Wednesday, January 31, 2007

International Association for the Study of Pain | Core Curriculum for Professional Education in Pain, 3rd Edition

The third revision of the International Association for the Study of Pain® (IASP®) Core Curriculum has been many years in gestation. It follows the very successful format used by Dr. Howard L. Fields, editor of the second edition. The content has been expanded by over one-third; new chapters have been added, and virtually all the text and the references have been revised. It is hoped that members will find this a significantly improved resource for patient care and training purposes.

In the future, the curriculum core group believes the Web to be an ideal way to bring timely and rapid updates of this curriculum to the widest possible audience. We hope that this resource can become a dynamic and freely available asset for anyone with an interest in pain.

This publication is copyrighted. To obtain permission to reproduce any part of the book from the hard copy or the Web site, please contact IASP at:

Tuesday, January 30, 2007

The Bane of Pain Is Plainly in the Brain - Dr. Allan Basbaum

Pain is generally considered a symptom of disease. The uniqueness of the disease of pain, of course, is that it cannot be seen by the physician. It is experienced and reported by the patient. Understanding how pain is generated and more importantly, how to treat pain, is the focus of this lecture. Among the topics to be discussed are the many different types of pain that can be produced, the difference between acute and chronic pain, whether placeboes really work and if so, how, and where in the brain is pain perceived. Series: "UCSF Mini Medical School" [Health and Medicine] [Professional Medical Education]

MedlinePlus: Brain stimulation relieves fibromyalgia pain

Electrical stimulation of the brain provides significant pain relief that can last for several weeks in patients with fibromyalgia -- a debilitating pain syndrome that affects 2 to 4 percent of the population.

Transcranial direct current stimulation (tDCS), as it is called, is simple to perform and has only rare and minimal adverse effects, results of the study, conducted at the University of Sao Paulo, Brazil, show.

Dr. Felipe Fregni of Beth Israel-Deaconess Hospital and Harvard Medical School in Boston, and colleagues divided 32 women with fibromyalgia and moderate to severe pain into three groups. One group received tDCS of the primary motor cortex, the main area of the brain that controls movement. Another group received tDCS of the dorsolateral prefrontal cortex, part of the frontal lobes involved in thinking, and the third received sham stimulation. Active and sham treatments lasted 20 minutes for 5 days.

The team found that tDCS of the primary motor cortex was significantly more effective for pain relief than tDCS of the dorsolateral prefrontal cortex or sham stimulation. The latter two groups achieved similarly lower levels of pain relief.

The effects of tDCS persisted through the 21-day follow-up period,
although some diminishing of the effect was noticed after 21 days.

Derby Winner Barbaro Euthanized: 'Difficult for Him To Go On Without Pain' |

Kentucky Derby winner Barbaro was euthanized Monday after complications from his breakdown at the Preakness last May.

"We just reached a point where it was going to be difficult for him to go on without pain," co-owner Roy Jackson said. "It was the right decision, it was the right thing to do. We said all along if there was a situation where it would become more difficult for him then it would be time."

Owners Roy and Gretchen Jackson were with Barbaro on Monday morning, with the owners making the decision in consultation with chief surgeon Dean Richardson.

It was a series of complications, including laminitis in the left rear hoof and a recent abscess in the right rear hoof, that proved to be too much for the gallant colt, whose breakdown brought an outpouring of support across the country.

"I would say thank you for everything, and all your thoughts and prayers over the last eight months or so," Jackson said to Barbaro's fans.

On May 20, Barbaro was rushed to the New Bolton Center, about 30 miles southwest of Philadelphia in Kennett Square, hours after shattering his right hind leg just a few strides into the Preakness Stakes. The bay colt underwent a five-hour operation that fused two joints, recovering from an injury most horses never survive. Barbaro lived for eight more months, though he never again walked with a normal gait.

Barbaro's Life Ended Peacefully

The battle for Barbaro's life ended peacefully, according to Dr. Dean Richardson, who spoke during a press conference at the University of Pennsylvania's New Bolton Center Monday afternoon, just hours after Roy and Gretchen Jackson's colt had been euthanized.

Monday, January 29, 2007

7th International Conference on Pain and Chemical Dependency

Announcing the 7th International Conference
on Pain and Chemical Dependency
Jointly sponsored by the
Department of Pain Medicine and Palliative Care
Beth Israel Medical Center and the
International Association for Pain and Chemical Dependency

June 21-24, 2007
Sheraton New York Hotel & Towers

Friday, January 26, 2007

Our Pain Bleeds Ink (click)

This community is for people who want an outlet for their pain
through poems or short pieces of writing. Photography or other forms
of art are also welcome, as long as they express emotion. Random pics
are not appreciated.

This is a safe place for people to share their feelings. I, dame_wilbur,
started this community as I often use poetry to get through my pain.
Now I want to help others, as I have had people help me. You are
welcome to post poems/writings that others have written.

There are a few simple rules:

If the content of your writing has adult content, try and put it
behind an lj cut. Swearing is allowed in moderation as a form of
self-expression. If your poem includes, masochistic/sadistic thoughts,
SI, or anything like that, put it behind an lj cut. If using somebody else's
writings, give them credit.

There is enough pain in the world without adding to it so please
don't insult one another. Other than that, anything is acceptable, and
will be accepted. Welcome.

Thursday, January 25, 2007

NYT: Just Doing His Job by John Tierney

Now that Rush Limbaugh has managed to keep himself out of prison, the punishment he once advocated for drug abusers, let me suggest a new cause for him: speaking out for people who can handle their OxyContin.

Like Limbaugh, Richard Paey suffers from back pain, which in his case is so severe that he's confined to a wheelchair. Also like Limbaugh, he was accused of illegally obtaining large quantities of painkillers. Although there was no evidence that either man sold drugs illegally, the authorities in Florida zealously pursued each of them for years.

Unlike Limbaugh, Paey went to prison. Now 47 years old, he's serving the third year of a 25-year term.

Pain Relief Cartoons

Chapter 6 - Somesthesia - Central Mechanisms (The Nervous System In Action, Michael D. Mann, Ph.D.)


In this chapter, we will examine the pathways that somatic activity can take in the central nervous system, and then we will consider the mechanisms by which different sensations can occur.

Chapter 5 - Somesthesia - Peripheral Mechanisms (The Nervous System In Action, Michael D. Mann, Ph.D.)


The broadest definition of somesthesia is the awareness of having a body and the ability to sense the contact it has with its surroundings. Our concerns at this point are about the receptors that serve to make us conscious of our bodies. Receptors are generally put into two broad classes: the exteroceptors, that sense stimuli from outside the body and signal what is happening in the outside world, and the enteroceptors, that receive stimuli from inside the body and tell us what is happening in the inside world. The broad class of exteroceptors includes, in addition to receptors in the skin, receptors for light in the eye, sound in the ear, and for chemical substances in the nasal mucosa and tongue. These specialized receptors are discussed in future chapters; for now, we will concentrate on the skin.

Virtual Pediatric Hospital - A digital library of pediatric information: Pain information

Virtual Pediatric Hospital is curated by Donna M. D'Alessandro, M.D. and Michael P. D'Alessandro, M.D.

Wednesday, January 24, 2007

Explain Pain by David Butler and Dr. Lorimer Moseley

Imagine an orchestra in your brain. It plays all kinds of harmonious melodies, then pain comes along and the different sections of the orchestra are reduced to a few pain tunes.
All pain is real, and for many people it is a debilitating part of everyday life. It is now known that understanding more about why things hurt can actually help people to understand their pain. Recent advances in fields such as neurophysiology, brain imaging, immunology, psychology and cellular biology have provided an explanatory platform from which to explore pain. In everyday language accompanied by quirky illustrations, Explain Pain discusses how pain responses are produced by the brain: how responses to injury from the autonomic motor and immune systems in your body contribute to pain, and why pain can persist after tissues have had plenty of time to heal.
Explain Pain aims to give clinicians and people in pain the power to challenge pain and to consider new models for viewing what happens during pain. Once they have learnt about the processes involved they can follow a scientific route to recovery.

Explain Pain by David Butler and Dr. Lorimer Moseley is an evidence based book designed for therapists, patients and students. It answers the most common questions asked by pain sufferers: 'why do I hurt?' and 'what can I do for my pain?' Written in simple language that anyone can understand, it encourages patients to move better and research shows that they will have less pain once they have understood its underlying causes.


Ecstasy, the new prescription drug? - By Amanda Schaffer - Slate Magazine

This year, the drug MDMA, otherwise known as ecstasy, could take a step toward medical respectability. Researchers in South Carolina have begun experimenting with MDMA for patients with post-traumatic stress disorder. At Harvard, a long-awaited pilot study will begin on whether the drug can help relieve anxiety and pain in terminal cancer patients in connection with psychotherapy. And studies will also start in Switzerland and Israel, where a former chief psychiatrist of the Israel Defense Forces will oversee work with people whose PTSD stems from terrorism or war.

Monday, January 22, 2007

Patient delusion -- or medical confusion? (Globe and Mail)

When Anet Greenley got sick four years ago, what upset her the most wasn't the continual nosebleeds, the numbness in her limbs, or even the fact that her stool had turned green. What really bothered her was the fact that nobody would take her seriously.

"My doctors all told me I was stressed out, that it was all in my head, that I was having panic attacks that upset my stomach," says the 38-year-old Ottawa native. "Even some of my family told me it was in my head.'"

But Ms. Greenley knew she was genuinely sick -- so sick that she had to quit the University of London and fly home from England. And several months later, after going from doctor to doctor, she finally found out she was right: She has multiple chemical sensitivity (MCS), a condition that makes her extremely sensitive, you could say allergic, to synthetic chemicals.

These days, Ms. Greenley can control her symptoms, as long as she avoids everything she reacts to: cologne, dryer sheets and car exhaust are just three irritants on a very long list. Other than that, though, there's nothing much she can do. The syndrome is so new that doctors still don't know what causes it -- or how to treat it.

And Ms. Greenley is not alone. According to a Statistics Canada study released last week, more than one million Canadians are suffering from illnesses that are stumping their doctors.

The most commonly reported conditions are MCS, chronic fatigue syndrome and fibromyalgia (all of which affect twice as many women as men). Reports of a host of other mysterious diseases -- such as Morgellons and vulvodynia -- also seem to be increasing in both the United States and Canada.

What these disparate illnesses have in common is patients' struggle not only to find a cure for baffling symptoms, but to establish legitimacy for their complaints. The causes of these conditions remain controversial -- and many doctors continue to label symptoms as delusional.

Wednesday, January 17, 2007

Tuesday, January 16, 2007

TierneyLab - Science - New York Times Blog

About TierneyLab

John Tierney always wanted to be a scientist but went into journalism because its peer-review process was a great deal easier to sneak through. Now a columnist for the Science Times section, Tierney previously wrote columns for the Op-Ed page, the Metro section and the Times Magazine. Before that he covered science for magazines like Discover, Hippocrates and Science 86.

With your help, he's using TierneyLab to check out new research and rethink conventional wisdom about science and society. The Lab's work is guided by two founding principles:

  • 1. Just because an idea appeals to a lot of people doesn't mean it's wrong.
  • 2. But that's a good working theory.
Scrubs Pain Chart Clip

Sunday, January 14, 2007

When It’s O.K. to Run Hurt - New York Times

JUST before the end of last year, a prominent orthopedic surgeon was stretching to lift a heavy box and twisted his back. The pain was agonizing. He could not sit, and when he lay down he could barely get up.

So the surgeon, Dr. James Weinstein of Dartmouth College, decided to go out for a run.

“I took an anti-inflammatory, iced up, and off I went,” Dr. Weinstein recalled. When he returned, he said, he felt “pretty good.”

It sounds almost like heresy. The usual advice in treating injuries is to rest until the pain goes away. But Dr. Weinstein and a number of leading sports medicine specialists say that is outdated and counterproductive. In fact, Dr. Weinstein says, when active people consult him, he usually tells them to keep exercising.

Saturday, January 13, 2007

Pain Management - HealthBoards

Dealing with a medical condition is often difficult. Connecting with others who are going through the same thing can make a world of difference. is a place where you can make those connections. HealthBoards provides a unique one-stop support group community offering over 150 message boards on various diseases, conditions, and health topics. The HealthBoards community is one of the largest and most dynamic on the Web, with over 300,000 registered members, and over 2.5 million messages posted. And through a partnership with WebMD, HealthBoards offers its users a comprehensive Health Guide with valuable health information and tools for managing health. HealthBoards was rated as one of the top 20 health information websites in 2005 by Consumer Reports Health WebWatch.

Friday, January 12, 2007

Pain and Depression: An Interdisciplinary Patient-Centered Approach

Pain and Depression
An Interdisciplinary Patient-Centered Approach
2nd printing

Editor(s):   Clark, M.R. (Baltimore, Md.);    Treisman, G.J. (Baltimore, Md.)

Pain is the most common physical complaint while depression is the second most debilitating chronic medical condition. The co-occurrence of pain and depression is well known but a detailed understanding of their phenomenology, interrelationship, and effective therapies remains speculative. This book provides a synthetic approach to the evaluation and treatment of patients with chronic pain and depression that will generate therapeutic optimism and lead clinicians to improve quality of life and restore function.

The recognition that depression is not just an affective disorder or demoralization is discussed in detail in the contributions: “Function, Disability, and Psychological Well-Being” and in “Structural Models of Comorbidity among Common Mental Disorders: Connections to Chronic Pain”. Other articles review the complex regional pain syndrome and the Gulf War syndrome. Further papers discuss issues relating to the use of opioids in the treatment of chronic pain.

Giving birth in Berkeley. - By Michael Lewis - Slate Magazine

Tabitha never wanted the full Berkeley. But back when we started, seven years ago, she gave a passing thought to employing a midwife instead of a doctor, and thought that it might make the experience more meaningful if she skipped the painkillers. She picked out music and found scented oils with which to be rubbed. To the immense irritation first of her obstetrician and then of herself, she hired a doula, who was meant to use said oils to massage her feet during the delivery, but instead went out for turkey sandwiches and never came back.

That was seven and a half long years ago. With her slender build and narrow hips and near total intolerance of physical discomfort, my wife was ill-designed for childbirth. The first time around, in this very hospital, she began to hemorrhage. The doctors saved her life, and with so little drama that we didn't realize what they'd done until well after. The second time around, again in this hospital, they saved not only her but our second daughter, who had entered the birth canal at a historically tragic angle. Entering her third pregnancy, my wife's lost interest in doulas and incense. She longs only for painless, antiseptic, impersonal modern medicine. Numb is good. If they ran tubes underground from hospitals to homes so that painkillers could be delivered in advance of labor, she might well have been their first paying customer. Of the original Berkeley Dream, the mirror's all she's got left.

Academy of Cognitive Therapy - - Chronic Pain

How our thoughts, feelings, and actions affect our pain

When the pain signal is experienced and processed in the brain, certain thoughts, memories and emotions may be activated. So, when a person experiences a pain sensation, s/he will have some emotional response(s) to it and will experience certain thoughts and/or images during or immediately following the pain. Similarly, thoughts and emotions that are activated in the brain may also affect the pain signal. In other words, our thoughts, memories, and emotions can influence the experience of pain physiologically.

For example, a chronic pain patient named Phil experiences burning, numbing sensations in his lower back and legs. He feels frustrated and sad, and thinks, “This pain is horrible. I cannot handle it. This is so unbearable. I cannot go on like this.” Next, Phil imagines the pain taking over his whole body. His pain worsens. He becomes even more absorbed in his pain, frustration, and sadness. He decides to go back to sleep to escape from this pain. Why is Phil feeling horrible? It isn’t simply because he is experiencing severe pain. It is, in part, because of what he is telling himself about the pain—in other words, the meaning he has given his pain. Phil has interpreted his pain as being “uncontrollable” and “unmanageable.” He thinks of himself as a victim—powerless to stop his pain. His negative thoughts start taking on a life of their own.{07056306-1756-40E2-ABB1-9DA4C4FBC99F}

Tuesday, January 09, 2007

Welsh "Jackass" Admits TV Was To Blame

Jonathan Maybery, of Swansea, Wales, has started 2007 with a bang, or rather a staple. After a night of boozing and watching "Jackass," the 24-year-old caretaker for the elderly thought it would be a brilliant idea to staple his hand to a coffee table. According to reports, he and a friend lined up the hand and, well, stapled-gunned it -- though apparently he was "too busy laughing to feel any pain." Paramedics arrived shortly thereafter, but they were unable to separate him from the table. Instead, they took him to the hospital by ambulance "with the piece of furniture still attached to his hand."

Women with migraines more likely to have depression

Women with chronic headache, especially migraines, are more likely to be depressed, feel tired, and have a host of other severe physical symptoms, according to a study published in the January 9, 2007, issue of Neurology, the scientific journal of the American Academy of Neurology.

The study involved 1032 women at headache clinics in five states. Of the women surveyed, 593 reported episodic headache (fewer than 15 headaches per month) and 439 had chronic headache (more than 15 headaches per month). Ninety percent of the women were diagnosed with migraines.

The study found women with chronic headache were four times more likely than those with episodic headache to report symptoms of major depression. Chronic headache sufferers were also three times more likely to report a high degree of symptoms related to headache, such as low energy, trouble sleeping, nausea, dizziness, pain or problems during intercourse, and pain in the stomach, back, arms, legs, and joints.

Among patients diagnosed with severely disabling migraine, the study found the likelihood of major depression increased 32-fold if the patient also reported other severe symptoms.

"Painful physical symptoms may provoke or be a manifestation of major depression in women with chronic headache, and depression may heighten pain perception," said study author Gretchen Tietjen, MD with the University of Toledo-Health Science Campus and a member of the American Academy of Neurology. "This relation between migraine and major depression suggests a common neurobiology."

Monday, January 08, 2007

Medstory Health Search: pain


Hurts so good (from Neuroscience Gateway)

Hurts so good

Neuroscience Gateway (January 2007) | doi:10.1038/aba1705

Different mutations in the same sodium channel gene may cause
excessive pain or the inability to sense pain.

According to Goldilocks, just right lies between too little and too
much. The same principle can be applied to pain. People with too
little pain sensation often injure themselves, but too much pain can
be debilitating. Now researchers identify mutations in the same gene
that associate with too little and too much pain sensation in recent
articles in Nature and Neuron.

Nociceptive neurons of the dorsal root ganglion (DRG) express several
different sodium channels. The voltage-gated sodium channel Nav1.7,
encoded by SCN9A, is enriched in DRG neurons and helps sum the
activity of other sodium channels to generate action potentials,
which cause pain sensation.

Cox et al. identified SCN9A mutations in people in a northern
Pakistani clan who cannot sense pain, but have normal nerve
conduction and temperature and pressure sensation. By positional
cloning, the authors identified an 11.7 Mb region on chromosome 2
shared in all affected individuals in three related families. Finer
mapping failed to show a single haplotype in affected individuals,
suggesting that several mutations resulted in the same phenotype. The
authors sequenced SCN9A, the best candidate gene as shown by
bioinformatic analysis, and found discrete mutations in each family.
All of the mutations were 'nonsense' mutations that resulted in early
translation termination, presumably truncating Nav1.7.

Each SCN9A mutation rendered Nav1.7 nonfunctional. Cells transfected
with the mutated forms of Nav1.7 had normal resting currents, but
unlike cells transfected with wild-type Nav1.7, did not respond to
depolarization. These data suggest that action potentials that
communicate pain information are not generated in affected individuals.

Fertleman et al. identified SCN9A by positional cloning and haplotype
analysis as the gene involved in paroxysmal extreme pain disorder
(PEPD), which causes burning pain in ocular, mandibular and rectal
regions. In eight of the thirteen families examined, affected
individuals were heterozygous for one of eight SCN9A mutations. All
of the mutations were 'missense' mutations, replacing one amino acid
for another, and were located in the inactivation domain or regions
that interact with the inactivation domain of Nav1.7.

Cells expressing Nav1.7 mutants had prolonged sodium currents
relative to cells expressing wild-type Nav1.7, suggesting persistent
activity of DRG neurons in people with PEPD. However, carbamazepine,
an anti-epileptic drug that is effective in some people with PEPD,
reduced persistent current in cells expressing a Nav1.7 mutant,
suggesting that it relieves PEPD by restoring Nav1.7 inactivation.

According to Cox et al., SCN9A polymorphisms may cause population-
wide variations in pain threshold. Because people with nonfunctional
Nav1.7 lacked pain sensation but were otherwise normal, Nav1.7
inhibitors might relieve pain without causing side effects.

Debra Speert
Cox, J. J. et al. An SCN9A channelopathy causes congenital inability
to experience pain. Nature 444, 894–898 (2006).
Fertleman, C. R. et al. SCN9A mutations in paroxysmal extreme pain
disorder: Allelic variants underlie distinct channel defects and
phenotypes. Neuron 52, 767–774 (2006).

Sunday, January 07, 2007

Our Story Ended With a Slow Fade to Black - New York Times

“I’m concerned,” the doctor said. “I’m scheduling a brain M.R.I. Immediately.”

I dropped Willem at his appointment five blocks away and went to pick up Jake at preschool.

Before Willem got home, the phone rang. It was our doctor, who said softly: “I am sorry but I have very bad news. Your husband has glioblastoma, which is the worst form of brain cancer.”

Jake had opened the refrigerator and was pouring orange juice on the floor.

“Do you want me to tell him?” the doctor asked.

Jake was tugging on my sleeve to show me his handiwork.

“No, no, thank you,” I murmured. “I’ll tell him. Tell me one thing: Is he going to die?”

“Yes,” he said.

Excerpt from The Goldfish Went on Vacation: A Memoir of Loss (and Learning to Tell the Truth about It) by Patty Dann


Drugs nearing approval for mysterious pain condition -

Not all doctors are sure about the pain and fatigue condition known as fibromyalgia, but drug companies are racing to win U.S. regulatory approval to serve this potentially lucrative market.

The sometimes-debilitating disorder afflicts an estimated 2 percent to 4 percent of Americans, mainly women.

But diagnosing fibromyalgia is not easy because its cause remains unknown and its symptoms, which also include depression, can overlap with other conditions.

With no test to confirm fibromyalgia, doctors rely on patient complaints of symptoms and subjective responses to physical exams. As a result, some physicians are wary of viewing it as a distinct ailment.

Still, a who's who of pharmaceutical companies -- including Pfizer Inc., Eli Lilly & Co., Forest Laboratories Inc. and Wyeth -- are looking to seize on a market now dominated by older anti-depressants as well as painkillers and other drugs.

"What they're thinking is: This has a huge, untapped, unmet need," said Maria Marzilli, an associate analyst with market research firm Decision Resources.

Decision Resources expects sales for drugs used for fibromyalgia to roughly triple to at least $1 billion by 2014.

The companies are vying for the first clearance by the U.S. Food and Drug Administration for a fibromyalgia treatment, which could occur as soon as 2008.

Doctors can prescribe medicines for fibromyalgia even though the drugs are not cleared specifically for it. However, without FDA approval, companies cannot promote the drugs as treatments for that condition.

Neuroscience Database Gateway

Friday, January 05, 2007


In January 2006, Seed debuted ScienceBlogs, its brand-new experiment in cyberspace, initially housing 14 blogs about science. In ScienceBlogs' first year, the network has grown to feature more than 50 blogs, 20,000 posts, and 200,000 user-generated comments.

Thursday, January 04, 2007

Genetic Mechanism Helps Explain Chronic Pain Disorders

Researchers at the University of North Carolina at Chapel Hill have discovered that commonly occurring variations of a gene trigger a domino effect in chronic pain disorders. The finding might lead to more effective treatments for temporomandibular joint disorder (TMJD) and other chronic pain conditions.

Catechol-O-methyltransferase (COMT), an enzyme that metabolizes neurotransmitters such as epinephrine, norepinephrine and dopamine and that has been implicated in the modulation of persistent pain, as well as cognition and mood, is regulated by a gene, also called COMT. Previous UNC-led research showed that common genetic variants of this gene are associated with increased pain sensitivity and the likelihood of developing TMJD.

Now, the researchers have discovered that specific variants of the COMT gene can dramatically affect the secondary structure of corresponding messenger RNA - which, in turn, leads to alterations in the amount of enzyme crucial for regulating pain processing. The discovery is published in the Dec. 22 issue of Science.

"TMJD is a complex pain condition that is frequently associated with other pain conditions such as fibromyalgia syndrome, chronic headaches and irritable bowel syndrome," said Dr. William Maixner, director of the Center for Neurosensory Disorders in UNC's School of Dentistry and a study co-author.

"This study has identified a new genetic mechanism that influences an individual's susceptibility to develop chronic pain conditions such as TMJD," Maixner said.

Wednesday, January 03, 2007

PTSD Alters Pain Response - Psych Central News

Scientists discover patients with posttraumatic stress disorder (PTSD) are less sensitive to pain, a finding that may be related to altered pain processing in the brain. Dutch researchers used functional brain imaging along with psychophysical assessment as individuals rated the pain they experienced from variable and fixed temperatures applied to their hands.

The research is reported in the January issue of the Archives of General Psychiatry, one of the JAMA/Archives journals.

Posttraumatic stress disorder (PTSD) is an anxiety disorder that may occur in individuals exposed to a traumatic event. It is characterized by chronic arousal, re-experience of the event, and avoidance of stimuli related to the event, according to background information in the article. To the authors’ knowledge, no functional imaging study has explored whether patients with PTSD experience and process pain in a different way than control subjects.

Elbert Geuze, Ph.D., of Central Military Hospital and the Rudolph Magnus Institute of Neuroscience, Utrecht, the Netherlands, and colleagues conducted a study to examine neural correlates of pain processing in patients with PTSD. Twelve male Dutch veterans with PTSD and 12 male veterans without PTSD were recruited and matched for age, region of deployment and year of deployment.

The experimental procedure consisted of psychophysical assessment and neuroimaging with functional magnetic resonance imaging (fMRI)–the use of magnetic resonance imaging to learn which regions of the brain are active in a specific function. During fMRI, the patients rated the pain they experienced from fixed and variable temperatures applied to their hands.

“Patients with PTSD rated temperatures in the fixed-temperature assessment as less painful compared with controls,” the authors report.

“Before fMRI, patients with PTSD already showed a significant reduction in pain sensitivity,” the authors write. “During imaging, patients with PTSD rated a fixed temperature as significantly less painful than control veterans.” Patients with PTSD showed altered pain processing in brain areas associated with mood and cognitive pain processing.

“These data provide evidence for reduced pain sensitivity in PTSD. The witnessed neural activation pattern is proposed to be related to altered pain processing in patients with PTSD,” the authors conclude.

What’s Making Us Sick Is an Epidemic of Diagnoses - New York Times

For most Americans, the biggest health threat is not avian flu, West Nile or mad cow disease. It’s our health-care system.

You might think this is because doctors make mistakes (we do make mistakes). But you can’t be a victim of medical error if you are not in the system. The larger threat posed by American medicine is that more and more of us are being drawn into the system not because of an epidemic of disease, but because of an epidemic of diagnoses.

Americans live longer than ever, yet more of us are told we are sick.

How can this be? One reason is that we devote more resources to medical care than any other country. Some of this investment is productive, curing disease and alleviating suffering. But it also leads to more diagnoses, a trend that has become an epidemic.

This epidemic is a threat to your health. It has two distinct sources. One is the medicalization of everyday life. Most of us experience physical or emotional sensations we don’t like, and in the past, this was considered a part of life. Increasingly, however, such sensations are considered symptoms of disease. Everyday experiences like insomnia, sadness, twitchy legs and impaired sex drive now become diagnoses: sleep disorder, depression, restless leg syndrome and sexual dysfunction.

Monday, January 01, 2007

Pediatric Critical Care Website - searching for medical information

Internet Resources

Web Sites


E-mail lists

Web searching

Googling for a diagnosis--use of Google as a diagnostic aid: internet based study -- Tang and Ng 333 (7579): 1143 -- BMJ

Googling for a diagnosis—use of Google as a diagnostic aid: internet based study

Hangwi Tang, respiratory and sleep physician1, Jennifer Hwee Kwoon Ng, consultant rheumatologist2

Objective To determine how often searching with Google (the most popular search engine on the world wide web) leads doctors to the correct diagnosis.

Design Internet based study using Google to search for diagnoses; researchers were blind to the correct diagnoses.

Setting One year's (2005) diagnostic cases published in the case records of the New England Journal of Medicine.

Cases 26 cases from the New England Journal of Medicine; management cases were excluded.

Main outcome measure Percentage of correct diagnoses from Google searches (compared with the diagnoses as published in the New England Journal of Medicine).

Results Google searches revealed the correct diagnosis in 15 (58%, 95% confidence interval 38% to 77%) cases.

Conclusion As internet access becomes more readily available in outpatient clinics and hospital wards, the web is rapidly becoming an important clinical tool for doctors. The use of web based searching may help doctors to diagnose difficult cases.