Topical NSAID Ketophen or Diclofenac – Poor Showing

Posted on April 1, 2017 by admin

Topical anti-inflammatory drug would be the safest way to go in knee arthritis for example. Yet the number of patients needed to treat to help one case was
Ketoprofen – one in 6.9 cases
Diclofenac (Voltaren) – one in 9.8 cases
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Posted in Drugs, Knee, Topical Pain Treatments | Leave a comment

Burning Mouth Syndrome – Could a Subgroup With Elevated B6 Levels be Helped by Stopping B6?

Posted on March 27, 2017 by admin

Recent study paradoxically found elevated B6 levels – up to 4 times normal in 1/6 of burning mouth cases and stopping B6 seemed to help in a case. Could this be of help in others?

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Posted in Drugs, ENT | Leave a comment

MRI God Fails Again – Peroneal Neuropathy

Posted on March 16, 2017 by admin

Peroneal neuropathy is a symptom complex of shin weakness, atrophy and foot drop, and knee pain. A common cause is a cyst in the nerve as it wraps around fibula. However, this will be missed in 64% of MRI negative cases but seen later. Another example how MRI God is not infallible.

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Posted in Knee, Leg Pains, neuropathic | Leave a comment

Pramipexole Stops MS in Animal Model – Helps Restless Legs, Fibromyalgia, and May Help Resistant Depression

Posted on March 15, 2017 by admin

In the mouse model of Multiple Sclerosis, Pramipexole, a antiparkinson drug, stops the brain neuroinflammation and that form of MS called “Experimental Autoimmune Encephalomyelitis”. This agent is used extensively for restless legs – Got MS and restless legs? – I would get on this drug…

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Posted in central & spinal, Drugs, Leg Pains, Uncategorized | 1 Comment

A Serious Version of Migraine with Aura – CADASIL

Posted on March 13, 2017 by admin

An heriditary version of migraine with aura could be cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL). Early on, nothing is evident even on MRI; but later, damage can be seen on MRI from this vasculopathy. Clinical features include migraine with and without aura, cognitive decline, ischemic events (mini-stroke events), and mood disorders. Imetrix/Sumatriptan – like vasoconstrictor agents potentially contraindicated

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Posted in Headaches | Leave a comment

Maxillary Sinus Mucocele – Cause of Cheek Pain and Treatment

Posted on March 11, 2017 by admin

Patients with chronic allergies and chronic sinus conditions can end up with cysts in cheek sinus – the cyst does expand and causes remodeling pressure on bony margins and give pain with it. Sinus issues and pain in cheek? – that could be the cause and the treatment is surgery

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Chronic Rectal Perineal Pain Helped by Simple Caudal Block

Posted on March 6, 2017 by admin

80 year old with sharp, intermittent, burning pain worsened on sitting down relieved by simple steroid caudal block when all other measures failed.

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Posted in Back Pain, neuropathic, pelvic | 2 Comments

Post Herpetic Neuralgia (PHN) – Repeat Case – Pulse Radiofrequency (PRF) To Dorsal Root Ganglion Again Works

Posted on March 6, 2017 by admin

Case T7 PHN helped by PRF to dorsal root ganglion

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Posted in post herpetic neuralgia | Leave a comment

Post Dural Headache Treatments

Posted on March 5, 2017 by admin

Came across a wonderful list of drugs available for post-dural headaches:
https://www.asra.com/content/documents/aug-14.pdf
p13-14,23

If you can’t reach it, here is the list and more

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Posted in Drugs, Headaches, Injection | Leave a comment

Instructions for Dealing With Calcific Tendonitis Shoulder

Posted on March 5, 2017 by admin

It has always been vague on the fine points of this techique. A beautiful account for this procedure is available in this newsletter:
http://www.asra.com/content/documents/nov-13_asra_news.pdf
on pages 14-17

I have included a summary for those who can’t reach it.

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Posted in Injection, shoulder | Leave a comment

Dying in Long Term Care Facility (LTC) Issues

Posted on March 5, 2017 by admin

Some LTC facilities are reluctant to be involved in end stage care as they already have a reputation as the place the old go to die. Those that embrace it, require more staff, as the dying have rights to increased supervision, pain control and not dying alone..

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Posted in Uncategorized | Leave a comment

ECG Evidence of Acute MI with Left Bundle Branch Block

Posted on March 5, 2017 by admin

A modified Sgarbossa criteria can be used to suggested and Myocardial infarct in the presence of a LBBB. Additionally, it has been suggested to look for “Wellen’s signs” in V1-6:
Wellens’  Type A – biphasic pattern of T waves in V leads
Wellens’  Type B – deep  negative T wave inversion in V leads

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Posted in chest pain | 1 Comment

Chronic Migraines – Repeated Occipital Nerve Blocks Cut pain in 1/2 in 3 Months

Posted on March 4, 2017 by admin

Earlier I wrote about Nerve blocks controlling headaches.
Quick Fix For Headaches – Repeated Nerve Supraorbital, Infraorbital, and Occipital Nerve Blocks – and What To Do For The Very Bad
http://painmuse.org/?p=2886
Several protocols had been made up. This present one, was weekly Occipital Nerve Blocks either unilateral or bilateral for one month and then monthly thereafter. After 3 months, headache frequency was cut about in 1/2, and the headaches were some shorter and a bit less severe. This is a good or better than botulinum but if used in combo should give great results.

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Posted in Headaches, Injection | Leave a comment

New Treatment for Uncontrollable headaches New RX for Nummular Headache Underlying

Posted on March 4, 2017 by admin

Had one case where I treated unrelenting headache with repeated IV Dihydroergotamine and metoclopramide just to find, as patient settled, that headache originated from a painful patch on the scalp called nummular headache. This is often due to a crushed nerve in area with nerve damage pain in a circular/oblong area. This triggered the unrelenting migraines which  overshadowed it. Nummular patch headaches can respond to botulinum sometimes but other treatments are lackluster. Now it look like palmitoylethanolamide (PEA) combined  with topiramate might do the trick.

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Posted in Drugs, Headaches | 1 Comment

Getting Carpal Tunnel Surgery? – Take Alpha-Lipoic Acid

Posted on March 4, 2017 by admin

Taking Alpha-Lipoic acid 800 mg/day for 40 days reduced pain and increased 2 point discrimination.  Some nerve operations are fought with problems (nerve transfer in cubital tunnel syndrome); now there is a help.

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Posted in post-surgery persistent | Leave a comment

Achilles Mid-belly Tendonitis Could Be Plantaris Muscle Rupture

Posted on March 4, 2017 by admin

Pain in midportion achilles tendon medially could be a Plantaris muscle rupture. Eccentric exercises for Achilles tendonitis will not help.

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Posted in ankle | Leave a comment

New -Mab Cuts Sickle cell crises in Half

Posted on March 1, 2017 by admin

Antibody biologic administered 14 infusions cut sickle cell crises from 2.98/yr to 1.63/year.

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Posted in sickle crisis | Leave a comment

Hopeless Case Of Lower Leg CRPS Helped by Pulsed Radiofrequency of Sciatic Nerve at Knee

Posted on February 26, 2017 by admin

Pulsed radiofrequency to dumb down treated nerve is becoming a useful adjunct to treating untenable pain CRPS states. Post hip fracture leg painv pain state left patient with VAS 6-7/10 with breakthru of 9/10.  Following dropped to 3/10 – after 8 months went back to 6/10 and was repeated and then down to 2-3/10.

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Posted in complex regional pain, foot, Leg Pains, neuropathic | Tagged | Leave a comment

Good Cane Use

Posted on February 26, 2017 by admin

In Dr. Travell and D. Simon’s book they talk about proper cane position:
– on opposite side to leg pain (it become good leg when you lift good leg)-shoulder horizontal with cane held out 15 degrees from body

Now additionally, 15% of your weight should be applied when using it.
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Posted in Knee, Mechanical aids | Leave a comment

Vertebroplasty Does Work For Vertebral Back Compression Fractures

Posted on February 26, 2017 by admin

Clin Cases Miner Bone Metab. 2016 Sep-Dec;13(3):234-236.
doi:10.11138/ccmbm/2016.13.3.234
Safety and efficacy of vertebroplasty in the treatment of osteoporotic vertebral compression fractures: a prospective multicenter international randomized
controlled study.
Leali PT, Solla F, Maestretti G, Balsano M, Doria C
https://www.ncbi.nlm.nih.gov/pubmed/28228788

  • 200 patients in each group (good study size)
  • VAS pain scores dropped from 4.8 to 2.3/10 within 24 hours (p <0.023)
  • 65%) treated with Vertebroplasty were able to stop any analgesia after 48 hours (p ≤ 0.0001)
  • Control group – pain medication, osteoporosis medication, physiotherapy or bracing – very little change
  • “Pain relief and improve mobility, functionality physics after VP
    are quick and significantly better in the near compared to non-surgical treatment.”

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Posted in Back Pain, Injection | Leave a comment

Kidney Stone – Renal Colic – Ketoralac and Nifedipine Superior to Ketoralac and Tamsulosin

Posted on February 25, 2017 by admin

Spanish journal which I do not get but results seem clear enough – ketoralac 60 mg ?IM and Nifedipine XL 30 mg by mouth give best results.

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Posted in Abdominal pain, Drugs | Tagged | Leave a comment

Bacterial Overgrowth and Irritable Bowel Syndrome (IBS) – What is the Hypothyroid/Levothyroxine Connection?

Posted on February 25, 2017 by admin

Hypothyroid victims on Levothyroxime have a 3 times relative risk to having bacterial overgrowth and the IBS connection that goes with it.

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Posted in Abdominal pain | 1 Comment

New Effective Treatment for Intractable Sore Mouth Mucositis

Posted on February 24, 2017 by admin

0.05% Methylene Blue oral rinse therapy was cheap and effective treatment for mucositis from chemotherapy or radiotherapy. Amazing result could be big help.

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Posted in Abdominal pain, Drugs, ENT, Injection, neuropathic, skin | 2 Comments

Reasons Why Vit D Helps Chronic Pain Coming Clearer – Vit D Genes

Posted on February 20, 2017 by admin

A Fokl DNA gene polymorphism in the Vitamin D receptor would reduce its sensitivity to vitamin D. Vitamin D supports many metabolic processes beyond calcium and gene variations are even associated with certain cancers.  In athletes, the FF Fokl genotype is found in 58.3% of those with pain and only 27.8% without with an enormous relative risk OR= 5.78.

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Posted in Back Pain, Drugs, Fibromyalgia, pain mechanisms, Uncategorized | Leave a comment

Can Pharyngeal GERD Be Cured?

Posted on February 19, 2017 by admin

Reflux into throat has a something in throat “globus “feel, throat clearing and annoying  cough. When ulcer “PPI”pills fail one author suggests injecting T5-6, 1 cm from spine, to influence sympathetic nerve trunks and gradually reset the nervous system – for relief.

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Posted in Abdominal pain, ENT, Injection | Leave a comment