The Pain Source

By Chris Faubel, MD -- MRI certainly has a substantially valuable place in the diagnosis of patients with neuromusculoskeletal disorders; but the excessive ordering of lumbar MRIs are not only unnecessarily costly, but also lead to results that are misunderstood by patients, and can lead to a psychological fixation on those findings. Knowledge of the prevalence of lumbar spine pathology in the pain-free general population is important.

By Chris Faubel, MD -- Understanding nerve injury classification is essential for prognostic value clinically. Some basic anatomy, along with the two classification systems, and their corresponding EMG findings need to be learned and remembered.

The following information is NOT meant to be used to treat yourself or patients Generic name= Pregabalin Trade name = Lyrica Class = antiepileptic MOA binds to voltage-gated calcium channels and inhibits neurotransmitter release Advantages Efficacious against many neuropathic pain conditions Linear pharmacokinetics =...

The following information is NOT meant to be used to treat yourself or patients Generic name = Gabapentin Trade name = Neurontin Class = antiepileptic MOA binds to voltage-gated calcium channels and inhibits neurotransmitter release Advantages Relatively inexpensive Efficacious against many neuropathic pain...

The following information is NOT meant to be used to treat yourself or patients Generic name = Milnacipran Trade name = Savella Class = "antidepressant" (selective serotonin and norepinephrine reuptake inhibitors) Advantages Shown effective for fibromyalgia Dosing Fibromyalgia Day 1: 12.5 mg x 1 ...

By Chris Faubel, MD -- Five patients had radiofrequency ablation/neurotomy of various medial branches of the dorsal primary rami, causing denervation of the multifidus muscle at those levels. Atrophy of multifidi muscles has long been found in patients with chronic low back pain; and many believe the atrophy causes the low back pain in some patients.

The following information is NOT meant to be used to treat yourself or patients Generic name = Venlafaxine Trade name = Effexor, Effexor XR Class = antidepressant (selective serotonin and norepinephrine reuptake inhibitors) Disadvantages Not been shown to be effective in postherpetic neuralgia (PHN) ...

The following information is NOT meant to be used to treat yourself or patients Generic name = Duloxetine Trade name = Cymbalta Class = antidepressant (selective serotonin and norepinephrine reuptake inhibitors) Advantages Simple dosing Common adverse effects Nausea - can reduced with 30mg q...

  The following information is NOT meant to be used to treat yourself or patients Generic name = Nortriptyline Trade name = Pamelor Class = antidepressant (secondary amine TCA) Has been shown to be effective in the treatment of chronic pain in patients without depression,...

The following information is NOT meant to be used to treat yourself or patients Generic name = Amitriptyline Trade name = Elavil Class = antidepressant (tertiary amine TCA) Has been shown to be effective in the treatment of chronic pain in patients without depression,...