Brachial and lumbosacral plexus

While spinal nerve impingement can cause shooting arm or leg pain, many patients have instead pain from nerve entrapments. Common entrapments include Alcock canal, carpal & tarsal tunnels, meralgia paresthetica, and more than 50 others. Treatment starts with accurate diagnosis by specialist physicians familiar with the complex nerve anatomy and ultrasound visualization of the nerves.…

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Drug-herb-gene CYP2D6 interactions

Several pain medications require the liver enzyme CYP2D6 to become active. But some herbal supplements & medications can interfere with this enzyme. Patients on these medications should consult with a doctor before starting herbal supplements. Drugs activated by CYP2D6 Hydrocodone Oxycodone Codeine Tramadol Drugs deactivated by CYP2D6 Amitriptyline Nortriptyline Desipramine Duloxetine Venlafaxine CYP2D6 inhibitors Drugs: Bupropion Cimetidine…

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Drug-herb-gene CYP3A4 interactions

The liver enzyme CYP3A4 is the key body mechanism for metabolizing pain medications. Patients who take pain medications must be aware that drugs, herbs, & genes can complexly alter CYP3A4 activity. Ask your doctor before making changes. Drugs metabolized by CYP3A4 Fentanyl Buprenorphine Oxycodone Methadone Diazepam Midazolam Alprazolam Metoprolol Losartan Amlodipine Rivaroxaban Dabigatran Apixaban Tacrolimus CYP3A4…

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Fibromyalgia

Patients with fibromyalgia experience chronic, diffuse pain across the body, due to exquisitely sensitivity of the brain & spinal cord (“central sensitization”). The keys to relief are prompt diagnosis, interdisciplinary pain care, & not overlooking co-existing pain conditions. Total body pain The best way to describe the experience of fibromyalgia is total body pain including a…

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Diet and pain

While the science of nutrition continues to evolve, I have seen many patients with pain profoundly improve after making one of the following dietary changes. Such changes are low-cost, & are low-risk when made under medical guidance. Patients with chronic pain may find it worthwhile to try one or more of these diets. Gluten-free diet…

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Lumbar radiculopathy

The vertebrae, which protect the spinal cord and spinal nerves, through daily activities experience normal wear-and-tear. Sometimes this causes slight impingement of nerves, in turn causing spinal nerve inflammation and shooting pain down to the feet. Radiating back pain Back pain that shoots down the leg into some (not all) toes can be due to lumbar…

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Cervical radiculopathy

The vertebrae, which protect the spinal cord and spinal nerves, through daily activities experience normal wear-and-tear. Sometimes this causes slight impingement of nerves, in turn causing spinal nerve inflammation and shooting pain down to the hand. Radiating neck pain Neck pain that shoots down the arm into some (not all) fingers can be due to cervical…

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Lumbar facet arthropathy

Axial low back pain is often due to arthritic pain of spine facet joints, which sustain wear-and-tear from daily activities. The joints can hurt and cause pain across the low back. Ablating the small “medial branch nerve endings” to the facets can help kick-start recovery. Axial low back pain Axial low back pain — involving only the back…

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