I have recently attended the annual Canadian Association of Orthopaedic Medicine conference, this year held in the big TO. As usual there were some excellent presentations and workshops, and I left feeling inspired and privileged to be working in musculoskeletal pain management. There was a lot of focus on nutrition: so much of pain can be attributed to the foods we eat! Also there was an excellent talk on genetic testing - knowing one's genome can help tailor treatment very specifically and even prevent certain problems/diseases from occurring. I presented a workshop on the hydrodissection of peripheral nerves using 5% dextrose under ultrasound guidance, along with a colleague, Dr Jag Gupta. This was well-attended, showing the interest in treating neuropathic pain without using drugs which have many side effects (aka brain fog). Dr Gordon Ko organised a terrific conference and I hope to incorporate new pearls of wisdom into my practice!
After reviewing the medical literature we have decided to offer medical ozone injections to relieve painful joints. We are excited at this addition to our practice as it is yet another excellent option for the treatment of pain. It has been used for many years in Europe with success, and there are many studies on its use and effectiveness in the literature. We will be posting some of these under our research page in the near future. Medical ozone is injected into the affected joint following a local anaesthetic injection and is well-tolerated.
David and I have enrolled in a recent pain management certificate program at the University of Alberta. We never stop learning! Things have certainly changed since we were undergraduates. Over the next couple of years we'll be participating "virtually", attending "e-classes" and online lectures, submitting assignments electronically, searching virtual libraries and accessing a wealth of material, adding citations with a computer-generated program that automates the process so quickly, and best of all, able to enjoy Victoria instead of the frozen north!
Botox injections can provide very effective relief from migraine. If you have an extended medical plan this treatment may be more affordable than you think. Botox is thought to mediate pain by blocking the release of substances our bodies make (CGRP) which cause pain, as well as by relaxing some of the tense muscles around the face and neck. It prevents or lessens migraine intensity and frequency for at least 3 months before it needs to be repeated again. The procedure involves very superficial injections with tiny needles and is tolerated well and doesn't take long. Relief is in sight! Note: this is a preventative treatment meaning if it is effective, you won't suffer nearly as many migraines during the 3 months after treatment.
An interesting study was published recently. Having a knee arthroscopy (a surgical procedure with a "telescope" looking into the knee, and cleaning out any part that is rough or loose) does not improve pain. Many, many people suffer from knee arthritis and so this is helpful in deciding on a course of action. Having a knee replacement may be the eventual answer, but in the mean time regenerative injections (perineural injecting of dextrose, or prolotherapy, or PRP) can be a big help in reducing symptoms, and may even prevent the "kneed" to do surgery at all.
The University of BC regularly sends out articles by physicians who have found some aspect of medicine has changed the way they practice. I have been meaning to send them my views on the subject and here they are! Thank you to the many patients over the years who have taught me so much about the treatment of pain.
Most physicians like to see evidence of any medical therapy before they embrace or promote it. This is the world of research, which is often not clear cut but at least gives us guidance about what works and what doesn't. Recently we met up with a colleague in BC who is studying the effect of prolotherapy for TMJ or temporomandibular joint syndrome, aka painful jaw. The study is on-going and won't be published for at least a year, but the results thus far are very promising. Most of the patients who were in the non-prolotherapy arm of the study opted to have prolotherapy after their involvement in the study was complete, as they hadn't benefited from the "blinded saline" injection to the same extent as the "blinded dextrose" group. This shows that the proliferative effect of concentrated dextrose into damaged joints is effective, leading to healing and of course less pain - our goal! We have updated the research section of the website, and for your interest and information you can look at these studies near the top of the Links page. Some of the researchers are Jack Taunton, well-known Vancouver sports injury clinic physician, Dean Reeves, "father" of prolotherapy research collation, and David Rabago (and the late Jeff Patterson) of the University of Wisconsin, home of the Hackett Hemwall Patterson Foundation whose teaching of prolotherapy is first class. We have met several of the researchers in the world of prolotherapy and they are enthusiastic about this simple, elegant and effective treatment.
In March 2015 David and I attended a workshop in Vancouver on this muscle testing technique. David Weinstock has found that musculoskeletal pain is often related to muscles being "out of sync" with each other, and he has developed a muscle testing system that helps to identify specific problems, and then has a method to "reboot" the system with a specific time-frame of opportunity for these muscles to learn how to function correctly. The brain (the motor control centre) learns new patterns and often the pain is diminished or goes away.
In March 2015, David and I travelled to Honduras, to the village of Tela, to spend 2 weeks at a medical mission for people with chronic pain. We gave prolotherapy injections to many needy and willing recipients. The people of Honduras are so gracious: first the support team to run these clinics is second to none, and the patients who have so little (and line up for long hours and often travel many miles to come) are so grateful for anything we can do to help relieve their pain. We treated many people with arthritis, injuries, and poorly healing conditions and also benefited ourselves by being surrounded by other fantastic volunteering physicians, including a first rate teaching team. We are all better injectors as a result of these experiences. We salute the Hackett Hemwall Foundation who has been running humanitarian relief work in Honduras (prolotherapy, vein clinics and an ear, nose and throat team) for many, many years. We had the privilege of working under Dr Carl Osborn from Oregon, who celebrated his 20th year of this volunteer work. He is an excellent teacher! (see photo below - Carl is in the brown scrub top below). OK, so we had a bit of time to relax too...
Jannice is a family physician with an interest in the treatment of pain. Anything to help the process is added to this blog.