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.”
Men with prostate cancer live in fear that surgery or radiation will induce incontinence. Recent review confirms a simple outpatient mesh sling easily works 62-80% of time to cure situation. 
Criteria for Complex Regional Pain sydrome may be being relaxed with perhaps only 2 features being necessary and only 1 feature needing to be visible at any time.
Continue reading
A new canadian university study finds 86% of mobile device users have musculosketal issues.
Several studies presented at the International Association for Study of Pain at Montreal 2010, all find the association of psychological problems and Chronic pain to be weak.
Previously, Dennis Turk has contended that only 1/2 of chronic pain sufferers will tolerate of find opioids effective. See: http://painmuse.org/ref/turk.pdf
Now a Norwegian study suggests even in “planned” opioid users, only 23% will be taking opioids 3 years later. Meanwhile, doctors in Orthopaedic Medicine, are being targeted by Provincial Colleges… Continue reading
A case demonstrating that work on the neck can be helpful in Trigeminal Neuralgia (TN).
Do you have any further info up to date for 2010 as my IC friend’s condition is very severe presently for last 2 weeks & here in India we are being told they know little about IC. She’s desperate for some effective help asap. She’s history of 2 ulcers + suffers from gastritis & IC symptoms began to appear after her hip fracture with poor catheter asepsis was given. This whole bacterial over growth is something we would like to hear more in depth information about. Thank you.
Back Spinal leads – Spinal cord stimulation (SCS) is useful for leg pains where you can elicit Funny feeling “paresthesias” with implanted leads. Obtaining the same for back pain has been more difficult. In cases where they were unable to get the paresthesias in the back, or patient refused spinal leads, leads put in under the skin subcutaneously was used with some success.
After a talk with our provincial lab, serum tryptase levels will be allowed for select patients
Sacral Nerve Root Stimulation (SNS) was compared with Peripheral Subcutaneous Field Stimulation (PSFS). SNS attenuated pain 50 – 60% at low stimulation with good patient satisfaction.
This is my favorite neuropathic scale- for your use – it’s 2 pages
from:
The LANSS Pain Scale: the Leeds assessment of neuropathic symptoms and signs
Michael Bennett
Pain 92 (2001) 147-157 free article here
Laryngeal spasms are a frightening life threatening condition in anesthesia. Bilateral Pressure behind the ears at TMJ level might release this spasm in kids. Hiccups can be relieved by lifting the “thingy” uvula in the back of your throat’s palate.
Not a Pain Meeting Goes By Without someone extolling the virtues of IV Ketamine in refractory patients. Its use has been thwarted by preceived side effects. Now it appears these fears have been over-rated. Here are some protocols I have encountered . Continue reading
Proteases are inflammatory chemicals like cytokines. They were first described in 1991 and have become a target for therapy. Now they are connected to chronic prostatitis.
I have a patient with multiple level cysts where the nerves exit the spine in the neck. He also has some mild foraminal stenosis. He is symptomatic with arm and referred upper back pain. Getting his problem taken seriously has been an issue. Now it appears these perineural cysts do indeed cause trouble and can be treated.
Just got back from a course showing how to give ultrasound guided injections so you can hit the right spot. Now it appears you don’t need to be close at least for shoulders…
Author devised a 3.5 cm out for L4-5, 3.5 cm down from there, for L5-S1 – 2 mm down for each model for injections. Injected 60 mg Depomedrol each level needed for radiculopathy. Got excellent results without image intensifier in 100 cases though 18 needed another shot in 3 weeks and 11 had recurrences despite that.
I have written how tarsal tunnel syndrome is commonly missed in Dabetic Peripheral Neuropathy:
Surgery For Diabetic Peripheral Neuropathy – Another Option Not Available Here
Now it appears that Tarsal Tunnel syndrome enerve slowing is to be expected in Diabetes.
Program of twice daily 20 minute of specific music therapy dropped chronic pains from 6.3 to 3.2/10 over 6 weeks.
I often say I hate the term neuropathy because it assumes they can all be treated similarly. Now three trials using Topiramate in Diabetic peripheral neuropathy have failed to show benefit. – yet one using less strick response criteria has…
The endorphin system in the brain and its counterpart enkephalin system in the spine help to shut down pain awareness in acute situations. Had a bad headache that suddenly disappeared? That is that system kicking in. This system is called the Diffuse Noxious Inhibitory Control (DNIC) (you either love or hate that term – it’s impossible to remember). It is frequently deficit in Fibromyalgia and Irritable bowel sydrome. Now it appears commonly deficit in a variety of pain situations.
Those who have epidural steroid injections for back pain know they are limited often to injections every 3 months (except for initial 3 shots). When the pain comes back in 3-6 weeks – what can one do? Now it looks like Spinal Midazolam can fill the gap…
I had previously promoted this as an option –
Midazolam Augmentation of Lumbar Steroid Injections – Use, in Just Mechanical Back Pain
Now its effectiveness has been proven:
Just treating Infraspinatus and Trapezius triggers will drop pains in FM by 20% – renewing interest in idea that a portion of FM is peripherally driven.