MedicineHouse.com SOTA OMOIGUI'S LAW OF PAIN The origin of all pain is inflammation and the inflammatory response.

What happens between injury and our perception of pain? This book is about the first unifying law of Pain that explains the origin of all types of pain: from Arthritis to Fibromyalgia and from Migraine to Sciatica.

Designed for quick access to pain drugs information, Sota Omoigui's Pain Drugs Handbook is a complete clinical guide in a handy portable format

As a synopsis of anesthetic pharmacology it is a useful review for the beginning trainee and the advanced practitioner. An all-time best seller, The Anesthesia Drugs Handbook has been translated into Italian, Japanese, Malaysian, Polish and Portuguese.

This booklet is written to guide those who suffer or know someone suffering from pain. It provides the most current information about the common painful syndromes, the right medications, useful herbs and various treatments that can be utilized in the home, clinic or hospital to successfully ease pain.

One of the best books on Self Improvement and Management ever published. Animals have been taking care of business much longer than humans and they do it with an instinct few humans possess.

The Universal
Drug Infusion Ruler

Drug Infusions Made Easy

To obtain a phone consultation from pain specialist, Dr. Sota Omoigui, click here.

MEDICAL PUBLICATIONS

Med Hypotheses. 2005;65(3):559-69
Cholesterol Synthesis is the Trigger
Omoigui S. MD.

L.A. Pain Clinic, Los Angeles, California, USA.

Read the full Article

Pain Med. 2005 Mar-Apr;6(2):149-51
Treatment of ptosis as a complication of botulinum toxin injection
Omoigui S, Irene S.

L.A. Pain Clinic, Los Angeles, California, USA.

Read the full Article

Regional Anesthesia and Pain Medicine 23 (4): 427, 1998
A Safer Technique for Epidural Lysis of Adhesions
Omoigui S. MD.

L.A. Pain Clinic, Los Angeles, California, USA.

Read the full Article

Anesth Analg. 1991 Mar;72(3):392-3
Blind nasal intubation with Audio-Capnometry
Omoigui S, Glass P, Martel DL, Watkins K, Williams KL, Whitefield SM, Wooten LL.

L.A. Pain Clinic, Los Angeles, California, USA.

Read the full Article

Medical News for Today

BREAKING NEWS!!!!!!:
New Breakthrough Biotechnology Treatment for Pain

Medical Publications U.S. Patents

Pain Med. 2004 Jun;5(2):229-30
Subcutaneous Injection of Anakinra
Omoigui S. MD.

Subcutaneous Injection of Anakinra in patients with shoulder pain due to Rotator Cuff Tendonitis and Subacromial Bursitis.

To the Editor

The pathology involving the rotator cuff is a spectrum ranging from simple inflammation as in rotator cuff tendonitis, subacromial bursitis and impingement syndrome, to rotator cuff tears. The management of rotator cuff pathology depends on various factors including the extent of the tear, and failure to improve after six months of conservative treatment. Initially, patients are treated conservatively with the use of non-steroidal anti-inflammatory drugs (NSAID), physical therapy and rest. The second line of treatment is injection of corticosteroids into the subacromial bursa. For unresponsive cases and for larger tears of the rotator cuff surgical intervention becomes the preferred treatment option.^3.We have treated numerous patients with rotator cuff pathologies using anakinra. We will provide a case report of one patient who presented with pain in his right shoulder after a fall. On examination, there was severe tenderness in the rotator cuff. There were no signs of joint dislocation or fractures. MRI of the right shoulder was ordered and findings were compatible with a complete tear involving the anterior aspect of the supraspinatus tendon adjacent to the intertuberous sulcus. He was subsequently given anakinra (Kineret) 100mg subcutaneously. On re-evaluation one week later, he gave the information that his pain dropped from a score of 9/10 to 3/10 within five minutes of receiving the injection. He received six more subcutaneous doses of anakinra over a period of five months. The first three doses were given once weekly, thereafter he got the injections at an average frequency of once a month. The range of motion in the right shoulder joint improved dramatically. Five months after initiating treatment, his range of motion had been fully restored from an initial value of forty degree of abduction. A subsequent MRI of the right shoulder shows no sign of the rotator cuff tear. However this MRI was done at a different facility and read by a different Radiologist.

The origins of pain are the biochemical mediators of inflammation and the inflammatory response. To treat pain, we must block these mediators and block the signals they send up through the nerve cells. A variety of mediators are generated by tissue injury and inflammation. These include substances produced by damaged tissue, substances of vascular origin as well as substances released by nerve fibers and various immune cells.⁴ In one study of patients with rotator cuff diseases, the levels of the cytokine IL-1 beta was significantly correlated with the degree of pain.⁵ In another study, the levels of IL-1 beta were significantly higher in the shoulder joints in patients with anterior instability and chronic inflammation of the joint.⁶ Immunohistological staining demonstrated the expression of Interleukin-1 beta (IL-1 beta), Tumor necrosis factor alpha (TNF-alpha), transforming growth factor beta (TGF-beta), and basic fibroblast growth factor (bFGF) in subacromial bursa derived from the patients suffering from rotator cuff tear.⁷ Anakinra is a form of the human interleukin-1 receptor antagonist (IL-1Ra) produced by recombinant DNA technology. In this and other patients that we have treated, we obtained complete pain resolution for significant periods of time with a subcutaneous injection of anakinra. These patients were able to avoid surgery and achieve full range of motion in their shoulders. Subcutaneous anakinra could obviate the need to administer intra-articular steroid injections for subacromial bursitis or rotator cuff tendonitis. The risks of a subcutaneous injection of anakinra are much less than an intra-articular steroid injection. Steroid injections are associated with myriad of local and systemic side effects while subcutaneous injection of anakinra is associated with a decreased immune response and increased risk of infection when the injection is administered daily as in rheumatoid arthritis. In patients with rotator cuff tendonitis and subacromial bursitis, we have only had to administer a single subcutaneous injection once every week to six months. Subcutaneous injection of anakinra becomes an exciting new option in the treatment of inflammatory pain syndromes such as rotator cuff tendonitis and subacromial bursitis.

Sota Omoigui M.D.

Sunday Irene MD

L.A. Pain Clinic, Hawthorne, California

References

1. Nirschl RJ. Rotator cuff tendonitis: basic concepts of pathoetiology.

Instr. Course Lect. 1989; 38: 439-45.

2. Santavirta S, Konttinen YT, Antti-Poika I, Nordstrom D.

Inflammation of the subacromial bursa in chronic shoulder pain.

Arch Orthop Trauma Surg. 1992; 111(6): 336-40.

3. Iannotti JP, ed. Rotator cuff disorders: evaluation and treatment. Park Ridge, Ill. American Academy of Orthopedic Surgeons monograph series 1991:5

4. Omoigui S. The Biochemical Origin of Pain: How a new law and new drugs have led to a medical breakthrough in the treatment of persistent pain. Hawthorne, CA. State-of-the-Art Technologies Publishers, 2002. p. 14-17

5. Interleukin-1-induced subacromial synovitis and shoulder pain rotator cuff diseases. Rheumatology (Oxford) 2001 Sep; 40(9): 995-1001.

6. Gotoh M, Hamada K, Yamakawa H, Nakamura M, Yamazaki H, Inoue A, Fukuda H. Increased interleukin-1 beta production in the synovium of glenohumeral joints with anterior instability. J Orthop Res 1999 May; 17(3): 392-7.

7. Sakai H, Fujita K, Sakai Y, Mizuno K. Immunolocalization of cytokines and growth factors in subacromial bursa of rotator cuff tear patients. Kobe J Med Sci 2001 Feb; 47(1): 25-34.