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chronic pain

This tag is associated with 13 posts

The burden of unnecessary surgery: partial meniscectomy for degenerative tears no better than placebo

Arthroscopic knee surgery is big business in the United States. Arthroscopic partial meniscectomies alone cost $4 billion/year. Yes, billion. But do they work? I’ve written previously about arthroscopic surgery for a torn meniscus and how it adds nothing above and beyond physical therapy for people with arthritis. We also know that arthroscopic knee surgery for arthritis … Continue reading

Vaginal Valium is ineffective for pelvic floor muscle spasm

A common cause (possibly the most common cause) of both pelvic pain and pain with sex is spasm of the pelvic floor (the levator ani and obturator internus muscles). Some physicians have promoted vaginal Valium as a treatment. There is a retrospective study of 26 patients (which has all the inherent problems of small retrospective … Continue reading

Low-dose naltrexone for fibromyalgia is not standard of care

This week I saw an interesting tweet about low-dose naltrexone for fibromyalgia purporting that this therapy is “standard of care.” I’m not that surprised since I’m asked about it now and then. Google “fibromyalgia and low-dose naltrexone” and the Internet is awash with efficacy claims. Even Medscape, a physician education portal, has a post from … Continue reading

To cut isn’t always to cure: knee surgery, health care, and our love affair with the scalpel

An article, just published in the NEJM, caught my attention not only for the study results, but because of what is says in a between-the-lines kind of way about the American health care system. The study looks at arthroscopic surgery for a torn meniscus in people over the age of 45 who also have arthritis … Continue reading

The FDA’s new restrictions on hydrocodone are unlikely to solve any problem.

America consumes 80% of the world opioid supply (99% of the world hydrocodone supply), but has about 5% of the world’s population. If you don’t think America has some kind of opioid problem, then move along because this rational, evidence-based, experience-laden way in which I’m going to discuss opioid use and misuse will not interest you. … Continue reading

Abortion, health care, HPV, chronic pain: what I’ve learned from my most popular posts of 2012

I published 97 posts in 2012 and during the year my blog was viewed approximately 970,000 times.  I’m humbled that anyone took the time to read anything that I wrote. Some posts were read by a couple of hundred people and some posts by a couple of hundred thousand. I don’t think the writing on … Continue reading

The low oxalate diet and vulvodynia: how a case report becomes snake oil

Restrictive diets, the most common being the low oxalate diet, are widely reported in the lay press and on-line for vulvodynia (a chronic pain condition of the vulva). In one study, 41% of women with chronic vulvar pain reported trying a low-oxalate diet. The only problem? The low oxalate diet doesn’t work. How this diet … Continue reading

When the pain doctor has chronic pain

The title says it all. I am a board certified pain medicine physician and on many days I wondered if my pain was worse than my patients. I had chronic low back pain, like 23% of the population. I was stiff and in pain in the morning and as soon as I came home from … Continue reading

Probiotics for irritable bowel syndrome: what does the medical evidence tell us?

Irritable bowel syndrome (IBS) is a chronic gastrointestinal condition associated with abdominal pain and changes in bowel movements. It affects approximately 12% of the population, and in practices devoted to abdominal and pelvic pain (like my own), up to a 1/3 of patients have IBS. Irritable bowel syndrome is subclassified based on “typical” bowel movements: constipation … Continue reading

Michael Jackson, Conrad Murray, patient empowerment, and why sometimes doctors must say, “No.”

I am a big advocate for patient empowerment. My ideal patient is both informed and engaged in her health. I try and remember that there are not always hard and fast rules in medicine. While acute appendicitis should be treated with appendectomy, there are many chronic conditions can be treated in a variety of ways. … Continue reading

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