ALTHOUGH I WILL NOW UPDATE THIS SITE, FOR PAST 6 MONTHS, BLOG NOTES (about 50) WERE PUBLISHED AT :
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I have recently achieved (previously unattainable) control in some of my chronic pain subjects using recent innovations – but to acheive this required use of multiple modalities at once.
Posted in arm, Back Pain, Botox, complex regional pain, Drugs, Fibromyalgia, Headaches, Injection, IV therapy, Leg Pains, Manual Med, myofascial pain, Neck, neuropathic, Pain Dystrophy, piriformis, post herpetic neuralgia, radiculitis, shoulder, Uncategorized
Over three minute pressure to occipital arteries can greatly relieve migraine pain in over 1/2 of cases; almost sounds too good to be true. Continue reading
Pain and spasm on the inside of the knee in adductors is not uncommon – – especially in the heavy set with stairs. A brutal stretch massage can relieve but takes effort and willingness of subject to deal with the pain.
Post thoracotomy pains have to be one of the banes of chest surgery occurring in high frequency. Now simple taping might reduce it.
POT’s is a syndrome where one is unable to maintain blood pressure standing and so often faint – and is often associated with attacks of tachycardia.
Finding this situation in a chronic pain patient, greatly complicates the situation, and makes pain recovery less likely. I find myself scratching my head about where to go.
- Association of POTS with autonomic neuropathy brings up issue that certain Fibromyalgia cases have small fiber neuropathy. Autoimmune mechanisms are involved and question lies, which ones would respond to IV gamma globulins or Plasmaphoresis – certainly the ones with frank Chronic Demyelinating Inflammatory Polyneuropathy (CIDP) but what about milder forms? Prednisone steroid pulses work in early CRPS and could help some autonomic neuropathy (certainly in CIDP) – but when to try? Measuring certain antibodies might help but in some situations testing is rare or unavailable.
- Association of a case of POTS with chairi malformation brings up association of certain FM cases with treatable chairi syndrome cases. Our MRI testing is either unavailable or untrustworthy.
- Large association of POTS with Ehlers-Danlos hypermobility syndrome makes pain issues much more likely. Saw one case of CRPS caused by superficial radial nerve injury from unstable distal radius. Does one dare try prolotherapy to an already painful site?
- Body- wide serotonin in POTS is low and POTS is associated with high suicide risk, adding a deeply troubling challenge to pain in POTS cases.
- Treatment of associated sleep apnea with CPAP may be complicated. Ordinary CPAP might not work and BIPAP might need to be tried. The anxiety that is associated might limit mask use and in one case, clonazepam 1 mg hs had to be used to reduce nightmares and ensure CPAP use.
- Cases are found of CRPS and POTS helped by treatment of bacterial overgrowth. Is this why Cefadroxil antibiotic cured one CRPS case?
- Using Naltreoxone dual opioid blocker /mild stimulator could help CRPS and POTS but how does one get subjects off opioids first?
- Rare POTS cases found deficient in thiamine, B12 and Vitamin D offer rare cures. These deficiencies also flare Fibromylagia. Treatment of the POTS with local measures and Flourinef and or Midodrine can help.
Antidepressants are poorly tolerated in elderly and DHEA, found to be low in elderly, has been found to help with depression. I suspect part of its effect is through androgen stimulation as some is converted to such. I have patients order DHEA from USA and have it sent C/O my office as I thought it would legitimize its import. Had a visit today from 2 men from Canada Customs who made it clear that wasn’t so.
Cost-utility Analysis suggests not. I am not a big fan of attributing chronic pain to anxiety-depression – (sorry Dr. Sarno)… Recent analysis suggests in osteoarthritis it is not cost -effective to spend special time on anxiety depression
Study did meta-analysis of multiple article and found at 1 or 2 months will drop pain by 1.1/10 with no difference between 100 or 200 units. Often there is significant inflammation around the knee – anserine bursa being an obvious one. Botulinum, not being directly injected into it would have zero benefits there. Steroid is very forgiving and would effect inflamed areas close by. I contend they should be both injected at same time.
I’ve always liked the anterior knee injection using a 2 inch needle but have had to accept the recent statistics put forth by Durolane injectable lubricant that lateral injection mid patellar is better
Awe inspiring case of chronic migraine headaches eliminated by pulsed radiofrequency (low burn) to a neck sympathetic ganglion.
Local steroid/local injections can greatly attenuate shingles and post shingles pain yet has received very little notice.
I wrote about it in a couple blog notes:
Alternate Approaches to Post-Herpetic Neuralgia (PHN)
Early Fix For Herpetic Zoster/Shingles – Inject the Spots With Local and Steroid
Now a controlled trial found pains in 12.8% of injection treated group versus 47.8% in the standard treatment group (P<0.001)
The most successful treatment for CRPS especially early is Prednisone. It is even used in wrist fracture situation. Yet this fact seems not all that well known as is the fact one should continue the course for 8 weeks. Needless suffering though ignorance.
Steroid injection of SI joints can be very helpful. It is more common than one would think as is seen in post-traumatic cases, in celiac disease, in various colitis, and in certain Fibromyalgia misdiagnosed subgroups. I highlight this study so patients can see its benefits.
Recent Article diagrammatically demonstrates where opioid deaths have been coming from
So spend less time looking at medical opioid prescriptions and more at illicit fentanyl trade. All doctors are now under tremendous pressure to cut their dose of opioids for chronic pain sufferers from organizations that feel they have to do something even when it is not the issue. Just don’t do something – stand there! (instead) cheap air max 95 cheap air max 95
Not a new study but the benefits mandated that I include it. Study presented were 2 cases in their 80’s with severe Post Herpetic Neuralgia – one on face, other T8-10 that tried everything including spinal stimulator without effect. Pain level was 10/10. Relief was gradually obtained by increasing doses of Nabilone, starting with 0.5 mg hs and working up over 1 year to 4 mg hs – got pain down to 4/10 without opioids. Having gone generic, cost is not prohibitive .
When I first started Botulinum injections I just just injecting intradermally the areas where they felt the pain. Then it became clear the trigger zone needed special treatment and subcut was more done. I used to have a researcher repeatedly email me for any updates on TN injections. Now there are some – Injecting the roots (origins) of the affected trigeminal nerve (II and III anyway), and injecting the muscle in the trigger zone.
Pisiform instability can cause nondescript pain over lateral hand eminence, and in some cases present with ulnar nerve damage. It is little recognized.
Growing evidence that some gluten sensitivity is actually sensitivity to the carbrohydrates in Gluten Foods rather than to gluten. None the less, avoiding gluten foods during colitis flareups, helps suggesting a temporary sensitivity.
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
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. cheap air max 95 cheap air max 95
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:
or you can read my version.
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.
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.
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.
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.
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.
This advice is being circulated and I’m putting it here so it won’t be lost in ensuing weeks.