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?

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.

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How to Smell a Dirty Rat Addict Prone Patient

Instead of treating pain patients, doctors have now been saddled with added responsibility of being a policeman for addiction prone patients. Part of the problem stems from fact that opioids only reduce pain on average by 1/10. Add- ons like cymbalta, pregabalin and gabapentin do little to help chronic back pain and sciatica. Despite some “raves” about marijuana, other studies have found help more marginal. So the non-interventional doctors, who may not even know what a quadratus lumborum is, might be tempted to push opioids beyond what is helpful.

I offer tongue – in -cheek advice on finding the addiction prone patient.
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Medial Knee OA Minimal Help by Lateral Heel Wedges

A 5° lateral heel tilt (comes out to about 5 mm lateral height) has been tried many times with mediocre results. They made it more likely by eliminating those with partellofemoral issues, and demanding a 2% reduction in KAM =external knee adduction moment (markers and 3d analysis needed for that). Still, drop in pain was […]

Isolated Lumbar Disc Disease Found and Treated

Isolated Lumbar Disc Disease Can be Determined by Non-Invasive Magnetic Resonance Spectroscopy (MRS) and Responds to Surgery. Non-Invasive Magnetic Resonance Spectroscopy scans for certain disc chemicals-  lactate (LA) and proteoglycan (PG), as quantifiable biomarkers for discogenic pain. It was found to have “total accuracy of 85%, sensitivity of 82%, and specificity of 88%. These increased to 93%, 91%, and 93%
respectively, in non-herniated discs” – when compared to provocative discography (PD).  Surgery to positive discs made it practical: :”when all MRS positive discs were treated, surgical success was 97% versus 57% when the treated level was MRS negative, or 54% when the non-treated adjacent level was MRS positive.”

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