Monday, July 31, 2006

I Dulled Her Pain, and My Judgment - New York Times

That afternoon I walked into the room as if into a one-act play. The patient, a dirty blond in a wheelchair who looked to be in her mid-30’s, observed me coolly from behind sunglasses. Her husband, who had moody eyes under the rounded brim of a well-worn baseball cap, looked exactly like the daytime courier and moonlighting guitarist he was. They watched as I located the rolling stool, opened her chart, reviewed her vital signs and looked up. The encounter could now begin.

She told me she was on an antidepressant (Paxil) as well as Toprol XL for an irregular heart rate. Until recently, she had also been on pain medication, the Duragesic fentanyl patch, which releases a low dose of narcotic over three days. Her relationships with doctors, she explained, had been contentious. A psychiatrist had refused to prescribe Paxil and insisted on switching her to another antidepressant. Another had tapered her pain medication against her wishes. And a third had made inappropriate comments and had begun to stalk her.

I was easily charmed by her theatrical humor, colorful anecdotes (told in a deep Kathleen Turner voice), and seeming sincerity. I was touched by her stories of pain and depression. And she openly flattered me with lines like, “You seem different from the other doctors,” “You’re really listening to me,” and “Wow, you really know your medications.”

A MENTOR had cautioned me that addicts are often creative, ruthless, persistent and even seductive to get what they need. But as a new practitioner, I was like a blossoming teenage girl, startled by my sudden power and vulnerable to experienced advances. I was still pretty green socially as well, having just re-entered the dating world after years of being cocooned by the intense work of graduate school.

She suffered, she reported, from fibromyalgia, which rendered her nonfunctional and nearly bedridden, and she had come to the clinic seeking relief from the pain. Per protocol, I offered Ultram, a new drug that mimics an opiate without inducing addiction.

In nurse practitioner school, they teach that pain is the fifth vital sign, as important to the assessment of a patient’s well being as blood pressure, pulse, temperature and respiratory rate. Although they urge us to treat pain as we might treat bronchitis or bad case of diarrhea, the reality can be more complex.

As a rookie, I looked to the clinic’s head doctor for guidance. He was aggressive in treating pain, an anomaly in clinics that accept Medicaid patients. Most anyone who entered our clinic with persuasive medical records and an MRI report was prescribed a narcotic. Word of this traveled quickly and patients flocked to us like gulls to a beach picnic, some truly in pain and others with the voracious appetite of the addict.


Wednesday, July 26, 2006

Research Finds Little Proof on Menopause Treatments (click here)

Almost half of American women seek alternative or complementary treatments for the unpleasant symptoms of menopause. But a systematic review of the evidence has found little proof that any of them work.

Researchers reviewed 70 randomized controlled trials of alternative treatments and found insufficient scientific evidence to support the effectiveness of any of the commonly used remedies: herbs, mind-body techniques, energy therapies using magnets or electrical nerve stimulation, homeopathy, naturopathy or culturally based non-Western medical treatments. The review was published yesterday in The Archives of Internal Medicine.

Most of the studies were of poor quality, but even those judged by the researchers to be “fair” or “good” on a three-point scale most often demonstrated little difference between alternative treatments and placebo. For example, a study that compared 56 patients given a soy drink with 55 who drank a medically inactive liquid found no difference between the groups, although both groups got some symptom relief.

Three of four trials of the herb black cohosh, a common alternative treatment for menopausal symptoms, showed no improvement, but the studies suffered from poor methodology. The fourth, judged “fair” by the researchers, enrolled 304 women, half of whom took black cohosh and the other half a placebo for 12 weeks. Compared with placebo, there was greater improvement in the treatment group as measured by the participants’ own reports. Dr. Anne Nedrow, the lead author of the review, said the study “did show some benefits, but we had to balance it with studies that showed none.”

The scientists examined nine studies of mind-body therapies, treatments that focus on the ways in which emotional, mental, social, spiritual and behavioral factors can affect health. While they varied considerably in quality, none found a significant improvement compared with placebo treatment using stress-management techniques, meditation, relaxation exercises, audiotape relaxation or supportive counseling.

Therapies involving reflexology, bone manipulation and magnetic devices were found to be almost completely useless. In one small study of magnets, the placebo group showed more improvement than the group that received the magnet treatment.

Acupuncture was also ineffective. The reviewers examined four trials; three demonstrated no difference between real and sham procedures. The fourth, judged by the reviewers to be of fair quality, compared standard estrogen therapy, sham acupuncture and electroacupuncture, a variation on the practice in which continuous electrical pulses are delivered through the needles. Only the estrogen group improved.

Monday, July 24, 2006

Voices of Chronic Pain: Results of national survey by the American Pain Foundation

Chronic pain is one of the greatest and least understood epidemics in America. Millions of Americans suffer with their pain needlessly, resulting in significantly losses of productivity and income as well as negative impacts on their personal and family lives. 

While options exist for the control and management of this chronic pain, many suffers avoid using some of the most effective treatments. This avoidance is rooted in several areas, including social stigmas difficulties with dosing schedules and even the overall efficacy of the medications. 

In an effort to better understand these attitudes, the American Pain Foundation asked David Michaelson & Company, LLC to conduct a comprehensive study of chronic pain patients who use opioids in order to better understand their attitudes toward this treatment as well a understand their unmet needs for pain manage-ment. This report presents the detailed findings from that study.

The American Pain Foundation: Voices of People With Pain

Voices of People With Pain asks you to write a few paragraphs in your own words about your experience with pain. If you are a person with pain or know someone who lives with pain, we invite you to share your story in your own words. If you are able, we ask you to write how you have learned to triumph over your pain. Please include in your story any words of support, hope and encouragement you wish to convey to others.

Patients in chronic pain flood ERs - The Detroit News Online (click here)

The problem of chronic pain -- one of the biggest financial and time drains on Detroit's emergency rooms -- is worsening as fewer people have health insurance to treat the problem before it becomes extreme.
Chronic pain affects three times as many people as heart disease and costs the nation as much as obesity, yet Detroit and some suburban emergency rooms often fail to effectively treat chronic pain.
"It's a constant frustration for both sides and there's no good answer," said Gerald Fitzgerald, president and chief executive officer of the Dearborn-based Oakwood Health System.
More than 50 million Americans suffer from chronic pain, costing more than $120 billion in reduced productivity, sick time and medical costs, the American Chronic Pain Association and the National Institutes of Health estimate.
As Americans live longer, they're more likely to suffer from painful, chronic conditions such as arthritis and diabetes.
Metro Detroit hospitals are aware of the problem and are taking preventive steps, from requiring hospital staffs to measure patients' pain more frequently to making drugs more readily available. An Upper Peninsula hospital is creating a pain network to help streamline care for patients; a doctor recently opened a clinic in West Bloomfield specifically aimed at treating pain.
But the problem is especially pronounced in Detroit, where large numbers of poor and uninsured, along with already overburdened emergency rooms, overwhelm the system. Doctors say patients who return to the ER repeatedly seeking help for pain are the biggest drain on their time and resources. Patients complain they are ignored or undertreated for debilitating symptoms.

"Pain is the No. 1 reason people visit their physicians, yet many physicians don't receive much training in how to handle pain," said Dr. Carmen Green, director of pain research at the University of Michigan.
A number of factors exacerbate the problem in the emergency room:
Lack of training on how to handle pain is a major contributor.
Patients who go to the ER for the first line of treatment are often poor and uninsured and not getting regular care.
Many are women and minorities, two groups that many studies indicate often receive less adequate treatment for pain.
"There's an intersection of all these vulnerable populations that creates a situation where people don't get very good treatment," Green said.

Sunday, July 23, 2006

Pain! It's not all in your head (click here for article)

In your old comic books, it’s simple. A few punches. Sharp, fleeting pain. Then it’s over.

That type of pain happens in real life too. But more often, the pain that puts us in the examining room isn’t colorful, and it isn’t quick — it lasts for weeks, months, even years. LaDonna Lindstedt, for instance, visited an ear, nose, and throat (ENT) specialist because of earaches and trouble hearing as well as daily “droning, constant” headaches. Occasionally she’d have a headache so bad she couldn’t open her eyes.

Before the headaches started, Lindstedt had experienced episodes of jaw pain and tension. She’d know it was coming on because “the first bite of anything I ate was excruciating,” she says. “It actually felt like an electric shock running through my jaw and my head.” Over a week, the pain and tightness would get so severe that she could open her mouth only wide enough to drink through a straw.

The ENT specialist diagnosed Lindstedt with Temporomandibular joint disorder (TMD), a chronic pain condition that affects 5 to 15 percent of the population. Like many chronic pain disorders, TMD has no apparent cause. The patient hurts all the time, but often x-rays and other tests don’t show tissue damage or inflammation.

In the three hundreds B.C., Aristotle suggested that pain was not a physical sense but an emotion. Today, most scientists would agree that pain is physical — the stuff of nerve fibers and receptors and chemicals. But for some chronic pain disorders, we wonder. Often these types of pain get labeled as possibly psychogenic — psychological in origin with no biological cause.

A study from Carolina shows that the pain is real. But the source won’t show up on an x-ray; it is in the genes, and in the firing of brain cells. This research is the first study to link a genetic variation with a chronic pain disorder.

This discovery took seven years of work from a team of thirteen scientists. One of those researchers is William Maixner, a pharmacologist, neuroscientist, and dentist. Maixner is a genial man with blue eyes, ruddy skin, and wavy hair turned mostly gray. In Carolina’s Oral and Maxillofacial Pain Clinic, he sees patients with TMD, including LaDonna Lindstedt. Her treatment includes twice-a-week physical therapy, nightly muscle relaxants, and a mouth guard to wear when she feels her jaws are beginning to clench. Such treatments help, but scientists still don’t know exactly what causes pain disorders such as TMD. Maixner says, “Patients will come to me and say, ‘I don’t see any reason why I should be having this pain. Do I have a brain tumor? Am I crazy?’”

Scientists know that, in general, people who suffer from chronic pain disorders are more sensitive to pain and often struggle with mild depression and anxiety. But which comes first: the pain disorder, or these other symptoms? And what makes some people, especially women, more likely to get chronic pain disorders?

Recover from sports injuries with knowledge and patience

Frequently athletes react to injuries with wide range of emotions including denial, anger, and even depression. An injury often seems unfair to anyone who has been physically active and otherwise healthy. Although your feelings are real, it’s important to move beyond the negative and find more positive strategies to cope with this setback. In many cases dealing gracefully with an injury will make you a more focused, flexible, and resilient athlete. Here are some suggestions for coping with an injury.

Learn About Your Injury

Learn as much as possible about the cause, treatment and prevention of your injury. Not fully understanding an injury can cause fear or anxiety Ask the following questions of you doctor, trainer, coach or therapist until you know exactly what you can do to heal quickly and fully.

What is my diagnosis (what type of injury do I have)?

How long will recovery take?

What is the purpose of the treatments I am receiving?

What should I expect during rehab?

What alternative workouts can I safely do?

What are the warning signs that I am getting worse?

By understanding the injury and knowing what to expect during the rehabilitation process, you will feel less anxiety and a greater sense of control.


New medical technique treats chronic facial pain News Staff

A new method for treating patients suffering from severe chronic facial pain is being introduced at select medical centres in Canada.

When traditional drugs or physical therapy fails in the treatement of chronic pain, considered consistent or intermittent pain that lasts six months or more, some doctors are turning to an experimental treatment known as motor cortex stimulation.

The treatment method, an electrical pain control system, places electrodes under the patient's skull over an area of the brain (motor cortex) that processes facial pain.

For Jen Dafoe, who suffered from a rare jaw disorder that required multiple surgeries, the resulting nerve damage was so severe that for two years she was often confined to her bedroom.

Not even surgery or heavy doses of narcotics could deaden her 'invisible' neuropathic pain.

"I couldn't work, I couldn't go to school, I couldn't do anything," Dafoe said.

As a result, London Health Sciences' Dr. Andrew Parrent successfully performed motor cortex stimulation on Dafoe.

"She appeared to be at her wit's end is a good way of putting it," Dr. Parrent said.

Now, with 99 per cent of her pain gone, Dafoe relishes in the simple act of buying a bicycle.

"Just to ride and have the wind on my face would be a great feeling," Dafoe said as she shopped for a bicycle.

Dr. Parrent tried to explain the complex procedure.

"Our presumption is that we are interfering with the way the brain perceives pain. But if it is jamming the signal or introducing another signal that overrides it ... isn't clear."

The surgery has been used in about two dozen Canadian cases after the patients -- suffering from facial pain caused by nerve damage or stroke -- failed all other methods of treatment.


Video story:

Guidelines for Trials of Behavioral Treatments for Recurrent Headache, First Edition: American Headache Society Behavioral Clinical Trials Workgroup

Donald B. Penzien, PhD; Frank Andrasik, PhD; Brian M. Freidenberg, PhD; Timothy T. Houle, PhD; Alvin E. Lake, III, PhD; Gay L. Lipchik, PhD; Kenneth A. Holroyd, PhD; Richard B. Lipton, MD; Douglas C. McCrory, MD; Justin M. Nash, PhD; Robert A. Nicholson, PhD; Scott W. Powers, PhD, ABPP; Jeanetta C. Rains, PhD; David A. Wittrock, PhD

Guidelines for design of clinical trials evaluating behavioral headache treatments were developed to facilitate production of quality research evaluating behavioral therapies for management of primary headache disorders. These guidelines were produced by a Workgroup of headache researchers under auspices of the American Headache Society. The guidelines are complementary to and modeled after guidelines for pharmacological trials published by the International Headache Society, but they address methodologic considerations unique to behavioral and other nonpharmacological treatments. Explicit guidelines for evaluating behavioral headache therapies are needed as the optimal methodology for behavioral (and other nonpharmacologic) trials necessarily differs from the preferred methodology for drug trials. In addition, trials comparing and integrating drug and behavioral therapies present methodological challenges not addressed by guidelines for pharmacologic research. These guidelines address patient selection, trial design for behavioral treatments and for comparisons across multiple treatment modalities (eg, behavioral vs pharmacologic), evaluation of results, and research ethics. Although developed specifically for behavioral therapies, the guidelines may apply to the design of clinical trials evaluating many forms of nonpharmacologic therapies for headache.

(Headache 2005;45[Suppl 2]:S110-S132)


Saturday, July 22, 2006

Pain Assessment in the Non-verbal Patient Position Statement with Clinical Practice Recommendations

American Society of Pain Management Nurses

Summary: Individuals who are unable to communicate their discomfort are at greater risk for inadequate analgesia. This position paper describes the severity of this issue, defines populations at risk and offers strategies, tools, and resources for appropriate pain assessment. Nurses have a moral, ethical, and professional obligation to advocate for all individuals in their care. Just like all other patients, these special populations require consistent, ongoing assessment, appropriate treatment, and evaluation of interventions to insure the best possible pain relief. Clinicians are encouraged to monitor current research regarding new developments in strategies and tools for assessing pain in these populations.

Study Shows Chronic Pain Treatment in Canada Still Seriously Lacking

Canadians with chronic pain suffer in silence for a long time before they are able to access the specialized treatment required for this disease. This is the normal state of affairs according to poster study presented at the Canadian Pain Society conference.

The STOP Pain project reviews the availability of, and patient access to, what are known as Multidisciplinary Pain Treatment Facilities (MPFTs) in Canada including how and what services they offer to those with this disease.

Results are startling. For a disease that affects more Canadians than diabetes or asthma, there is one MPFT for every 250,000 Canadians and the vast majority of these clinics are located in major centres.

Of the 101 MPTFs studied, less than one in two was publicly-funded. The median wait time to access this type of clinic is 10 times longer than a private clinic (32.5 weeks vs. 3 weeks) and can be as long as five years.

Friday, July 21, 2006

The Pain Market Outlook to 2011 - Research and Markets - Market Research Reports (PDF copy, $2,875)

The patient populations for neuropathic and nociceptive pain are large, and are driven by separate disease trends that necessitate pain relief; across the seven major markets in 2005 it was estimated that 37.6m individuals suffered from neuropathic pain and 170.1m suffered from nociceptive pain. 

The major constituents of the neuropathic pain market are lower back pain, neuralgia/fibromyalgia, diabetic neuropathic pain and pain associated with multiple sclerosis. The nociceptive pain market is driven by the prevalence of the major indications of arthritic pain, particularly osteoarthritis and rheumatoid arthritis, post-operative pain, cancer-related pain and HIV-related pain. 

Current management of pain is mostly pharmacological consisting of the use of opioids, non-opioids and non-steroidal anti-inflammatory drugs (NSAIDs), as well as adjuvant therapies such as anti-depressants and anti-convulsants. 

Just some of the key findings of the report...

- Within the pain therapy market there remains a substantial unmet need for drugs with improved efficacy and superior side-effect profiles, however there are few novel drugs in the pipeline and companies are heavily dependent on reformulations of existing drugs targeting better drug delivery, more convenient dosing schedules and specific patient populations.

- Over the 2001-05 period, the global pain market expanded at a CAGR of 7.9%, accounting for a net growth in sales of $9,571m. While the pain market has experienced several years of continuous growth, over 2004-05 sales dropped by 7.0% due to the withdrawal from the market of COX-II inhibitors, Vioxx and Bextra for safety reasons. Sales in this drug class plummeted by 66.2% in 2005.

- Currently the pain market is led by the anti-convulsant class, hich accrued sales of $11,574m in 2005 with the majority of revenue being derived from off-label use. Although the anti-convulsant class will maintain its leading position through 2010, future growth in the pain market will be driven by a small number of blockbuster drugs and the re-uptake of COX-II inhibitors

- Pfizers current dominance of the pain market is forecast to continue through 2011 due to the evolving success of its blockbuster drug, Celebrex and the recent launch of Lyrica, which promises market success comparable to its predecessor, Neurontin.

"The most prevalent tumor-related nociceptive cancer pain syndrome is bone pain. The spine is the most common site of bone metastases, which results in back pain as a highly prevalent problem among cancer sufferers..."

Pain as a growth industry: 48 pages, PDF, $445.00

Report Finds a Heavy Toll From Medication Errors - New York Times

Medication errors harm 1.5 million people and kill several thousand each year in the United States, costing the nation at least $3.5 billion annually, the Institute of Medicine concluded in a report released on Thursday.

Drug errors are so widespread that hospital patients should expect to suffer one every day they remain hospitalized, although error rates vary by hospital and most do not lead to injury, the report concluded.

The report, “Preventing Medication Errors,” cited the death of Betsy Lehman, a 39-year-old mother of two and a health reporter for The Boston Globe, as a classic fatal drug mix-up. Ms. Lehman died in 1993 after a doctor mistakenly gave her four times the appropriate dose of a toxic drug to treat her breast cancer.

Recommendations to correct these problems include systemic changes like electronic prescribing and tips for consumers like advising patients to carry complete listings of their prescriptions to every doctor’s visit, the report said.

Wednesday, July 19, 2006

Breastfeeding 'kills baby's pain'

Breastfeeding may be the ultimate natural painkiller for newborn babies.

A review of research found that breastfeeding newborns helps
relieve the pain from a needle prick used to screen their blood
for disease.

Breastfed babies appeared to experience less pain than those
who were swaddled, given a pacifier, or a placebo. Comfort
from a mother's presence may be key.

The researchers say that breastfeeding could possibly help
relieve pain for premature babies who need to undergo many
painful intensive care procedures.

However, they stress that their study did not test the impact
of breastfeeding on the pain associated with repeated procedures.

Monday, July 17, 2006

3-Rx Engine: pain

Welcome to, a goldmine of good medical and health information containing comprehensive, accurate, unbiased, and reliable database of health articles and reference materials. Consumers and health professionals alike can depend on it for information that is authoritative and up-to-date.

Me, die? You must be joking

t started with a joke. The previous day I had developed numbness in my left hand and foot and on the left side of my tongue. After being fobbed off by an avuncular locum GP (“nothing to worry about, old chap, come back in a couple of days”), I called my friend and writing partner Phil Hammond, a doctor. I told him my symptoms.
There was a pause. That was worrying because Phil rarely thinks before he speaks. “Are you telling the truth?” he asked.

“Of course.”

“In that case, mate, you’re ****ed.”

It wasn’t a very good joke.,,8123-2261166,00.html#

Vent (BBC Radio):

The radio equivalent of 70% chocolate, Vent (Radio 4) is dark and bitter, and quite delicious. It's a situation comedy about a situation potentially short on laughs - Ben, the central character, is in a coma - and it doesn't shy away from its bleaker dimensions. In fact, it revels in them. "If I wasn't in a coma before," says Ben, played by Neil Pearson, of his mother's dreary bedside account of her day, "I would be by now." That's typical of the sardonic mood of this comedy, based on writer Nigel Smith's own experience of a coma; an experience which, I think, gives Vent its sharp, hilarious edge.

Mind Hacks

Neuroscience and psychology tricks to find out what's going on inside your brain.

Saturday, July 15, 2006


Did you know that pain can hurt you? A poster from MGH.

Pain is a natural and necessary response of our body to
harmful or potentially harmful stimuli in our environment
and we rely on it to help us survive. However, after the
warning, it can cause some unwanted and unneeded
havoc in our bodies!

COMPELLING EVIDENCE. Topics/Pain Can Hurt You.pdf

JCAHO Pain Standards: Impact on Practice

In January 2001 the Joint Commission on the Accreditation
of Healthcare Organizations (JCAHO) added two new
pain-related standards and explicitly included pain in
several existing standards. In this article I will describe
the new standards and their implications for professional
practice. Topics/JCAHO PAIN TOPICS article.pdf

MGH - Information for patients

What you need to know about PAIN     
     -A GUIDE for patients and families

Cancer Pain Can Be Relieved

Eight Facts Everyone Should 

Know About Cancer Pain

Pain Relief Connection Archives

Pain Relief Connection 
The Pain Information Newsletter

MGH - Our PLEDGE to Patients with Pain


  • Your caregivers will listen to you about your pain and take it seriously.
    Each person reacts differently to pain and to its treatment. Only you know what your pain feels like and how much it distresses you. Informing your care providers that you have pain and requesting treatment is not a sign of drug addiction, or being a "complainer." We need for you to tell us just how you feel.
  • Your pain will be carefully assessed.
    With your help, we will evaluate your pain carefully. We need specific information from you to help in this process. We may ask you to describe the intensity of your pain on a scale from zero to ten (where zero is no pain and ten is the worst imaginable pain). We need you to describe the quality of your pain (for instance, as stabbing, aching, or burning), its location, how it varies over time, and what makes it better or worse. We also need to find out from you how well our treatment is working and how long relief lasts.
  • We will provide you with the information you need to understand your pain and the ways it can be managed.
    We want to keep you informed about how we propose to diagnose your pain and how the pain can be treated. We hope to develop a plan of care that fits your values and goals. You should feel free to ask questions and to discuss with your physician and nurse the cause of your pain and the alternatives for treatment. Both medications and non-drug treatments may be helpful, and you should be informed of potential side effects of specific treatments. If the need arises, pain specialists are available to consult with your health care team.
  • We will seek to prevent pain as well as to treat it.
    Ongoing pain is not good for you. It hinders your recovery from illness and injury and your ability to enjoy life. Unnecessary pain should be avoided, and pain treatment should be given before a discomfort becomes troublesome. In general, pain is easier to manage and can be controlled with less medication when it is treated quickly and prevented from becoming severe. Let us know what seems to bring on your pain and how it can be avoided, and ask for treatment before the discomfort becomes difficult to bear.
  • We will try to respond promptly to your reports of pain.
    While we cannot always come immediately when you report a problem or concern with pain or its management, promptness is our goal.

MGH Cares About Pain Relief Initiative

MGH Cares About Pain Relief is an educational initiative. We do not treat patients, nor do we provide consultation in the diagnosis or treatment of individual patients. If you are seeking treatment for pain, click one of the buttons below to be taken to the web page for these treatment programs.

There is a complex interaction of factors that create significant barriers to pain relief in spite of our ability to adequately treat most pain. MGH Cares about Pain Relief is an MGH-wide initiative to raise consciousness about the problem of pain and to provide information and education about pain for patients and their families as well as for professionals. The Pain Relief initiative was originally in funded 1999 by a grant from the Mayday Fund. In 2003 it became part of Patient Care Services. The Mission of MGH Cares About Pain Relief is to support all Massachusetts General Hospital educational, clinical, and research programs related to pain. We support the Hospital's Mission by providing educational programs and resource assistance to clinical educators, practicing clinicians, administrators, and patients and their families.

Mark R. Collen is the creator and project manager of the PAIN Exhibit. He started it in 2001 as a response to the years of undertreatment he endured. In addition, Mr. Collen has created art pieces about his pain and has discovered that art is far more effective at communicating the pain experience than words; his first piece entitled “Chronic Pain” marked the beginning of the Exhibit. Mark's desire to help end undertreatment coupled with his understanding of the power of art to educate were the seminal factors in the birth of the PAIN Exhibit. 

The PAIN Exhibit received over 500 entries of pain art from across the globe. While reviewing the art, various themes emerged. These themes revealed the most important aspects of the pain experience which artists wanted and needed to communicate. The online exhibit is organized by these themes. Although the art depicts great suffering, it also expresses transcending the suffering. 


Portraits of Pain - Suffering - Pain Visualized - But You Look So Normal - God and Religion

Isolation and Imprisonment - Miscellaneous - Unconditional Love - Hope and Transformation

Friday, July 14, 2006

YouTube - World of Pain (don't try these at home)

CFIDS/Fibromyalgia Self-Help, San Francisco

Our Philosophy

CFIDS and fibromyalgia are long-term illnesses that impose limits and bring uncertainty. Often they create isolation, frustration and a sense of helplessness. Even though a small number of patients recover and many improve, there is no cure for either illness and medical help is often quite limited. Therefore, we believe it is productive to explore what patients can do to help themselves.

Our program is based on other scientifically-proven self-management programs for chronic illness. In our groups, we aim to combine support with tools for managing chronic illness. Support means we attempt to create a safe environment in which people feel accepted, understood and respected. We believe that exchanging ideas with others who share a similar condition can be a powerful way to counteract the isolation of chronic illness, and can inspire and console. Tools means we aim to have a problem-solving orientation focused on a set of ideas and techniques that form a structured program of self-management. We believe that there are many things patients can do to improve their quality of life. We focus sharing practical solutions to common problems of chronic illness.

In the course, you will learn a comprehensive framework for understanding your illness, and receive many ideas from us and fellow participants about illness management. The framework and tools are designed to help you create an individualized and flexible plan for managing your illness.


Pain Redefined - heavy metal band, Disturbed

Fading, falling, lost in forever
Will I find a way to keep it together?
Am I strong enough to last through the weather in the hurricane of my life?
Can it be a conscious decision?
That I look for ways to alter my vision?
Am I speeding towards another collision in the alleyways of my life?



Pain as the 5th Vital Sign Toolkit

This Pain as the 5th Vital Sign Toolkit has been prepared as a resource toolkit for use by healthcare professionals. It is organized into the following sections:

Section 1: Introduction. This section presents the objectives of the VHA National Pain Management Strategy and a synopsis of the major sections of this toolkit.

Section 2: An Overview of the VHA National Pain Management Strategy. This section highlights the key components of the strategy and provides recommendations for implementation at individual VHA facilities (or in individual healthcare facilities if it is being used by non-VHA systems).

Section 3: Barriers to Pain Screening and Assessment. This section reviews many of the common barriers to reliable pain screening and assessment, including barriers attributable to healthcare professionals, patients, and the healthcare system. Appreciation of the factors is critical to the development of an effective program for pain management.

Section 4: The Pain Screening Process. This section includes information about the Numeric Rating Scale (NRS) for pain screening, a description of the tool, tips for using it reliably; guidelines for frequency of screening across diverse clinical settings; and suggestions for using the tool within the context of patient/family education on pain and pain management. This section also contains information on methods for documenting pain scores in the patient record.

Section 5: Conducting a Comprehensive Pain Assessment. This section emphasizes the role of pain screening as an initial step in the comprehensive assessment of pain. The section discusses pain as a complex, perceptual phenomenon and provides a rationale for more comprehensive assessment. Key components and commonly employed methods of pain assessment are also described, followed by a description of common barriers to reliable pain assessment.

Section 6: Educational and Resource Information. This section provides information to assist individuals and facilities in the successful implementation of the Pain as the 5th Vital Sign initiative.

APS - Pain: The Fifth Vital Sign

Vital Signs are taken seriously. If pain were assessed with the same zeal as other vital signs are, it would have a much better chance of being treated properly. We need to train doctors and nurses to treat pain as a vital sign. Quality care means that pain is measured and treated.

Five Things You can Do To Improve Pain Assesment and Treatment

  • Consider pain the fifth vital sign and assess patients for pain every time you check for pulse, blood pressure, core temperature, and respiration.
  • Urge your colleagues to take their patients' complaints of pain seriously. Remind them not to put patients in the position of asking for a favor when they want pain relief.
  • Inform patients that they deserve to have their pain evaluated and treated.
  • Work to implement the APS Quality Improvement Guidelines for the Treatement of Acute Pain and Cancer Pain in your own practice setting. (JAMA, 274, 1874-1880)
  • Wear your Fifth Vital SignTM button and make opportunities to explain the importance of pain evaluation and treatment to other healthcare professionals and to the public.

EPERC - Advancing End of Life Care Through an Online Community of Educational Scholars


Pain & Policy Studies Group

Pain & Policy Studies Group

University of Wisconsin 

Comprehensive Cancer Center

The Resource Center of the American Alliance of Cancer Pain Initiatives

The American Alliance of Cancer Pain Initiatives (AACPI) serves the national network of State Pain Initiatives, which are volunteer interdisciplinary organizations that work to disseminate accurate pain management information, educate healthcare professionals, promote clinical and institutional change, raise public and patient awareness of the importance of pain management, and advocate for the removal of regulatory and legislative barriers to pain management. The Resource Center of the AACPI is dedicated to improving pain management nationwide by supporting the work of the State Pain Initiatives and by developing programs and educational resources to positively influence health care systems, the regulatory climate and the culture at large.

American Society of Pain Educators

The American Society of Pain Educators (ASPE) is a 501(c)(3) non-profit professional organization dedicated solely to training healthcare professionals to become Credentialed Pain Educators (CPEs), specialized resources for pain management in their clinical settings.  The only agency for training pain educators, the ASPE teaches healthcare professionals to educate their peers and patients, together with families and caregivers on ways to relieve pain by the safest means possible.