Pain Medical Musing

Neck and shoulder tip/shoulder pains are common in the workplace and are not easily eliminated. A program of strength training only worked in those that are doing well and likely to continue program until end (I call them responders).

Influence of frequency and duration of strength training for effective management of neck and shoulder pain: a randomised controlled trial.
Christoffer H Andersen et al
BJSM in press  free article here

• 20 weeks training
• Results:

Many years ago a Canadian study was done over the 35 years of a low fat diet on progression of MS. It demonstated quite well that those on a low fat diet, if started early, never ended up in a wheel chair (p<0.001):

Never hear of it? I phoned my MS society and asked for a copy of the diet and they too never heard of it. Reason – it assumed those that were not doing well would just go off the diet and hence create a bias. This article suffers from the same bias – doing well – would continue with therapy.

To be fair, if one does the program and notices benefit, s/he should continue with it. They had regular attendance in 1/2 of their cases.

The details of the strength program can be obtained  free fulltext

An interesting note is that it contains NO neck exercises – all are exercises to shoulders and shoulder tips.

Actual treatment of shoulder tip pains is complex and requires treatment to C4/5 facet:
Can’t Get Rid of Shoulder Tip Pain? – Think C4/5 Neck Facet

First rib issues also create problems as a ligament on fits rib stretches the T1 nerve root:

I inject onto first rib with a 30 guage needle (careful with bigger needles as lung is nearby)using 0.5 ml 5% lidocaine – it relaxes it. Of course I inject trapezius as well. There is some suspicion the suprascapular nerve has been irritated and involved as well, and I inject 5% lidocaine into it as well in selected cases.

A forearm support is needed for computer users and I suggest a support:

Articulating Gel Forearm Support with Removable Mouse Tray

Available here

and probably other places..

There is more here and I will add to this…

Any suggestions?

Recent article concludes simple wedge resection for ingrown toenail leads to nail bed damage and unacceptable recurrence rates – and should be considered obsolete.

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Back in 2006, Janice Montbriand  and I wrote a poster about “Often Missed Treatable Co-Morbidities in Patients with Treatment Resistant Chronic Pain”. They included Bipolar disease, B12 and Vitamin D deficiencies, and sleep disorders.  Each one of these is still an important issue today.

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Recent studies have shown a correlation between low Vitamin D levels and sickle pains. Case studies have shown significant relief of sickle pain with Vitamin D supplementation.

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Various desperately in pain cases have written me wondering how useful it actually is. The answer is not easy and runs like this – “It depends”. Firstly, I feel sick to find that people are being gouged $2,000 – 5,000 dollars for a simple blind paraspinous injection that anyone could give – it spreads so well from paraspinous subcutaneous injection that the relief occurs within 20 minutes. Having said that, since the wild enthusiasm of Tobinick’s initial cases, the enthusiasm of etanercept injections has not taken off in the literature as one would have thought.

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After causing extreme shortages of drugs in US, the US FDA came to Canada and shut down production of 90% of injectables from a Sandoz site in Quebec. This was not based on any finding of injury; merely because they can and want to adhere to standards that are cosmetically appealing. We are in a war against disease, and being thrust back into 1890’s medicine in Canada by a US agency brings up images of international war crimes. Sandoz then had a fire in their plant that completely halted production – that just sounds fishy to me.

Drug shortages could mean 1890s-style surgery

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