For years, IBS has been known as a “psychological disease”, an intestinal spastic disease, and a segmental hypersensitivity syndrome (nerves hyperirritable). Now there is increased gut permeability, particluarly in the diarrhea predominant form. This “leaky gut” creates an immune reaction with “increased numbers of T lymphocytes, mast cells and enterochromaffin cells.” This offers new avenues to treatment like probiotics. Continue reading
Pain post mastectomy can be an important issue. Associated with the pain is swelling called lymphedema. Now it appears transplanting lymph nodes from the groin can resolve the pain and lymphedema Continue reading
Costovertebral (rib) joints are just starting to be recognized as a source of pain. A recent provocative study demonstrated their referral patterns Continue reading
I was always bemused by “specialists” that point out facet OA changes and claim to patients these old age changes are responsible for their pains. Now the Framingham study has put a nail in the coffin for that attitude. Continue reading
Recent Study did injection by anterior, lateral and posterior portals and checked subacromial penetration arthroscopically. “RESULTS: The mean distance with anterior needle placement was 2.9 +/- 0.6 cm. The mean distance with lateral needle placement was 2.9 +/- 0.7 cm. The mean distance with posterior needle placement was 5.2 +/- 1.1 cm.” Continue reading
20% of missed celiac cases are found after age 60 and present with iron deficiency anemia. The gold standard is duodenal scope and biopsy but this might not be the best place to be. Continue reading
There was recent mention on using IV Magnsium in acute migraines in a previous blog note. I had used it in combination 1-2 gms Magnesium sulphate with lidocaine 100 – 200mg IV for migraines but was not impressed that it worked for that long. If given too fast, it could also cause some burning in the blood vessels in the arm used which did seem distressing. I was using a small volume that I could give slow push rather than putting it in 250 mls saline so concentration could be the cause. However, this is has encouraged me to review the use of IV magnesium: – in neuropathic, migraine, and regionally. , Continue reading
I have found inflatable neck traction very useful for neck radiculopathy cases. A cheap source is available on ebay Continue reading
I recommend good support bras for some of my female patients but have had complaints about $200-300 dollar price tags on some of them. One of my patients, suggested I give this link for decently priced bras. They do have some with posture and back support. Continue reading
Testing MRI/CT imaged Sacroilitis versus clinical testing and comparing it to positivity of tests with Low back pain came up with low sensitivities and specificities. Continue reading
Study finds in cases that meet the criteria for actual osteoarthritis in TMJ responded equally as well to Diclofenac and splint althought the former worked faster Continue reading
Candida-related denture stomatitis is an annoying chronic concern. Comparison of “topical application of miconazole three times per day for 30 days” versus “upper denture microwaved IN WATER (650 W per 6 min) three times per week for 30 days”. The microwave group was effective treatment – the other not Continue reading
A blood clot in a hemorrhoid can cause extreme pain. Caught early, it can be surgically evacuated. Once several days old, there is no advantage in doing so. Now it looks like an intrasphincteric injection of 0.6 ml of a solution containing 30 units botulinum toxin can give dramatic relief of pain within 24 hours. Continue reading
A new wonder of technology has created a new suboccipital stimulator at 1/12th the size of previous! It has been found useful for chronic one sided headache called chronic hemicrania for which indomethacin has been the mainstay of treatment Continue reading
Recent article found both regimens below equal efficacy:
prochlorperazine 10 mg and diphenhydranate 25 mg intravenously
metoclopramide 20 mg and diphenhydranate 25 mg intravenously
“Three quarters of subjects in both arms would want the same medication for their next migraine.”
In Burn Cases, both Pain and Sleep Onset Insomnia predicted pain chronicity and their model suggested that the sleep problem was beyond what one would expect from the pain Continue reading
Recent metanalysis of studies suggests recovery is not great after 3 months Continue reading
Phantom limb pain is suprizingly resistant to treatment and some articles on the subject have concluded “put them on opioids – perhaps methadone”. Now come two different approaches to treating the leg version of this – memantine and pulsed radioifrequency. Continue reading
In 2006, my daughter, Janice Montbriand, and I did a pilot study on selected chronic pain patients looking for sleep apnea. We found a high incidence of nocturnal oxygen desaturations in these cases. Methadone classically has also been known to induce sleep apnea. Now a cases series of people on other opioids has been published:
Certain sore kneecap cases will benefit from foot orthotics. Continue reading
The subscapularis muscle is the key muscle in shoulder pain. It is strong and pulls the shoulder up to impinge “better”. It is a principle muscle involved in frozen shoulder. The best trigger / Botox injection would perhaps hit the most motor points (where the nerve ends into the muscle). A block with phenol has recently been shown to help spastic shoulders in cervical injury patients. Continue reading
In osteoarthritics, Doxycycline, a tetracycline, was found to reduce knee joint space narrowing by 40% at 16 months and 33% at 30 months compared to placebo. In another study, after noticing a rapid reduction of inflammation in an OA case on Sulfa-Trimethoprim (Cotrimoxazole), a case series was done which again noted “high improvement in pain, joint limitation, and patients’ global assessment of disease activity” in 6/10 cases. Continue reading
Are these legitimate arguments?
1) One shot should fix it and if it doesn’t then that’s it (I call this the “one shot wonder” attitude). I think the only person who could be sure to fix things at one go would have to be God and I know I’m not him/her…
2) Steroid injection rots the cartilage from joints and accelerates osteoarthritis. If steroid injections are used to treat symptomatic mensicial tears, I would not think repeated injections would not be the best idea as accelerated deterioration would be happening anyway.
But evidence do we have? Continue reading
A Recent Framingham study has demonstrated on MRI:
Recently, there was a workshop on muscle energy techniques. I know the name sounds corny but it is a gentle postitional push- release-stretch technique that has become one of the principle manual spinal techniques now taught to physiotherapists and besides Maitland techniques has become the standard. A recent application was made for family physicians to have credit for taking this course in Manitoba and word was received back that family docs don’t need to know this stuff.
Not only does this show incredible ignorance, as 30% of Canadians live in chronic pain, it sends the message that doctors don’t need more than the 11 hours of training (see other blog article re this) they receive in medical school when it comes to treating pain. Not only is this physiotherapy technique a treatment technique – it is a diagnostic process for spinal problems that would allow doctors to converse with physiotherapists. Continue reading