Diffuse idiopathic skeletal hyperostosis (DISH) disability should be ameliorated, by use of IV pamidronate, Vitamin D 3 4000 u/day and methyl f0rm B12 3000 mg/day. HCG shots are helpful. Mood could be relieved with Transcranial magnetic stimulation and hyperbaric oxygen treatments. Muscle knots might be helped with Intramuscular stiimulation (IMS devised by Dr. Chan Gunn from Vancouver and many physios now do). Facet botulinum or stem cell injections might help. All expensive but she didn’t work all these years for nothing.
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Pamidronate IV Biphosphonate Treatments
There are bone building inflammatory disorders – the most common is SAPHO syndrome (Synovitis, Acne, Pustulosis, Hyperostosis, Osteitis).
Nguyen, Minhchau Thi, et al. “The SAPHO syndrome.” Seminars in arthritis and rheumatism. Vol. 42. No. 3. WB Saunders, 2012.
https://www.sciencedirect.com/science/article/pii/S0049017212001382
It is oft treated with IV bone building meds called biphosphonates – widely used in any bone inflammatory condition of spine and out of control CRPS newer pains.
(multiple article on painmuse.org site – use search function)
http://painmuse.org/?s=pamidronate
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Pamidronate is an Iv given in this case monthly – takes few hours to run IV in. Have to have decent teeth as can get tooth infection or loose teeth otherwise.
One article mentioned its use in DISH:
Slobodin, Gleb, et al. “Pamidronate treatment in rheumatology practice: a comprehensive review.” Clinical rheumatology 28 (2009): 1359-1364.
“we recently used six monthly 60-mg intravenous pamidronate infusions in three patients
with painful diffuse idiopathic skeletal hyperostosis (unpublished data), with resulting significant pain relief in all patients”
given there are multiple articles using it in all sort of back pain issues not surprising it works. (search pamidronate on my site)
http://painmuse.org/?s=pamidronate
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Vitamin B12:
B12 has been found useful in back pain:
Chronic Back Pain Help – Forgotten B12 Injections and What Else Good For…
I did a study on injectable B12 (given like a insulin shot) for chronic pain and found a 20% drop in pains with use. It also helped fatigue and mood.
I uses injectable but you can try oral methyl based B12 at 3000 mg though response would be slower.
Vitamin D3
Vitamin D at 4000 u/day has pain relieving effect by about 1/3
several studies found vitamin D helpful it helpful in chronic back pain particularly if their levels are lowish:
HCG Injections
Human Chorionic Gonadotrophin pregnancy hormone shots are used by weightlifters and people trying to lose weight but can remarkably reduce pain:
Human Chorionic Gonadotrophin (HCG) Touted as Only Curative Agent For Pain That Has Centralized
intramuscular needling stimulation to tender muscle triggers could give significant pain relief:
wealth of information at their web site:
as well as info on practitioners near you.
Warning though – there are three ways to do IMS
-temporary needle maybe with some twisting of needle
– needle with electrical stimulation
I was one of the first few people taught IMS by Dr. Gunn and he was using a pointer plus at time. It has a DC settling and you can add pulses every few seconds by depressing a switch. If done 120 – 180 times you can get profound relaxation of muscle you are needling. I had one lady with neck instability that needling this way gave profound relief while other straight IMS did not. She ask for the pointer plus with added pulses 180 times for each stop. Could take 30 min+ to do all spot
self manipulation:
You can “thump” your own tender facet joints with an activator chiropractic manipulator:
This is best done initially under supervision with a physiotherapist. I thump joints from the front, side and back. You can buy them off ebay. If you don’t have muscle strength in hands, then maybe get an electrical
Injections of facets
I found injecting cervical facets with 5-10 u botulinum could cause remarkable improvement in facet pains using a technique described in South Korea
Orthopedics. 2009 Aug;32(8), 557-567
doi:10.3928/01477447-20090624-04
Injection in the cervical facet joint for shoulder pain with myofascial trigger points in the upper trapezius muscle.
Tsai CT(1), Hsieh LF, Kuan TS, Kao MJ, Hong CZ.
https://www.ncbi.nlm.nih.gov/pubmed/19708635
I presented this technique a twice to the Canadian Association of Orthopaedic Medicine (CAOM)
perhaps contacting them can find out if anyone is using it near you.
Last year someone at CAOM discussed use of stem cell injections to facet joints but I can’t find reference.
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Depression and Pain – TMS and Hyperbaric oxygen
Weekly Transcranial magnetic stimulation is effective for mood and avoids medications:
Leung, Albert, et al. “Transcranial magnetic stimulation for pain, headache, and comorbid depression: INS-NANS expert consensus panel review and recommendation.” Neuromodulation: Technology at the Neural Interface 23.3 (2020): 267-290.
https://www.sciencedirect.com/science/article/abs/pii/S1094715921021309
Hyperbaric oxygen is helpful for pain and depression as well. Could she get her own equipment?
Krzystanek, Marek, et al. “Whole Body Cryotherapy and Hyperbaric Oxygen Treatment: New Biological Treatment of Depression? A Systematic Review.” Pharmaceuticals 14.6 (2021): 595.
https://www.mdpi.com/1424-8247/14/6/595/pdf
I hope this gives her some ideas. There would be one dangerous thing to worry about if you have DISH syndrome: – Don’t get in any car accidents as it can snap your neck and potentially damage spinal cord:
Spine (Phila Pa 1976). 2010 May 15;35(11):E458-64.
doi:10.1097/BRS.0b013e3181cc764f.
Spine fractures in patients with ankylosing spinal disorders.
Caron T et al
https://www.ncbi.nlm.nih.gov/pubmed/20421858
I had one of my patients with DISH like Xray stiffness driving people from car dealership while their car was being repaired. Showed him article and don’t think he’s putting himself in that much risk anymore.