Now that Kyphoplasty has become widespread, these techniques might be outdated. However, there are cases where you cannot do kyphoplasty, and these techniques would apply – they involve caudal or epidural catheter blocks, intercostal nerve blocks, trigger injections, and near infrared radiation with a 9 cm penetration.
I had a patient on Methotrexate want the shingles vaccine. Had to look this one up…as people with Rheumatoid arthritis and related diseases are on immunosuppressives…
Some cases of thoracic back pains can get horrendous – partially because there are pain generators coming form both thoracic spine and neck, and because postural and instability effects are rampant there as well. It seems that measures may only had temporary effects. Now a case of peripheral field generation helped – but included both a low cervical and a thoracic leads – susceptible to migration…
Repeated nerve Blocks work within 100 days of Herpes zoster – quicker results if before the first 20 days
Agents that block opioid effects on bowel but can’t enter the brain to block things there – is a new upcoming option in opoiod induced constipation – something that can be severe and hard to find acceptable alternatives
Fibromyalgia posters at the IASP congress in Montreal highlighted abnormalities in DHEA and tryptophan. Treatments of these conditions could help. Testosterone could be a concern as well.
I usually only deal with chronic pain subjects now but was begged by a Grandmother patient to see a 3 year old Grandson with recurrent croup symptoms. He had been going to medicenters much like the child in the movie “As Good As It Gets” with Jack Nicholson and Helen Hunt. They would prescribe antibiotics and he was left to whoop and cough. It turns out the father had been my patient with recurrent croup as a toddler and they remembered how dexamethasone had worked so well, and wanted some for this child as well. With treatments was better in two days. Now I understood how care can vary.
The Prostatitis Symptom Index can be used to clock improvements with therapy and document severity
In the scalp, when there are small spots of severe pain, they call it nummular headache areas – they are remarkably resistant to treatments (botox helps though). Similar painful areas the size of the palm were treated with a 2 hertz,0.5- 1.0 millisecond pulse width, with enough amplitude to elicit funny feeling paresthesia stimulator. Pain went from 6.7/10 to a 3.5/10After a 5 minute treatment.
15 Cases of intractable chronic post-operative groin pain post hernia surgery had spinal cord stimulation leads implanted. All experience >75% reduction in pain and in some cases back pain was covered some as well. 11 stopped painkillers; the other 4 reduced it. Followup 1 year so far.
Ketamine use is complicated – it is a restricted drug that is abused as “special K”, it can cause dysphoria and hallucinations at higher doses; It is a general anesthetic at high dose. A pain anesthetist tells me it is just too complex to arrange IV ketamine. A usual starting dose in IV chronic pain would be 20 mg – now it looks like low dose 10 mg administered subcut can get results in CRPS.
39% of chronic migraine cases will achieve over a 50% improvement with adjustable occipital stimulation – but not with static stim
Besides WAD level, there are multiple findings that predict bad whiplash outcome.
Recent article suggests there is no evidence basis for giving oxygen to heart attack patients. So we should wait until there is, and deny patients access? -Not likely
This, however, happens all the time in Pain issues and is blatantly unethical.
In rodents were either afflicted with either:
– peripheral nerve injury – string tied about sciatic nerve
– sciatica / radiculitis – string tied about a lumbar nerve
Botox injections into paw cut senstivity by 50% in the peripheral injury but had no effect on lumbar root pain
ºAlthough I have been happy with Rectal Coupled Piriformis Injections, Ultrasound Guided injections are becomeing more popular. Combined with Botulinum, the results can last 6 months or more.
At the IASP congress in Montreal, it was stated metanalysis show epidural steroid block do not work. I mentioned the fact putting the bad side down can near double its effectiveness:
Steroid Epidurals – Why Some Work And Some Not So Well
Now it appears there is a midline septum and the injected contents tends to stay on the side the needle is closer to. This has been confirmed with a recent article at end.
I hate forehead/eye Post-herpetic Neuralgia. Upper facial Post herpetic Neuralgia has to be the worst case scenario. Local eye drop make a difference for eye. See:
Lidocaine Eye Drops For Ophthalmic Postherpetic Neuralgia
A case study highlights the benefits of nerve block to forehead in PHN
Pain Hyperalgesia is a condition where “allegedly” you become more sensitive to pain once on opioids. This is used by opioid-haters that tell of doom to those on opioids. A Stanford associated study couldn’t find any and another failed to ascertain it as well.
CRPS is induced by a constriction event like a too tight cast. Capillaries in affected area collapse and develop endothelial protrusions that do not allow red blood cells through. Pro-inflammatory cytokines likie Interleukin – 6 and TNF alpha are increased. Irritating Free radicals become rampant, venules leak, arterioles spasm and compartment pressures increase. The peripheral nervous system becomes a player and “global autonomic dysfunction” occurs. A small fiber neuropathy becomes evident.
There have been various reports of Infared spot treatment for limb CRPS. The Infrared laser machine is very expensive – there is a cheap substitute that seems to help
Radiculopathy (sciatica) cases were categorized by their pain diagrams and physical findings. Only 16- 37% of cases showed MRI findings. If there is an MRI-visible issues – only 22-78 % cases have symptoms (positive predictive values of MRI-visible nerve involvement). I can’t help but say it – Frankly, MRI’s suck in chronic radiculopathy. – The test that would be king – but fails badly. –
Though faith runs high in MRI’s – in Post hernia pain issues they do not help
Sciatic nerve stretch treatments help diabetic peripheral neuropathy pain and vibration sense further confirming nerve entrapments in diabetes
Continuous multithoracic level paraspinous blocks for 5 days lead to relative cure in certain post-mastectomy patients.
