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Pain reduction, relative to placebo treatment was, 14% for nortriptyline (95% CI = [-2%, 30%]), 7% for morphine (95% CI = [-8%, 22%]), and 7% for the combination treatment (95% CI = [-4%, 18%]). This was a double-blind, randomized, 2-period crossover trial of topiramate (50 to 400 mg) and diphenhydramine (6.25 to 50 mg) as active placebo to assess the efficacy of topiramate.

Mean doses were: nortriptyline alone, 84 ± 24.44 (SD) mg/day; morphine alone, 62 ± 29 mg/day; and combination, morphine, 49 ± 27 mg/day plus nortriptyline, 55 mg ± 33.18 mg/day. Each period consisted of a 4-week escalation, a 2-week maintenance at the highest tolerated dose, and a 2-week taper.

There is no need to go too deep as dispersion seems fast (some can feel it going up and down spine though I am not sure this is not placebo effect).

Side effects I have seen have included one sore throat. The shots work and give the patient a false sense of being “cured”, though the pain will return by three months.

I find Enbrel so helpful that at times I have paid out of my own pocket for a patient’s shot.

Without the epidural steroid enhancements potentially in Tobinick’s studies, I find it will give me at least a 2-3/10 pain reduction lasting 3 months.

However, where ever I go to a conference this moron study is quoted because it was “randomonized and controlled” – they don’t mention it ignored all previous experience re requiring more than one shot.

The leg triggers are often in piriformis, gluteal musclses, lateral calf, and posterior tibialis.



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