Vitamin D Mistake – Actual requirement Ten Times More

For years people were told they needed 400 u/day; Now it looks like 8000 is more like it. There are all sorts of cures for disease’s with taking vit d which is probably just making up for deficiency.

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Tolerance to Arthritis Pill Mediated by Opioid Tolerance System

NSAID/arthritis pills have painkilling action centrally and this now appears to be related to its effect on opioid system. Unfortunately it means you can develop tolerance either because you are on an opioid or because its effects on descending inhibitory circuits do  undergo tolerance.

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Some Fibromyalgias are Treatable Arthritis

I have a patient with psoriatic arthritis that had widespread pains. His rheumatologist told him it was “fibromyalgia” He developed such bad bronchitis I had to put him on steroids – at which point his “fibromyaglia” pains went away. He was so mad he went back to his rheumatologist and told him what he thought of his diagnostic ability.  Enthesitis is  inflammation where tendons, ligaments and capsules attach to bone. Psoriatic arthritis is thought to start there.

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Posted in arthritis, Back Pain, Fibromyalgia, Insurer issues, myofascial pain, pain mechanisms | Leave a comment

Supraventicular Tachycardia (SVT) – New Predisposing Initiation Process

35% could bring on their SVT by flexing trunk – a sign they called  “sign of lace-tying.”

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Chronic Nonspecific Shoulder Pain -Look For Infraspinatus Trigger

At a recent conference, it was stated that the Infraspinatus muscle was key to all pain in the upper quadrant. He advised rolling a lacrosse ball back and forth it over it. You either sit or stand against a wall or lie down and roll it. Now a study on elderly with nonspecific shoulder pain shows it is involved.

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Posted in arm, Manual Med, myofascial pain, shoulder | 1 Comment

Extra B12 – Lung Cancer Link for Men

I have used frequent B12 shots as an analgesic for resistant pain cases. For men over 40, 10 yr. use of injectable B12 is linked to doubling lung cancer risk.

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Chronic Severer Abdominal Pain – Why Has It taken So Long To Realize it’s Partly the Abdominal Wall and Treatable?

Early last year I wrote about my experience chronic severe abdominal pain as it being from the abdominal wall:
Chronic Severe Abdominal Pain is a Skin Nerve Pain
Now, someone has taken it a step further by doing a widespread abdominal nerve block called the transversus abdominis plane (TAP)  block – bilaterally if need be – and finds it generate significant pain relief. This could be a major milestone for abdominal pain relief.

Brings up the question of why it took so long to understand bad chronic abdominal pain could be part abdominal wall and treatable…

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Posted in Abdominal pain, Injection, neuropathic | Leave a comment

Will Dorsal Root Ganglion Stimulation Surpass Spinal Stimulation re Pain RX?

Spinal stimulators are often used in resistant pain cases. Where there is a peripheral source like CRPS of knee, a dorsal root ganglion stimulator was much preferred over spinal stimulator Continue reading

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Diffuse idiopathic skeletal hyperostosis (DISH) -Stiffness Disease

Diffuse idiopathic skeletal hyperostosis (DISH) is were you get extensive ossification of ligaments and entheses(endings of tendons and ligaments). It is relatively common (10% of people over 50). If you get boney bridging of vertebrae you can get a very stiff spine.Treatment options are limited.

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Sjogren’s Dye Mouth Syndrome Responded to Bovine Clostrium and vitamin D

A vegetarian who develop Sjogren’s has zerostoma and sicca treated with B12 and Vit D without effect for 1 year. Adding bovine clostrium Lactobin improved things gradually.

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Topical NSAID’s Don’t Work Much for Corneal Abrasions

A review of studies on topical NSAID’s did not find strong reason to use. Agents included 0.1% indomethacin, 1% indomethacin, 0.03% flurbiprofen, 0.5% ketorolac, 0.1% diclofenac). The article was only an abstract; they grudgingly admitted used of oral painkillers might be less.

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Persistent Groin/Buttock Pain Oft Post Hip Surgery Cause and Treatment

Close proximity of pelvis side wall (Ischium) and lesser trochanter of hip can cause pains in groin or buttocks. This ischiofemoral-impingement might required trimming or lesser trochanter. This is new to me.

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Median Nerve Flossing for Neck- Arm Pains

Several years ago I listened to a talk on using nerve “flossing” mobilizations to help victim with hypermobility issues. This would stretch the nerve in their “tracts” and help reduce pain.

They were taught to do a routine -repeated like a dance –  with their arm that varied from
– arm up in “stick’um up position” with wrist fully extended like you were holding a tray
– arm straight out 90 degrees at side with wrist still bend up
– then move arm straight down behind you with wrist bend other way = fully flexed

then proceed to first position.

It was never clear how much difference this would make until present article did therapist led median nerve flossing 5 days a week for 6 weeks. The wait listed group did not change in pain level while the active group cut their pain by half.  Unfortunately, we don’t know about the placebo effect of active touching so it is not clear how much it actually helped.

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Posted in arm, Neck, neuropathic, radiculitis | Leave a comment

Alternate Cause of Thumb MCP Joint Pain – Sesamoiditis – With Tests

There are small bones surrounding certain joints called sesamoids. In the thumb, they can get inflamed at the thumb MCP joint and respond to 10 mg triamcinolone injection or rarely to surgical removal. Continue reading

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Resistant Piriformis Syndrome – Could We be Missing the Boat? – Obturator Internus

I have a case of long term piriformis syndrome that I have been whittling away for some time. To be fair, she has seen multiple specialists and is some better but not enough to improve quality of life, (old sad joke – If you fix 3/4 problems in chronic pain patient how much better do they feel – answer – not at all – because remaining issue can take them to ceiling re pain) . I found a potential answer in a 2010 thesis from Norway that describes exploration surgery on resistant buttock pain – sciatica cases that found a very contractured obturator internus muscle – a muscle felt pelvically only by palpating the front of the pelvis.

(I love the image but it looks copyrighted so I only link to image site which is

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Resistant Tennis Elbow – Open Release or Radiofrequency Microtenotomy – and More

Randomized trial of open release (OR) or radiofrequency microtenotomy (RFMT) for tennis elbow. Article suggests: “As a result of the extra expense of RFMT, we therefore recommend that OR is offered as the standard surgical management.”

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AC Joint Treatments

Recent article defines treatments as steroid injection or distal clavicle excision. It found little evidence of persistent benefits of AC steroid injection and found arthroscopic distal clavicular excision satisfactory in 92.5% of cases on average.

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New Ion Channel Abnormality Found in Diabetic Neuropathy

Hyperpolarization-activated cyclic nucleotide-gated (HCN2) channels have been found to cause issues in animal models of diabetic neuropathy and the rush is on to find a drug safe to use to block them.

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Neuropathic Treatment Failure -The Greatest Issue In Treatment of Chronic Pain

I was asked to put a letter in a time capsule for my great nephew. I reflected over the near 40 years I have been working on chronic pain and my wishes for 2034. The treatment of neuropathic pain is an issue in which breakthroughs have to occur. I suspect genetic manipulation of gene  activation levels (especially in the spine) could play a role because otherwise, up to now, treatments have failed to work well.


(Note – the picture reflects radiculitis which amounts to over 1/2 of neuropathic patients)

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Imipramine and Pregabalin – Little correlation Effect with plasma concentration

Imipramine drops polyneuropathy pain by one and has no increasing effect with dosage suggesting most effect is placebo. Pregabalin drops pain by 0.4 and marginal/not significant drug dosing effects suggesting neither is much use alone.

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Magnesium Oxide Better Absorbed Than Citrate

Magnesium oxide is (surprisingly) better absorbed than citrate –

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Complex Grief or PTSD – New Treatment – Mirror Neuron Network Activation

It is proposed that PTSD and abnormal grief reactions are due to mal-wired brain connections that loop painful recollections.

In phantom limb, abnormal circuit changes potentiate the pain. Some of these connections can be over-written by “mirror therapy” where a mirror is placed so that missing limb is mirrored and limb movement is registered in brain as happening in missing limb. Repeated 10 minute session could have an impact.

“Mirror” therapy is similarly used in abnormal grief and PTSD and in a couple of cases noted improvements after two session.

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Supratrochlear Neuralgia







This is a newly described condition. Ignored as a possible cause of head pain (astoundingly, 6/15 had a prior supraorbital nerve block but not trochlear). Tip off is it’s near midline location. Pressing or stabbing is the usual nature and 9/15 had an intermittent nature with great variability and length. Inner upper orbital rim is tender.

4/15 had bilateral pains, making it more difficult to access. 3-5/15 got lasting effects from blocks; no one drug was consistently used.

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Posted in Headaches, neuropathic | 1 Comment

Persistent Hiccups in Cancer – 0.1 ml Vinegar Squirted Into Nose and What Else

Using vinager for hiccups is a Japanese folk medicine treatment. After testing in regular subjects for safety, 0.1 ml; of vinerger (4.2% acetic acid) was used in a cancer patient with persistent hiccups with effect.

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Diabetic Medication Aids

Putting together info on using newer agents. Note: DPP4 and SGLT2 combo not allowed by EDS. Lectures from Dr. Sue Petersen 2017

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