Pain

Chronic shoulder pain: comparison of acupuncture and conventional treatments

San Jose Care Resource Guide: Chronic shoulder pain can have many causes, the next link  Chronic Shoulder Pain: Part I. Evaluation and Diagnosis   will bring you to an detailed article from Kelton  M. Burnank et. al. on the the diagnosis of the various aspects of it.

•  rotator cuff disorders,
•  adhesive capsulitis,
•  shoulder instability,
•  shoulder arthritis

This article is quite technical: as the it  goes into the details of sub-categories of underlying illness or condition, , the complexities of the diagnosis of the causes of shoulder pain become apparent.

The classical treatments of such causes is described in another article by the same author.  Chronic shoulder pain: part II. Treatment.

Those treatments consist of

• Activity modification and analgesic medications
• physical therapy
•  Combined steroid and local anesthetic injections

Then: “…Symptoms that persist or worsen after six to 12 weeks of directed treatment should be referred to an orthopedic specialist…”

Cure or long term relief does not seem  a given.

Then come a method apparently more benign: accupuncture.  Accupuncture seems to have  some good rate of success according to an article in JAAPA   Chronic Shoulder Pain and Acupuncture Treatment. This article concluded:

“… A treatment series of 15 acupuncture sessions produced signifi­cantly greater pain relief than sham acupuncture or conservative treatment in patients with chronic shoulder pain not due to osteoarthritis or rheuma­toid arthritis…..”

Talk to your Doctor

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Sleep Remedies and Strategies in Fibromyalgia & Chronic Fatigue Syndrome

San Jose Care Resource Guide: Adrienne Dellwo has an interesting blog on Fibromyalgia, this time the topic is sleep problems  Click Here for link.

San Jose Care Resource Guide:  Here is a link to a study showing some help from  pregabalin (Lyrica)

San Jose Care Resource Guide: On an alternative note Hydrotherapy seems to also help sleep for FS patients, click here for link to Brazilian article in sciencedirect

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Aging: Pain and worry about health in older men and the CHAMP study

San Jose Care Resource Guide: Pain and health worry seem to be a common issue for older people. Here is a link to a study on a group of  1217 community-dwelling men in australia, aged 70years or older the CHAMP study, published in the pain journal. 

Results are interesting,quoting :

•  12.5% had persistent and intrusive pain,
• 22.4% were worried about their health,
• and 6.3% had anxiety.

Let us us rephrase this:

       Of the men studied,

•  87.5% did not have persistent and intrusive pain,
• 77.6% were not worried about their health,
• and 93.7% did not have anxiety

Remarkable! The Australian sun?

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Fibromyalgia: Comparative Effectiveness of Drugs

San Jose Care Resource Guide: The study we are linking you to is mostly about  pregabalin (Lyrica) and gabapentin (Neurontin). Study is from the Journal of Pain

The study’s conclusion is not enthusiastic:  “…We conclude that pregabalin and gabapentin are modestly effective for the treatment of fibromyalgia but that their long-term safety and efficacy remain unknown….”

Background:

• Pregablin/Lyrica                       click here for wikipedia article
• Gabapentin/Neurontin        click here for wikipedia article

Another  article from Medscape Today gives more detailed information about what the FDA approved for Fibromyalgia Treatments ”Recent Advances in the Treatment of Pain Associated With Fibromyalgia: FDA-approved Medications” Click here for article

Note the medscape article brings in SNRI ( Serotonin–Norepinephrine Reuptake Inhibitor) like duloxetine, milnacipran

That brings two classes of drug treatment against Fibromyalgia

• anti epileptic
• SNRI
  • The efficacy of SNRI sounds also moderate, click here for expert opinion in PubMed

Conclusions:  Some medicines are there  against fibromyalgia, but with moderate efficacy

Talk to your doctor..

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Severe Migraines: Injections of botulinum toxin (Botox) to prevent chronic migraine sufferers

San Jose Care Resource Guide: Botox has gained traction as a severe chronic migraine treatment. The Wall stree Journal has published an article on this. 

 San Jose Care Resource Guide: So, does it work?   Results are mixed but for some people it might help.

Quoting the WSJ: “…Botulinum toxin is a bacterial protein that scientists say blocks chemicals responsible for muscle contractions and pain….”

Let us go to the FDA’s anouncement of it’s approval of Botox as a treatment for certain kind of  chronic migraines, click here

Quoting the FDA:

“…Migraine usually begins with intermittent headache attacks 14 days or fewer each month (episodic migraine), but some patients go on to develop the more disabling chronic migraine. ….To treat chronic migraines, Botox is given approximately every 12 weeks as multiple injections around the head and neck to try to dull future headache symptoms. Botox has not been shown to work for the treatment of migraine headaches that occur 14 days or less per month, or for other forms of headache..”

Then again the FDA issued ”Drug Safety”  warnings about botulinum toxin treatments:

“Information for Healthcare Professionals: OnabotulinumtoxinA (marketed as Botox/Botox Cosmetic), AbobotulinumtoxinA (marketed as Dysport) and RimabotulinumtoxinB (marketed as Myobloc)” Click Here for FDA warning

Overview of the litterature:

1. Method of injection of onabotulinumtoxinA for chronic migraine ,  Headache Center of Southern California.  Quoting them:’..have yielded insight into appropriate patient selection, injection sites, dosages, and technique. Initial approaches used a set of fixed sites for the pericranial injections…” Mmmm.., pericranial injections.., that tells you that Botox injections method weeds out your casual migraine sufferers..
2. OnabotulinumtoxinA for treatment of chronic migraine: results from the PREEMPT 2 trial.
3. A double-blind comparison of onabotulinumtoxina (BOTOX) and topiramate (TOPAMAX) for the prophylactic treatment of chronic migraine
   1. ==>” ….OnabotulinumtoxinA and topiramate demonstrated similar efficacy in the prophylactic treatment of CM. Patients receiving onabotulinumtoxinA had fewer Adverse Events and discontinuations..”

Serious treatment for a serious problem

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Darvon and Darvocet Pulled From Market Over Heart Problems

SJCRG: Follow this link to the injuryboard. This is after a FDA request. Seems risks greater than benefits

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Fibromyalgia: Study shows music can help

SJCRG: This study from Spain entered in the ScienceDirect shows that “… The [fibromyalgia] treatment group reported a significant reduction in pain and depression at week 4 compared with the control group…”

Music Therapy

SJCRG: Note that the study doesn’t seem to care about which genre of music: From Bach to Beatles, whatever works for you….One of the key elements seems to be that there is some discipline and commitment  involved: “..Music interventions consisted of listening to music once a day for 4 consecutive weeks using two types of CDs…”  Abstract does not provide the duration of listening  per day , though.

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Fibromyalgia: Relationships among pain and depressive and anxiety symptoms in clinical trials of pregabalin (Lyrica) in fibromyalgia (Psychosomatics)

SJCRG: According to this study in Psychosomatics , Pregabalin (Lyrica) had positive effects on Fibromyalgia regardless of  the depression level of the patients. Points out to a “..direct analgesic effect..(MDLinx)…”

So much for Fibro being a mental health problem….

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Fibromyalgia: Herbs and Roots that could help (Dellwo,About)

SJCRG:  Adienne Dellwo has brought our attention to two natural supplements that could help people with Fibromyalgia Syndrome (FMS) or Chronic Fatigue syndrome (CFS):   

•  Theanine (a tea amino acid) Adrienne used it as a treatment for “ Essential Tremor” . Theanine sounds like the tea counterpart for caffeine. But they are very different. Theamine is a nutrient, and Caffeine is a  psychoactive stimulant drug.  See  Wikipedia on Teamine    and Wikipedia on Caffeine

The tea ritual helps too...

•  Rhodiola rosea ( golden root)  Adriennes uses Rhodiola to improve FMS  quality of life. You will find an  example of what rhodiola can do following that link to a Swedish study entered in the US NIH database.  Essentially anti fatigue properties

Rhodiola rosea: Look for the root

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Comments on “FDA clears Cymbalta to treat chronic musculoskeletal pain”

SJCRG:  Good news, more treatment options for chronic musculoskeletal pain! Here is the link to the FDA press release.   “..Cymbalta was first used to treat major depressive disorder in 2004..” 

SJCRG:  Very interesting is the FDA’s philosophy for drug approval for serious illnesses:

Quoting:  “..While these serious side effects have been associated with the use of Cymbalta, they have occurred in less than 1% of treated patients. There are a finite number of drugs available for the treatment of chronic musculoskeletal pain, all of which are associated with rare, serious side effects. There are patients in whom none of the available treatments are effective. ….

So let us do the math: According to the US Govn’t “..An estimated 1.5 million adults had rheumatoid arthritis in 2007….”
…so 15,000 patients are expected to come down with serious side effects.

 But  “..Since its initial approval, about 30 million patients in the United States have used Cymbalta..[for other conditions]..”  Let us do the math now for that larger population: 1% of 30 million= 300,000 patients with serious side effects!  half of the Multiple sclerosis popultation in the US!

Please do a careful risk/reward analysis with your doctor if you need Cymbalta, or any of these potent drugs….

Cymbalta is no free ride…

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