Chemotherapy Induced Sore Mouth Mucositis – Cut Pain in Half with Topical Ketamine

Must be horrible to have a sore mouth with chemotherapy – ketamine  20 mg/5ml used four times daily reduced pain from 6 to 3 within days.

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Posted in ENT | 1 Comment

Opioids and Tranquilizers/Sedatives Don’t Mix

“Sedative-hypnotic use compared with nonuse was associated with 6.4 times the risk of opioid overdose death. … Even at opioid doses 1-19 mg/d, patients using sedative-hypnotics concurrently had 5.6 times the risk than patients without sedative-hypnotics”. I must admit I have found clonazepam helpful for restless legs and sleep but cannot bring myself to allow sedative use with these sort of statistics.

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Certain Orthopedic Issues over 70 yr Old – Easy Pain Help – low Dose Radiotherapy- But Will you ever see it?

Low dose Radiotherapy over age 70 has minimal risks but can often drop pain by 1.9/10 in following issues – sore heel and achilles pains, knee pains, and trochanteric bursitis.

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Posted in achilles, ankle, foot, Hip Pains, Knee, Mechanical aids, Uncategorized | Leave a comment

Depression in Chronic Back Pain? – Twin Study Suggests More Familial Than Related to Pain

Spine J. 2017 Jul;17(7):905-912. doi: 10.1016/j.spinee.2017.02.009.
Chronic low back pain and the risk of depression or anxiety symptoms: insights
from a longitudinal twin study.
Fernandez M
https://www.ncbi.nlm.nih.gov/pubmed/28267634

“The relationship between chronic LBP and the future development of depression or anxiety symptoms is not causal.”

Shared familial factors was considered more likely

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Peripheral Neuropathy Pain Unresponsive to Creams – Try 5% Doxepin

Child cancer case where chemotherapy induced peripheral neuropathy pain was not helped by usual topicals was helped by 5% doxepin cream

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Sad News of Hip Replacement – Less Pain and Better Function but No Increase in Physical Activity Seen

J Arthroplasty. 2017 Jul;32(7):2191-2198. doi: 10.1016/j.arth.2017.02.002.
Total Hip Arthroplasty Improves Pain and Function but Not Physical Activity.
Jeldi AJ et al
https://www.ncbi.nlm.nih.gov/pubmed/28285898

  • 30 cases ages 67 +/- 7 yrs
  • Physical Activity of Total Hip Arthoplasty  patients was quantified to 12 months postoperation
  • “Physical activity did not change from presurgery to 12 months postsurgery despite improvement”

Comment – my brother dislocated his artificial hip just bending down so there are certain restrictions. People need to be warned about their function after surgery not being associated with more activity

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Buttock-Posterior Thigh Neuropathic Pain – Posterior Femoral Cutaneous Nerve Injury and Treatment

Pain in butt and hamstring is not uncommon and usually involves hamstring. However, neuropathic level pain in areas can happen after surgery or injection suggesting nerve damage to Posterior Femoral Cutaneous Nerve. Present article used cryoablation successfully to treat.

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Pain News – Short Snaps June 2017

June 2017 Pain News: I put them up as short snaps because not going to blog note them – hope you like. You will probably not find many in news elsewhere.

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Posted in Abdominal pain, celiac, chronic fatigue, Fibromyalgia, Headaches, Injection, Interstial Cystitis/Gynecologic, Knee, psychology, shoulder | Leave a comment

Dispelling Myth That Chronic Pain is Unresponsive to Treatment

This was the title of a recent article in British Journal of Sports Medicine. It is what my blog is all about – recognizing that there are new things coming out every week that make a difference –

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Epidural Steroid Injection – Pain on Lumbar Extension Determines Extent of Benefit

In Chronic Low Back Pain and Radiculopathy (sciatica) epidurals are used with varying success.
“The mean length of relief duration is 38.37 weeks for individuals without painful lumbar extension and 14.68 weeks for individuals with painful lumbar extension.”

CONCLUSIONS:: The mean length of relief following a caudal injection is reduced by 62% in patients who exhibit pain with lumbar extension.

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Recurrent Abdominal Pain (RAP) in Children – More Than it Seems

European study found in RAP syndrome without any alarm features, 57% were found to have organic disease – and treatment of such lead to resolution of symptoms.

Things found included:

  • 19 (22.6%)  lactose intolerance.
  • 17 patients (20.2%)  celiac disease.
  • Two (2.4%) cow milk allergy.
  • 9 (10.7%) ureteral calculosis.
  • One (1.2%) was affected by teniasis = tapeworm

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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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Posted in Drugs, ENT, neuropathic | Leave a comment

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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Posted in Drugs, gynecologic, Interstial Cystitis/Gynecologic | Leave a comment

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

I’ve treated OA knee patients with various measures, steroids, lubricants and prolotherapy only to find they were excessively walking because they though it would be good for them. Now it’s been shown that limiting walking to 30 minutes at a time is better.
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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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Posted in Deficits, Knee, pain mechanisms | Leave a comment

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:

 

Posted in Drugs | 2 Comments

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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