Shoulder Operation -More Confusion

Posted on February 18, 2018 by admin

A Canadian study on full thickness tears found the no-op subgroup did well over 5 years. A Netheraland study found removing bursa (B) and taking off acromium(A) not any better than just removing bursa alone  in chronic subacromial shoulder pain. Tear progression was not statistically different though at trend for A+B. Both suffer from not examining the patient subsequently to see what troubles they did actually have. British study found no clinically relevant benefits to Arthroscopic sub-acromial decompression

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Botulinum Helps Photophobia and Dry Eyes

Posted on January 31, 2018 by admin

People who were given botulinum for migraines found coincidentally that phobia and dry eye symptoms improved as well.

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Want Do You Do For Desperate Neuropathy? – Implantable Pain Pump

Posted on January 28, 2018 by admin

Some years ago, Neuropathic study demonstrated meaningful reduction in neuropathic pain occurred in only 23.7% of cases.

Severe Neuropathic Pain – Only 1/4 Respond to Standard Drug Protocols – What Else Is There?   http://painmuse.org/?p=2640

Subject of present article was case of Amyloid Neuropathy which proved very resistant to treatment but responded “immensely” well to intrathecal drug delivery system with infusion of hydromorphone.

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Anterior Tongue Sore? – Consider Tooth Paste

Posted on January 28, 2018 by admin

3 cases submitted where the anterior tongue was sore because of the Sodium Lauryl Sulphate in toothpaste

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Post Breast Surgery Pain – Clearer Reason It’s Bad – High Prevalence of Neuropathic Pain

Posted on January 18, 2018 by admin

Literature reviews suggest neuropathic pain in 1/4-1/3 of post breast cancer surgery patient. A review of the effectiveness of neuropathic pain found only 23.7% achieved any significant relief from usual pyramid schemes of treatment for neuropathic pain
Severe Neuropathic Pain – Only 1/4 Respond to Standard Drug Protocols – What Else Is There?   http://painmuse.org/?p=2640

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Do Soft Knee Sleeve Help Knee Pain? – Yes

Posted on January 13, 2018 by admin

I was always suspicious that soft knee sleeves just cover up the pain area without helping.  However multiple studies show benefit and presence of “stay” supports does not add any benefit.

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Back Pain -Easy Help -Slumping

Posted on January 13, 2018 by admin

Looking for cheap and easy techniques to treat pain, I came across a treatment for back pain using the slump test.  Sitting with legs out straight and your feet flat against a wall, you slump forward and put your head down. If your back pain radiates into the buttocks this would suggest that your dural spinal lining is irritated and doing the slump regularly can “floss” free any adhesions and help the back pain..

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Does Cervical Traction Help Radiculitis of Neck? – Yes

Posted on January 10, 2018 by admin

metanalysis of studies shows positive effects of cervical traction.

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Posted in Manual Med, Neck, Uncategorized | Leave a comment

Vitamin D Mistake – Actual requirement Ten Times More

Posted on January 10, 2018 by admin

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

Posted on January 10, 2018 by admin

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

Posted on January 7, 2018 by admin

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

Posted on January 6, 2018 by admin

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

Posted on January 6, 2018 by admin

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

Posted on January 5, 2018 by admin

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?

Posted on January 5, 2018 by admin

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
http://painmuse.org/?p=4840
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?

Posted on January 4, 2018 by admin

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

Posted on January 4, 2018 by admin

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 Dry Mouth Syndrome Responded to Bovine Clostrium and vitamin D

Posted on January 4, 2018 by admin

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

Posted on January 3, 2018 by admin

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

Posted on January 3, 2018 by admin

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

Posted on January 2, 2018 by admin

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

Posted on January 2, 2018 by admin

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

Posted on January 1, 2018 by admin

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 https://www.kenhub.com/en/atlas/musculus-obturatorius-internus)

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Posted in Back Pain, piriformis, Uncategorized | Leave a comment

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

Posted on January 1, 2018 by admin

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

Posted on December 27, 2017 by admin

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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