Segmental Colitis Associated with Diverticulosis (SCAD syndrome)

Diverticulosis can exist with segmental colitis – have an older patient who had bad diarrhea on a trip and was diagnosed with such. Not something I was aware of. Continue reading

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Achilles Tendonitis – New Eccentric Program

Achilles Tendonitis is one condition I hate and any treatment program is welcome. This is an upgraded eccentric program that does not involve dorsiflexion (foot pushed up from normal) Continue reading

Posted in Leg Pains | 3 Comments

I wish I Had Fibromyaglia – Then I Couldn’t Have Anything Else…

I hate the term Fibromyaglia (FM) – not because it doesn’t exist but because it stops people looking for potentially treatable issues as well. “It’s all just Fibromyalgia” is just too convenient. Here is an example of a subject with FM and a dural leak (leaking spinal fluid at some level in the spine) that would have had a zero life if it had gone undetected Continue reading

Posted in Fibromyalgia | 1 Comment

Rehab – Forget Fear-Avoidance – Give Them Opioids

I have a picture that portrays my view of fear-avoidance:My perspective is that, in a good many of cases, everything is controlled by pain intensity. Some articles try to avoid the issue by saying “they just thought they were in a lot of pain” and that in itself was a psychological problem (oh brother).

Now it appears controlling the pain with opioids can facilitate exercise rehab without having to tell the patient to suck it up and say “It’s just pain”. Continue reading

Posted in Insurer issues, psychology | Leave a comment

Zinc and Magnesium Deficiency Common in Fibromyaglia- and What are Zn and Mg Good For?

A recent article found a relationship of low zinc levels and tender point counts, and low magnesium and fatigue Continue reading

Posted in Deficits, Fibromyalgia | 3 Comments

Optimal Fentanyl Patch Use

There is alot of confusion of what amounts to optimal fentanyl patch use. Many patients contend it only lasts 2 days. How does one adjust the dosage? Continue reading

Posted in Drugs | 4 Comments

Hope For Failed Backs – Spinal Cord Stimulation

Given there is little evidence medications work well for chronic radiculitis, It is encouraging to note that Spinal Cord Stimulation might give 50% relief in failed back patients. Continue reading

Posted in Back Pain, Mechanical aids | Leave a comment

Angiogenesis (new blood vessel growth) the root of all pain?

Angiogensis and its accompanying nerves are evident in disc disease with the formation of neurovascular growth in the High Intensity Zone facing the spinal cord. Similarly, I have written how chronic tendonitis is associated with neurovascular growth. Now it appears arthritis pain may be angiogenesis related as well. Continue reading

Posted in Pathophysiology | 1 Comment

Is Facet Injection Better Than Medial Branch Block?

Facet injection appeared to be superior to medial branch block of SPECT scan positive facet joints Continue reading

Posted in Back Pain, Injection | Leave a comment

New Treatment For Vulvodynia – 6% Gabapentin in Lipoderm

6% Gapapentin in Lipoderm is helpful in vulodynia. Interesting how they made it up. Continue reading

Posted in gynecologic, Interstial Cystitis/Gynecologic, Topical Pain Treatments | 4 Comments

Dorsal Wrist Impingement – How to Diagnose

Dorsal wrist impingement is pincing of dorsal wrist capsule between the extensor carpi radialis brevis and the dorsal ridge of the scaphoid. It’s diagnosis is strictly clinical. Continue reading

Posted in wrist | 3 Comments

Acute Nerve Injury – Try Gabapentin and Tramadol

After a sciatic nerve as accidentally injected, gabapentin and tramadol helped the pain until some recovery came about. Continue reading

Posted in Drugs, neuropathic | Leave a comment

Want a Cheap Nerve Stimulator needle? -Look No More…

Disposable insulated needles are not readily available but a 20 gauge cannula is easy enough to find… Continue reading

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Child in Pain & Distressed – Healing Potential of Massage + some techniques

Children in a chronic pain clinic respond significantly to massage. The laying on of the hands also has a significant effect on distress. This is an under-utilized resource that needs to be taught to parents.

Continue reading

Posted in children, Fibromyalgia | 2 Comments

New Treatment for Chronic Daily Headaches – Mexiletine

Chronic daily headahces has to be the bane of most doctors frustrated by fact use of painkillers will potentially only make things worse. Now it looks like Mexiletine may help but …the patient has to be prepared to accept side effects. Continue reading

Posted in Drugs, Headaches | 6 Comments

Diabetic Peripheral Neuropathy – Pregabalin to 600mg or bust

I am used to 75-150 mg doses of pregabalin but doses of 300 mg BID are being used for diabetic peripheral neuropathy. Continue reading

Posted in Drugs, neuropathic | 1 Comment

Tennis elbow and desperate – try Duloxetine

Two cases resistant to any treatment responded to Duloxetine suggesting complex origin. Continue reading

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Neuropathic Pain More Spinal and there are potentially better treatments

Recent Japanese article hilights spinal sensitization in neuropathic pain suggesting lidocaine and ketamine maybe should play bigger role Continue reading

Posted in neuropathic, Pathophysiology | Leave a comment

Hypnosis in Chronic Pain

Hypnosis helps chronic pain and should be part of a chronic pain program, if not managed by mindfulness meditation. Continue reading

Posted in psychology | 3 Comments

NSAID’s and Gastritis – new help

Arthritis pills longterm, particularly in the elderly, is a risky business. Stomach bleed have been reported to cause more deaths than car accidents and other injuries. These stats are now relatively old and comments from doctors has been that they are not seeing as much. Question is why:

1) Use of selective Cox 2 celebrex agents – well maybe- but if they are on any aspirin, you can forget any benefits.

2) Use of proton pump inhibitors – omeprazole, pariet (Rabeprazole), pantaloc, prevacid, nexium and so on… It does reduce gastritis problems and might explain reduction seen.

3) Now it appears eradication of Helicobacter pylori helps Continue reading

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Polymyalgia Rheumatica – Back and Neck Pains

http://ard.bmj.com/cgi/content/full/67/6/758

“Cervical interspinous bursae lie anteriorly in C6–C7 interspinous spaces (arrows). B. Median sagittal section through L3–L5 of the vertebral column. Lumbar interspinous bursae lie posteriorly in L3–L5 interspinous spaces (arrows).”
These are inflamed bursas between the posterior neck (and back) spines (the bumps on the spine you can feel. Not only will it heighten the suspicion of PMR, it should be treatable by local injection (in a hospital setting). Continue reading

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For MS Sake, Give Vitamin D to Your Kids

In 2006, a US military study did a GOOD perspective study on MS that involved taking blood samples some 4-5 years prior to the start of their MS. In subjects under 20, high vitamin D levels offered a high rate of immunity form the disease Odds ratio = 0.09 which means perhaps 1/11th less likely to get it. A March 2008 good perspective study found a susceptible gene type with persistent Epstein Barr (mono) high titers had a wooping 9 times risk of getting MS later. Continue reading

Posted in Deficits | 1 Comment

Fast Fix for Shingles Pain – and Doctors: For God’s Sake – Give a Block!

Nerve blocks combined with tricyclic antidepressants gave rapid relief of pain in 80% cases in one Japanese report. I feel nerve blocks or epidural blocks are manditory for any cases of shingles in which the current acutely infected pain would be too high to live with long-term. Continue reading

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Immorality of Canadian Agency for Drugs and Technologies in Health

The Common Drug Review is part of the Canadian Agency for Drugs and Technologies in Health. It is a national program that determines what drugs are worth putting on formularies in the province. They decided that Lyrica should not be used just because a comparison with amitriptyline was not forthcoming. I wrote them this letter:

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Re decisions made: Decisions made by your organization would NOT stand ethics board analysis. For example Lyrica is delisted because there has been no adequate comparison with Amitriptyline. This, however, does not claim it is not effective particularly in patients unable to tolerate amitriptyline. Nonetheless, I have had acute herpes zoster elderly subjects unable to tolerate other agents (amitriptyline and other TCA’s and gabapentin) decide to go off lyrica once my samples depleted and live in relative agony. I would suggest your organization be disbanded as provincial formularies will use your conclusions to their advantage without taking intolerances to other agents in mind. The bare minimum you would need is ethics board approval of your recommendations. Shame on you – what would you do if your grandmother developed shingles and was in so much pain, unable to tolerate gabapentin and tricyclics? Yours disgusted, I am sure their decisions are all scientifically based. I am reading a Book Called Contemplative Science by B. Alan Wallace. In it he states: “It is sobering to note that the twentieth century, which generated the greatest growth of scientific knowledge in the entire course of human history, also witnessed man’s greatest inhumanity to man, as well as the greatest degradation of our natural environment and the decimation of other species. The expansion of scientific knowledge has not brought about any comparable growth in ethics or virtue.”
It is disgusting that we are paying a government agency to be soul-lessly scientific and immoral.

Make your own views known

site:

http://cadth.ca/index.php/en/cdr/cdr-overview

just use contact us at the top.

Posted in Regina Pain News | Leave a comment

Want to See a Pain Expert? – See a Vet, not a Doctor

A Canadian Pain Society Survey found medical students only get on average 11 hours training in pain education. A vet, however, gets on average 98 hours education. This might explain why patients are treated poorly by some doctors. Continue reading

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