise when diabetes type 2 is now considered the toxic effects of fat around the pancreas…
  12. 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
    “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…
  13. 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
  14. 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
    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.
  15. 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



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This entry was posted in Abdominal pain, celiac, chronic fatigue, Fibromyalgia, Headaches, Injection, Interstial Cystitis/Gynecologic, Knee, psychology, shoulder. Bookmark the permalink.

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