Simple Test For Medication Overuse Headaches

Posted on October 13, 2013 by admin

Medication overuse (not opioids in this study) is implicated in  chronic daily headaches.  A simple screening questionnaire has been devised to suggest this is a problem.

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Obscure Groin Pain Could Be Lumbar Disc Even if Back Not Painful

Posted on October 13, 2013 by admin

Five  cases of groin pain that refused deliniation  and had NO back pains. They all turned out to be L4/5 or L5/S1 disc pain found on discogram/discoblock.  They all got relief with anterior intrabody fusion.

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Posted in Back Pain, central & spinal, neuropathic | Leave a comment

Parkinsonism – Low Vitamin D Common and Makes It Worse

Posted on October 13, 2013 by admin

Vity D deficiency was seen in  in 17.6% of patients with Parkinson Disease versus 9.3% of controls. Deficient cases had higher parkinsonism severity ratings.

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Acromegaly Peripheral Neuropathy Responded to 5% Baclofen

Posted on October 13, 2013 by admin

Subject treated for acromegaly developed peripheral neuropathy and could not tolerate oral meds. Though pain was 9/10;  5% baclofen once daily, profoundly reduced pains in legs.

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Tryptan Plus NSAID – Not as Great as One Would Like For Migraine Relief

Posted on October 13, 2013 by admin

Sumatriptan (Imetrix) 85 mg plus Sodium Naproxen (like Aleve or Anaprox) 500 mg gave 29% – 2 hour painfree response and 24% sustained 24 hour painfree response yet 62% were satisfied/very satisfied.

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Think Sinus Headache? – Try a Tryptan and See

Posted on October 13, 2013 by admin

82% of cases diagnosed as sinus headahces will respond significantly to tryptans.; but take heart – I think it could be a double crunch

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Tremor In Inflammatory Neuropathy

Posted on October 13, 2013 by admin

Non-diabetic painful numbness in hands/feet is often caused by inflammatory neuropathy. Tremor is common in these disorders and does not respond to usual treatments

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Proof of Cervical- Trigeminal Convergence

Posted on October 13, 2013 by admin

Two cases of cluster headahces with drropy eye. Droopy eye rapidly disappeared with occipital nerve block confirming association of cervical and trigeminal systems

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Dyspnea Scale

Posted on October 13, 2013 by admin

Simple tool to use in hospital.

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Chronic Back Pain May Be a Pamidronate Infusion Treatable Disease – And Why Did It take 10 Years to Replicate That?

Posted on October 7, 2013 by admin

For Chronic back pain – Pamidronate 90 mg diluted in 250 mls saline and given over 4 hours – initially and in 4 weeks resulted in 85% getting 100% relief at 6 months versus very little response in the placebo group…..Initial good results of this nature were known 10 years ago – why is it just coming out now?

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Posted in Back Pain, Drugs, IV therapy, pain mechanisms, Sask Pain Advice | 1 Comment

Neurogenic Neurogenic Thoracic Outlet (TOS)- The Existence Killer – Yet Poorly Recognized

Posted on September 9, 2013 by admin

Neck and/or arm pain/numbness with progressive disability and many negative evaluations is typical of the disease. Emotional decompensation from pain and poor treatment from others, forms an integral part of the disease. Evaluation is actually quite simple – treatment often only palliative. Situation reminds me of people laughing at a joke – when they hear it, when they tell it, and when they finally get it. I had plenty of knowledge on TOS but the perspective and wisdom from Dr. Togut made it all clear (went to his talk twice)…

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Lipoderm Superior to PLA Gels

Posted on September 8, 2013 by admin

I found PLO gels irritating but not Lipoderm. At a recent conference they bragged about their ability which can be seen at:
http://www.pccarx.com/pcca-products/pcca-exclusives/bases/lipoderm

Disclaimer – don`t get squat from anybody

Posted in Drugs, Topical Pain Treatments | Leave a comment

How Much Relief Does One Get From NSAIDs in Tennis Elbow

Posted on September 8, 2013 by admin

You can get abut 1/3rd reduction in pain on 2 weeks of Naproxen 500 mg bid. Continue reading →

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Adding Famotidine 26.6 mg tid to Ibuprofen 800 TID Cut GI Bleed 50%

Posted on September 8, 2013 by admin

Combo pill with ibuprofen 800 mg and 26.6 mg famotidine when given tid has 50% Stomach bleed reduction – marketed in US as Duexis. In Canada probably famotidine (pepcid) 20 mg tid with ibuprofen 800 tid would make a good combo. Think now – many patients won`t touch NSAID`s because of stomach trouble but most have taken ibuprofen/advil so might be will to try that combo.

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Human Chorionic Gonadotrophin (HCG) Touted as Only Curative Agent For Pain That Has Centralized

Posted on September 8, 2013 by admin

When pain becomes severe, constant, and unremitting –  chances are high the pain has imprinted on the brain and centralized. This is a tragic disease with poor treatment options. In those that persisted with treatment (failures may have dropped out?) all had permanent reduction in pain with HCG use making it the only agent to actually remit chronic centralized pain.

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Posted in central & spinal, complex regional pain, Fibromyalgia, Injection, neuropathic, pain mechanisms | 1 Comment

Botulinum For Post Herpetic Neuralgia (PHN)

Posted on September 8, 2013 by admin

I had a recent question on treatments for PHN…I felt I needed to add more info on Botox for PHN. (Using equivalents) Putting equivalent of 6 units Botox INTRADERMAL per 3.56 cm diameter (1.4 of an inch) diameter area, could result in 35% drop in pain (like 8 to 5.2/10 VAS). The benefits are apparent by 2nd day and lasting 7.4 weeks. I would consider it an adjunct to other treatments but 35% is as good or better as one would get from painkillers.

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Posted in post herpetic neuralgia | 4 Comments

Back Pain Worsening? – Look For Back Pain Multipliers – They Are Treatable.

Posted on August 26, 2013 by admin
  • I had a recent personal experience of back pain that showed me conditions that would multiply pain several times or more.  I have patients on opioids that have complained their meds no longer “cuts it” – and I have been able to see that these back pain multipliers are at work – and responsive to treatment. This is a work in progress but so important I thought I better publilsh what I had time to write down.

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Posted in Back Pain, Botox, neuropathic | 3 Comments

New Rx For Chronic Abdominal Pain – Pulse Radiofrequency to Bilateral T10-T11

Posted on August 5, 2013 by admin

Patient with abdominal wall pain and no distinct triggers had bilateral pulse radiofrequency to T10 and 11. This brought pain levels down from 6/10 to 1/10 at 10 weeks by procedure and still relief after 10 months. Though their case was neurogenic type of pain, one wonders if it would help other abdominal pains
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Quick Fix For Headaches – Repeated Nerve Supraorbital, Infraorbital, and Occipital Nerve Blocks – and What To Do For The Very Bad

Posted on July 22, 2013 by admin

Series of 3 simple eyebrow, just below eye and bottom of skull posterior injections can give long-lasting relief of headaches. Now, just to get family doctors to pick up a syringe…

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Posted in Headaches, Injection | 2 Comments

Post Herpetic Neuralgia – Pulse Radiofrequency to Dorsal Ganglion Treatment -and Various Intercostal and Infraorbital Nerve Blocks and Beyond

Posted on July 22, 2013 by admin
  • To round out my discussion of post herpetic neuralgia, I have included an article on pulse radiofreqency to dorsal root ganglion in spine – a benign, not destructive, resetting of senstivity of the ganglion by 41 degree centrigrade heat. My feeling is, intercostal nerve areas are safer to do than ganglion blocks, and semineurolytic agents, perhaps repeated several times – would be alot easier and safer. Details on approach to infraorbital block displayed.

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Posted in Uncategorized | 1 Comment

How much relief does one get from lidocaine patches?

Posted on July 21, 2013 by admin

Lidocaine patches can drop pains by 1.5-2 points on the pains scale – which is about as much as you get from painkillers.

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Posted in neuropathic, Topical Pain Treatments, Uncategorized | Leave a comment

Some Recurrent Abdominal Pains (RAP) in Kids are Missed Protozoan Infection

Posted on June 28, 2013 by admin

Some 6-11% of recurrent abdominal pains in children are protozoan infections. Those cases “did not show a characteristic presentation when compared with patients with other causes of abdominal pain” – so you can’t tell by looking at them.

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Posted in Abdominal pain | 1 Comment

What Determines Severity of Neuropathic Pain – The Neuropathicity, Not the Mood – and Good-Bye Fear Avoidance Model(FAM)

Posted on June 13, 2013 by admin

Factors such as pain on light touch (allodynia) and excessive pain on pinprick (hyperpathia) were strong indicators of pain severity. “Female gender, age, and history of serious mental disorders were found to be weaker indicators.”  Psychological factors are played up as being the prime indicator of chronic pain – much to the delight of insurers who would like to be off the hook for compensation if they could deem client’s problem as psychological and hence of their own doing. This has always been rubbish – pain severity has always been the unmost important factor and each victim has a breaking point where psychological decompensation will be evident. That does not mean that coping strategies don’t help – its just that it still is a pain problem, not a psychological one. Recent review of Fear Avoidance Model states it has not worked out well and needs to be re-vamped with multidimensionality.

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Posted in Insurer issues, neuropathic, pain mechanisms, psychology | Leave a comment

Need Help with Headache Sufferer – and Headache Convergence Site Good Pic

Posted on June 12, 2013 by admin

Good pic on how neck, scalp, occipital nerves, trigeminal nerves and face all impact on migraines and lady with nummular headache in posterior scalp ended up activating this convergence.

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Neurogenic Thoracic Outlet Syndrome – Diagnosis Concensus

Posted on June 10, 2013 by admin

Though Thoracic Outlet Syndrome (TOS) with vascular findings can be more easily resolved by disappearance of pulse, neurogenic TOS remains more controversial. Now there has arrived a concensus of opinion on diagnositic criteria.

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