Successful Abatacept treatment for an autoimmune disorder that causes painful and swollen joints

Source of Featured Image:

Dear Pain Matters readers,

I am sure that you will enjoy this story about Karla as much as I did!

Genome testing has changed Karla De Lautour’s life and helped scientists understand her autoimmune condition (21/5/2020)

Quoting her rheumatologist, Dr Davinder Singh-Grewal,

“[Karla] had a lot of pain [due to painful and swollen joints], she was stiff every morning and it really was affecting her ability to live a normal life.” 

Enter Professor Chris Goodnow and his team at Sydney’s Garvan Institute who not only found a single fault in her genome, but also knew that an existing drug, Abatacept, could target the problem.

When Chris Goodnow met Karla for the first time (after successful Abatacept treatment), he was overjoyed to find Karla transformed into “a fantastic, chirpy, totally normal, 7-year-old”, thanks to his team’s research.

Not only does Abatacept directly target Karla’s painful autoimmune disorder, but it is also much easier for her to tolerate.

Karla now has an Abatacept infusion once every 2 weeks that offers her pain relief.

In closing, her rheumatologist said,

“Had they not sequenced the genome, [Karla] would have continued on in pain.”

Karla added,

“It feels better because it makes my pain go away and it feels comfortable.”

What could be better than this??

I hope you enjoyed this heart-warming story about Karla.

Sabina Walker

Blogger, Pain Matters (



Abatacept (brand name Orencia) is part of a new class of medicines called biological disease modifying antirheumatic drugs (biological DMARDs or bDMARDs).

Abatacept blocks T cell (a type of white blood cell) responses. This leads to reduced inflammation, less joint damage and, best of all (from a patient’s perspective), decreased pain, swelling and other symptoms.

Abatacept is offered as a drip (infusion) into the vein. Alternatively, it is given as an injection under the skin of the abdomen or thigh (subcutaneous injection). The infusion usually takes 30 minutes. Additional doses may be given every 2 – 4 weeks after the first dose.


(1) Lloyd, Mary. Genome testing has changed Karla De Lautour’s life and helped scientists understand her autoimmune condition. ABC News (21/5/2020).

(2) Abatacept. Arthritis Australia


Enbrel (Etanercept) for CRPS – Professional Footballer, Nazair Jones, and his CRPS Story

Feature Image of Nazair Jones, Professional Footballer, sourced from:

Dear Pain Matters readers,

Here is a patient story that may inspire, empower and offer hope.

This story is about a footballer named Nazair Jones who developed CRPS at only 15.  Amongst many treatments, Nazair received regular injections of Enbrel (Etanercept) and physiotherapy.  Details follow:

As a teenager, Nazair Jones always enjoyed playing football and basketball.  Unfortunately, his passion for competitive sports led to a number of injuries including torn anterior cruciate ligaments, shoulder surgeries and broken limbs.

On 5 November 2011, Nazair Jones (then 15) woke up to a body inexplicably paralyzed from his waist down.  He could not get out of bed to go to the bathroom.  His body was frozen in agony and he could not move his legs due to excruciating pain.

Quoting Nazair,

‘On a scale of 1 to 10, the pain was a 12.’

Terrified, he yelled to his mom for help.

In Nazair’s words,

 ‘It’s hard to explain…It was a shock…In my head, I’m saying ‘Walk.  Walk!  Why aren’t you walking?’  It was scary.’

Nazair’s mom called an ambulance to take him to Emergency.  He was discharged shortly after receiving an injection for pain.

Sadly, Nazair’s pain came back with a vengeance.  He was given injections including an epidural for pain.  Despite ultrasounds of his legs as well as nerve and blood tests, no one knew why Nazair had severe pain or why he could not walk.

Nazair’s ankle was extremely swollen.  The swelling would switch from one ankle to the other the following morning.  His swollen leg would also sweat profusely even while lying down.

In Nazair’s words,

‘They didn’t know what was wrong with me.  That was the worst part.’

Nazair was finally diagnosed with CRPS in December 2011.  He required a cane, a walker and ultimately a wheelchair for mobility. Doctors were unsure if he’d ever walk again, let alone play football again.

Despite his pain including allodynia* and mobility issues, Nazair never forgot his dream of becoming a professional footballer.

Motivated by his dream, Nazair started daily physiotherapy including walking exercises in the pool and mirror therapy.  Despite pain medication including ibuprofen, he suffered excruciating pain.  It would take Nazair an entire 30 to 60 minutes just to walk around the hospital floor.

Quoting Nazair,

It sounds easy to take a lap, but it was, by far, the worst pain.  You’re trying to get your body to do something—you want it to do it—but it’s just not doing it. You’re forcing yourself to move, and it just hurts. I can’t even explain the hurt. It just hurts … with all of that swelling, that was the most painful part …’

In 2013, Nazair started receiving weekly Enbrel (Etanercept) injections to manage the swelling in his ankles.

The good news is that Nazair was finally able to walk on his own again in May.  Two months later in July, he started playing sport again.

In his words,

‘… I just know I’ve been able to be myself with no pain.(Adelson, 2016; Adelson, 2017; Dunne, 2017; Supportive Care Matters, 2018).


Wishing all pain patients inspiration, hope and empowerment

Sabina Walker

Masters Appl. Science (Neuroscience)

Blogger, Pain Matters (in WordPress)


Author of soon-to-be published book called Pain Matters 




* Allodyniis pain caused by a stimulus that is usually not painful.


(1) Adelson, Andrea. UNC DL Nazair Jones was nearly paralyzed five years ago. ESPN (28 Sept 2016).

(2) Adelson, Eric. NFL draft prospect Nazair Jones on his rare disease: ‘On a scale of 1 to 10, the pain was a 12.’ Yahoo Sports (7 April 2017).

(3) Dunne, Tyler. Unable to Walk at 16, UNC Lineman Naz Jones Is About to Get Drafted into the NFL. Bleacher Report (6 April 2017).

(4) Supportive Care Matters. Nazair Jones Goes from Chronic Disease to NFL Hopeful (2018).

Surgery to Remove Schwannoma Leads to Relief from Tumour Pain in Face

Feature Image of a woman holding her face in her hands is sourced from:

Dear Pain Matters readers,

When severe pain is caused by tumours, benign or cancerous, surgery including stereotactic radiosurgery to remove the tumour may be the most effective way to reduce or eliminate tumour-induced pain.

A Decade of Severe Facial Pain Caused by an Undiagnosed Tumour

Stereotactic Radiosurgery of Schwannoma Leads to Pain Relief

Michelle Ellerbe, married and mother of 2 daughters, suffered a decade of severe facial pain.

Michelle’s excruciating pain started on the right side of her face in 2008 after giving birth to her second child.

In her words,

‘I felt a sharp pain radiate from my right ear to my right nostril … The whole day, the pains got worse. … I went to emergency … They told me I had Bell’s palsy, gave me steroids and sent me home.’

During her next emergency room visit a week later, she undertook numerous tests including MRI, CT scan and blood tests – but still no correct diagnosis.

Despite seeing countless doctors, taking ‘too many pain pills’ (ibuprofen, oxycodone, morphine, methadone and Dilaudid) and antiseizure medication and undergoing multiple surgeries and procedures (e.g. Gamma Knife procedure, nerve blocks), Michelle’s facial pain persisted more than 2 years.

A doctor diagnosed trigeminal neuralgia while another doctor performed a glycerol nerve block, to no avail.  A neurosurgeon performed craniotomy while an oral surgeon extracted all of her teeth on the right side of her mouth, all without success.

In Michelle’s words,

‘I was broken.  Everyone started saying they can’t help me, and kept giving me more medication.  I was taking 22 pills a day to show up at work. … I thought I was going to die from an overdose.’

Then one day, Michelle saw Dr Philip Stieg, a neurosurgeon in New York.  After diagnostic imaging, Dr Stieg found a tumour, specifically, a Schwannoma around her trigeminal nerve.  Usually benign in nature, a Schwannoma is a nerve sheath tumour that develops from the Schwann cell.

Whilst dismissed as ‘calcification’ on an older CT scan dated 2013, this (growing) tumour was (likely) the source of her severe facial pain for a decade.

Stereotactic radiosurgery was done to eliminate the tumour.  After 3 radiation therapy sessions, Michelle reduced her daily intake of pain pills from 22 to 7, and later on, a maximum of 2 pain tablets a day.

Whilst Michelle still has some residual pain due to nerve damage caused by all the past surgeries and procedures, her quality of life is significantly improved.

In Michelle’s words,

‘I’m off all of that medication …this summer, … I will be on a beach or sitting in a park with my family enjoying the breeze pain free!’

For more details, please see:

Michelle Ellerbe’s Story

NewYork-Presbyterian (2019)


Tumour facial pain may be effectively treated via surgery including stereotactic radiosurgery to remove the tumour.



Wishing all pain patients inspiration, hope and empowerment

Sabina Walker

Masters Appl. Science (Neuroscience)

Blogger, Pain Matters (in WordPress)


Author of soon-to-be published book called Pain Matters 




A SINGLE Perispinal Etanercept Injection by Edward Tobinick MD for Severe Nerve Pain including Sciatica and Post-Stroke Pain (2/2)

Feature Image sourced from:


Dear Pain Matters blog readers,


Infliximab, Etanercept and other selective anti-TNF drugs are sometimes used to treat:

  • Lumbar radicular pain;
  • Sciatica;
  • Post-stroke pain;
  • Complex regional pain syndrome (CRPS);
  • Rheumatoid arthritis;
  • Crohn’s disease; and
  • Other painful conditions.

This blog post explores the pain-relieving effects of a single perispinal Etanercept injection in certain patients with sciatica, post-stroke pain and other severe nerve pain.

An earlier blog post discussed anti-TNF drugs (Infliximab) for CRPS:

Anti-TNF Drug (Infliximab) Therapy for CRPS and Other Chronic Pain Conditions (1/2)

A Single Perispinal Etanercept Injection for Pain in Back (Sciatica), Neck and after Stroke – 9 Patient Stories

A handful of pain patient stories (N=9) were selected from the Institute of Neurological Recovery’s (INR’s) website (that has over 300 patient videos).  This website also includes media stories, a blog and countless scientific publications by Dr Tobinick and his peers (see References).

Please note the following disclaimer quoted from Dr Tobinick’s Patient YouTubes: 

‘Disclaimer: Individual results vary, not all patients respond. Additional doses may be necessary to maintain the clinical response. Treatment for these indications is innovative (“off-label”). The method of off-label treatment utilized is a patented invention of the INR®.’


(1) Kerry and Her Single Perispinal Etanercept Injection for Severe Leg and Back Pain

‘Kerry’ (not her real name) had intense right ankle, leg and back pain including burning pain for 6 months nonstop.  She walked very slowly with an abnormal gait to prevent the pain from shooting down her leg.  Her sleep was severely compromised.

Kerry was offered a single dose of perispinal Etanercept by Dr Tobinick at the Institute of Neurological Recovery, Florida, on 11 September 2009.

Kerry was immediately pain free at rest!  When her right leg was gently lifted, there was only a little pain. She said that this was likely due to not doing enough stretching exercises.   Kerry did not have pain in her buttocks nor lower back and her gait was vastly improved.

In Kerry’s words, ‘I feel good!  Thank you.  Yeah, I feel good.’

At her follow-up 2 weeks later on 25/9/2009, Kerry said that she felt excellent.  She slept well and was able to do all her normal activities.

Kerry attributed her complete recovery from pain and mobility to her single dose of Etanercept.

For more details, please view Immediate and sustained relief from severe pain (a 4-minute YouTube dated 25/11/2009 by the Institute of Neurological Recovery, Florida).


(2) Ana and Her Single Perispinal Etanercept Injection for Severe Back and Leg Pain

‘Ana’ (not her real name), a woman with a warm Spanish accent, suffered constant severe back and leg pain for 2 years.

Ana’s unrelenting pain affected her mobility and sleep.  Her husband had to help put on her shoes and underwear.  Ana tried different pain medications including Tramadol, Vicodinand Naproxen without success.  Ultimately,Ana lost her job because of her ongoing pain.

Ana booked an appointment with Dr Tobinick at the Institute of Neurological Recovery, Florida, on 4 May 2009. While seated during the examination, Ana’s left leg was gently raised.  This resulted in increased pain in her back that spread down her left leg. It was impossible to lift her other leg due to excruciating pain.

Thereafter, Ana received a single dose of perispinal Etanercept.  Three minutes afterward, Dr Tobinick stated,

‘All right now. … The dose was at 9 minutes after 4, and this … is 3 minutes [later].  What is happening?’

Ana said, ‘I can move my legs!  [She laughs, with tears of joy in her eyes.]  Oh God! Oh God!’

Dr Tobinick asked, ‘Is this different?’

‘Oh yeah!’, she exclaimed.

He continued, ‘When was the last time you felt like this?’

Ana replied, ‘I don’t know, about 2 or 3 years ago.  Oh my God! … I can’t believe this!  Two years of pain … Oh my God!  Wow!  You’ve given my life back!

Dr Tobinick asked, ‘What do you think?’

She tearfully said, ‘Thank you!’

Dr Tobinick continued,

‘How do your legs feel? … Before, it was hurting.’

She happily replied, ‘Oh, thank you … I have legs!’

He added, ‘Can you walk?’

She said, ‘Oh my God!’

Dr Tobinick said, ‘How do you feel?  Let’s go down the hall.’

Ana said, ‘Oh my God! … This is incredible!  Oh God.’

He asked, ‘Did it work?’

She enthusiastically replied, ‘Yes!! … Thank you so much!’

Ana (and her husband) had a follow-up visit with Dr Tobinick a week later on 11 May 2009.

Ana’s husband exclaimed,

‘… This is another person.  That was not her … I got her back! … The smile! … She’s alive! … She’s getting back into the game … She’s moving!’

Ana had another follow-up visit with Dr Tobinick 3 months later on 14 August 2009.

Dr Tobinick asked,

‘What kind of difference has this [single dose of perispinal Etanercept] made for your life?’

Ana replied, ‘Tremendous! … I’m holding my grandson and playing with him … I can have him in my lap and play with him. … And enjoy it!  I wasn’t able to do that before!  I’m doing a lot better!’

Dr Tobinick said, ‘Wonderful!’

‘Thank you, Dr Tobinick!’

‘You’re welcome!’

For more details, please view Immediate relief of 2 years of constant back pain and sciatica (an 8-minute YouTube dated 25/11/2009 by the Institute of Neurological Recovery, Florida).


(3) Brenda’s Single Perispinal Etanercept Injection Brings Fast Relief from Severe Sciatica

A young woman named ‘Brenda’ (not her real name) had a slipped disc in her 4th vertebra and severe sciatic pain for 5 months since December 2008.  Her gait was affected and she had severe pain from the right side of her lower back and buttocks that spread down both legs.  There was unbearable pain in her right leg down to her toes and less pain in her left leg.

Brenda was given Vicodin, steroids and morphine injections for her pain, to no avail.  When she was rushed to hospital for severe back pain (several times), the neurosurgeon told her that she needed emergency back surgery.

When Brenda went to see Dr Tobinick on 21 April 2009, he confirmed that the pain on the right side of Brenda’s back worsened when her left leg was lifted.  Thereafter, Brenda was offered a single dose of perispinal Etanercept.

Within only 1 minute after her injection, Brenda’s knee no longer hurt!  There was no pain in her back even as she lifted both legs.  When she stood up to walk around, there was nil pain and her gait was normal.

Happy to finally be pain free, she started dancing!

When asked by Dr Tobinick, ‘How much pain do you have?’

She replied, ‘I don’t have any pain!’

He confirmed, ‘Your pain is all gone?’

She answered cheerfully,

‘I’m not in pain!  Nope, I’m not in pain!  Nope! I’m good!  Before, I couldn’t stand on this leg … I feel good!  I feel great!’

For more details, please view Rapid relief after 5 months of severe sciatic pain (a 5-minute YouTube dated 7 Jan 2016 by the Institute of Neurological Recovery, Florida).


(4) Tim’s Single Perispinal Etanercept Injection Offers Relief from Sciatica in Minutes

‘Tim’ (not his real name) went to see Dr Tobinick on 4 April 2007 for severe sciatica.  The intense pain was constant and unbearable for 3 weeks and affected his work, quality of life and sleep.  He had pain in his back and buttocks that extended down his left leg to his calf.

In Tim’s words, ‘It feels like somebody took a baseball bat and hit my leg.’

The pain increased in Tim’s left (not right) leg when Dr Tobinickgently moved his right leg.  Tim’s pain was more intense when seated and it lessened when he stood up.  He was able to walk ‘with a slight limp but real slow … real gently’.

Tim had pain relief within a 1 minute after Dr Tobinickinjected Etanercept perispinally.  

In response to Dr Tobinick’s question about how he was feeling right after the injection, Tim replied,

[The pain] feels kind of pulsating right now … down my leg.  It’s not a constant pain like it was.’

Dr Tobinick replied,

‘… So [the pain has] changed in character a little bit … already’

‘Correct,’ Tim replied.  ‘I feel it in my butt still but not down the leg.’

Dr Tobinick confirmed, ‘But you feel it in your lower back and in your butt?’ 


Dr Tobinick continued, ‘But you’re starting to feel a little bit more comfortable … in general?’


 ‘… And your leg?’

‘It’s a miracle.  It’s amazing.’

‘You’re walking a lot faster … Wow!’

Tim replied, ‘Yeah I’m loving this stuff.  Once again, it worked!’

Dr Tobinick phoned Tim 3 months later on 3 July 2007 to follow up.

‘I’m wondering now how you’re feeling?’

Tim replied, ‘I am feeling like a million bucks, doctor!’

Pleased for his patient, Dr Tobinick said, ‘I love it!’

Tim continued,

‘… By the time I got back to UCLA that day [of the perispinal Etanercept injection], I was better … You would have never known I had a back problem! …’

Dr Tobinick said, ‘That’s fantastic! … You know, you had some very interesting findings. That finding of moving your right leg, making your left leg hurt, that’s a very specific finding that indicates inflammation of the nerve root.  And so, it was clear what we were treating.  And that, of course, got better, very quickly … So, it’s very interesting, scientifically … You’re better, and you didn’t have to have surgery!’

Tim replied, ‘Yes, I am too. That’s wonderful stuff you got there.’

For more details, please view Improvement within minutes in sciatica (an 8-min YouTube dated 12 Nov 2009 by the Institute of Neurological Recovery, Florida).


(5) Gerry’s Single Perispinal Etanercept Injection Offers Pain Relief in Minutes after 5 Years of Sciatica

‘Gerry’ (not his real name) suffered from sciatic pain for 5 years nonstop.  In his words, he had pain ‘every day, all day’.  Gerry tried different treatments including chiropractic and decompression treatments.

Dr Tobinick treated Gerry for sciatica via a single dose of perispinal Etanercept.  It took ‘just a few minutes’ for the Etanercept to offer lasting pain relief (as confirmed at the follow-up 2 weeks later on 9 July 2009).

For more details, please view Relief in minutes after 5 years of constant pain (a 1-min YouTube dated 6 January 2016 by the Institute of Neurological Recovery, Florida).


(6) Mirabelle has Improved Hand Strength After A Single Dose of Perispinal Etanercept

‘Mirabelle’ (not her real name) suffered ongoing and never-ending severe pain for 15 years.  Walking and standing up caused pain in her hips and low back.  Mirabelle had pain in both hands.  Her left hand was weaker and more painful than her right hand ever since her ski accident in 1986 or 1988.

Mirabelle was seen by nearly 30 different doctors including 10 or 11 pain specialists.

During her appointment with Dr Tobinick, Mirabelle received asingle dose of perispinal Etanercept.

When followed up 2 weeks later on 24 October 2007, Mirabelle had significantly more strength in both hands, compared to before Etanercept injection.  Her hands no longer had ‘that arthritic feeling’ (that she felt for weeks).

While there was some residual muscular pain, Mirabelle no longer had neck pain, post-Etanercept.

For more details, please view Hand improvement after treatment at the INR in 2007 (a 6-min YouTube dated 6 January 2016 by the Institute of Neurological Recovery, Florida).


(7) Caroline’s Sole Perispinal Etanercept Injection Relieves 25-Year Pain in 10 Minutes

At follow-up on 15 July 2009, 2 weeks after ‘Caroline’s’ (not her real name) single injection of perispinal Etanercept, Dr Tobinick asked,

‘What happened [after this injection]?’

Caroline replied, ‘… I got up … I felt … so much taller … I felt … this wonderful feeling … I stood up and it was just great … I was elated because Ihave been in pain for sooo long … [The pain was] like a knife going through you …’

Dr Tobinick continued, ‘And how long did you have the pain?’

Caroline answered, ‘Oh, I’ve had the pain … I started maybe 25 years ago …’

He asked, ‘How long?’

Caroline clarified, ‘This has been the worst, these last few years. … The last 4 years.’

Dr Tobinick asked, ‘Have you had it every day?’

She replied, ‘Just about!’

He continued, ‘Just about every day? And how many hours a day were you having the pain before you came in?’

Caroline answered, ‘Oh gosh, very, very often.’

He clarified, ‘So most of the day? …’

Caroline stated, ‘And this time when I had that injection, it’s unbelievable.’

‘How long did it take to work?’ he asked.

‘10 minutes!’

‘10 minutes,’ he confirmed.

She said, ‘Unbelievable.  It is.  It really is!

Dr Tobinick asked, ‘Has anything like this happened at all in the last few years?’   

‘No.  [Not] at all,’ she replied.  ‘It’s incredible.  I really did not believe this could happen …’

Dr Tobinick asked, ‘Have you had to take any pain medicine in the last 2 weeks?’

‘No,’ she answered.

‘Not a single … no pills?  Nothing?’ he confirmed.


‘Ok,’ he said.

‘It’s really great! …’, she said.  ‘…I’ve had … surgery … I got worse.’

Dr Tobinick asked, ‘You had surgery for your back?’


‘And you got worse?’

‘And I got worse … And yet I come to this, and it’s great! … It’s the greatest thing that’s come along. …’

‘… Alright, thank you very much,’ Dr Tobinick said.

For more details, please view the 4-minute video called Rapid pain relief after 25 years of pain July 15, 2009 (a 4-min YouTube dated 6 January 2016 by the Institute of Neurological Recovery, Florida).


(8) Lola and Her Single Perispinal Etanercept Injection for Post-Stroke Pain

‘Lola’ (not her real name) suffered ongoing severe pain for almost 2 years after a stroke on 27 November 2016.  Her excruciating pain (10/10) affected the entire left side of her body including arm, breast, ribs, hip and leg.  She rarely moved her left arm nor left foot due to extreme pain.  Walking was next to impossible as her pain would only intensify with activity.

Lola tried Baclofen and Gabapentin for pain without success.

Lola booked an appointment with Dr Edward Tobinick on 20 November 2018, almost 2 years after her stroke.  After an assessment, Lola received a single perispinal Etanercept injection.

Lola enjoyed immediate pain reliefand improved left arm mobility within 10 minutes after her injection.  Her pain levels in her chest dropped to 6/10.  Lola was finally able to move her left arm without pain.  The spasticity in her left arm was also reduced.

Lola no longer had hip pain (that was 10/10 prior to injection).  The pain in her left leg and foot was gone, she was able to move her left foot for first time in 2 years and her balance was significantly improved.  Lola finally took her first steps without pain.

Overall, Lola enjoyed significantly less pain and enhanced mobility thanks to her single Etanercept injection.

According to her daughter, there was a new look in Lola’s eyes.

When Dr Tobinick asked, ‘Are you happy you’ve come?’,

Lola replied, ‘I’m very happy … And I hope I give hope to other patients too!’

For further details, please view Immediate improvement in chronic post-stroke pain nearly 2 years after stroke (a 3-minute YouTube dated 28/11/2018 by the Institute of Neurological Recovery, Florida).


(9) Debbie and Her Single Perispinal Etanercept Injection for Post-Stroke Pain

‘Debbie’ (not her real name) had a massive stroke that led to mobility issues and severe, unrelenting pain in her neck, both shoulders and upper left arm.  While strong pain medication reduced some of her pain, it did not eliminate it.

Debbie was unable to get out of a chair without assistance and she required a wheelchair during shopping.  She had significant loss of function in her left hand and arm as well as loss of sensation in the left side of her body including face, hand and leg.

Debbie had her first appointment with Dr Tobinick 3 years after her stroke on 29 February 2012.

Dr Tobinick asked, ‘Do you have pain every day?’

‘Yes, every minute of every day, I’ve got pain.’

Dr Tobinick confirmed,

‘Every minute of every day?  You have constant pain?’

‘Yes’, she replied.

‘Even now, you’re in pain?’, he asked.

‘Yes, I am…’

Within only minutes after a single perispinal Etanercept injection, Debbie had significantly less pain and restored sensation to the left side of her body including face, hand and leg. The motor skills in her left hand were dramatically enhanced and she was finally able to get out of a chair without assistance.

‘How different is that from before?’

‘I can’t believe it.  It’s a miracle!’, she said with a big smile.  It’ll change my life totally!’

For further details, please view Rapid improvement in chronic post-stroke pain 3 years after stroke (a 4-minute YouTube by the Institute of Neurological Recovery, Florida).


Perispinal Etanercept Injections for Pain due to Bone Metastasis – Case Study (N=2)

Two patients received perispinal Etanercept injections near the site of bone metastases for pain.  This treatment led to (quoting) rapid, substantial, and sustained relief of chronic refractory pain at the treatment site’ in both patients (Tobinick, 2003).


Perispinal Etanercept Injections for Chronic Back and/or Neck Disc-Related Pain – A Study (N=143)

A study was done involving perispinal Etanercept injections into the spine of 143 patients with chronic back and/or neck disc-related pain.  This treatment led to significant reductions in pain, sensory dysfunction and weakness (Tobinick and Davoodifar, 2004).


An Australian Trial involving Perispinal Etanercept Injections for Stroke

Inspired by the outstanding results achieved after a single perispinal Etanercept injection by Dr Tobinick at the Institute of Neurological Recovery (INR), Florida, a clinical trial is now underway for stroke patients in Australia.


‘The project will enable more Australians of working age who have had a stroke to access new … treatment options to aid their recovery.’


While results are not yet finalised, further details are here:


  • $1 million to support the rehabilitation of stroke survivors (6 October 2018)    


  • Australian Government designates funds to advance Perispinal Etanercept stroke research in Australia (8 October 2018)


More research into anti-TNF drug treatment for CRPS, sciatica, post-stroke pain and other nerve pain conditions is encouraged.  Such studies should confirm whether localised TNF levels are elevated in CRPS-affected limbs and other pain-affected areas in the first place.  If yes, analysis is necessary whether any anti-TNF drug treatment leads to a significant reduction in these elevated localised TNF levels, and if yes, whether this is also accompanied by reduced pain (etc).  Induced skin blisters or skin biopsies may be necessary to confirm localised TNF levels in CRPS-affected limbs and other pain-affected regions, both ‘before’ and ‘after’ anti-TNF drug treatment.

NOTE:  If localised TNF levels are already low to begin with (prior to anti-TNF drug treatment), anti-TNF drug treatment is (likely) not indicated.

Possible adverse effects also need to be considered prior to anti-TNF drug treatment.  Medical supervision is always advised.


Wishing all pain patients less pain,

Sabina Walker

Masters Appl. Science (Neuroscience)

Blogger, Pain Matters (in WordPress)


Author of soon-to-be published book called Pain Matters 




For more information about Dr Tobinick’s treatment involving perispinal Etanercept for nerve pain, please see:

Patient videos (N=307) by the Institute of Neurological Recovery, Florida:

Scientific publications by Dr Tobinick and his peers:

Media stories:

Blog by the Institute of Neurological Recovery, Florida:

Please note that treatment involving perispinal Etanercept injection is protected by multiple patents owned by Edward Tobinick MD including U.S. patents 6 015 557; 6 177 077; 6 419 944; 6 537 549 and Australian patent 758 523 (Tobinick and Davoodifar, 2004).




Anti-TNF drugs (e.g. InfliximabEtanercept) are TNF monoclonal antibodies that selectively block TNF, hence limiting the pro-inflammatory process.

The reduction of TNF and other pro-inflammatory mediators (via anti-TNF drug therapy or otherwise) may alleviate certain painful symptoms in CRPS, sciatica, post-stroke pain and other severe nerve pain conditions.

Ongoing trials are warranted including analysis of side effects.

For further details, please refer to all papers by Edward Tobinick MD and his peers.

Other papers are also available in the References including 24-page Review Paper by Sabina Walker and Prof. Peter Drummond. In particular, please see pages 1790 – 1791, plus related references on page 1804 (included below).



Selected Scientific Publications by Dr Tobinick and His Peers

(1A) Ignatowski TA et al. Perispinal Etanercept for Post-Stroke Neurological and Cognitive Dysfunction: Scientific Rationale and Current Evidence.CNS Drugs(August 2014); 28(8): 679-697.

(1B) Tobinick E and Davoodifar S.Efficacy of etanercept delivered by perispinal administration for chronic back and/or neck disc-related pain: a study of clinical observations in 143 patients. Davoodifar S. Curr Med Res Opin(July 2004); 20(7): 1075-85.

(1C) Tobinick, Edward et al. Immediate Neurological Recovery Following Perispinal Etanercept Years After Brain InjuryClin Drug Investig(May 2014); 34(5): 361-6.

(1D) Tobinick, Edward et al.On Overcoming Barriers to Application of Neuroinflammation Research. In: Abreu GEA, ed. Mechanisms of Neuroinflammation: InTechOpen; 2017.

(1E) Tobinick, Edward. Perispinal Delivery of CNS Drugs. CNS Drugs (2016); 30(6): 469-80.

(1F) Tobinick, Edward. Perispinal etanercept advances as a neurotherapeutic.Expert Review of Neurotherapeutics (2018); 1-3.

(1G) Tobinick, Edward. Perispinal etanercept: a new therapeutic paradigm in neurology.

Expert Review of Neurotherapeutics (June 2010); 10(6): 985-1002.

(1H) Tobinick, Edward. Perispinal etanercept for neuroinflammatory disorders.Drug Discovery Today(Feb 2009); 14(3-4): 168-77.

(1I) Tobinick, Edward et al.Perispinal Etanercept for Traumatic Brain Injury.Chapter 7, pp. 109-29, in New Therapeutics for Traumatic Brain Injury, Cambridge, Mass.: Academic Press. 2017.

(1J) Tobinick, Edward et al.Rapid intracerebroventricular delivery of Cu-DOTA-etanercept after peripheral administration demonstrated by PET imagingBMC Res Notes(27 Feb 2009); 2: 28.

(1K) Tobinick, Edward L. Targeted etanercept for treatment-refractory pain due to bone metastasis: two case reports. Clinical Therapeutics. (Aug 2003); 25(8): 2279-88.

(1L) Tuttolomondo et al.Studies of Selective TNF Inhibitors in the Treatment of Brain Injury from Stroke and Trauma: A Review of Evidence to Date. Drug Design, Development and Therapy(Nov 2014); 8: 2221-2239.

Other Scientific Publications 

(2) Karppinen et al; Tumor necrosis factor-alpha monoclonal antibody, infliximab, used to manage severe sciatica. Spine 2003;28:750–4.

(3) Manning; New and emerging pharmacological targets for neuropathic pain. Curr Pain Headache Rep 2004;8:192–8.

(4) Korhonen et al; The treatment of disc-herniation-induced sciatica with infliximab: One-year follow-up results of FIRST II, a randomized controlled trial. Spine 2006;31:2759–66.

(5) Burnett, Day; Recent advancements in the treatment of lumbar radicular pain. Curr Opin Anaesthesiol 2008;21:452–6.

(6) Cohen et al; Randomized, double-blind, placebo-controlled, dose-response, and preclinical safety study of transforaminal epidural etanercept for the treatment of sciatica. Anesthesiology 2009;110:1116–26.

(7) Lipsky et al; Infliximab and methotrexate in the treatment of rheumatoid arthritis. Anti-tumor necrosis factor trial in rheumatoid arthritis with concomitant therapy study group. N Engl J Med 2000;343:1594–602.

(8) Emery, Buch; Treating rheumatoid arthritis with tumor necrosis factor alpha blockade. BMJ 2002; 234:212–213.

(9) Blam et al; Integrating anti-tumor necrosis factor in inflammatory bowel disease: current and future perspectives. Am J Gastroenterol 2001;96:1977–1997.

Scientific Publication by Sabina Walker (Blogger of Pain Matters) and Professor Peter Drummond

(10) Sabina Walker, Peter D. Drummond; Implications of a Local Overproduction of Tumor Necrosis Factor-α in Complex Regional Pain Syndrome [Review Paper, 24 pages]; Pain Medicine (Dec 2011), 12 (12), 1784–1807.

In particular, please refer to pages 1790 – 1791, plus related references on page 1804 (also listed above).

Can Aromatase Inhibitors and/or Surgery Relieve Endometriosis in Women?

Feature Image of artistic depiction of female pelvic area in pain due to endometriosis sourced from:

Dear Pain Matters readers,


Hearing about women like Jessica Hirst inspired me to write this blog post today:

Jessica Hirst (28), a mother of a baby boy, has endured severe pelvic pain due to aggressive endometriosis since she was 11 when her periods started.


Jessica and her family


Quoting Jessica:

‘It feels like someone is stabbing me repeatedly in the abdomen.  I get a constant burning pain.  There’s an aching that starts in my lower back and comes right down through my legs … it feels like there’s a bowling ball in my uterus.’

Unable to work due to pain, Jessica relies on her husband as her full-time carer.  Despite her excruciating pelvic pain, Jessica finds joy and happiness in their 18-month old baby boy.  Jess is urgently in need of treatment.

Source:  ‘It’s like someone’s stabbing me in the abdomen.’ – Jessica has been in pain since she was 11 (by Gemma Bath, 18 April 2019).


Endometriosis is a painful disorder that affects up to 10% of all women of child-bearing age.  This includes approximately 1.5 million women in the UK and 176 million women worldwide.

Furthermore, 71% to 87% of all women with chronic pelvic pain plus 38% of all infertile women have endometriosis.

Endometriosis occurs when the tissue similar to the lining inside the uterus (i.e. endometrium) grows outside of the uterus.  This tissue may be found on the ovaries, fallopian tubes, tissue lining the pelvis (i.e. pelvic peritoneum), ureter, bladder, bowel and recto-vaginal septum.  It has even been found in the lungs and diaphragm in rare instances.

Endometriosis can cause severe pelvic pain during periods, ovulation and/or sex.  Heavy and/or irregular menstrual cycles, infertility, low energy levels, poor sleep and fatigue result.  Symptoms vary depending on where the rogue endometrium grows.  This can affect the women’s overall health and well-being (Amsterdam et al, 2005).



Women often suffer years of pain before they are finally diagnosed with endometriosis.  It takes 7.5 years on average before endometriosis is diagnosed.  This is because the pain and other symptoms are all-too-often dismissed as ‘normal’ and ‘not serious’.

Endometriosis is diagnosed via biopsy obtained during diagnostic laparoscopy.  This involves keyhole surgery under general anaesthetic.

Treatment Options

Endometriosis is said to be incurable (Howarth, 2019) …

… but is this always true??  Read on…

Several treatments exist that may offer relief from pelvic pain due to endometriosis:

  • Oral contraceptives;*
  • Aromatase inhibitors (e.g. letrozole, anastrazole); and
  • Surgery (excision) to remove endometrial tissue that grows outside of the uterus.

Whilst excision of endometriosis may offer pain relief in some women, multiple surgeries may be required.  Furthermore, there is a risk of recurrence.  Finally, surgery is more invasive than treatment involving aromatase inhibitors.

Studies suggest that aromatase inhibitors (e.g. letrozole; anastrazole) may reduce masses hence leading to relief from pelvic pain due to endometriosis.

Aromatase inhibitors have been used to treat postmenopausal breast cancer patients for over 10 years.


(1) An American Study (N=10) Involving Aromatase Inhibitors (Letrozole)

An American study found that aromatase inhibitors (letrozole) significantly reduced pelvic pain due to endometriosis in 9 of 10 patients.

Ten (10) premenopausal patients with endometriosis who had undergone surgical and medical treatment were selected for this study.

Endometriosis was confirmed via biopsy obtained during diagnostic laparoscopy.

Oral treatment of letrozole, together with norethindrone acetate, calcium citrate (to minimize bone loss) and vitamin D (to strengthen bones), was offered daily for 6 months.

Second-look laparoscopy was done following letrozole treatment for 6 months.

The good news:

This 2nd biopsy showed nil endometriosis in all 10 patients.  Nada!  

Furthermore, pelvic pain due to endometriosis was significantly reduced in 9 out of 10 patients following letrozole treatment for 6 months.  Bone density appeared unaffected.

In conclusion, letrozole may offer effective treatment for endometriosis (Ailawadi et al, 2004).

(2) A 2nd American Study (N=15) Involving Aromatase Inhibitors (Anastrazole)

A 2nd American study led by the same doctor revealed that another aromatase inhibitor called anastrazole also decreased pelvic pain due to endometriosis.

Fifteen (15) premenopausal patients with endometriosis and pelvic pain were selected for this study.   

Oral treatment of anastrazole and oral contraceptive was offered daily for 6 months.  Anastrazole treatment led to suppression of estradiol levels.

The good news:

Fourteen of 15 endometriosis patients obtained significant pain relief following 6 months of anastrazole treatment.  Specifically, median pain levels were reduced by 55% while mean pain scores were decreased by 40%.

In conclusion, anastrazole may offer effective treatment for endometriosis (Amsterdam et al, 2005).


(3) A Young Italian Woman with Endometriosis Finally Found Relief from Severe Pelvic Pain Thanks to Letrozole (After Ovariectomy Failed to Offer Pain Relief)

A young Italian woman named ‘Maria’ (not her real name) with aggressive endometriosis finally found relief from severe pelvic pain thanks to daily oral aromatase inhibitor (letrozole) treatment for 9 months.

Maria had initially undergone a subtotal hysterectomy as well as removal of both ovaries in an unsuccessful bid to reduce pelvic pain.

Following 3 months of daily oral letrozole treatment, Maria’s pelvic pain including pain during sex was significantly reduced.  Her pelvic ultrasound showed nil endometrial tissue in the pelvis.  Maria’s bone density remained unchanged thanks to daily calcium and Vitamin D supplements.

Given these encouraging results, treatment was continued for another 6 months.

In summary, daily oral aromatase inhibitor (letrozole) treatment may relieve severe pain in young women with endometriosis (Razzi et al, 2004).

(4) The First Woman to be Successfully Treated for Endometriosis via an Aromatase Inhibitor (Anastrozole)

An American woman (57) named ‘Jane’ (not her real name) with aggressive postmenopausal endometriosis finally found relief from severe pelvic pain thanks to daily oral aromatase inhibitor (anastrozole) treatment for 9 months.

Jane had previously undergone a hysterectomy as well as removal of her ovaries and fallopian tubes.

Guess what happened next?

Jane’s pelvic pain completely vanished after 2 months of daily oral anastrozole treatment!

Furthermore, a large 30mm X 30mm X 20mm bright red vaginal lesion had reduced to a mere 3mm gray tissue after 9-month anastrozole treatment.

Bone density was however decreased by 6.2% following 9 months of aromatase inhibitor treatment.

Aromatase inhibitors may offer benefits including pain relief and substantial eradication of endometrial tissue (Takayama et al, 1998). 

(5) Two Sisters Successfully Treated for Severe Endometriosis via an Aromatase Inhibitor (Anastrozole)

Two sisters, aged 24 and 26, had undergone several minimally invasive surgeries (i.e. laparoscopies) that, unfortunately, failed to alleviate severe pelvic pain due to aggressive endometriosis.

Both women received oral aromatase inhibitors (anastrozole), oral contraceptives (for birth control), calcitriol (to minimise bone loss) and rofecoxib (for pain control) on a daily basis for 21 days followed by 7 days off (i.e. a cycle).  Six cycles were offered over 6 months.

Within only 3 months, pelvic pain and other symptoms of endometriosis were eliminated in both sisters.  These positive effects lasted over a year, post-treatment.  

There was nil evidence of endometriosis disease in one of the 2 sisters, as confirmed via laparoscopy done 15 months after treatment.

Bone densities remained normal in both sisters after treatment (Shippen & West, 2004).

(6) A Woman (55) Successfully Treated for Endometriosis via an Aromatase Inhibitor (Letrozole)

‘Joan’ (55) in Belgium (not her real name) underwent a total abdominal hysterectomy 10 years earlier.

Recently, Joan had right-sided sciatic pain that radiated down her right leg due to recurring endometriosis.  

A pelvic ultrasound confirmed an endometrial mass that compressed against her lumbo-sacral plexus.  This mass was 4cm X 8cm in size.   

A daily oral aromatase inhibitor (letrozole) was offered to treat this large mass.

After 12 months of letrozole treatment, Joan no longer had sciatic pain. Following 18 months of treatment, Joan’s mass had shrunk to only 1cm in size.  

Due to a successful outcome, oral letrozole was stopped after 21 months.

Recurring endometriosis may successfully be treated via an aromatase inhibitor (letrozole).  This is a less invasive treatment option than surgery (Fatemi, 2005).


An enzyme called aromatase is important in oestrogen production.  This enzyme is absent in normal endometrium in the uterus.

However, this enzyme is aggressively produced in endometriosis, an oestrogen-dependent disease.  Increased aromatase activity leads to high estradiol levels in endometriosis.

Being potent oestrogen blockers, aromatase inhibitors ‘starve’ endometrial tissue of oestrogen.  This leads to shrinkage, and in some cases, complete elimination of endometriosis.

Thus, in the presence of aromatase inhibitors (that block oestrogen production), endometriosis may shrink, and even vanish altogether, during daily letrozole or anastrazole treatment for a certain period of time.

Aromatase inhibitors exert their anti-oestrogen effects on ovaries and on endometrial tissue growing outside of the uterus (Bulun et al, 2001; Ailawadi et al, 2004; Bulun et al, 2004; Amsterdam et al, 2005; Fatemi, 2005).


In addition to oral contraceptives* and excision, aromatase inhibitors (e.g. letrozole, anastrazole) may offer effective treatment for endometriosis (Ailawadi et al, 2004; Amsterdam et al, 2005; Hofmann-Werther)

Isn’t this exciting?

If you know someone with endometriosis, please forward this blog post to her.


Wishing all pain patients inspiration, hope and empowerment,

Sabina Walker

PS From a patient’s perspective, Gabrielle Jackson’ book called Pain and Prejudice offers enormous insight into endometriosis (Jackson, 2019).



Sabina Walker, Masters Appl. Science (Neuroscience)

Blogger of Pain Matters (in WordPress)


Author of soon-to-be published book called Pain Matters 





(1) Howarth, Angus. Lack of cash hinders research into condition affecting 10% of women. The Scotsman (8 April 2019).

(2) Facts about endometriosis.

(3) Bulun, Serdar & Wood, Ros. Aromatase in endometriosis.

* (4) Endometriosis in adolescence. Women’s Health Queensland

(5) Hofmann-Werther, Amelie. Chronic pelvic pain and endometriosis. Middle East Medical.


(1) Jackson, Gabrielle. Pain and Prejudice – A Call to Arms for Women and their Bodies. Allen & Unwin (2019).

ISBN 978 1 76052 909 3


 (1a) Amsterdam et al. Anastrazole and oral contraceptives: a novel treatment for endometriosis. Fertility and Sterility (Aug 2005); 84(2), 300–304.


(1b) Ailawadi et al. Treatment of endometriosis and chronic pelvic pain with letrozole and norethindrone acetate: a pilot study. Fertility and Sterility (Feb 2004); 81(2): 290–296.


(1c) Bulun et al. Aromatase and endometriosis. Semin Reprod Med (Feb 2004); 22(1): 45-50.

(1d) Takayama, K, Zeitoun, K, Gunby, RT, Sasano, H, Carr, BR, Bulun, SE. Treatment of severe postmenopausal endometriosis with an aromatase inhibitor. Fertil Steril (1998); 69: 709713.

(1e) Bulun et al. Role of aromatase in endometrial disease. J Steroid Biochem Mol Biol (Dec 2001); 79(1-5): 19-25.

(2) Razzi et al. Treatment of severe recurrent endometriosis with an aromatase inhibitor in a young ovariectomised woman. BJOG (Feb 2004); 111(2): 182-184.

(3) Shippen & West. Successful treatment of severe endometriosis in two premenopausal women with an aromatase inhibitor. Fertil Steril (May 2004); 81(5): 1395-8.

(4) Fatemi, Human Mousavi. Successful treatment of an aggressive recurrent post-menopausal endometriosis with an aromatase inhibitor. RBM Online (2005); 11(4): 455-457.


There are many support groups including:

(1A) Endometriosis – Perth Sisterhood of Support.

Above support group is run by endometriosis sufferers, Joanne McCormick and Monique Alva (see below story).

(1B) Hedley, Kate. ‘The bad days are shocking’: Fresh hope for endometriosis sufferers. WA Today (15 Dec 2017).




A Doctor and a Nurse who can Literally Feel Pain in Other People

Feature Image of Dr Joel Salinas sourced from:

Dear Pain Matters readers,


Most doctors and nurses have great empathy and compassion for their pain patients.

Dr Joel Salinas and Megan Pohlmann, a nurse, take empathy to a new level.  They literally feel pain, physical sensations and emotions in patients.  They have heightened empathy for others that may also be viewed as ’empathy on steroids’, ’empathy in overdrive’ or ‘ultimate empathy’.

Dr Joel Salinas and Megan Pohlmann have mirror touch synesthesia.  This is when a person can perceive someone else’s pain or tactile sensation.

For some mirror touch synesthetes, this can be a curse rather than a blessing.  These people may require long periods alone after being exposed to other people’s pain and emotions.  They may even become recluses in their own homes for fear of ‘sensory overload’.

Others including Dr Joel Salinas and Megan Pohlmann embrace their mirror touch synesthesia as a special gift to help others.  These people apply their unique neurological trait in their work and personal life, when appropriate. 

Joel Salinas, Neurologist

Joel Salinas (34) is a neurologist, writer, researcher and Assistant Professor of Neurology at Harvard Medical School.  As stated, he can feel pain, physical touch and emotions in other people.  This ‘mirrored touch’ ability is automatically triggered by sight.  For example, when he sees someone’s right arm being touched, he feels a touch on his left hand, like in a mirror.  

In Dr Salinas’ words:

[Having mirror touch synesthesia] blurs this boundary between the self and the other’ (Kalter, 2017).

[Mirror touch synesthesia] is as close as I can get to literally putting myself ‘in the other person’s shoes” (Salinas, 2017).

‘… Like I’m the reflection … It’s really like I’m a reflection … Mirror touch is … like an automatic, very physical, super empathy …’ (quoted from video, below).

For more insights into Dr Salinas’ ‘super power’, see his TED Talk dated 18 May 2018:


Two interviews with Dr Salinas are also available:

  1. What It’s Like to Have Mirror Touch Synesthesia (a 4-minute interview dated 13 Dec 2018) (; and
  2. Mirror Touch: Rare condition means Dr Joel Salinas feels what others feel (a 7-minute interview by Boston 25 News dated 25 May 2017) (

Finally, Dr Salinas is the author of a fascinating book called Mirror Touch: Notes from a Doctor Who Can Feel Your Pain. 

Megan Pohlmann, Nurse

As noted, Megan Pohlmann is a paediatric nurse who has mirror touch synesthesia.  This trait often enables her to feel other people’s emotions, pain and other sensations as her own. In her words,

‘If someone’s hurting, for instance, if they have a cut on their arm … when I visualise the injury, I’ll get a feeling on my spine that’s kind of similar to being on a roller coaster.  It’s that gut-dropping feeling … the electricity … shoots up my spine and out my arms and my extremities.’

See 7-minute interview called ‘Meet the nurse who feels other people’s pain – literally’.

Please note that Dr Salinas is also featured in this interview, together with Megan Pohlmann.

The Science of Mirror Touch Synesthesia

A study revealed that 45 of 2,351 (2%) psychology students had mirror touch synesthesia (Medina & DePasquale, 2017; University of Delaware, 2017).

Mirror neurons are said to underlie mirror touch synesthesia (Linkovski et al, 2017).

Prof Ramachandran, a respected neuroscientist, nicknamed these mirror neurons ‘Gandhi neurons’or ’empathy neurons’.  In his words:

‘… You are, in fact, connected not just via Facebook and Internet.  You’re actually quite literally connected by your neurons.  And there [are] whole chains of neurons around this room, talking to each other.  And there is no real distinctiveness of your consciousness from somebody else’s consciousness.’ 

See TEDIndia by Prof Ramachandran called The neurons that shaped civilization (2009; a 7-minute video):


A question:

As noted, Dr Salinas’ ‘mirrored touch’ ability is automatically triggered by sight.  For example, when he sees someone’s right arm being touched, he also feels a touch on his own left hand – just like in a mirror.

Could Dr Salina’s experience with mirror touch synesthesia offer certain insight into why mirror therapy may offer relief from phantom limb pain in many amputees? 

See my 4 blog posts for further details on mirror therapy including:

Mirror Therapy for Relief from Phantom Limb Pain Inspired By Professor Ramachandran


This world is lucky to have many doctors, nurses and other medical clinicians who show empathy and compassion for their patients.

The fact that some doctors and nurses can literally feel their patients’ pain may be one of the highest levels of empathy.


Articles and Book 

Joel Salinas, Neurologist


(1A)  Love, Shayla. The Anatomy of Empathy. Vice (8 May 2019).

(1B) Salinas, Joel. I’m a doctor with a rare neurological condition: I can literally feel your pain. Quartz (30 April 2017).

(1C) Carlton, Lindsay. A doctor who can feel his patient’s pain. Fox News (26 Apr 2018).

This article includes a 7-minute interview with Dr Joel Salinas:

Mirror-touch synesthesia: A doctor who can feel his patient’s pain

(1D) Ridley, Jane. This doctor can really feel your pain. New York Post (18 April 2017).

(1E) Angley, Natalie. This doctor can feel your pain. CNN (16 June 2017).

(1F) Kalter, Lindsay: This doc can feel your pain. Boston Herald (3 May 2017).

(1G) Salinas, Joel & Lee, Samantha. What It’s Like to Have Mirror Touch Synesthesia. The Cut (13 Dec 2018).

(a 4-minute interview with Dr Joel Salinas dated 13 Dec 2018)

(1H) Mirror Touch: Rare condition means Dr Joel Salinas feels what others feel

(a 7-minute interview with Dr Joel Salinas by Boston 25 News dated 25 May 2017)

A Book by Dr Joel Salinas

(1I) Salinas, Joel. Mirror Touch: Notes from a Doctor Who Can Feel Your Pain. HarperOne (18 Apr 2017); 320 pages.

ISBN-10 0062458663

ISBN-13 978-0062458667

ISBN 0062458663

Megan Pohlmann, Nurse


(1A) Kelly, Megyn. Meet the nurse who feels other people’s pain – literally. Today (11 April 2018).

(1B) Seaberg, Maureen. Meet the Nurse Whose Superpower Is Feeling Your Pain—Literally. Glamour (1 Mar 2018).

(1C) Nuñez, Gabriella. People You Should Know: Megan Pohlmann and her world of many colors. krcgtv (14 May 2018).

Peer-Reviewed Papers

(1A) Linkovski et al.   2017). Mirror Neurons and Mirror-Touch Synesthesia. Neuroscientist (April 2017); 23(2): 103-108.

doi: 10.1177/1073858416652079

(2A) University of Delaware. ‘I feel for you: Some really do: Researchers examine unusual condition of mirror-touch synesthesia.’ ScienceDaily (6 Feb 2017).

(2B) Medina J & DePasquale C. Influence of the body schema on mirror-touch synesthesia. Cortex (2017);  88: 53.

doi: 10.1016/j.cortex.2016.12.013

The Gall of Gallstones to Cause Pain

Feature Image sourced from:

Dear Pain Matters readers,


You may have heard a friend or family member say that they have an intense pain in their chest, upper right or mid abdominal area, just below their breastbone.  Alternatively, they may feel pain in their back, right shoulder blade or in between their shoulder blades.  They may feel sweaty, nauseous and an urge to vomit.  They may have to lie down due to pain, especially after a rich and fatty meal.

Patients may not understand why this is happening to them.  Could it be back pain, indigestion, ulcers or irritable bowel syndrome (IBS)?  Or are they simply over-reacting to a spicy meal?

What they do know though is that their pain is severe and repetitive.  This pain may last anywhere from a few minutes to several hours.

Here’s a thought:

Could gallstones* be responsible for the pain?  If yes, then the severe pain attacks will likely persist until properly treated.  Imaging via ultrasound, CT and/or MRI is necessary to rule out the possibility of gallstones that may otherwise lead to a blockage in a duct or gallbladder inflammation (cholecystitis).

If present, gallstones (and gallstone pain attacks) usually do not go away on their own.  Surgery to remove the gallbladder may be necessary.  Alternatively, if only 2-3 gallstones are present, shock wave treatment plus medication may offer relief from pain (although there is a risk of recurring gallstones) (more later).


Denise Fernholz, Germany 

Denise Fernholz, an editor in Germany, had severe pain attacks for 4 long years. Despite exclusively seeing her family doctor for 4 years, her symptoms were never taken seriously nor was any ultrasound test ordered.  As such, Denise had no idea that excess gallstones were the cause of her excruciating pain.

Denise first felt an intense pain emanating from her breast area when she was 17.  She attributed this pain to her tight-fitting bra.  However, her pain only became worse after she removed her bra.  Panicking, she thought she was having a heart attack.  She felt better after laying down for an hour or so.

After her doctor ruled out any cardiac issues, it was thought that she may have done something to her back.  Unconvinced, Denise hoped for the best anyway.

However, the severe pain attacks kept returning.  Her pain attacks were so unbearable that they rendered her bedridden during these episodes.  Denise felt like she was going to die.  Her parents always wanted to call an ambulance but Denise resisted.  By now, Denise was convinced that she was ‘only suffering from back pain’.  She was worried about being ridiculed by paramedics for ‘calling an ambulance for back pain only’.

Instead, Denise continued to see her family doctor who regularly performed his manual adjustments.

One day, Denise had an MRI that, sadly, did not elucidate the cause of her pain.

As such, Denise was told that ‘her pain was likely psychosomatic’.  She was asked if she had a lot of stress in her life.  Alternatively, ‘did she do drugs?’  Her answer, ‘No.’  Denise was then asked, ‘Are you sure?’  Her answer, ‘Yes, damn it, I am sure!’  Denise added, ‘Can you please prescribe something stronger for my pain?’  

Denise thought that it seemed rather convenient to simply attribute pain as being psychological in origin if a doctor can not find anything wrong with a patient.

Nothing was offered other than Ibuprofen.  Denise felt that no one was taking her pain seriously.  Her doctors simply did not believe her.  

By now, Denise was in her early 20’s.

Denise’s pain attacks would often occur on special days such as birthdays or while away with her girlfriends.  After pizza, Denise would have to lie down in pain.  Then she’d go to the toilet to vomit.  Her concerned friends were tempted to call an ambulance.  However, by now, Denise had become accustomed to her pain attacks.  

Because she’d been told countless times that ‘her pain was due to back tension’, that she was otherwise healthy, that she was ‘merely imagining her pain’ and that ‘her brain was simply fabricating pain to avoid having fun’, Denise even started believing these so-called ‘reasons’ for her pain.

It was much later when Denise finally made a connection between pizza and pain.  

Until then, Denise’s doctor had prescribed gymnastics and sent her to an orthopedist.  Denise was urged to do more sport and given new insoles for her shoes.  She even bought a new mattress for her bed.

Guess what??  None of this helped with her pain attacks!  

Four (4) years went by.

At times, Denise was pain free for a month.  At other times, her pain attacks would occur several times in a week.  However, not once did Denise call an ambulance.

One day, Denise moved to another country to study.  She regularly returned home to visit her parents.  While home, she always returned to her trusted doctor for ongoing pain treatment.  Denise did not want to seek an alternative opinion from a new doctor or hospital for ostensibly back pain in a foreign country where she studied. After all, Denise had no reason to doubt her doctor’s opinion that she had back pain.

The turning point:

Despite being sceptical of alternative medicine, Denise was finally convinced by her friends to see an osteopath.  She felt strange when the osteopath placed his hands on her body.

Denise noted however that the osteopath was the first person to take time to do a proper medical history.  Denise told him about her pain, the vomiting and her doctor’s ‘diagnosis’.

Thereafter, the osteopath was quick to conclude that Denise’s pain did not come from her back, but rather, from her organs.     

During her next visit to her doctor, Denise insisted that he check her organs.

Then came the moment of truth!  An ultrasound clearly showed that Denise’s gallbladder was chockablock full of very small gallstones!  

Diagnosis:  Biliary colic, aka gallbladder attack or gallstone attack.

Because her gallbladder was full of very small gallstones, Denise would feel excruciating pain every time a gallstone would exit her gallbladder and force its way through the bile duct.*  Generally, this would occur after a fatty meal (e.g. pizza).  

Denise’s doctor thought that her newly-revised diagnosis was rather strange given that she was young and not overweight.

Denise, on the other hand, was ecstatic to have finally received a proper diagnosis after 4 long years of suffering due to pain attacks!  FINALLY, A CORRECT DIAGNOSIS!  YIPPEE!

Treatment:  Gallbladder removal surgery

While in hospital during her gallbladder removal operation, everyone was surprised by her gallstone story.  After all, even young, slim women and children routinely presented with gallstones these days.  Furthermore, gallstones were usually easy to diagnose via ultrasonography.

Denise was merely grateful that her gallstones were finally being removed forever.

The good news:

After 4 long years of sporadic and intense pain for ostensibly back pain, Denise finally received a correct diagnosis.  Shortly after, she underwent effective treatment involving surgical removal of her gallbladder.  This led to complete relief from pain (Fernholz, 2018).

Fiona Tapp, a British Freelance Writer and Educator based in the US 

Fiona Trapp first became aware of an intense pain in her breastbone after ordering a huge amount of Chinese food one day.  Thinking that her pain was due to eating too much, she went to lie down in the hopes that her pain would pass.  Instead, her pain got worse as it spread from her chest into her stomach and back.  Fiona felt as if an iron bar had impaled her from the front of her ribs and straight through her back.  Her then-boyfriend (now-husband) tried his best to help by massaging her in between her shoulder blade area.

While enduring excruciating pain for a few hours, Fiona thought that she was having a heart attack.  Fiona’s pain finally went away after vomiting and she fell into a deep slumber.

Sadly, this was not the last of her pain attacks.  Instead, these pain attacks arose at least once every 2 weeks over the next 5 years.  Her severe pain attacks in her chest, stomach and back would wake her up in the middle of the night.  As she cried out in pain, her partner would also be awakened.

Tragically, Fiona went from one misdiagnosis to another.

Fiona’s general practitioner (GP) first suggested that she keep a food diary to help identify any food allergies.  However, her pain attacks would persist regardless whether she drank water or indulged in junk food.

When her friends and family suggested that she might have an ulcer, Fiona returned to her GP.  However, after saying it was ‘just indigestion’, he prescribed antacids (which, of course, did nothing for her pain).

Fiona decided to get a second, and even a third, opinion.  Her third doctor prescribed esomeprazole pills daily for stomach acid.  Of course, these pills also did nothing for her pain attacks.

Upon returning to her GP, Fiona discovered that a new doctor was available to see her instead.  This doctor was energetic, empathetic and cheerful.  Moreover, after reviewing her history and doing some checks, he suggested that there may be more going on than ‘just indigestion’.  He then arranged for Fiona to do some blood tests and an ultrasound.

Guess what happened next?  You guessed it!  Finally, Fiona received a proper diagnosis after 5 long years of pain attacks and vomiting!  Whew!  

Fiona was finally diagnosed with ‘a lot of gallstones’ in her gallbladder, an organ next to her liver that holds bile until it is released to help digest food.*  These gallstones were blocking her bile duct as well as causing pain attacks and vomiting episodes.

Gallbladder removal surgery was recommended.

After awakening from surgery to remove her gallbladder, her surgeon said that her gallbladder was FULL of gallstones.  He had never seen so many gallstones in his entire life!  He also added that he was sympathetic for all the pain that she had endured over 5 years.

Fiona was simply grateful that a correct diagnosis was finally made and that gallbladder removal surgery was done.  Finally, her severe pain attacks ended after 5 long years! 

Please see Fiona Tapp’s inspiring story for more details and advice:

(Tapp, 2017; Stinton & Shaffer, 2012).    



Gallstones are not rare.  They can affect both young and healthy people as well as the young-at-heart.  Between 10% to 15% of adults in developed societies have, or will have, gallstones including 25 million Americans.

Despite being common, gallstones are sometimes mistaken for back pain, food allergies, ulcers, indigestion, excess stomach acid and even irritable bowel syndrome (IBS).


Ultrasonography is done to diagnose gallstones.  Other imaging techniques (e.g. CT, MRI) may also be useful.

Two Treatment Options

(1) Gallbladder Removal Surgery (Cholecystectomy)

Treatment usually involves gallbladder removal surgery (cholecystectomy).

Risk of Ongoing Pain Despite Surgery in Some Patients

After gallbladder removal surgery, some patients may still suffer from ongoing pain.  As such, the risk of a poor outcome following surgery needs to be discussed with patients prior to surgery (Dijk et al, 2019; Guest & Søreide, 2019; Rapaport, 2019).

(2) Extracorporeal Shock Wave Lithotripsy (ESWL)

Alternatively, extracorporeal shock wave lithotripsy (ESWL) may be offered if there are only a few gallstones (i.e. no more than 3).  This treatment involves generating sound waves (shock waves) from outside of the body.  Produced by a machine called a lithotripter, these shock waves are aimed directly at the gallstones until they shatter.  Medication is usually necessary to dissolve the remaining shattered fragments.

While shock waves shatter gallstones, they are not harmful to muscle, bone or skin.

Risk of Recurrent Gallstones

Despite ESWL being less invasive than gallbladder removal surgery, there is a risk of recurrent gallstones (mydr; Barhum, 2018).


What lessons can be learned here?

According to Denise Fernolz, if a diagnosis and treatment(s) are not effective, please urgently seek a second medical opinion.  Importantly, always trust your own instincts and feelings (Fernholz, 2018).

According to Fiona Tapp, if your gut feeling tells you that there is something wrong with your body, please persist in trying to get to the bottom of this. Please don’t ever give up.  

Most doctors do want to help their patients get better.  However, sometimes it is up to the patients to also insist on getting further tests done right from the start.   

Patients have to learn to become better advocates for their own health.  They have to learn to become more assertive and take responsibility for their well-being.  After all, they know their own bodies better than anyone else does.   

Patients should never feel as if they are wasting their doctors’ time.  After all, that is what the doctors are there for – to help diagnose medical problems.

Patients and doctors need to work together as a team to properly diagnose medical problems including the cause(s) for any pain.  A patient-doctor team approach will lead to more effective and timely treatments as well as better results and outcomes.

If necessary, patients may need to pursue a 2nd, 3rd or even 4th medical opinion (as Fiona did).  

I hope these 2 stories inspire.


* Gallstones (aka cholelithiasis) are solid masses, or crystals, of cholesterol or pigment that sometimes form in the gallbladder.  Gallstones may be as small as a grain of sand or as big as a golf ball.  While gallstones are asymptomatic in some people, they may cause excruciating pain in others.

Bile is a yellow-green digestive fluid made in the liver and stored in the gallbladder.  During digestion, bile is released into the bile duct and upper part of the small intestine to help break down the fat in food.




(1) Tapp, Fiona. I Lived in Hell for 5 Years Due to a Misdiagnosis. Healthline (9 June 2017). 

(2) Gallstones: Treatment.

(3) KevinMD (15 March 2005).

(4) Rapaport, Lisa. Gallbladders may be removed too often. Reuters (10 May 2019).

MEDIA (In German)

(1) Fernholz, Denise. Vier Jahre Schmerzen – Weil ich meinem Arzt vertraute. Protokoll einer Fehldiagnose – Angeblich nur Rückenprobleme. Stern (20 April 2018).–vier-jahre-schmerzen–weil-ich-meinem-arzt-vertraute-7950602.html


(1) Gallstones. Mayo Clinic.

(2) Fletcher, Jenna. What are the most common gallbladder problems? Medical News Today (16 Nov 2018).

(3) Stinton & Shaffer. Epidemiology of gallbladder disease: cholelithiasis and cancer. Gut Liver (2012); 6(2): 172–187.


(4) Barhum, Lana. Lithotripsy for stones: What to expect. Medical News Today (3 July 2018).

(5) AIHW. Gallstone lithotripsy. Australian Institute of Health and Welfare (1 Dec 1988).

(6A) Dijk et al. Restrictive strategy versus usual care for cholecystectomy in patients with gallstones and abdominal pain (SECURE): a multicentre, randomised, parallel-arm, non-inferiority trial. The Lancet (26 Apr 2019).

(6B) Guest & Søreide. Pain after cholecystectomy for symptomatic gallstones. The Lancet (26 Apr 2019).

Inserting A ‘Mini Cushion’ and/or Other Implants in the Spine to Reduce Back Pain

Feature Image sourced from:

Dear Pain Matters readers,


Degenerative Cervical Myelopathy

The most common cause of spinal cord dysfunction and pain in adults is degenerative cervical myelopathy.  Myelopathy is spinal cord damage caused by disc degeneration (disc bulges), bone spurs (osteophytes) and other inflammatory triggers.

If not effectively treated, back pain, limb sensory loss and abnormal sensations (paraesthesia)* may result.  Gait and hand dexterity may be compromised.

See Anne’s story (below) that highlights degenerative cervical myelopathy including the importance of timely diagnosis and effective treatment

Degenerative Disc Disease   

Countless people suffer from severe back pain due to degenerative disc disease.  

Damaged discs in the spine may lead to reduced shock absorption while walking, jogging or pursuing other activities.  Shortened discs due to injury, disease or prior surgery may cause vertebrae to come into direct contact with one another.  This may result in bone-on-bone pain, sciatica and other complications.

Tingling and/or numbness in the buttocks or legs may occur due to herniated (i.e. bulging, collapsed or slipped) discs.  This may render walking difficult for some patients.

Once injured or arthritic, discs are usually unable to heal due to their avascular nature.  

Sadly, back pain may become a constant companion.

Novel Treatment for Back Pain Resulting from Damaged Discs: An Implant Called a Device for Intervertebral Assisted Motion (DIAM Implant)

Traditionally, the only surgical option for back pain caused by degenerated discs involved fusing the spinal bones together (aka spinal fusion).

A new implant called a Device for Intervertebral Assisted Motion (DIAM implant) is now available that may offer relief from back pain due to diseased or injured discs.

The DIAM implant is as a polyester-covered silicone interspinous shock absorber that works like a ‘bumper’.  Being small and H-shaped, this implant is designed to shift the weight away from the anterior column.  This helps restore the functional integrity of the posterior column of the spine.

Like a small cushion inserted between injured or diseased vertebrae in the spine, this implant may prevent vertebrae from coming into contact, hence preventing further damage to the vertebrae.  By acting as a shock absorber by reducing stress on damaged vertebrae, a DIAM implant may lead to reduced or eliminated back pain.

During surgery, a small surgical incision is made along the spine and a low amount of bone, interspinous ligament, muscle and/or other soft tissue is removed.  The DIAM implant is then inserted into the space between the spinous processes.**  This implant is subsequently attached to nearby vertebrae.

Other Interspinous Spacers Including Aperius Devices

Degenerative spinal disease may also be treated via alternative interspinous spacers including Aperius PercLID system (Fabrizi et al, 2011).


Wear and tear and/or rejection by the immune system of DIAM implants and other interspinous spacers may occur in some patients.  This may lead to pain and inflammation as well as the removal of affected implants (Seo et al, 2016).

‘Anne’, a 62-Year Old Woman, has Discectomy and Implants for Severe and Painful Cervical Myelopathy

‘Anne’ (not her real name) (62) suffered from severe degenerative cervical myelopathy since she was 59 (although this diagnosis was not confirmed until 3 years later).  As a result, Anne was hospitalised 11 times in the emergency room (ER) in 3 years.

Anne endured pain and abnormal sensations (paraesthesia) from her neck down including in her hands, groins, trunk and legs.  She had a ongoing feeling of water retention throughout her body.

Anne had many strange sensations including:

  • ‘A wet gel-like substance’ had invaded the skin of her face, limbs and trunk; and
  • ‘Something [was] stuck on her skin’ and ‘her hair was stuck down’.

Anne thought that these odd feelings were caused by her olive oil moisturising cream.  (This was because her severe degenerative cervical myelopathy was not diagnosed until 3 years later.)  

During her 11 visits to ER, doctors dismissed Anne ‘for being delusional’ (despite her not taking any psychiatric medication).

While doctors urged her to undergo a psychiatric assessment and a mental health review, Anne resisted.

Anne had back and neck pain as well as numbness and tingling in her arms.  Her legs were stiff and she had difficulty walking.  Anne’s right leg often gave way resulting in numerous falls.   Her coordination and manual dexterity were severely compromised.  Anne had difficulty urinating as well as urinary and faecal incontinence.

Three years later, Anne was finally referred for MRI imaging of her spine.

Following MRI imaging, Anne was diagnosed with severe cervical myelopathy due to degenerative changes in her cervical spine NOT delusions!  Specifically, there was 2 bone spur protusions, one that compressed her spinal cord at C3/4 and another one that led to a narrowing near C5/6.

Surgery for decompression via anterior cervical discectomy at C3/4 was expedited as well as spinal implants.

Following recovery from spinal surgery, Anne’s pain levels decreased while her other symptoms improved.

In summary, despite having been seen by many doctors during 11 visits to ER, Anne was not diagnosed with severe cervical myelopathy until 3 years later.  As a consequence, Anne suffered from intense neck and back pain, abnormal sensations and other symptoms of severe cervical myelopathy for 3 long years.

The good news is that once a correct diagnosis was finally made, and successful spinal surgery was done, many of Anne’s symptoms either decreased or disappeared (Mowforth et al, 2019; Berres, 2019).

A Back Pain Patient Named Rebecca Who Had DIAM Implant Surgery

Having suffered severe low back pain for several years that worsened after becoming a mom of two, Rebecca Morgan of Bristol, UK, said:

‘I started to find everyday activities difficult — even sitting down for any length of time was painful.  The thought of having to lift my son in and out of the bath would sometimes drive me to tears.’

An X-Ray and MRI revealed a collapsed disc as well as changes in the adjacent joints.  Due to the disc’s shortened height, (quoting Rebecca) ‘the nearby joints were inflamed and rubbing together.’ 

In her spinal surgeon’s words:

‘A standing X-Ray showed that one of [her joints in her back] slipped backwards every time she moved or stood up.’

A DIAM implant was inserted between the inflamed joints via minimally invasive surgery.

Rebecca continued with her story (quoting):

‘… my disc was so unsupported and unstable that [the specialist] could move it every which way during the operation.’

No wonder Rebecca had severe back pain prior to her DIAM implant!!

Following successful surgery involving DIAM implant, Rebecca stated (quoting):

‘I was up and walking within a couple of hours after the operation, and within a few weeks I was back to normal. I went on a long-haul flight to Australia, to take the children to visit relatives, just seven weeks after the operation. Now, I’m looking forward to starting pilates classes.’

‘[The DIAM implant] has changed my life … As a result, I have finally said goodbye to all the prescription drugs I used to take, and gone back to the gym.’

In her surgeon’s words:

‘[The DIAM implant] acts as a firm cushion and a stabiliser, and is unique in that it is not made out of metal and isn’t stiff. Rebecca had instant relief and needed only a short stay in hospital’

(Dobson, 2010).

What a heart-warming and inspiring story!

Four Studies Involving Interspinous Spacers (e.g. DIAM Implants, Aperius Devices) for Degenerative Spinal Disease

1. A DIAM Implant Study

A study involving back pain patients (N=68; aged 23 to 75) showed that all patients enjoyed benefits including 92% who had good to excellent improvements, post-DIAM implant.  

Best of all, implant patients enjoyed pain reductions of 71% and enhanced movements by 64% (on average) (Dobson, 2010).

2. A Taiwanese DIAM Implant Study

Back pain patients (N=34) who underwent DIAM implant surgery were followed up for a minimum of 3 years.

All 34 patients enjoyed relief from symptoms.

Specifically, 31 patients (91%) remained symptom free and enjoyed excellent/good results throughout the study, post-DIAM implant. 

However, back pain not due to DIAM surgery nor degenerated discs returned in 3 patients (9%) (Lu et al, 2016).

3. An Italian Review Involving Interspinous Spacers (i.e. DIAM and Aperius Devices) for Degenerative Lumbar Spinal Disease

An Italian review was done of low back pain patients (N=1575) who underwent interspinous device (DIAM or Aperius) insertion for the treatment of degenerative spinal disease.  This included patients with degenerative disc disease (N=478), canal and/or foraminal stenosis (N=347), disc herniation (N=283), black disc and facet syndrome (N=143) and topping-off (N=64).

The average operating time for a DIAM implant was 35 minutes and for an Aperius device was 7 minutes.

Complications arose due to infections (N=10) and fractures of the posterior spinous processes (N=10).  Forty patients required spinal fusion (N=30) or total disc replacement (N=10).

The review reported that symptoms were resolved or improved in 1505 patients (95%) after interspinous device insertion.

This included 924 patients who enjoyed excellent results including nil back pain and complete restoration of mobility after implant surgery.  All 924 patients were able to return to normal work and pursue normal activities.

Another 483 patients had good results including relief of symptoms albeit with some nonradicular pain.  All 483 patients were able to return to modified work.

A further 98 patients had fair results with some improvement in function.  However, these patients could not return to work and/or remained disabled.

Sadly, the remaining 70 patients had a poor outcome following interspinous device insertion.  Their symptoms remained unchanged and they required further surgical intervention.

Having said that, interspinous implant is reversible in failed back syndrome.  More importantly, the vast majority of patients enjoyed partial or complete relief from back pain after interspinous device insertion (Fabrizi et al, 2011).

4. A French DIAM Implant Study

A French study involving back pain patients (N=104) showed that 88.5% enjoyed improvements, 9.6% had no change and 1.9% were indeterminable.

Pain medication intake was decreased in 63.1% of the patients, increased in 12.3% and unaltered in 24.6% (Taylor et al, 2007).


I hope that the stories about Rebecca and Anne as well as the 4 studies may offer hope to some patients with severe back pain due to degenerative spinal disease.

Sabina Walker, Blogger of Pain Matters (in WordPress).


* Paraesthesia is abnormal sensation.  This may include tingling or pricking (i.e. pins and needles).  This may be due to pressure or damage to peripheral nerves.

** Spinous processes are the vertebrae that stick out in the back of your spine.  These can be felt as bumps on your back.   


(1) Dobson, Roger. Tiny cushion that sits in your spine to cure back pain. Daily Mail Australia (

Peer-Reviewed Paper

(2) Lu et al. Clinical outcome following DIAM implantation for symptomatic lumbar internal disk disruption: a 3-year retrospective analysis. J Pain Res (31 Oct 2016); 2016: 917—924.

(3) Taylor et al. Device for intervertebral assisted motion: technique and initial results. Neurosurg Focus (15 Jan 2007); 22(1): E6.

(4) Seo et al. Foreign Body Reaction after Implantation of a Device for Intervertebral Assisted Motion. J Korean Neurosurg Soc (Nov 2016); 59(6): 647–649.

(5) Fabrizi et al. Interspinous spacers in the treatment of degenerative lumbar spinal disease: our experience with DIAM and aperius devices. Eur Spine J (2011); 20(Suppl 1): S20–S26.

doi: 10.1007/s00586-011-1753-2

(6) Mowforth et al. “I am not delusional!” Sensory dysaesthesia secondary to degenerative cervical myelopathy.

Peer-Reviewed Papers Not Discussed Above

(7A) Pintauro et al. Interspinous implants: are the new implants better than the last generation? A review. Curr Rev Musculoskelet Med (2017); 10(2): 189–198.


(7B) Buric and Pulidori. Long-term reduction in pain and disability after surgery with the interspinous device for intervertebral assisted motion (DIAM) spinal stabilization system in patients with low back pain: 4-year follow-up from a longitudinal prospective case series. Eur Spine J (2011); 20(8): 1304–1311.

doi: 10.1007/s00586-011-1697-6

(7C) Gazzeri et al. Failure rates and complications of interspinous process decompression devices: a European multicenter study. Neurosurg Focus (2015); 39(4): E14.

doi: 10.3171/2015.7.FOCUS15244

Media (in German)

(8) Berres, Irene. Eine rätselhafte PatientinDie ist doch verrückt. Spiegel (5 May 2019).

Should Unloader Knee Braces Be Prescribed For Osteoarthritic Knee Pain BEFORE Total Knee Replacement?

Feature Image of an Unloader Knee Brace sourced from:

An earlier blog post discussed autologous cartilage transplantation for defective knee cartilage:

Transplantation of One’s Own Knee Cartilage – Is this ‘The Bee’s Knees’ for Painful Knees?

Dear Pain Matters readers,


Here’s a sobering thought:

The biggest cause of disability in the U.S. is osteoarthritis (OA), with the medial compartment (i.e. inside part) of the knee being most commonly affected (Vincent et al, 2012).

Most medical experts state that due to its avascular and aneural nature, articular cartilage cannot regenerate in vivo, especially during persistent inflammation following trauma or injury to cartilage (Huey et al, 2012).  

Other researchers believe that knee cartilage is able to regenerate in vivo, but only in a chondrocyte-friendly environment.  This would require nil ‘bone-on-bone’, nil localised inflammation, reduced or nil knee pain, healthy synovial fluid in the articular cavity and highly vascularised underlying subchondral bone (Lyu et al, 2011; Tiku & Sabaawy, 2015).

In the absence of effective treatment, deterioration of the knee joint may continue until finally, most if not all of the cartilage tissue is worn out and arthritic.  At this stage, total knee replacement (arthroplasty) may be the only option left.

As such, a proactive approach to knee health is important.  This is because a painful knee joint will either get better or worse.  Nothing stays the same.

The good news is that treatments do exist whereby ‘bone-on-bone’ knee pain may be reduced and even eliminated altogether in some instances.  These include non-weight-bearing exercises such as swimming, aquatic exercises and cycling.  Wearing a fitted unloader knee brace may also be helpful.   

Unloader Knee Braces

Regardless whether cartilage is able to regenerate in vivo or not, fitted unloader (or offloader) knee braces may offer benefits including relief from knee pain, increased knee stability and enhanced mobility.

By shifting the load-bearing weight toward the lateral (outside) part of the knee, the brace may help increase the gap between the femur bone and the medial (inside) part of the tibia.  (The lateral side is usually the ‘good’ side of the knee in patients with medial knee OA.)  This gap reduces ‘bone-on-bone’ and hence leads to reduced inflammation in an OA-affected knee joint. 

An unloader brace-induced gap can promote a chondrocyte- and mesenchymal stem cell**-friendly environment that might lead to cartilage regeneration. 

On the other hand, the absence of normal cartilage or the absence of a compensatory unloader knee brace may lead to ‘bone-on-bone’ between the connecting bones in the knee joint.  Without a gap between the bones, further knee joint deterioration occurs until finally, ‘bone-on-bone’ knee pain results.  Walking may become unbearable unless the patient opts for an unloader knee brace (if beneficial) or has total knee replacement.

Thus, OA knee patients may benefit from a prescription for a fitted unloader brace for walking, hiking and other light load-bearing activities.  Wearing an unloader brace may relieve knee pain, swelling and other symptoms as well as prevent further deterioration in the defective knee cartilage.

For some OA patients, wearing an unloader knee brace may be all that is required ‘to keep going’ and hence, defer costly total knee replacement indefinitely (Mistry et al, 2018).

A Friend’s Unloader Knee Brace Story

Several years ago, I kept running into a nice lady named ‘Jane’ (70) in a nearby park.  Appearing fit and trim while walking her dog, Jane always wore her unloader knee brace.

One day while chatting, I asked her why she wore a knee brace.  Jane replied that sadly, one of her knees was now ‘bone-on-bone’.  Consequently, Jane found walking very painful without her knee brace.  She added that luckily, she finally found pain relief while walking her dog as long as she wore her unloader brace. 

It all started when Jane’s orthopaedic surgeon stated that she needed total knee replacement due to ‘bone-on-bone’ knee pain.  When the surgeon proposed a date for this surgery, she realised that the date for surgery conflicted with a long-planned golfing holiday with her husband.  Since there were no other times available for surgery, her surgeon prescribed an unloader knee brace until her return.

From Jane’s perspective, this was the best treatment ever for her knee pain.  Jane was finally able to walk her dog for kilometres at a time without pain.  She was able to manage without a knee brace in her own house.

The story does not end here.  It only gets even better!

A year later, I saw Jane outside of her house while walking past.  She was not wearing her knee brace.  After a chat, I asked her how her knee was doing.

Jane’s answer took me by complete surprise.  Jane told me that she had cancelled her knee surgery indefinitely.  This was because she no longer needed her knee brace while walking her dog.

Lost for words, I asked, ‘Why not?’

Jane replied that recently, her small dog had run out of the house to chase another dog down the road.  Worried that her dog might get hit by a car and in a hurry to catch up to her dog, Jane forgot to put on her knee brace.  Instead, she ran as quickly as she could to chase down her beloved dog.  When Jane finally did catch up, she was relieved to find her dog safe and well.

On their way back home, Jane noticed something weird.  She was not wearing her unloader knee brace.  Even stranger, Jane had nil knee pain despite running after her dog without her knee brace! 

‘How is this even possible?’, she asked herself.

In Jane’s opinion, her knee cartilage may have regrown due to her wearing an unloader brace daily while walking her dog.  Jane would never have realised that her cartilage had regenerated if her dog hadn’t suddenly run out of their house that day.   This is because normally, Jane would never walk her dog without her knee brace.

Jane joked that her brace must have given her knee a much-needed ‘knee holiday’.

Thanks to Jane’s brace, her knee no longer endured ‘bone-on-bone’ pain while walking her dog.  This led to reduced irritation and inflammation as well as possible cartilage regeneration.

I thought it was fantastic that in lieu of total knee replacement, Jane was prescribed an unloader knee brace.  This knee brace enabled Jane to take long walks with her dog every day without knee pain.  Furthermore, Jane no longer needed her knee brace one year later.

Jane’s knee cartilage may have regrown thanks to the ‘knee holiday’ that her brace offered.  Despite no longer wearing her brace while walking her dog, Jane no longer had any ‘bone-on-bone’ knee pain.

Just as a dog can be a man’s (or a woman’s) best friend, an unloader knee brace may be an OA knee’s best friend.

An unloader knee brace was the only thing that Jane needed for ‘bone-on-bone’ knee pain.  And thanks to her misadventure with her dog, she found out that she no longer needed a knee brace one year later!

After listening to this incredible story, I was happy that Jane was able to defer total knee replacement surgery indefinitely.

Some questions:

What would have happened if Jane had done nothing at all?  In other words, what if Jane was not prescribed an unloader knee brace and had not considered total knee replacement surgery?

I suspect that if Jane had done nothing at all, her knee may have deteriorated even further.

A ‘bad’ knee sometimes degenerates to the point where walking becomes impossible without a cane, walker or wheelchair – until joint replacement.

As such, doing nothing is not usually a good option.  One needs to be proactive in the care of one’s own health including the health of one’s knees.

If one has painful knees, one should first seek out less invasive knee treatments.  This may include an unloader knee brace, physiotherapy, non-load-bearing exercises (e.g. swimming and other aquatic exercises, cycling), a healthier diet, losing weight and/or autologous cartilage transplantation (see link at top).

If conservative treatment(s) are pursued in a timely manner, it may be possible to save a knee joint, hence defer total knee replacement indefinitely.

Finally, what exactly went on inside Jane’s knee while she wore her unloader knee brace??

To try to answer this question, I explored the science behind Jane’s knee recovery.  This is what I found:

The Science Behind Jane’s Knee Recovery  


Image of unloader (valgus) knee brace for medial knee OA sourced from:


A properly fitted unloader knee brace may help keep a patient on his/her feet while slowing or stopping further ‘bone-on-bone’ deterioration of the knee joint.  This may lead to reduced knee pain and increased mobility.

A fitted unloader brace is designed to alleviate the mechanical strain on the defective load-bearing cartilage.  As such, cartilage regeneration in vivo may occur in some OA patients after wearing an unloader brace for many months.

Whether cartilage regenerates or not is not the biggest issue.  It may even be impossible in most OA knee patients.

A greater concern is whether reduced (or nil) ‘bone-on-bone’ pain and increased mobility results while wearing an unloader knee brace during weight-bearing activity.  If yes, ongoing use of this brace is warranted as long as desired.

Some OA patients may prefer a non-invasive unloader brace over total knee replacement surgery, osteotomy, pain medication including knee injections or doing nothing at all.

Others may not qualify for total knee replacement surgery due to being younger than 50 or older than 80.  As such, patients aged less than 50 with a severely arthritic and painful knee may benefit from an unloader brace.

Patients with unicompartment knee OA* may benefit from unloader braces that may decrease (or eliminate) pain, enhance knee function and perhaps even slow OA progression.

Knee Joint Distraction Therapy

Knee joint distraction therapy involves applying an external force to the knee joint via an unloader knee brace (preferably, not via an invasive external fixation frame).  Such a brace can be adjusted to exert external forces to either the inside or the outside of the knee, depending on which side is affected by OA.

Pain relief and reduced swelling often occur following distraction therapy of the arthritic, load-bearing part of the knee.  This therapy may either shift load-bearing weight from the medial (i.e. inside; valgus) compartment to the lateral (i.e. outside; varus) compartment of the knee, or vice versa (depending on which side is affected by arthritis).

In other words, knee joint distraction therapy via an unloader brace shifts the weight away from the arthritic knee compartment including degenerated cartilage and toward the ‘good’ side of the knee joint.   

Furthermore, an unloader brace may improve the overall alignment of the knee joint.  

Finally, an unloader brace may alleviate the ‘bone-on-bone’ pain in the knee by slightly increasing the gap between the femur bone and tibia bone on the arthritic side of the knee joint.

For example, a knee unloader brace with valgus adjustments may be prescribed for medial unicompartment knee OA.  This may be desirable before considering other more invasive surgical options such as osteotomy or arthroplasty (Ramsey & Russell, 2009).


In summary, an unloader brace-induced chondrocyte-friendly knee joint may result.  This may lead to reduced or nil pain and swelling, increased mobility and perhaps even cartilage regeneration (Callaghan et al, 2015; Kirane et al; Lafeber et al, 2006; Lee et al, 2017; Mastbergen, 2013; Ornetti et al, 2015; Ramsey & Russell, 2009; Thoumie et al, 2018; Tiku & Sabaawy, 2015; van der Woude et al, 2016a; van der Woude et al, 2016b; van der Woude et al, 2017; Verkerke et al, 2014).

One last question:

Is cartilage regeneration more likely to occur if both:

  • An unloader knee brace is worn; and
  • Autologous cartilage transplantation is done (where appropriate)?

(The latter is discussed here:

Transplantation of One’s Own Knee Cartilage – Is this ‘The Bee’s Knees’ for Painful Knees?)

Unloader Knee Brace Patient Stories

Dermott Brereton 


Dermott Brereton 


Former Australian Football League Player, Dermott Brereton (54), endured painful OA in his left knee for more than 30 years after tearing his cartilage during a game in 1984, aged only 19.

Following unsuccessful knee surgery, his injured cartilage had to be removed a year later.  Sadly, Dermott was left with ‘bone-on-bone’ knee pain.  Quoting Dermott,

‘It’s been painful to walk on ever since and can be excruciating when the pain’s most acute.’

Dermott continued,

‘… People ask me what’s it like, ‘bone-on-bone’ [pain] … I describe it as biting on a bit of tin foil.  That’s what it is in between the 2 [bones] of your knee … 

Rather than having invasive total knee replacement surgery, Dermott decided to wear the Unloader One Lite knee brace … and he hasn’t looked back since!

Weighing only 296g and featuring Össur’s 3-Point Leverage System, the Unloader One Lite knee brace is the lightest unloader knee brace currently available.

Dermott has worn this unloader knee brace for several months with significant success.  In his words,

‘… The Unloader [knee brace] … pulls those 2 sensitive points apart …

… I’ve got enough confidence now to take on the [96km Kokoda] track again.  So these days, any sporting activity I take on, I’m wearing the Unloader knee brace …’
‘… I wear the brace when I go on longer walks and play golf and have found that it really reduces the strain and pain in my knee …’

More details are available in the 1-minute YouTube video as well as in the following links:

Other Unloader Knee Brace Stories

Quoting a 61-year old retired male professional,

‘I have one of these [unloader knee] braces and I wish I had this 3 years ago. I now ride my Trike all over New Zealand.’

For additional positive unloader knee brace stories, see YouTube videos and testimonials by OA patients including by:

  • ‘Tony’, a father of 2 girls;
  • A 45-year old male who enjoys kite surfing;
  • 9 other men including fathers;
  • A female hiker (age unknown);
  • An Asian woman who practices yoga.
  • A female (61); and
  • A knee pain patient (gender unknown).

For ‘Stories From Unloader Brace Users’, click here:


Osteoarthritis knee patients should wear fitted unloader knee braces before contemplating total knee replacement surgery.

One never knows … there may be some life left in many knees, thanks to fitted unloader knee braces.


* Unicompartment knee OA involves degeneration of the knee joint including defective articular cartilage.  The medial part of the knee joint is more commonly affected than the lateral part.

** Mesenchymal stem cells are the progenitor of chondrocytes.  They originate and reside in peri-articular bone marrow and subchondral bone.  Mesenchymal stem cells are also present in cartilage, synovium, synovial fluid, infrapatellar/sub-synovial fat pad and adipose tissue (Mastbergen, 2013; McGonagle et al, 2017).



(1A) Global Orthopaedics leader Össur announces AFL Legend Dermott Brereton as ambassador for revolutionary osteoarthritis knee braces – Unloader One Lite. Össur.

(1B) Stories From Unloader Brace Users. Össur.

(2A) Bedard, Richard. Knee Cartilage Repair: How One Patient Proved His Doctors Wrong. Huffpost (16 Aug 2011).

(2B) Bedard, Richard. Saving My Knees: How I Proved My Doctors Wrong and Beat Chronic Knee Pain. Pages 1-208.



(1A) Lyu et al. Knee Health Promotion Option for Osteoarthritic Knee: Cartilage Regeneration is Possible, Osteoarthritis – Diagnosis, Treatment and Surgery, Prof. Qian Chen (Ed.) (2012).

ISBN: 978-953-51-0168-0, InTech, option-for-osteoarthritic-knee-cartilage-regeneration-is-possible

(1B) Lyu et al. Arthroscopic cartilage regeneration facilitating procedure for osteoarthritic knee. MC Musculoskeletal Disorders (21 Nov 2012); 13: 226.

(1C) Other papers and thoughts by Lyu et al on whether cartilage regeneration could occur by itself, and in vivo:

(1D) Ding et al. Natural History of Knee Cartilage Defects and Factors Affecting Change. Arch Intern Med (27 March 2006); 166(6): 651-658.

doi 10.1001/archinte.166.6.651


(2A) Tiku & Sabaawy. Cartilage regeneration for treatment of osteoarthritis: a paradigm for nonsurgical intervention. Ther Adv Musculoskelet Dis (2015); 7(3): 76-87.

(2B) Callaghan et al. (2015) A randomised trial of a brace for patellofemoral osteoarthritis targeting knee pain and bone marrow lesions. Ann Rheum Dis (16 January 2015); 74(6): 1164–1170.

doi 10.1136/annrheumdis-2014-206376

(2C) Lafeber et alUnloading joints to treat osteoarthritis, including joint distraction. Curr Opin Rheumatol (2006); 18(5): 519–525.

(2D) Verkerke et al. Knee Orthosis for Cartilage Repair. Knee Orthosis for Cartilage Repair (October 2014); 32-33.

doi 10.13140/2.1.2702.6244

(2E) Ramsey & Russell. Unloader Braces for Medial Compartment Knee Osteoarthritis. Sports Health (Sept 2009); 1(5): 416–426.

(2F) van der Woude et al. Five-Year Follow-up of Knee Joint Distraction: Clinical Benefit and Cartilaginous Tissue Repair in an Open Uncontrolled Prospective Study. Cartilage (July 2017); 8(3): 263–271.

(2G) van der Woude et al. Knee Joint Distraction Compared to Total Knee Arthroplasty for Treatment of End Stage Osteoarthritis: Simulating Long-Term Outcomes and Cost-Effectiveness. (12 May 2016); 11(5): e0155524.

(2H) van der Woude et al. #885 – Six Weeks of Knee Joint Distraction: Sufficient for Cartilage Tissue Repair. Abstracts / Osteoarthritis and Cartilage 24 (2016); S63eS534

(2I) Ornetti et alClinical effectiveness and safety of a distraction-rotation knee brace for medial knee osteoarthritis. Annals of Physical and Rehabilitation Medicine (June 2015); 58(3): 126-131.

(2J) Mastbergen, S. SP0166 Joint Distraction and Cartilage Regeneration – What is the Basis for Structural Repair? Ann Rheum Dis (2013); 72(Suppl 3).


(2K) McGonagle et al. Native joint-resident mesenchymal stem cells for cartilage repair in osteoarthritis.  (Dec 2017); 13(12): 719-730.

doi 10.1038/nrrheum.2017.182.

(2L) Centeno, CJ. Can an Aggressive Knee Surgical Implant Regrow Cartilage? Regenexx (5 Sept 2013).


(2M) Intema et al. Tissue structure modification in knee osteoarthritis by use of joint distraction: an open 1-year pilot study. Ann Rheum Dis (12 May 2011); 70: 1441–1446.

doi 10.1136/ard.2010.142364

(2N) Wiegant et al. Sustained clinical and structural benefit after joint distraction in the treatment of severe knee osteoarthritis. Osteoarthritis Cartilage (Nov 2013); 21(11): 1660-7.
doi 10.1016/j.joca.2013.08.006.
(2O) Eustice, Carol. Relieve pain and improve stability with an unloader knee brace for osteoarthritis. Braceworks (22 Oct 2018).

(2P) Mistry et al. An Update on Unloading Knee Braces in the Treatment of Unicompartmental Knee Osteoarthritis from the Last 10 Years: A Literature Review. Surg J (N Y) (2 Jul 2018); 4(3): e110–e118.


(2Q) Lee et al. Unloading knee brace is a cost-effective method to bridge and delay surgery in unicompartmental knee arthritis. BMJ Open Sport Exerc Med (31 Jan 2017); 2: e000195.


(2R) Thoumie et al. Effect of unloading brace treatment on pain and function in patients with symptomatic knee osteoarthritis: the ROTOR randomized clinical trial. Sci Rep (12 Jul 2018); 8(1): 10519.

doi 10.1038/s41598-018-28782-3 

(2S) Kirane et al. Offloading strategies for knee osteoarthritis. ler magazine (Sept 2010).


(3) Vincent et al. The Pathophysiology of Osteoarthritis: A Mechanical Perspective on the Knee Joint. PM R (May 2012); 4(5 Suppl): S3–S9.


‘Off-Label’ Use of Epidiolex (Cannabidiol; CBD) and Tilray 2:100 for Pain?

Feature Image of Epidiolex (cannabidiol; CBD) bottles sourced from:

Dear Pain Matters readers,

Epidiolex (Cannabidiol; CBD)


An oral solution called Epidiolex (cannabidiol; CBD) was approved on 25 June 2018 by the US Food and Drug Administration (FDA).  Made by GW Pharmaceuticals, Epidiolex may be used for the treatment of epileptic seizures in patients with Lennox-Gastaut syndrome and Dravet syndrome aged 2 and above.

Epidiolex is the first FDA-approved drug that is based on a molecule (i.e. CBD) derived from marijuana (in this instance, CBD-rich cannabis).  Contrary to tetrahydrocannabinol (THC) that may lead to a ‘high’, the CBD molecule does not exert psychoactive effects.

For more information about CBD and pain, please visit my blog post called:

Cannabidiol (CBD) – ‘Cannabis With the Fun Bit Taken Out’ – For Severe Chronic Pain

Possible ‘Off-Label’ Use of Epidiolex (Cannabidiol; CBD) for Pain

Given that:

  • Cannabidiol (CBD) may offer pain relief; and
  • Epidiolex virtually is CBD,

‘off-label’ use of Epidiolex for pain may be warranted (Anson, 2018; Urits et al, 2019).

Thus, while specifically approved for the treatment of certain epileptic conditions, ‘off-label’ prescription by doctors for Epidiolex for pain may be possible.

Tilray 2:100

Tilray 2:100 (that is comparable to Epidiolex) is now available in Canada for patients with epilepsy.  Tilray 2:100 offers a target concentration of 100 mg/ml of CBD and 2 mg/ml of THC (Henriques, 2019; Tilray, 2018).

Similar to Epidiolex, ‘off-label’ prescription by doctors for Tilray 2:100 for pain may be warranted.


You may ask yourself,

‘Why would anyone request an ‘off-label’ prescription for Epidiolex or Tilray 2:100 when one could simply buy CBD for pain online (where legal)?’

According to Kyle Varner, MD, Internal Medicine Specialist in Washington:

‘CBD oil has tremendous therapeutic potential.  Epidiolex is just CBD— but sold at a price tag of over $30,000 per year’ (Tapp, 2019).

The answer is that many CBD products sold online are mislabeled and unregulated.  This may lead to ineffective treatments and/or side effects (Bonn-Miller et al, 2017).

As such, Epidiolex and Tilray 2:100 may be prescribed ‘off-label’ for pain in the US and Canada, respectively (in addition to, or instead of, CBD).

This is great news!  Now there are more treatment options available for pain!

Please forward to anyone who may benefit from this blog post.

Sabina Walker

Blogger, Pain Matters (in WordPress)



(1) Urits et al. An Update of Current Cannabis-Based Pharmaceuticals in Pain Medicine. Pain Ther (5 Feb 2019).

doi: 10.1007/s40122-019-0114-4.

(2) Anson, Pat. FDA Approves First Marijuana-Based Prescription Drug. Pain News Network (25 June 2018).

(3) van der Walt, Eddie & Dawson, Rob.America’s First Cannabis-Based Medicine Is Made in England. Bloomberg (31

(4) FDA. FDA approves first drug comprised of an active ingredient derived from marijuana to treat rare, severe forms of epilepsy. FDA (25 June 2018).

(5) Tapp, Fiona. Businesses envision a boom in CBD, the non-intoxicating oil from hemp. Boston Globe (24 Jan 2019).

Tilray 2:100

(1A) Henriques, Carolina. Tilray Launches New High-CBD Cannabis Oil for Seizure Treatment in Canada. Dravet Syndrome News (29 May 2019).

(1B) Tilray Introduces New High-CBD Extract. Tilray (06/19/2018).

Labelling Accuracy of Cannabidiol Available Online

(1A) University of Pennsylvania School of Medicine. Nearly 70 percent of cannabidiol extracts sold online are mislabeled, study shows. Science Daily (7 Nov 2017).

(1B) Royal Queen Seeds. The Recent Approval of Epidiolex and its Implications.

(1C) Bonn-Miller et al. Labeling Accuracy of Cannabidiol Extracts Sold Online. JAMA (2017); 318(17): 1708.

doi: 10.1001/jama.2017.11909

This is the story of my exploration on matters of chronic pain.