Tuesday, March 31, 2009

Really? - The Claim - Heart Attack Symptoms Differ According to Sex


Most people can spot the classic symptoms of a heart attack: chest pain, shortness of breath, and radiating pain in the neck, back, jaw and arms.

But there may be a gender divide. While symptoms can vary greatly by person, studies show that men are more likely to exhibit classic signs. Women often experience symptoms not typically associated with heart attacks, which can appear weeks before the actual event, known to doctors as an acute myocardial infarction.

Some researchers point out that until the 1980s, heart disease was considered a male problem. As a result, many studies focused only on men and drew a narrow picture of the hallmark signs.

But in a study financed by the National Institutes of Health, scientists focused on female heart patients, 515 of them. They found that in the weeks before their attacks, 70 percent reported severe, unexplained fatigue, 48 percent reported sleep disturbances, and slightly fewer than half had shortness of breath, indigestion and anxiety. During the attack, more than 50 percent had shortness of breath and weakness, and slightly fewer than half experienced extreme fatigue, a profuse cold sweat and dizziness. Other studies have had similar findings. The American Heart Association says chest pain is still the most common warning sign in both sexes; and while men can experience “atypical” symptoms as well, women should be particularly aware of them.


Women are more likely than men to experience nonclassic heart attack symptoms.


Afflictions of the Brain, Cured or Not - Two books about headache - New York Times

There are two sides to every disease story — a lot more if you count the patient and the doctor, the patient's relatives and the doctor's relatives, the nurses, the therapists and the insurer. What a shame that the only time we ever get to hear all of them is in court. Otherwise, it is pretty much all monologue out there in the literature of health lost and regained, with all the usual problems of perspective and turf.

Someday, perhaps, a multi-author volume will do justice to the whole elephant. In the meantime we are left with makeshift composites, like the dialogue provided by two new books on the triumphs and failures of neurosurgery.

This is the realm of bad headaches — headaches that thrive on ibuprofen and just get worse, headaches that may eventually bring patients to doctors like Keith Black, scans in hand. A neurosurgeon at Cedars-Sinai in Los Angeles, Dr. Black is one of a few dozen in the country specializing in brain tumor surgery (most neurosurgeons work on the brain's blood vessels, or in the spinal cord). Among the patients he recalls in his fascinating, if somewhat stilted, memoir are a hip-hop artist with a benign tumor destroying her hearing and balance, a California pastor with nodules of melanoma in the brain, and a Hong Kong tycoon with a glioblastoma multiforme — the most feared of all brain tumors — extending its tentacles through the right temporal lobe.

No music is allowed in Dr. Black's operating room. It requires superhuman patience and concentration to peer into a microscope for hours, peeling apart gauzy layers of tissue to remove all these invaders. He likens the work to that of a cat burglar, his aim to get in and out of the brain without leaving a trace. One false move and the patient may never see, hear, smell again — or may never wake up at all.

Out of the operating room, with a concentration no less intense, Dr. Black does a lot of mental bargaining. In exchange for torturous surgery — one unlucky man is essentially cut in half to remove a tumor — patients with malignancies may get months to years of remission, while those with benign tumors may be fixed forever.

But how much grisly recuperation is fair payment for how much subsequent health? When should Dr. Black stand back and let nature take its course? Despite all the shades of gray, he has to make a decision in each instance, and so his world is an orderly progression of decision, action and result. And if there is the constant background thrum of other people's bad headaches, it is a chorus he has learned by now to accept.

For Lynne Greenberg, a Brooklyn Heights resident, mother of two and scholar of 17th-century English literature, the headache is the only thing, really, the metronome by which she has lived out the last three years. It struck in 2006 while she was sitting in a London library making her way through a stack of ancient documents: "Any movement or physical activity at all sent shock waves through the center of my head." It has never gone away.

More than two decades ago, when Ms. Greenberg was 19, a car accident catapulted her over an embankment to a 30-foot fall. She broke her neck but miraculously escaped all neurologic injury, and after a few months of neck immobilization she was declared cured.

After the headache appeared, a series of scans showed that Ms. Greenberg's old fracture had rebroken — or perhaps it had never healed at all. Was this the cause of the headache? Was it a coincidental finding? Did she need emergency surgery to stabilize her spine? Or was she a neurotic narcotic-seeking depressive reaping secondary gain from her alleged pain? Every doctor rendered a different opinion, leaving her increasingly frantic, confused, in a tangle of medications and pain.

Ms. Greenberg nails whole portions of the health care elephant in her compulsively readable book: the doctor shopping, the postop misery, the unhappy effects of chronic illness on marriage and small children, the looking-glass world of detox and rehab. The chorus in this book — other than the array of doctors, some good and some bad — are the poets Ms. Greenberg lives among, most prominently the blind John Milton, whose "Paradise Lost" chronicled a similarly cataclysmic fall.

Literate, fraught and unsettling, Ms. Greenberg's book has no resolution — none of the easy wrap-up Dr. Black offers us. He cured the hip-hop artist and put the pastor into a miraculously long-term remission; the Hong Kong tycoon fought a good fight but ultimately succumbed. Dr. Black's own story wraps up happily as well: an African-American kid from segregated Alabama, he was a science prodigy whose parents refused to limit his horizons, and he has soared high.

But it is Ms. Greenberg's epic journey through a gray landscape of pain, with a few rest stops along the way but no resolution in sight, that forms the more memorable narrative.


Wednesday, March 25, 2009

Pain Carnival: March, 2009 | How To Cope With Pain Blog

Chronic Illness Pain Support lists 10 Unreasonable Behaviors Your Doctor Shouldn't Have.  Do you see any you put up with?

Pain Health News looks at how the economy is affecting patients with pain.

Andrea's Buzzing About explores unusual sleep symptoms.

This article shares information about TENS units and how they can help.

Somebody Heal Me looks at a test useful in evaluating medication overuse headache.

Fighting Fatigue presents new information about how adrenal problems may contribute to Chronic Fatigue Syndrome.


Thursday, March 19, 2009

Chronic Pain Today

A Today.com weblog designed by a chronic pain sufferer FOR chronic pain sufferers


Tuesday, March 17, 2009

Top Pain Scientist Fabricated Data in Studies, Hospital Says - WSJ.com

A prominent Massachusetts anesthesiologist allegedly fabricated 21 medical studies that claimed to show benefits from painkillers like Vioxx and Celebrex, according to the hospital where he worked.

Baystate Medical Center, Springfield, Mass., said that its former chief of acute pain, Scott S. Reuben, had faked data used in the studies, which were published in several anesthesiology journals between 1996 and 2008.

The hospital has asked the medical journals to retract the 21 studies, some of which reported favorable results from the use of painkillers like Pfizer Inc.'s Bextra and Merck & Co.'s Vioxx -- both since withdrawn -- as well as Pfizer's Celebrex and Lyrica. Dr. Reuben's research work also claimed positive findings for Wyeth's antidepressant Effexor XR as a pain killer. And he wrote to the Food and Drug Administration, urging the agency not to restrict the use of many of the painkillers he studied, citing his own data on their safety and effectiveness.

"Dr. Reuben deeply regrets that this happened," said the doctor's attorney, Ingrid Martin. "Dr. Reuben cooperated fully with the peer review committee. There were extenuating circumstances that the committee fairly and justly considered." She declined to explain the extenuating circumstances. Dr. Reuben didn't respond to requests for comment sent through Ms. Martin and left at his former office.

The retractions, first reported in Anesthesiology News, have caused anesthesiologists to reconsider the use of certain practices adopted as a result of Dr. Reuben's research, doctors said. His work is considered important in encouraging doctors to combine the use of painkillers like Celebrex and Lyrica for patients undergoing common procedures such as knee and hip replacements.

Last month, the journal Anesthesia & Analgesia retracted 10 of Dr. Reuben's studies and posted a list of the 11 published in other journals on its Web site. The journal Anesthesiology said it has retracted three of Dr. Reuben's articles.

Dr. Reuben had been a paid speaker on behalf of Pfizer's medicines, and it paid for some of his research. "It is very disappointing to learn about Dr. Scott Reuben's alleged actions," Pfizer said in a statement. "When we decided to support Dr. Reuben's research, he worked for a credible academic medical center and appeared to be a reputable investigator."

Wyeth said it isn't aware of any financial relationship between the company and Dr. Reuben.

An FDA spokeswoman said late Tuesday she wasn't aware of the matter. Merck had no immediate comment.

Hal Jenson, the chief academic officer at Baystate Medical, said a routine audit last spring flagged discrepancies in Dr. Reuben's work. That led to a larger investigation in which Dr. Reuben cooperated, Dr. Jenson said. "The conclusions are not in dispute," he added.

Dr. Reuben is on an indefinite leave from his post at Baystate, the hospital said. He no longer holds an appointment as a professor at Tufts University's medical school, according to the university.

Baystate concluded that "Dr. Reuben was solely responsible for the fabrication of data," Dr. Jenson said.

Jeffrey Kroin, who co-wrote four papers with Dr. Reuben, said he was dumbfounded to receive a letter earlier this year from Baystate, retracting the studies.

"We analyzed it and made figures and graphs, and sent it back, and wrote papers, and everything seemed fine," said Dr. Kroin of Rush University Medical Center in Chicago. "If someone has a good reputation, has 10 years of papers and has a very high position within their medical school, generally you assume they have a lot of integrity."

Jacques E. Chelly, the head of acute interventional postoperative pain service at the University of Pittsburgh Medical Center, said he was "shocked" by the news of the retractions. Dr. Reuben "was very well respected," Dr. Chelly said.

He added that the situation has prompted his hospital to review the protocols it uses to treat patients for pain, because Dr. Reuben's work was so influential in establishing them. He said the hospital was now conducting its own study to verify the efficacy of drugs that Dr. Reuben claimed were effective painkillers.

In an editorial in the journal Anesthesiology, editor James C. Eisenach warned that "these retractions clearly raise the possibility that we might be heading in wrong directions or toward blind ends in attempts to improve pain therapy."

The retracted studies aren't expected to affect the drugs' regulatory status because Dr. Reuben's studies weren't part of the packages that manufacturers submitted to the FDA or European authorities.


Study Tests Reliability Of More Accurate Measure Of Patient Pain

A new study appearing in Pain Practice successfully established the reliability a newly developed device for assessing pain. This device is called the continuous pain score meter (CPSM). It enables continuous real time pain score measurement, which is used to obtain exact measurements of pain intensity in humans during the course of a procedure. The findings provide more detailed information on patients' pain perception and may lead to better pain management for certain clinical procedures. 

The ability to accurately measure pain intensity, pain duration and the effect of analgesics is an important task in both medical practice and research. The sharp increase in present-day office procedures, without general anesthesia, has made this even more important. The CPSM procedure can be valuable to study pain intensity in clinical procedures that take between 1-30 minutes. 

Currently, there are various validated instruments available to assess pain in patients. The visual analog score (VAS) is the most widely used scale. The VAS scale measures pain by a single score indicated by a patient the end of a procedure. It uses a scale that ranges from "no pain" to "worst imaginable pain." The VAS is frequently used for diagnostic and technical procedures to evaluate patient tolerance in an office setting.

This method, however, has three major disadvantages. If a procedure consists of multiple different actions, pain intensity may vary according to each action. This important information is not detected by a single measurement afterwards. Second, pain intensity measurements after the procedure may be biased by the inaccuracy of the memory to recall pain sensations. Third, pain is by nature not a short, limited phenomenon; pain sensation does not suddenly stop after a stimulus, but gradually disappears, requiring continuous measurements in order to fully cover the pain sensation. With this new pain score meter it is possible to measure pain continuously throughout the procedure. In this way, a clinician gains more insight into the patients' pain perception. 

More ...


Thursday, March 12, 2009

Research links weather, headaches - The Boston Globe

Many migraine sufferers will tell you they don't need a weatherman to tell them the forecast; their headaches signal what is coming. But there has been little scientific evidence to link the two - until now.

Researchers from Beth Israel Deaconess Medical Center - who studied 7,000 emergency-room visitors over a seven-year period - reported yesterday that headache-related hospital visits increased in the 24 hours after air temperatures rose. Lower barometric pressure in the 48 to 72 hours before a patient's arrival was also associated with a higher risk of headache.

The study used weather records and air pollution readings from a monitor on the roof of the Countway Library of Medicine and matched them to headache diagnoses from emergency doctors. For every temperature increase of 9 degrees Fahrenheit (5 degrees Celsius) in 24 hours, there was a 7.5 percent higher risk of severe headache. For every 5 millimeters the barometric pressure reading fell over 72 hours, there was a 6 percent higher risk of headache. There was no clear association with air pollutants.

"Our study was not big enough to look at air pollution definitively," Dr. Kenneth Mukamal, lead author of the study, said in an interview. "What we did see is that there are environmental triggers to headache."

More ...