Poor Pain Treatment – Here We Go Again

Posted on March 24, 2018 by admin

Back in the 1984, I listened to Dr. John Bonica admonishing Doctors over the poor treatment of cancer pain. I felt ashamed. Now, with the war of Chinese based Fentanyl washing over all use of opioids, cancer patients are again being targeted and living in undo pain. I had one patient with arrested  metastatic cancer having to deal with severe issues over her opioid use. My college actually wrote me about complaints and I sent her cancer clinic report and bone scan and told them that is all they needed to know. Now a human rights group has picked up on fact cancer pain patients  are forced to reduce their opioid doses. This is inappropriate in cancer cases and again I feel ashamed for the medical profession.

You can read about the problem here:
Human Rights Watch Investigating U.S. Pain Treatment
March 15, 2018
Pain News Network
https://www.painnewsnetwork.org/stories/2018/3/15/human-rights-watch-investigating-treatment-of-pain-patients

I have to admit Doctors can be very stupid. It took them years to realize you needed to use sterile technique with deliveries, that a germ caused ulcers, and now it extends to opioid use as well – go for the fad – forget the patient.

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Upper Facial Pain Treatment- Home Based Sphenopalatine Block

Posted on March 24, 2018 by admin

About eye, forehead, and temple pains from headache source, or surgery can be disabling yet responsive to blocks of the back of nose. The description is laid out in an online article at:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5545953/

or you can read my version.

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Post Craniotomy Headache Local Treatments

Posted on March 23, 2018 by admin

Post-Craniotomy Headaches are annoyingly common – “Headaches following craniotomies are reported in up to 91% of neurosurgical cases”.  Injecting craniotomy edge defect triggers,  scar neuromas, and botulinum to temporalis muscle are local treatment options.

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Posted in Headaches, neuropathic | Leave a comment

What can One Do For Severe Limb Pain? Epidural Motor Cortex Stimulation

Posted on March 21, 2018 by admin

Severe limb pain unresponsive to treatment ends up a surgical problem with spinal or ganglion stimulation becoming more common. A pain pump is an option. Motor cortex stimulation is as well, if pain is localized.  This is technically more difficult to do on a leg but a  Japanese study shows it can be done.

 

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Posted in complex regional pain, neuropathic, Stimulation | Leave a comment

Using the Pain System to Treat Depression – Buprenorphine

Posted on March 20, 2018 by admin

I have published on the use of ketamine to treat pain/depression/suicidality. Now a weak painkiller / partial painkiller blocker has been shown to help depression, not with one study, but with findings from twelve studies.

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Posted in Depression, Drugs, pain mechanisms | 1 Comment

Dental Nerve Injury

Posted on March 18, 2018 by admin

Yanking out a 3rd molar can damage the associated nerve, but done inferiorly, this just seems to create a numb chin most of the time. Dental implants however, can damage the nerve and leave persistent pain. Article found that early surgical exploration and perhaps nerve  resuturing could significantly improve things.

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Does Gargling with Probiotic Align Help Persistent Sore Throat – and what else you can do.

Posted on March 16, 2018 by admin

Had one patient with persistent sore throat gargle with Align Probiotic with rapid improvement in pain – just used it once/day, Would be interested in anyone with similar response.

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Fibromyalgia and Going For Surgery Advice.

Posted on March 11, 2018 by admin

This advice is being circulated and I’m putting it here so it won’t be lost in ensuing weeks.

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Chronic Abdominal Pain in Children – Are They Suffering Unnecessarily?

Posted on March 11, 2018 by admin

I recently wrote about how they are only now finding certain abdominal wall injections work for chronic abdominal pain in adults – confirming source is the abdominal wall – what already???

I suspect it is even worse with children in which 30% of chronic abdominal pain is thought originated from the abdominal wall and amenable to injection.  Study in press documents features and treatment.

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What are the Causes of Polyneuropathy?

Posted on March 10, 2018 by admin

Recent study gave a breakdown of what they found re cause. Frank diabetes was eliminated from selection as the cause would be obvious? Top 4 were Idiopathic 47%, Chronic Demyelinating Inflammatory Polyneuropathy(CIDP) 38%, Pre-diabetes 16%, and Charcot Marie Tooth syndrome (CMT) 9%.

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Does Small Fiber Neuropathy Progress?

Posted on March 10, 2018 by admin

Approximately 40% of “Fibromyagia” cases are actually small fiber neuropathy (SFN). There is now evidence of how this type of neuropathy progresses. 75% remain stable and 25% progress into large fibers.

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Intramuscular Stimulation (IMS) Works Even in Rats

Posted on March 10, 2018 by admin

Intramuscular Needle electrical needling of trigger knots in rat gastrocnemius(calf)  results in less irritable sites. I use IMS for areas I wish to avoid use of local (neck, about hip where need to be able to walk after etc.).  I couple it with massage techniques to remove any residual triggers and find it helpful.  Nice to have some basic science showing it works.

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Posted in Manual Med, Mechanical aids, myofascial pain | Leave a comment

Plantar Fasciitis – New Helps – Simple PRP and Nerve Ablation

Posted on March 9, 2018 by admin

Results from simple measures such as heel cup and ankle dorsiflexion night splint are not vigorous so am forced to look further. Steroid injection in the 21st century is out because it thins the heel pad making further problems more likely. I came across this protocol for PRP that is simple and could be done by anyone with a centrifuge. All PRP studies of plantar fasciitis only talk about long term results so I suspect immediate gratification like one gets from steroids, is not likely. It uses small amounts (from 10 mls blood) weekly x3.

Nerve radiofrequency abaltion of Inferior Calcaneal nerve gives spectacular results and so could chemical ablation

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Does Ritalin Help Traumatic Brain Injury Mental Fatigue and Mental Functioning? -Yes

Posted on March 8, 2018 by admin

Two year study found methylphenidate, average 60 mg /day, improved mental functioning in TBI.

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Posted in psychology, Uncategorized | Leave a comment

Masseter Facial Myofascial Pain – Botulinum Treatment

Posted on March 8, 2018 by admin

Treatment of Masseter Mysofascial pain with botulinum was successful in 64% of cases.

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Nasal Neuralgias – What to Do

Posted on March 5, 2018 by admin

A Nose pain issue with pain out of control could represent a nasal neuralgia with  a treatable injection regimen.

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Posted in ENT, neuropathic, Uncategorized | Leave a comment

Lateral to Upper Eyelid Lacrimal Neuralgia

Posted on March 3, 2018 by admin

Poorly known pain condition affecting outer eyelid and temple area. Such conditions I thought no one would care about but have had thank you’s in past so here it is.

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Posted in eyes, neuropathic | 1 Comment

Might Need Magnesium to Make Vit D Work Well – and Great Effects on BP.

Posted on March 3, 2018 by admin

Vitamin D is helpful in pain control and reduces cancer esp colorectal cancer – and recurrence rates.  Article makes a plausible case for magnesium needed for  Vitamin D to work.

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Cheek Pain – New Zygomaticofacial Neuralgia

Posted on March 3, 2018 by admin

The  Zygomaticofacial Foramen  is 2 cm lateral and 2 cm inferior to the lateral canthus  (edge)  of the eye. A case of neuropathic pain from there that responded well to injection is documented.

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New Test for Neck Radiculitis

Posted on March 1, 2018 by admin

I have now seen 2 cases of idiopathic cervical “sciatica”/radiculitis with stickingly bad pains in triceps. This arm muscle pains can help distinguish this from intrinsic shoulder pains and one author some years ago came up with the arm “squeeze” test for neck radiculitis

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Posted in Neck, neuropathic | Leave a comment

Cutting Opioid Dose Does What? And Why is Tapering so Difficult?

Posted on February 25, 2018 by admin

Opioid deaths seem to be fueling more by Chinese derived illicit fentanyl. However, massive efforts are made to lower opioid dose. One study was successful at getting opioid consumption down  from 288 mg to 150 mg. They weren’t any better for it despite the theoretically “dangerous high levels” which would probably not be a problem if they avoided chinese imports. There was no effort to have a control group to see how many more deaths there were in the “dangerously high” group.

I have not had much luck tapering opioids and a recent analysis explains why. They claim opioids are integrated in mood, energy,  motivation,  social functioning and personality systems and withdrawing doses will effects all of it. Above study was successful because they started with 5% reductions in the first month and upped it to 10% every 2 weeks in the second month.

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Opioid and Tranquilizer Deadly Mix- How Did We End Up That Way? – Bipolar and/or PTSD

Posted on February 24, 2018 by admin

It has been said Opioids and tranquilizers can increase risk of overdose death five fold.
In my population, there is a subgroup of cases with bipolar disorder. Indeed, a meta-anlysis found 21 – 25% of Fibromyalgia disorder have it and I suspect more not diagnosed.  In a mixed state, a pain patient gets little sleep and is in considerable distress with agitation and will inadvertently be put on significant doses of tranquilizers to deal with this “pain” when tolerance to atypical anti-psychotics is limited.   March is a good time to see it and I have seen a couple cases already this year.  After the mixed state subsides, they end up continued to take them because they can contend it helped them.

It is also easy to put pain patients that don’t sleep and have restless legs, on Clonazepam which is some cases is dangerous, particularly if subjects are obese and subject to sleep apnea.

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Posted in Drugs, Fibromyalgia | Leave a comment

Doctors Told To Skip Pain Severity Questions

Posted on February 23, 2018 by admin

Pain became the 5th vital sign and doctors were initially told to take tabs on severity through scales out of 10 testing. Now, out of fear severity analysis will over-treat pain with opioids, doctors in USA are being encouraged not to question pains severity and stick to level of function. There is evidence that, removed from placebo effect, opioids only reduce pain by 1/10 on average. For clinicians that are not trained in orthopedic medicine, opioids, and now marijuana, are the main tools to control pain. This is what fuels the opioid epidemic. I did an analysis of my practice and find other measures I do drops pain by 2/10 bringing pain to more acceptable levels. Those with 7/10 of more can be often dropped in pain by 3/10 for 3 days at a time by ketamine shots done 1-2 times a week and control depression. Regular treatments using alternatives written in this blog, can do more.

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Indication For Gallbladder Removal

Posted on February 20, 2018 by admin

Article starts by mentioning how up to 33% of cholecystectomy patients can have persistent abdominal pain so taking out Gallbladder (GB) is a serious decision. Indications however include frequent attacks, large stones, older age, inflamed GB attack(cholecystitis), and pancreatitis from gallstones.

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Gluteus Medius Tendonitis Injection Treatment and more

Posted on February 19, 2018 by admin

Although the question of whether one is dealing with hip bursitis or is this referred from back is important, I wanted to clarify what steroid injection would do for seemingly glutues medius bursitis. One study suggests it was good in 72% of cases at one month while another suggested it was good up to 6 weeks. Thereafter however, is problematic with PRP injection outshining it after 6 weeks. Problem is and I quote “an isolated passive intervention cannot hope to address the often complex mix of pre-existing and subsequent impairments”.

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Posted in Back Pain, Hip Pains, Injection | Leave a comment