40 mg Depo Medrol into tender TMJ was no better off a month later than saline injection. The crystals of the steroid made 5 subjects temporarily worse which they pegged as very bad “adverse events”.
It looks like the only agents to maybe survive are topical amitriptyline and gabapentin and hormones estrogen and testosterone.
It is commonly taught that drug combinations should be used in chronic pain – the most common pain being chronic back pain. Now it has been shown that little is gained from that. Only combo worth mentioning was buprenorphine plus pregabalin – the former is difficult if insurers won’t cover. There are other options that require actually treating the patient.
Analysis of 3 country surgery stats for spinal stenosis found a 77% one year response rate but no benefit from fusion.
Came across a list of causes of shoulder pain causes and I found myself saying “where is the myofascial pain syndromes?”. As an example here is a cause of nonspecific shoulder pain in the elderly – the infraspinatus muscle and some results with just one needling on muscle:
I once wrote that ankylosing spondylitis (AK) was impossible to diagnose in women:
The Pain Diagnosis that Cannot be Made in Women – Spine Arthritis – Ankylosing Spondylitis
Blood work is rarely positive including ESR, CRP, and HLA B27; MRI imaging takes at least 10 years to show positive and radiologist are not very good at reading them. Finally, women have hypermobile SI joints by necessity re pregnancy and rarely show much stiffness. To make things worse, are those cases that have AK and hypermobility syndrome – their chances of diagnosis are low. 4 cases were diagnosed mostly because they were HLA B27 positive (unusual finding) and they had a family history of rheumatic disease
Seemed so practical, have included algorithm