Using Ultrasound Does Not Improve Shoulder Injection Results

Years ago, though they injected local in shoulder bursa, they injected the cortisone in the buttock and got the same results as injecting it it bursa. This study was ignored by people who wanted ultrasound to be better. Now, a randomized control trial did not find ultrasound versus landmark shoulder injection made any difference. Using US could be a lengthy procedure and I’m glad it is put to rest.
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Antidepressants May Lessen Benefits of Codeine or Hydromorphone

Codeine and hydromorphone need to be converted to an active form in the liver.  Anidepressants use the cytochrome CYP2D6 system in the liver and may cut down conversion and hence opioid effectiveness. This has been determined in post-operative pains in people on SSRI anti-depressants. However common antidepressants used in chronic pain –  amitriptyline, venlafaxine and duloxetine – all use the CYP2D6 system as well.

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Topicals For Pain Fair Poorly So Selection May be Key

I once went to a talk on treatment of neuropathic pain and much to speaker’s surprise I told him I hated that term.  Reason being, neuropathic pain with considerable peripheral sensitization (coming from the skin tissues) will respond nicely to neuropathic pain drugs like gabapentin but nerve pain syndromes coming from brain, spine of nerve root near spine ( sciatica) do not. Then comes along a study that lumps them all together – most probably spinally related and the notice no benefits from topical meds.  That is nothing nerve shattering – most neuropathies respond poorly to the same drugs orally – a study using drug combinations orally only got 23.7% significant response rate: I wrote about it here:
Severe Neuropathic Pain – Only 1/4 Respond to Standard Drug Protocols – What Else Is There?
http://painmuse.org/?p=2640

based on article:
Moulin, Dwight E., et al. .
Long-term outcome of the management of chronic neuropathic pain: a prospective observational study.
The Journal of Pain 16.9 (2015): 852-861.
https://www.jpain.org/article/S1526-5900(15)00703-8/fulltext

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