Pulsed Radiofrequency – New Hope for “Sciatica”/radiculitis of Neck and Back – but where available?

Traditional treatments for referred nerve pain of neck and back have been inadequate. As mentioned previously, opioids and other pain modifying medications work poorly in radiculitis, leading to an American summation that there is no proved drug treatment for radiculopathy. Now, a simple, non-destructive pulsed radiofrequency could give relief for 6 months. Continue reading

Posted in Back Pain, Mechanical aids, Thoracic | Leave a comment

Post-Stroke Pain – New Hope – Vestibular Stimulation and Maybe for Spinal Pain too

Post- stroke victims with central pain can be left with excruciating pain, often one whole side. If their vestibular system is intact (absence of “marked post-stroke disequilibrium.”), then one cold water ear irrigation can drop pain scale levels by more than 2.58/10, lasting 1- 4 weeks or more. Its effects seem primarily for face and arm pains where pain can be replaced by numbness. Continue reading

Posted in central & spinal | 1 Comment

The Pain Diagnosis that Cannot be Made in Women – Spine Arthritis – Ankylosing Spondylitis

A recent study found doctors had a poor knowledge of the features of Ankylosing Spondylitis (AS) which is why only 6% of women with this disease are properly diagnosed by GP’s. This will mean women with active spinal arthritis might have to wait 7 years to be diagnosed. Men with concomitant back injuries can suffer the same fate Continue reading

Posted in arthritis | 4 Comments

New Treatment for Thumb base Arthritis – 60% relief but you won’t like it… and what else can be done

Arthritis of the joint in the wrist down from the thumb can be common and in some cases eludes successful treatment. Recent article published in the prestigious medical journal, Pain, describes one application of leeches to the area can reduce pain 60% for more than 60 days. Continue reading

Posted in arthritis | 9 Comments

Hip Warning in Elderly

In a prospective study, 26.3% of elderly subjects developed hip pain before their fracture. Study concluded that people should be questioned about appearance of new symptoms. “A better recognition of “prefracture” pain in the elderly may allow adequate management and treatment of patients, in order to avoid a proportion of hip fractures.” Question is, what could one do? Continue reading

Posted in Leg Pains | Leave a comment

Unresolved Whiplash? – Look for Shoulder Impingment.

11/220 cases of whiplash, examined medico-legally for non-resolution, had comorbid subacromial impingment, many of which had been missed. This adds to the growing legion of real problems missed in whiplash cases. Continue reading

Posted in Insurer issues, Neck, shoulder | 2 Comments

Are Canker Sores Part Neurologically Driven?

Article in press found injection of Botox into aphthous ulcers not only gave relief of pain in three days but freedom of recurrence for more than 6 months Continue reading

Posted in ENT | 2 Comments

Stomach Enteroviral infection in Chronic Fatigue?

In January, published report found evidence of persistent enteroviral infection in the stomach of people with chronic fatigue.
Similarly, duodenal ulcers were found to be due, in part, to a stomach germ, helicobacter pylori. Many carry this germ harmlessly but others can’t heal the irritation created by the germ presence so well. One factor is stress which can slow down healing because it can cut blood flow to stomach and the stress induced cortisone excess impairs wound healing. Now one wonders if chronic fatigue is a persistent stomach infection. Continue reading

Posted in chronic fatigue | 3 Comments

Super Capsaicin for Neuropathic Pain Control Looks Promising

The use of a SINGLE application of a 8% (vs 0.025 – 0.075 usually used) capsaicin patch (NGX-4010) resulted in significant relief for over 12 weeks in HIV neuropathic pain. Given the old technique (4 X/day gel application for two weeks just to see any benefit) was messy and labor intensive, this new approach could be a godsend. Continue reading

Posted in neuropathic, Topical Pain Treatments | Leave a comment

Action Pain Support Group Regina New Home

At the Canadian Pain Society Meeting in Victoria, it was announced that (National) Action of People with chronic pain has a new chapter in Regina. Terry Bremner, President of Action Atlantic, negotiated transition of the Fibromyalgia support group in Regina to an Action chronic pain support group. They have a series of video tapes discussing a variety of pain concerns to help with pain discussion and education.

Regina contact: Elaine Torrie ph – 306 – 522-8686

I hope to get more information. air max damen air max damen

Posted in Regina Pain News | 2 Comments

Can’t Tolerate Arthritis Pills? – Try SAMe But Give It a Month.

Most NSAID’s (arthrtis pills) have a GI bleed (stomach bleed) rate of 10%. Diclofenac is 7%. Celebrex is 5% but only if they are not taking ASA. I have cases that cannot tolerate any NSAID’s or due to major GI bleeds are ill advised to take any. Now it looks like SAMe (a health food store supplement) might be an alternative. Continue reading

Posted in arthritis, Drugs | 1 Comment

Migraine treatment options

Some years ago, I came across a graph, that explained some migraine treatments options. I found it handy to show patients but have upgraded it. The original graph was this:

Therapeutic gain of migraine prophylaxis compared to placebo. Graph shows the percentage of patients with a 50% decrease in attack frequency during active drug treatment minus the percentage with 50% decrease during placebo therapy.Article found here

I have upgraded it but categorized effectiveness as more vaguely.

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Posted in Headaches | 2 Comments

Microglia Key to Neuropathic Pain

While much is written about gimped NMDA receptors in chronic pain, the innocuous support tissues in the spinal cord, the “glial cells”, turn out to be a big player. An inhibitor of these cells, clopidogrel – known as Plavix – (an anti-platelet drug used in some instead of aspirin to prevent stroke) – surprisingly works to prevent this in animal studies Continue reading

Posted in neuropathic, Pathophysiology | 2 Comments

Dyspepsia (Indigestion) Under 45 – Eradicate Helicobacter Pylori

Controversy abounds over whether People with dyspepsia should have H. pylori colonization treated. Recent article concludes “The main therapeutic strategy for managing dyspepsia in patients under the age of 45 years is ‘test and treat’. H. pylori eradication is recommended in patients with dyspepsia and no other gastroduodenal abnormalities than H. pylori induced gastritis.” Now to get our drug plan to come on board with that… Continue reading

Posted in Abdominal pain | Leave a comment

Mast Cells and Histamine Receptors Cause Pain in Interstital Cystitis (IC) and We Must Deal Better With Peripheral Pain Generators

Startling findings from gene deletion mice experiments implicate mast cells and histamine receptors in IC. It is also implicated that other peripheral sensitizations might follow that process. Continue reading

Posted in Interstial Cystitis/Gynecologic | 1 Comment

WCB Suggestions

I have had some pleas about how to deal with case workers. Worker’s advocate, media, and politicians are impotent because of thier lack of medical knowledge. There is potentially some loose end they don’t know about that could make all the criticism go away… I have tried to include information on potential letters to case workers and some resources for treatment.

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Posted in Insurer issues | 6 Comments

Post Vertebral Fracture Pain – Balloon Kyphoplasty Resources – Miraculous Results

Post vertebral fracture pain can be disabling and longstanding and spell the beginning of the end for some cases. Almost immediate relief can be obtained by tunneling a balloon into the vertebral body and pumping it up with hot plastic. Regina has lead the way in Canada for starting these sort of procedures. At a recent meeting Dr. Buwembo discussed their statistics. I am including a list of contacts for referral. Continue reading

Posted in Back Pain, Mechanical aids | 5 Comments

Regina Chronic Pain Self-Management Eduaction Program Open to Public

At Wascana Rehab Centre on 23rd Ave., a chronic pain group meets. Formerly, it was only available through invitation from a rehab specialist. Now, it is open to the general public. Your doctor, or another health care professional, can refer you. Referral is to go to Adult Program, Wascana Rehabilitation Centre with notation “Refer to Chronic Pain Group”. Phone is (306) 766-5714. A fax number I have is 766 – 5901.The education program runs for 6 weeks and each session can run three hours.
There is one 3 hour session for family member to learn about chronic pain. [I think non-believers should have to sit on tacks for the three hours and explain why they simply cannot just ignore it…but the educators would be more professional than me…]
I hope to have more information later. Support like this can be very important to sufferers who feel no one understands. It will give you tools to cope.  Also may give opportunities to find out how others cope. Don’t miss this free opportunity…

Posted in Sask Pain Advice | Leave a comment

How Should One Investigate Chronic Back Pain and What about the Back Muscles?

Exercise programs and biopsychosocial fear-avoidance perspectives abound but what workup should be involved prior to such processes? Despite attempts to talk about “nonspecific chronic back pain”, research has demonstrated that in most many cases, a specific diagnosis can be made and hence specific treatment allotted. Continue reading

Posted in Back Pain | 11 Comments

Manipulation attacked as insufficent by self

Whether Manipulation helps is a long held dispute. Despite some positive studies, argument still rages whether this is better than “usual care”. This would have to assume millions of people getting manipulation are crazy.
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Posted in Manual Med | 1 Comment

Post Hernia Surgery Helped by TENS and Should Surgeons be Doing Hernia Repairs if They do Not Know How to Deal with the Persistent Pain Afterwards?

Pain after hernia surgery is common. Transcutaneous nerve stimulation (TNS) seems to help post operatively and one wonders if it might have lasting effects. I was always taught that one should not do a procedure unless one can deal with the common complications. If a procedure has a “common” risk of pneumothorax, then one better be able to deal with it. It then follows that surgeons should not be doing hernia repairs because they do not know anything about dealing with the pain afterwards.

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Posted in neuropathic, Post Hernia | 40 Comments

Estrogenic Effects on Pain Blocked by ACE Inhibitors?

Quoted article starts by saying: “Many painful conditions occur more frequently in women, and estrogen is a predisposing factor. Estrogen may contribute to some pain syndromes by enhancing axon outgrowth by sensory dorsal root ganglion (DRG) neurons.” This effect may be blocked by ACE inhibitors

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Posted in Drugs, Pathophysiology | Leave a comment

Pamidronate and Clodronate – hope for CRPS and Back Pain

Pamidronate can significantly help over 3/4 of RSD and reduce chronic back pain through a series of simple infusions. It is expensive and because of a poorly designed negative study, has not reached full acceptance for the good it can do. Fortunately an IV Clonronate double blind randomized study settled that doubt.
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Posted in complex regional pain, IV therapy, neuropathic | 12 Comments

Etanercept (Enbrel) for Radiculitis (Sciatica)

The common and disabiling pain condition is chronic lumbar radiculopathy (chronic back pain/Sciatica). Despite the widespread promotion of treatments of neuropathic pain a recent analysis of neuropathic pain treatments has concluded the following:

To date, no medications have demonstrated efficacy in lumbosacral radiculopathy, which is probably the most common type of NP(neuropathic pain).” This was certainly a surprise to me.
Pain 132 (Dec. 2007) 237–251
Review and recommendations Pharmacologic management of neuropathic pain: Evidence-based recommendations Robert H. Dworkin et al

abstract here
This suggests a great need for potential agents. Local injections of Enbrel appears to be one of them with in some cases dramatic responses despite long term misery. This is one of the agents I fear our drug plan will never carry.
Continue reading

Posted in Back Pain, Drugs, Neck, neuropathic, radiculitis | 35 Comments

Cannot treat Chronic Pain in Saskatchewan

I am sending out a call for people to help petition the government for coverage of pain medications in Saskatchewan. This is a letter I sent out through the Sask. Pain Network:

 

To Sask Pain Network:
It seems impossible to treat chronic pain in Saskatchewan. Many of the useful agents are NOT covered by the drug plan and never will be, because they do not demonstrate good effect as a “stand alone” treatment, and are not reliably responsive in groups that are of diverse causes. ( Ex. treating back pain only once with Botox will not hit all the necessary areas to show benefit and treating back pain with Botox may not help a facet and SI joint problem).
Dr. Theil (gynecologist),and I (separately) applied to the drug plan some years ago for coverage for Botox for pelvic pain. I submitted a report of about 20 pages, but got no response. It also seems clear that now the drug plan is more cash -strapped from covering seniors’ prescriptions. I feel nothing of value will ever be covered. People with chronic pain are generally too poor to handle much in the way of drug costs.
I discussed this with Dr. Murray Opdahl (Saskatoon Pain Clinic) and he is similarly frustrated by lack of access to useful treatments. Individually, we have been ignored. As a group, with knowledge in the area of pain, our voice would be one to be reckoned with. Some agents that have shown benefit in select cases include:
Botox as an adjunct to many problems. (~$400.00/bottle – could use 2+)
Pamidronate for Complex Regional Pain Syndrome (aka RSD), and post vertebral fracture ($400.00 x 2-3 for treatment)
Enbrel for radiculitis ( needs TWO shots – not like one one-shot failing remicade study) $250.00 X 2
Lyrica for – Fibromyalgia (recently gained formal approval in USA) and certain neuropathies ~ 150-200/month
Tramadol – especially for pain in elderly or those intolerant to other opioids $150+/month depending
Cymbalta for chronic pain with depression – $150+/month
There is more. We also need a pain clinic in Regina and Dr. Lang (Anesthesia) appears willing to run it (though obviously more multidisciplinary help would be needed).
I would invite all interested parties to submit here. ( I won’t publish your name online unless specifically requested or have comments you wish to make)

 

Posted in Sask Pain Advice | 8 Comments