Tuesday, February 27, 2007

BBC NEWS | Health | 'Perfectionism' bowel pain link

'Perfectionism' bowel pain link

Perfectionists are more prone to developing irritable bowel syndrome (IBS) after an infection, a study has suggested.

University of Southampton researchers asked 620 people with gastroenteritis about stress and their illness. Those who pushed themselves or were particularly anxious about symptoms were more likely to develop IBS. Experts said the study, published in Gut, may explain why only some people develop IBS after a gut infection.

'Not hypochondriacs'

In this study, each person was checked three and six months after their initial bout of bacterial gastroenteritis to see if they had developed IBS symptoms such as diarrhoea, constipation, abdominal pain and bloating.

In all, 49 people had IBS at both points. Women were more than twice as likely to have IBS as the men.

Those with IBS were significantly more likely to have reported high levels of stress and anxiety and psychosomatic symptoms than those who did not develop the condition.

They were also significantly more likely to be "driven", carrying on regardless until they were forced to rest, which the researchers say simply makes the initial condition worse and longer-lasting, potentially leading to IBS.

Dr Rona Moss-Morris, who led the research, said: "We found people's beliefs about their symptoms, how anxious they got and their behaviour were all important.

"These people were not hypochondriacs. But they did have a negative attitude towards their symptoms."

She added: "These are people who have high expectations of always doing the right thing - and going off work goes against their beliefs."

Such people try to remain active and may go back to work too soon, she said.

"They keep going - but then collapse in a heap.

"They are 'all or nothing' people who have high expectations of themselves."


Dr Moss-Morris said people who appear to have problems recovering from a bout of gastroenteritis could be investigated to see if they have a particularly anxious or perfectionist personality.

She suggested cognitive behavioural therapy might be an effective treatment.

But she added there was no suggestion that IBS was "all in the mind".

Professor Robin Spiller, an IBS expert from University Hospitals Nottingham and the editor of Gut, said: "There is probably a complicated mechanism at work here."

He said there were two potential explanations.

"It might be that stress and anxiety affects the immune system.

"But it could also be that if you don't rest, it might do you more harm."


Doctors Warned About Common Drugs for Pain - washingtonpost.com

Doctors Warned About Common Drugs for Pain
NSAIDs Tied to Risk of Heart Attack, Stroke

By Shankar Vedantam
Washington Post Staff Writer
Tuesday, February 27, 2007; A08

Doctors treating people for chronic pain should avoid using all medications -- at least at first -- the American Heart Association advised yesterday in guidelines designed to have a significant impact on the use of medications known as nonsteroidal anti-inflammatory drugs, or NSAIDs.

The scientific statement said that, with the exception of aspirin, there is now strong evidence that NSAIDs are associated with an increased risk of heart attacks and stroke. If 100 patients who have had heart attacks in the past or are at risk for heart disease take these drugs for a year, researchers would expect to see six additional deaths in this group. NSAIDs reduce fever, pain and inflammation.

The statement expressed particular concern over a subgroup of these drugs known as Cox-2 inhibitors. The only drug in this group currently on the market in the United States is Celebrex.

The professional association laid out a step-by-step approach that is very different from the way physicians typically have approached treating chronic pain and inflammation.

"In the past, many physicians would prescribe the Cox-2 drugs first," said Elliott Antman, a professor at Harvard Medical School who led a group of experts assembled by the heart association to study the issue. "We are specifically recommending that they should be used as a last resort."

"This is a very firm statement we are making," he added. "It is our belief, hope and desire that physicians will take our advice, and by doing so it is our belief and hope that we will reduce the number of patients who suffer heart attacks and strokes."

Patients should be treated first with nonmedicinal measures such as physical therapy, hot or cold packs, exercise, weight loss, and orthotics before doctors even consider medication, said the AHA scientific statement published in the journal Circulation.

Patients who get no relief after those measures have been exhausted can be considered for drug therapy, but doctors should try drugs only in a certain order, the statement said:

"In general, the least risky medication should be tried first, with escalation only if the first medication is ineffective. In practice, this usually means starting with acetaminophen or aspirin at the lowest efficacious dose, especially for short-term needs."

Friday, February 23, 2007

ABCD-CARING - Americans for Better Care of the Dying - Main Page

Handbook for Mortals : Guidance For People Facing Serious Illness

By Joanne Lynn, M.D. and Joan Harrold, M.D.
Foreword by Rosalynn Carter, Publication date: March, 1999, 242 pp., ISBN: 0195146018 (hardback)

There's a wealth of sensible advice on how to make decisions about care, where to find support and treatment resources, how to communicate with physicians, how to get effective pain management, when to let go of medical treatment, issues in hastening death, and a host of other fundamental concerns. There's a discussion of the ethical issues of assisted suicide that balances arguments from several sides of the question. The book handles many specialized situations, with details on several common disease processes and types of death. A solid resource guide points readers to major sources of information for further study and support.


Book: Understanding Pain for Better Clinical Practice

Understanding Pain for Better Clinical Practice 
A Psychological Perspective

By Steven James Linton, Department of Occupational and Environmental Medicine, Orebro University Hospital, Orebro, Sweden 


Online Continuing Medical Education Sites

This is the Annotated List of Online Continuing Medical Education (CME).  We now have links to, and descriptions of, more than 300 Online CME sites offering about 16,000 activities and more than 26,000 hours of AMA Category I CME credit.

Emerging Lifestyle of Pain In America, New Survey Reveals

Seventy-two percent of people with chronic pain have lived with it for more than three years, including a third (34 percent) who have lived with pain for more than a decade, according to results from the Americans Living with Pain Survey (ALPS), designed to uncover insights regarding attitudes and perceptions about chronic pain. Yet nearly half (44 percent) of people with pain who have talked to their doctor about it delay doing so, often for several months or longer, despite the impact it has on their lives. A little more than half (53 percent) of those who do eventually visit their doctor do so because their pain is becoming increasingly severe. 

"This survey demonstrates that chronic pain is a problem that has reached near epidemic proportions," said Edward Covington, M.D., Director of the Chronic Pain Rehabilitation Program at the Cleveland Clinic. "The 'can do, can cope' spirit of Americans can lead to untreated chronic pain, which has a severe impact on people's work, personal relationships, hobbies, and even sex, and can greatly diminish their quality of life. In addition to physical disability, it may also lead to irritability, anxiety, or depression." 


How Real is Your Pain? -- Feb. 20, 2007 -- TIME

"And now would you please choose a number from one to 10 describing your pain — one being almost no pain and 10 the worst pain imaginable." The ER nurse's voice seemed to trail off as she got to the end of the mandated recitation.


Medical technology has yet to invent a machine that can look into another's mind to see what he's feeling, or thinking. No doubt the body, with its physical brain, responds physically to noxious stimuli. But the non-physical mind is yet the only realm in which the bad experience of suffering exists. Mind and brain are mysteriously related. Lobotomized or drug-loaded patients can still answer questions. Stick one with a big needle and ask: does it hurt? Yes, it does, doctor. You can get him to report a VAS number. They might even withdraw from the needle. But there is no grimace, no groan. They certainly feel pain — but they don't care. And they don't need pain medicine.

There is, however, a mind-reading machine that certain doctors and nurses can use in cases like Charlene's and Jacob's. Its use is frowned upon by many in administrative positions and specific measures to render these machines useless, most notably long forms, committee meetings and menu-driven care algorithms, are being implemented with increasing ferocity. It is only this machine that can make rational and humane treatment decisions for the suffering though. It is, in fact, only this machine which suffers. See past the ones that beep and blink; the mind remains our most important machine in medicine.


MedicineWorld.Org: News and information links


Back Doc Blog

I have been practicing as a chiropractor in Maple Valley, Washington for six years at the SpinaCare Natural Pain Clinic.

Patients that understand what is going on with their health in general, and their spine in particular, do better. They tend to get better faster and stay better longer. And they have much less stress and anxiety about their condition.

Educating patients is something I like to do daily in my office. With this blog I hope to provide a resource not only for my patients, but those outside the community as well.


Pain in America - and how our government makes it worse (Book by John P. Flannery II and Holly S. Flannery)

Mr. Flannery is a former federal prosecutor from New York and a former Capitol Hill counsel, now in private practice, and has represented physicians and patients from across the nation. This book is a must-read for anyone who treats or suffers from chronic pain, or who knows anyone who may suffer from chronic pain, or who cares about this public health crisis, to inform them of this grave injustice, to explain what we must do to protect ourselves, and to explain the constitutional rights that are at stake for, if we are not vigilant, we may wake up to find that these critical constitutional rights no longer exist." --Siobhan Reynolds, President and Founder of the Pain Relief Network 


Wednesday, February 21, 2007

Pain - Three Days Grace

Oprah's Truly Amazing Kids: Gabby's Family and Their Fears

Gabby's parents say they knew something was different about her from the start, when she was still in the hospital. "They do the K test the very next day where they poke the heel and she slept right through it," Steven says. "The nurse said, 'Wow, what a good baby. She's still sleeping.' Well, she didn't feel any pain." 

"We've met families that have lost their kids," Trish says. "So at the same time, so what if our kid is blind? So what if she ends up in a wheelchair? We've got her. We can hold her. We can love her." 

In fact broken bones and joints are the greatest dangers Gabby faces through her life. However, there is at least one upside. Steven and Trish have contacted a woman in her 30s with Gabby's condition. "She has severe back and neck problems," Trish says. "But the good news is childbirth was very easy." 


Alexa - Search engine for pain information and top sites



Medworm: The latest news and RSS feed on pain

MedWorm collects updates from over 2500 authoritative data
sources (growing each day) via RSS feeds. From the data collected,
MedWorm provides new outgoing RSS feeds on various medical
categories that you can subscribe to, via the free MedWorm online
service, or another RSS reader of your choice.


Sunday, February 18, 2007

BBC NEWS | Health | Back pain linked to brain changes (click here)

Chronic back pain is linked to physical changes in the brain, according to researchers in Germany.

A team found patients with the condition also had microstructural changes in the pain-processing areas of their brains.

The scientists said the work provided evidence that the condition was real and it could aid treatment research.
They discovered the brains of patients with chronic back pain had a more complex and active microstructure compared with the healthy volunteers' brains.

The changes occurred in regions of the brain associated with pain-processing, emotion and stress response.

However, the researchers said more research would be needed to determine whether the physical changes were a cause or result of the pain.

Co-author Gustav Schelling, from the Department of Anaesthesiology at Munich University, said: "It's difficult to know whether these are pre-existing changes in the brain that predispose an individual to developing chronic pain, whether ongoing pain creates the hyperactivity that actually changes the brain organisation, or if it is some mixture of both.

"DTI may help explain what's happening for some of these patients, and direct therapeutic attention from the spine to the brain."


Friday, February 16, 2007

Women's Bioethics Blog

This is not your typical blog. We have recruited scholars and public policy analysts from around the world to provide daily news and commentary on the implications of bioethical issues for women.


Thursday, February 15, 2007

Chronic Pain Anonymous

CPA is a fellowship of men and women who share their experience, strength and hope with each other so that they may solve their common problem and help others recover from chronic pain.

The only requirement for membership is a desire to recover from the physical, emotional, and spiritual debilitation of chronic pain. There are no dues or fees for CPA membership.

We are self supporting through our own contributions.


Chronic Pain Anonymous Discussion List

Chronic Pain Anonymous is a 12 step support group for men and women to share their experience, strength and hope with each other that they may solve their common problem and help others to recover from chronic pain. The only requirement for participation in this group is a desire to recover from the physical, emotional and spiritual debilitation of chronic pain. We currently have face to face weekly meetings in Arizona, California, Indiana, and Maryland with more to come. We are planning to have a weekly online support meeting soon.

If you have any interest please email us with your questions, interests or suggestions. Please visit our website at http://www.chronicpainanonymous.org/.

We have just a couple simple rules. We ask that you be respectful of all members. We ask that you do not use this group as a means to promote your own products, services, or link (One of the traditions of any 12-Step group is to not endorse any outside organization). Please keep all communications “G rated”. Please keep all communications void of arguments or debates – this is not the form for such discussions. Also, please do not discuss politics, religion, etc. – there are many other forums for such discussions. This is not the forum to offer medication or clinical advice or to discuss prescription dosages. CPA, like any 12-step group, is a spiritual based group – not a religious group, please do not discuss religion on this site. Thank you for following these simple suggestions.


Wednesday, February 14, 2007

Steven Linton, Understanding Pain for Better Clinical Practice

Models of pain perception chapter


Chronic Pain: Hope Through Research - The Body

Chronic Pain: Hope Through Research

National Institute of Neurological Disorders and Stroke


CBC | The Nature of Things - A Look at Pain


MSC Pain Mangement e-learning module

Welcome to the MSc module: The Nature of Pain and its Management

We all warmly welcome you to this new module

To effectively care for the person with pain, it is recognised that practitioners undertaking this module want to ‘make things better’ for their patients. For many students, pain specialist teams may not be accessible to fill gaps in knowledge and understanding. We anticipate that the content of this module will provide a platform to enhance your practice. The module has been built upon current initiatives to identify standards for pain management education: the International Association for the Study of Pain, the British Pain Society, the European Federation of International Chapters of IASP, and the Dept of Health – NHS Plan and Modernisation Agency. This has been coupled with a desire for interprofessional shared learning to reflect multi-disciplinary teams managing pain in practice.

The expected learning outcomes of this module include opportunities for interaction with other disciplines. The approach to learning values your expertise and provides opportunities to build a portfolio of learning based on your practice environment. Online facilitation of the case studies will be undertaken by academics with specialist interest and clinical practitioners who have considerable knowledge and experience in their field.


Tuesday, February 13, 2007

Watch for reruns

Air Date: Tuesday, February 13, 2007
Time Slot: 9:00 PM-10:00 PM EST on FOX
Episode Title: (HOU-314) "Insensitive"



CNN.com - World without pain is hell, parent says

When you first meet 4-year-old Roberto Salazar, you can't help but notice his unwavering smile and constant laughter. By all accounts, he's a very happy boy.

It is only when he rams his head violently into walls or plays a little too roughly with a schoolmate, all the while smiling, that you are reminded that he suffers from an incredibly rare genetic disorder.

Roberto is one of 17 people in the United States with "congenital insensitivity to pain with anhidrosis," referred to as CIPA by the few people who know about it.

Roberto was born in July 2001, becoming Luis' and Juan's little brother. As a newborn, his parents thought he was the perfect baby.

"Roberto was wonderful. He never cried. He would sleep 23 out of 24 hours a day. He never cried to eat, never cried that his diaper is itching," said his mother, Susan Stingley-Salazar.

At 3 months, things abruptly changed. Roberto refused to eat. He was rapidly losing weight. His parents tried desperately to find ways to "force a child to eat that doesn't want to eat," Stingley-Salazar said.

First they tried to feed him with an eyedropper. Then a feeding tube was attached to his stomach at 8 months.

Other abnormalities quickly surfaced. Roberto was severely susceptible to heatstroke on hot summer days. His parents soon noticed he did not sweat.

"You can't carry Roberto because he sucks your heat from your body. You're hot, sweaty. His body can't sweat like yours so he's just absorbing all of your heat," Stingley-Salazar said.

His family was shocked when Roberto started teething. He gnawed on his own tongue, lips and fingers to the point of mutilation.

"If you could imagine when you bite your tongue how bad it hurts. At one point, you couldn't even distinguish that his tongue was his tongue," Stingley-Salazar said.

Stingley-Salazar, a registered nurse with a degree in molecular biology, took Roberto to see more than 60 physicians in the boy's first few years. She researched his symptoms on the Internet every night. She e-mailed any specialist she could find.

She came up with very few answers until she contacted Dr. Felicia Axelrod of the New York University Dysautonomia Treatment and Evaluation Center.

Axelrod has studied this family of "no-pain" diseases for more than 35 years. These genetic disorders affect the autonomic nervous system -- which controls blood pressure, heart rate, sweating, the sensory nerve system and the ability to feel pain and temperature.


Research Supports Medicinal Marijuana - washingtonpost.com

Research Supports Medicinal Marijuana
AIDS Patients in Controlled Study Had Significant Pain Relief

By Rick Weiss
Tuesday, February 13, 2007; Page A14

AIDS patients suffering from debilitating nerve pain got as much or more relief by smoking marijuana as they would typically get from prescription drugs -- and with fewer side effects -- according to a study conducted under rigorously controlled conditions with government-grown pot.

In a five-day study performed in a specially ventilated hospital ward where patients smoked three marijuana cigarettes a day, more than half the participants tallied significant reductions in pain.

By contrast, less than one-quarter of those who smoked "placebo" pot, which had its primary psychoactive ingredients removed, reported benefits, as measured by subjective pain reports and standardized neurological tests.

The White House belittled the study as "a smoke screen," short on proof of efficacy and flawed because it did not consider the health impacts of inhaling smoke.

But other doctors and advocates of marijuana policy reform said the findings, in today's issue of the journal Neurology, offer powerful evidence that the Drug Enforcement Administration's classification of cannabis as having "no currently accepted medical use" is outdated.


Sunday, February 11, 2007

A Chance to Pick Hospice, and Still Hope to Live - New York Times

The American health care system has long given patients a terrible choice: people told that they have a terminal illness must forgo advanced medical treatment to qualify for hospice care. Cancer patients have to pass up chemotherapy, for example, or patients with kidney failure must abandon dialysis.

Forcing patients into this either-or decision has prompted many who might benefit from a hospice program to instead opt for expensive hospital care that may end up costing Medicare and other insurers far more.

But now, some hospice programs and private health insurers are taking a new approach that may persuade more patients to get hospice care for the last months of life. These programs give patients the medical comfort and social support traditionally available through hospice care, while at the same time letting them receive sophisticated medical treatments that may slow or even halt their disease.


Wednesday, February 07, 2007

Review: The Worst of Evils by Thomas Dormandy

A glass of wine and a bullet to bite

Thomas Dormandy's remarkable study of surgery before the era of modern anaesthetics, The Worst of Evils, is wince-inducing, but splendidly so, says PD Smith

Saturday August 19, 2006
The Guardian

The Worst of Evils: The Fight Against Pain
by Thomas Dormandy
547pp, Yale, £19.99
The horror of surgery before anaesthetics is scarcely imaginable today. A patient who had his foot amputated without it recalled "suffering so great that it cannot be expressed in words". As well as the pain, he was overwhelmed by a "sense of desertion by God and man". Novelist Fanny Burney endured her mastectomy in 1810 with nothing more than a glass of "wine cordial" to deaden the pain. Afterwards she described the "terrible cutting" of the initial incision and the sickening feeling of "the knife rackling against the breast bone, scraping it". She remained conscious throughout. If patients didn't die of shock during the operation, many would later succumb to infection. "In terms of survival, men were safer on the battlefield of Waterloo than on admission to a surgical ward in any of London's teaching hospitals," writes chemical pathologist Thomas Dormandy in his remarkable cultural history of pain.


A Small Part of the Brain, and Its Profound Effects - New York Times

Suppose scientists could figure out how to tweak the insula without damaging it. They might be able to create that famed and elusive free lunch — an effortless way to kick the cigarette habit.

That dream, which may not be too far off, puts the insula in the spotlight. What is the insula and how could it possibly exert such profound effects on human behavior?

According to neuroscientists who study it, the insula is a long-neglected brain region that has emerged as crucial to understanding what it feels like to be human.

They say it is the wellspring of social emotions, things like lust and disgust, pride and humiliation, guilt and atonement. It helps give rise to moral intuition, empathy and the capacity to respond emotionally to music.

Its anatomy and evolution shed light on the profound differences between humans and other animals.

The insula also reads body states like hunger and craving and helps push people into reaching for the next sandwich, cigarette or line of cocaine. So insula research offers new ways to think about treating drug addiction, alcoholism, anxiety and eating disorders.

Of course, so much about the brain remains to be discovered that the insula’s role may be a minor character in the play of the human mind. It is just now coming on stage.