Persistent Plantar Fasciitis – TENS Like Stimulation of Low Impedance Spots Helps Resolve

Posted on June 24, 2017 by admin

Point stimulation has been found helpful in nummular headaches:
Small Spot Body Pain Treatment – Pen like Electrical Skin Stimulation
http://painmuse.org/?p=704

This case, involved treatment of persistent plantar fasciitis. Using a point probe (like an acupuncture point locator), Spots of low impedance in the skin were found on the heel, and they were stimulated for 10 minutes each with probe (pointer-plus is what I have) then the used a multiple small pad tens pad to stimulate these spots for a further 10 minutes. This was done 3 times a week for total 10 times. Pain was cut in maybe half.

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Pain and Swollen Arm? – Upper Arm DVT Protocol

Posted on June 8, 2017 by admin

Upper arm pain and swollen and no other likely cause? – combinations of D-dimer testing and compression ultrasounds seem to be the approach.

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Do Pelvic Belts Help Back Pain? – Yes

Posted on May 31, 2017 by admin

Study on SI belts for pregnancy back pain found it reduced pain by 2/10.

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Osteoarthritis (OA) Knee Suffers Should Limit Walking to 30 min at a Time

Posted on May 31, 2017 by admin

 

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One Reason Osteoarthritis Bad in Canadian Prairies – Persistent Low Vitamin D Levels – and Supplements Prevent

Posted on May 30, 2017 by admin

I do vitamin D levels on all my patients coming in for physical – they are almost always low. – Recently demonstrated that persistently low levels of Vitamin D associated with accelerated osteoarthritis and helping that helps. …

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Posted in Deficits, Knee, pain mechanisms | Leave a comment

Failure Back Surgery Post Laminectomy Pain Treatment- New High Frequency or Burst Mode Spinal Stimulation

Posted on May 29, 2017 by admin

Spinal stimulation is primarily for the sciatica -only 1/2 of back pains respond.. This leave a subgroup, with predominately back pain, with a need for options. High 10 Kz frequency stimulation and Burst stimulation are two options.

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Office Ketamine For Chronic Pain Poster

Posted on May 25, 2017 by admin

here is poster in pdf format:

 

Poster CPS 2017 ketaminefinal (2)

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Confirmed – Resistant Ulcerative Colitis – Fecal Transplant Works 1/2 Time

Posted on April 20, 2017 by admin

70%  showed clinical response, and “13 of the 30 (43.3%) patients achieved clinical and endoscopic remission.”

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Stabbing Headaches

Posted on April 19, 2017 by admin

Rather new entity is the stabbing headache – primary stabbing headache (PSH) – often in occipital area, happening 2-100 times a day and more occipital (back of head) in location.  Treatment is not all what you’d think – its indomethacin, prednisone, gabapentin or tricyclic antidepressants.

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Posted in Headaches | 1 Comment

Does Job Rotation Reduce Illness?

Posted on April 16, 2017 by admin

Job Rotation reduces wrist and hand pains but doesn’t do much else according to a review. Continue reading →

Posted in arm, Back Pain, hand, wrist | Leave a comment

Sacroiliac Joint – Leg symptoms

Posted on April 16, 2017 by admin

SI joints generate significant amount of lateral thigh and inguinal area pains.  About 1/3 will complain of lateral thigh numbness as well.

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Posted in Back Pain, Leg Pains | Leave a comment

Recurrent Aphthous Ulcers – Minocycline 0.5% Mouth Rinse Treatment

Posted on April 16, 2017 by admin

Canker sores respond to tetracycline/minocycline rinses – 0.5% minocycline works best

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Posted in ENT, Topical Pain Treatments | Leave a comment

Burning Mouth Syndrome – Remarkable Improvement with Botulinum Injections

Posted on April 11, 2017 by admin

“16 units of incobotulinumtoxinA (100 units diluted in 2 mL of saline), 4 units into each side of the lower lip and 4 units into each anterolateral side of the tongue” – “The beneficial effects lasted up to 16 weeks after injection in all but 1 patient, in whom they lasted up to 20 weeks.”

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Posted in Botox, ENT, neuropathic | 3 Comments

Antidepressants Don’t Necessarily Help that Much Re Back Pain

Posted on April 9, 2017 by admin

I contend antidepressants help very little in back pain and waiting for it to work before starting painkillers is an unethical abomination. Studies showing any benefit in the last century are laughable because dosages used would not be achievable today. Good studies do show statistical significance but not clinically significant changes. Studies showing benefit used only depressed patients where results might be due to change in depression.

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Please suggest help for this case of post back and post hip back-hip pain

Posted on April 9, 2017 by admin

A case in desperate need of help wrote and I have put it in a patient discussion forum:

http://painmuse.org/?topic=post-laminectomy-post-hip-pains/

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Greater Occipital Nerve Blocks Help Triptan Overuse Headaches

Posted on April 9, 2017 by admin

Triptan overuse can exacerbate and well as signify uncontrolled headaches. Use of Occipital nerve blocks can make transition of limiting triptans easier.
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Posted in Headaches, Injection | Leave a comment

Advanced Gallbladder Testing Can Miss Disease

Posted on April 7, 2017 by admin

Two approaches to gallbladder advanced testing – use of fatty meal (FM) as a substitute for cholecystokinin (CCK) in pain reproduction during hepato-imino-diacetic acid (HIDA) scan in functional gallbladder disorder. – will miss 1/2 of cases

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Back Pain in Crohn’s Colitis is a Spondyloarthritis

Posted on April 7, 2017 by admin

Imaging spine in Crohn’s Colitis found evidence of spondyloarthritis (active spine arthritis) in 1/2 of cases. Have a case of “arrested” crohn’s disease (there is usually evidence of continued activity in stool secretion – see http://painmuse.org/?p=374 re that) with chronic back pain. She had depression problems so often labelled as nonspecific. More likely it is spondyloarthritis which would respond to steroid injections to sacroiliac and maybe facets.

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Metformin May Augment Painkillers

Posted on April 7, 2017 by admin

Previously I wrote how metformin helps Fibromyalgia and Bipolar. It has anti-cancer properties and diabetics, just on it, live longer. Now in animal model it it cut analgesic needs by 56-73% in regard to ibuprofen, ASA, tramadol, and pregabalin in inflammatory induced pain. Is this drug great?

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Serotonin Syndrome May be Reversed by Famoditine (Pepcid)

Posted on April 7, 2017 by admin

Operative case serotonin syndrome induced by Merperidine caused “hypertension, tachycardia, tachypnea, hyperthermia, myoclonus, diaphoresis, retching, nausea, agitation, and semicoma mentality with no pupillary light reflex.”  Incidentally, patient was given famotidine, in this case IV, to prevent aspiration pneumonia. Within 15 minutes condition improved and in 2 hours patient was better.

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Neuropathic Pain – Phenytoin Topical Augments Ketamine or Baclofen

Posted on April 7, 2017 by admin

It is all very well to say a drug works topically. However it is easy to assume they work on similar mechanisms so one does not add to the other. Phenytoin (Dilantin) augmented both ketamine or Baclofen so might be good in any mix.

J Clin Anesth. 2017 May;38:154-155. doi: 10.1016/j.jclinane.2017.01.040.
Phenytoin in topical formulations augments pain reduction of other topically applied analgesics in the treatment of trigeminal neuralgia.
Kopsky DJ et al.
https://www.ncbi.nlm.nih.gov/pubmed/28372657

  • case of ablation trigeminal branch left with dysesthesias; 10% ketamine topically helped initially but needed 10 % phenytoin added to maintain benefit
  • another case of post-ablation dysthesias helped initially with baclofen 5% but needed 10% phenytoin to continue benefits.

Comment – given that tolerance to an agent can occur, adding phenytoin makes sense.

Posted in neuropathic, Topical Pain Treatments, Trigeminal Neuralgia | Leave a comment

Dysphonia Hoarseness Could be a Myofascial Pain Syndrome

Posted on April 6, 2017 by admin

Amazing discovery. While getting  Diagnostic Electrodiagnostic EMG needles stuck in dysphonic vocal cords,  some experienced a sharp pain (like one hitting a muscle trigger point). Subsequently, those that experience that, noted their dysphonia was better. Looking into it deeper, some cases had subtle vocal fold movement abnormalities that suggested they had this underlying trigger point. Hitting spots in these asymmetries could improve phonition suggesting muscle spasm caused the asymmetries. This lead to a diagnosis of laryngeal myofascial pain syndrome (LMPS) as a potential entity.

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Do Estrogen Creams Help Vulvodynia? – Maybe…

Posted on April 6, 2017 by admin

Estrogens, in 18-45 age group daily application, reduced dyspareunia 27% versus 3% in placebo though that was not considered statistically better due to small sample size – so answer is maybe…

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Epidural For Back – Particulate Steroids Work Better than Soluble

Posted on April 5, 2017 by admin

For Sciatica & spinal stenosis steroid epidurals are used but controversy exists over whether there is any benefit of particulate over soluble steroids. It would seem obvious that a steroid that last weeks would be better than one that last 6 hours. This study demonstrated just that.

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Posted in Back Pain, Injection | Leave a comment

Subtle Cervical Dystonia

Posted on April 3, 2017 by admin

Diagnosing early cervical dystonia and using botulinum toxin has been one of the major advances I have seen in my treatment. Sidebend or Rotation to one side can be subtle but very important as one can now get drug coverage for botulinum. Recently, one author noted that the shirt collar was asymmetrical as well.

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Posted in Botox, Neck | Leave a comment