Bad Thoracic Back Pain and Desperate? -Early Case of Peripheral Nerve Field Stimulation

Posted on October 1, 2010 by admin

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…

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Posted in Back Pain, Mechanical aids, Stimulation, Thoracic | Leave a comment

Post Herpes Zoster – Repeated Nerve Blocks within 100 days Works

Posted on September 30, 2010 by admin

Repeated nerve Blocks work within 100 days of Herpes zoster – quicker results if before the first 20 days

 

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Posted in Injection, post herpetic neuralgia | 1 Comment

New Options For Opioid Induced Constipation

Posted on September 30, 2010 by admin

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

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Posted in Uncategorized | 1 Comment

Biochemical and Hormonal Abnormalites Suggest Possible Treatments for Fibromyalgia

Posted on September 29, 2010 by admin

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.

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Posted in chronic fatigue, Drugs, Fibromyalgia | Leave a comment

Does Family Physician Access Make a Difference? – Any Suggestions?

Posted on September 28, 2010 by admin

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.

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Posted in Uncategorized | Leave a comment

Prostatitis Symptom Index – For Your Use

Posted on September 27, 2010 by admin

The Prostatitis Symptom Index can be used to clock improvements with therapy and document severity

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Posted in prostatitis / prostatism | Leave a comment

Small Spot Body Pain Treatment – Pen like Electrical Skin Stimulation

Posted on September 27, 2010 by admin

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.

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Posted in complex regional pain, Mechanical aids, neuropathic, post herpetic neuralgia, Stimulation | 1 Comment

Spinal Cord Stimulation – Good Control of Post Hernia Pains

Posted on September 26, 2010 by admin

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.

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Posted in neuropathic, Post Hernia, Stimulation | Leave a comment

Simplest Ketamine Technique Ever for CRPS – Low Dose 10 mg Ketamine Subcut Weekly

Posted on September 26, 2010 by admin

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.

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Posted in complex regional pain, IV therapy | 2 Comments

New Hope For Some Chronic Migraine Sufferers – Occipital Nerve Stim

Posted on September 25, 2010 by admin

39% of chronic migraine cases will achieve over a 50% improvement with adjustable occipital stimulation – but not with static stim

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Posted in Headaches, Neck, neuropathic | Leave a comment

Bad Signs in Whiplash

Posted on September 25, 2010 by admin

Besides WAD level, there are multiple findings that predict bad whiplash outcome.

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Posted in Neck | Leave a comment

Let’s Not Give Oxygen To Heart Attack Patients – No Evidence Based Validity

Posted on September 25, 2010 by admin

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.

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Posted in Uncategorized | Leave a comment

Botulinum (Botox) in Animals – Works on Peripheral Nerve Injury and Not Radiculitis

Posted on September 24, 2010 by admin

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

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Posted in Botox, pain mechanisms, post herpetic neuralgia, radiculitis | Leave a comment

Accurate Piriformis Injection

Posted on September 23, 2010 by admin

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.

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Posted in Back Pain, Botox, Injection, piriformis | 3 Comments

Epidural Primarily Work on Side Needle Tip is Closer To

Posted on September 22, 2010 by admin

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.

 

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Posted in Back Pain, Injection | 1 Comment

Treatment of Opthalmic Branch Post-Herpetic Neuralgia with Blocks

Posted on September 21, 2010 by admin

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

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Posted in post herpetic neuralgia | 3 Comments

Pain Worsening From Opioids Rare

Posted on September 20, 2010 by admin

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.

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Posted in Drugs, pain mechanisms, psychology | Leave a comment

Casting Without Fracture Can Initiate CRPS in Animals – Cause of CRPS

Posted on September 19, 2010 by admin

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.

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Posted in complex regional pain | Leave a comment

Cheap Infrared Treatment of Chronic Regional Pain

Posted on September 19, 2010 by admin

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

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Posted in complex regional pain, Mechanical aids | Leave a comment

People With Longstanding Lumbar Nerve Root Problems Have “MRI Invisible” Lesions

Posted on September 19, 2010 by admin

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. –

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Posted in Back Pain, Insurer issues, Neck, radiculitis | 3 Comments

MRI’s Don’t Help in Post Hernia Surgery Pain Management

Posted on September 18, 2010 by admin

Though faith runs high in MRI’s – in Post hernia pain issues they do not help

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Posted in neuropathic, Post Hernia | Leave a comment

Diabetic Peripheral Neuropathy – Sciatic Nerve Treatment

Posted on September 18, 2010 by admin

Sciatic nerve stretch treatments help diabetic peripheral neuropathy  pain and vibration sense further confirming nerve entrapments in diabetes

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Posted in Manual Med, neuropathic | 4 Comments

Possible Curative Treatment For Post Mastectomy Pain

Posted on September 17, 2010 by admin

Continuous multithoracic level paraspinous blocks for 5 days lead to relative cure in certain post-mastectomy patients.

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Posted in breast cancer, chest pain, complex regional pain | 3 Comments

Post Knee Replacement Pain – Needs Help

Posted on September 16, 2010 by admin

I got the following email:

“I had knee replacement about 3 years ago, got along famously, no problems. Now I have severe pain at night and cannot sleep. It starts at my knee on the outside and extends up to my hip. Sometimes it even goes down the leg to my calf. I am active, do light exercise and walk about half a mile a couple of times a week. I don’t know where this pain is coming from.”

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Posted in Knee, Leg Pains | 3 Comments

No Hope Severe Neuropathic/CRPS Pain?- 4-5 Day IV Lidocaine to Rescue

Posted on September 16, 2010 by admin

One study found a 5 day courses of IV lidocaine useful in both Complex Regional Pain and Peripheral nerve injury neuropathic pain.  Other used 1 hour sessions of increasing dose daily for 4 days. Each got good results. When all else fails, at least this is possible. Followup with topical lidocaine promoted long-term results (for how to make your own patches see:
Making Your Own Lidocaine Patches  )

Posted in complex regional pain, Drugs, IV therapy, neuropathic | 1 Comment