Refractory Burning Mouth – Try Clonazepam and Venlafaxine

Venlafaxine (300 mg/d) and Clonazepam (5 mg/d) in Refractory Burning mouth – All responded with a reduction in pain from 8.6/10 to 3.2/10 after 3 months

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Subdeltoid Hyaluronic Acid Lubricant Injection in Supraspinatus Tendonopathy Helps

Subdeltoid hyaluronic acid injections 2 ml x 2 weekly associated with mild improvement in pain

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What Should Patients be Advised Post Shoulder Injection?

  • 116 patients
  • Forty-one (35.3%) patients experienced post-injection pain. The mean duration of symptoms was 3.9 days.
  • At 6 months, 81 (69.8%) patients were discharged successfully and, at a mean of 23.2 months, did not require re-referral;
  • 29 (25%) had surgery; and six (5.2%) were referred for a spinal opinion.

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Vulvodynia Treatments 2017

New approaches include topical neuromodulation which means “Podophyllotoxin (5 mg/mL) applied locally to tender points of vestibule after 5% acetic acid application. Treated area was covered with a mild estrogen cream and covered with gauze pads until the next day” . This may be repeated monthly up to 3 times.  I found little articles but came across a patent that found half of vulvodynias and post hysterectomy pain patients were better though article here did not find much.

Another approach, local injection of tender spots with 2 – 4 mL of cortisone (betamethasone) and long-acting anesthetic agent (bupivacaine), 1:1 , injected submucously to the painful site has been suggested. Other measures included topical 6% gabapentin, topical 5% lidocaine before sex, amitriptyline 40 mg,  pregabalin 150-300 mg /day, laser treatments (less often used), physiotherapy, sacral neuromodulation, and finally surgery.

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SSRI Antidepressants Work Better Than older TCA Antidepressants in Irritable Bowel

Traditionally, an old antidepressant, amitriptyline, has been used for irritable bowel at doses far lower than its antidepressant level, as an aid to stimulating endophin system etc. Now it appears that more up to date SSRI’s work better. This was determined in children with functional abdominal pain.

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

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

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

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

 

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

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

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

here is poster in pdf format:

Poster CPS 2017 ketaminefinal (2)

Here is a pic of poster from which study was based as is no longer available online:

 

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

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

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Stabbing Headaches

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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Does Job Rotation Reduce Illness?

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

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Sacroiliac Joint – Leg symptoms

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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Recurrent Aphthous Ulcers – Minocycline 0.5% Mouth Rinse Treatment

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

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Burning Mouth Syndrome – Remarkable Improvement with Botulinum Injections

“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

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

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

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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Advanced Gallbladder Testing Can Miss Disease

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

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

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)

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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