Thursday, April 22, 2010

ChildKind International

Although pain management for children has improved dramatically in
some settings, children continue to suffer from inconsistent
application of available knowledge and principles. There are
enormous variations between institutions and within institutions as to
the attitudes and knowledge base of health care providers regarding
pain management.

ChildKind International is an initiative to improve the quality of pain
control for children in healthcare facilities worldwide, through the
awarding of a special designation and accreditation to institutions
that have implemented specific policies which are known to promote
pain reduction.

Pain Management Experts Guide - Mayday Fellows

This guide connects you with some of North America’s leading experts in the field of acute and chronic pain and pain management. Experts from the United States and Canada are listed by subject area and by patient population, and are available to take your call for an interview or discussion. They represent a geographically diverse group from the many pain management medical disciplines.

All of the experts are part of the Mayday Pain & Society Fellowship
Program. The Mayday Fund established the Fellowship to help physicians,
nurses, pharmacists, social workers, scientists, and legal scholars
become effective advocates for those who deal with acute and chronic
pain. For more information on the Mayday Pain & Society Fellowship,
please go to

The Mayday Fund, a New York City-based foundation dedicated to
alleviating the incidence, degree, and consequence of human physical
pain, established the Mayday Pain & Society Fellowship to expand the
pool of leaders who communicate about pain and pain management – the
research, the problems, and the solutions.

For more information on the Mayday Fund or the fellowship program,
please go to

Mayday Pain Project

The Mayday Pain Project was created in 1994 by an educator with a
background in rural health issues and a pharmacist with critical care
nursing experience. Initial funding was provide through a grant from
the Mayday Fund of New York. The Pain Project's initial goal was to
improve pain assesment and care of patients in Michigan's rural,
isolated Upper Peninsula. That goal still drives us today, but has now
expanded to a national and international scope.

Wednesday, April 21, 2010

Pallimed: A Hospice & Palliative Medicine Blog

Our target audience is the professionals (MD, DO, RN, LPN, LVN, Home Health Aide, ARNP, SW, Chaplain, Administrators, PT, OT, Speech, Pharmacy, etc.) working in hospice & palliative medicine, but we welcome all readers to this blog, including patients, families and other medical professionals outside of this field.

Our goal is to review current palliative medicine, hospice, end-of-life research with a particular focus on publications not from the major palliative care journals. We also highlight important events in end-of-life care from the news media and entertainment arenas. Pallimed is not intended to replace the patient-physician relationship.

Tuesday, April 20, 2010

Staging Pain, 1580-1800: Violence and Trauma in British Theater

Bookending the chronology of this collection are two crucial moments in the histories of pain, trauma, and their staging in British theater: the establishment of secular and professional theater in London in the 1580s, and the growing dissatisfaction with theatrical modes of public punishment alongside the increasing efficacy of staging extravagant spectacles at the end of the eighteenth century. From the often brutal spectacle of late medieval mystery plays to early Romantic re-evaluations of eighteenth-century appropriations of spectacles of pain, the essays take up the significance of these watershed moments in British theater and expand on recent work treating bodies in pain: what and how pain means, how such meaning can be embodied, how such embodiment can be dramatized, and how such dramatizations can be put to use and made meaningful in a variety of contexts. Grouped thematically, the essays interrogate individual plays and important topics in terms of the volume's overriding concerns, among them Tamburlaine and The Maid's Tragedy, revenge tragedy, Joshua Reynolds on public executions, King Lear, Settle's Moroccan plays, spectacles of injury, torture, and suffering, and Joanna Baillie's Plays on the Passions. Collectively, these essays make an important contribution to the increasingly interrelated histories of pain, the body, and the theater.

Monday, April 19, 2010

Words easily trigger painful memories - ScienceDaily

"Watch out, it'll hurt for a second." Not only children but also many adults get uneasy when they hear those words from their doctor. And, as soon as the needle touches their skin the piercing pain can be felt very clearly. "After such an experience it is enough to simply imagine a needle at the next vaccination appointment to activate our pain memory," knows Prof. Dr. Thomas Weiss from the Friedrich-Schiller-University Jena.

As the scientist and his team from the Dept. of Biological and Clinical Psychology could show in a study for the first time it is not only the painful memories and associations that set our pain memory on the alert. "Even verbal stimuli lead to reactions in certain areas of the brain," claims Prof. Weiss. As soon as we hear words like "tormenting," "gruelling" or "plaguing," exactly those areas in the brain are being activated which process the corresponding pain. The psychologists from Jena University were able to examine this phenomenon using functional magnetic resonance tomography (fMRT). In their study they investigated how healthy subjects process words associated with experiencing pain. In order to prevent reactions based on a plain negative affect the subjects were also confronted with negatively connotated words like "terrifying," "horrible" or "disgusting" besides the proper pain words.

"Subject performed two tasks," explains Maria Richter, doctoral candidate in Weiss's team. "In a first task, subjects were supposed to imagine situations which correspond to the words," the Jena psychologist says. In a second task, subjects were also reading the words but they were distracted by a brain-teaser. "In both cases we could observe a clear activation of the pain matrix in the brain by pain-associated words," Maria Richter states. Other negatively connotated words, however, do not activate those regions. Neither for neutrally nor for positively connotated words comparable activity patterns could be examined.

"These findings show that words alone are capable of activating our pain matrix," underlines Prof. Weiss. To save painful experiences is of biological advantage since it allows us to avoid painful situations in the future which might be dangerous for our lives. "However, our results suggest as well that verbal stimuli have a more important meaning than we have thought so far." For the Jena psychologist the question remains open which role the verbal confrontation with pain plays for chronic pain patients. "They tend to speak a lot about their experiencing of pain to their physician or physiotherapist," Maria Richter says. It is possible that those conversations intensify the activity of the pain matrix in the brain and therefore intensify the pain experience. This is what the Jena psychologists want to clarify in another study.

And so far it won't do any harm not to talk too much about pain. Maybe then the next injection will be only half as painful.

Sunday, April 18, 2010

Pain Medicine Position Paper (2009)

Since the 1950s, significant advances in the treatment of pain have resulted in greater relief for an increasing number of patients. However, the quality of pain care delivery in the United States continues to fall remarkably short of the current potential for optimal care. Pain medicine remains fragmented, and the absence of a unified organizational model of pain medicine hinders the effective provision of an integrated, cost-effective pain care, causing unnecessary and avoidable human suffering and societal expense. These consequences of fragmented care are unacceptable and threaten patient safety and well-being. Effective treatment of persistent pain requires the highest level of clinical reasoning, selectively coordinated medical skills, the strategic use of resources, and the orchestration of diverse areas of medical expertise. In order to close the gap between existing care and the potential for optimal pain care, significant institutional barriers to this goal must be addressed. To this end, the following position paper describes the history and context of this challenge, proposes recommendations to harness the collective abilities and knowledge within the discipline of pain medicine, and calls upon organized medicine to take action on behalf of patients and for the public health.

Monday, April 12, 2010

NIH Pain Consortium Symposium: “Moving Towards Personalized Pain Management”

This year's NIH Pain Consortium Symposium, titled "Moving Towards Personalized Pain Management," will include presentations and discussions of three topic areas: development of tools for individualized pain management, emerging therapies, and translating research in tailored pain management. The members of the Pain Consortium have invited a selective group of highly talented junior investigators to present posters representing a broad spectrum of current pain research findings. Researchers, health care providers, and the public are invited to attend. Registration is free. The event will be hosted by the co-chairs of the NIH Pain Consortium.
The symposium will be videocast live and archived at

Symposium Location
National Institutes of Health
Lipsett Auditorium, Building 10
Bethesda, MD 20892



Wednesday, May 5, 2010
7:30 AM  -  8:30 AMRegistration and Continental Breakfast
8:30 AM  -  8:45 AMIntroduction and Welcome 
Dr. Lawrence Tabak, D.D.S., Ph.D., Director, National Institute for Dental and Craniofacial Research, Pain Consortium Co-Chair
8:45 AM  -  9:00 AMMessage from the American Pain Society
Session One: 
Developing Tools for Individualized Pain Management
9:00 AM  -  9:20 AMHarvard Medical School: Assessment Tools to Characterize Individual Pain Phenotypes
Clifford Woolf, M.B., B.Ch., Ph.D., Children's Hospital Boston, Harvard Medical School
9:20 AM  -  9:40 AMDeveloping Imaging Biomarkers of Analgesic Effects
David Borsook, M.D., Ph.D., McLean Hospital, Harvard University
9:40 AM  -  10:00 AMMethodology for Adaptive Treatment Strategies for Chronic Disorders: Focus on Pain
Susan A. Murphy, Ph.D., University of Michigan
10:00 AM  -  10:20 AMMoving from the Means to the Standard Deviations in Pain Research: Novel Approaches to Characterize 
Christine Miaskowski, R.N., Ph.D., FAAN, University of California, San Francisco
10:20 AM  -  10:40 AMQuestions and Answers: Panel
10:40 AM  -  11:00 AMBreak and Posters
Poster presentations will be held outside the auditorium.
Session 2: 
Translating Research into Tailored Clinical Practice
11:00 AM  -  11:20 AMIdentifying Risk Factors for Post-Surgical Pain
Robert Edwards, Ph.D., Brigham and Women's Hospital, Harvard University
11:20 AM  -  11:40 AMTrends and Risks of Chronic Opioid Therapy Among the Elderly
Michael Von Korff, Ph.D., Group Health Research Institute
11:40 AM  -  12:00 PMPsychopathology as a Predictor of the Efficacy of Pain Management Strategies 
Ajay D. Wasan, M.D., Brigham and Women's Hospital, Harvard University
12:00 PM  -  12:20 PMPain in Rheumatoid Arthritis: More Than Inflammation
Daniel Solomon, M.D., Ph.D., Brigham and Women's Hospital, Harvard University
12:20 PM  -  12:40 PMQuestions and Answers: Panel
12:40 PM  -  2:00 PMLunch Break and Posters
Poster presentations will be held outside the auditorium.
2:00 PM  -  2:10 PMPresentation of the Mitchell Max Award for Best Poster
Story Landis, Ph.D., Director, National Institute for Neurological Disorders and Stroke, Pain Consortium Co-Chair
2:10 PM  -  2:10 PMSession 3: 
Emerging Therapies for Individualized Pain Management
2:10 PM  -  2:30 PMTargeted Nerve Toxin for Cancer Pain 
Michael Iadarola, Ph.D., National Institute for Dental and Craniofacial Research
2:30 PM  -  2:50 PMEmerging Therapies for Pain Management: Glial Targets
Linda Watkins, Ph.D., University of Colorado, Boulder
2:50 PM  -  3:10 PMCentral Role of Protein Kinase-C Epsilon in Mediating Analgesic Synergy in 
Primary Afferent Terminals 
George Wilcox, Ph.D., University of Minnesota
3:10 PM  -  3:30 PMEmerging Therapies for Pain Management: Spinal Analgesics
James Eisenach, M.D., Wake Forest University
3:30 PM  -  3:50 PMQuestions and Answers: Panel
3:50 PM  -  3:50 PMClosing Remarks
Josephine Briggs, M.D., Director, National Center for Complementary and Alternative Medicine, Pain Consortium Co-Chair

Tuesday, April 06, 2010

FDA Approves New Formulation For OxyContin

The U.S. Food and Drug Administration approved a new formulation of the controlled-release drug OxyContin that has been designed to help discourage misuse and abuse of the medication.

OxyContin is made to slowly release the potent opioid oxycodone to treat patients who require a continuous, around-the-clock opioid analgesic for management of their moderate to severe pain for an extended period of time. Because of its controlled-release properties, each OxyContin tablet contains a large quantity of oxycodone, which allows patients to take their drug less often. However, people intent on abusing the previous formulation have been able to release high levels of oxycodone all at once, which can result in a fatal overdose and contributes to high rates of OxyContin abuse.

The reformulated OxyContin is intended to prevent the opioid medication from being cut, broken, chewed, crushed or dissolved to release more medication. The new formulation may be an improvement that may result in less risk of overdose due to tampering, and will likely result in less abuse by snorting or injection; but it still can be abused or misused by simply ingesting larger doses than are recommended.

"Although this new formulation of OxyContin may provide only an incremental advantage over the current version of the drug, it is still a step in the right direction," said Bob Rappaport, M.D., director of the Division of Anesthesia and Analgesia Products in the FDA's Center for Drug Evaluation and Research.

"As with all opioids, safety is an important consideration," he said. "Prescribers and patients need to know that its tamper-resistant properties are limited and need to carefully weigh the benefits and risks of using this medication to treat pain."

According to the U.S. Substance Abuse and Mental Health Services Administration's National Survey on Drug Use and Health, approximately half a million people used OxyContin non-medically for the first time in 2008.

The manufacturer of OxyContin, Purdue Pharma L.P., will be required to conduct a postmarket study to collect data on the extent to which the new formulation reduces abuse and misuse of this opioid. The FDA is also requiring a REMS (Risk Evaluation and Mitigation Strategy) that will include the issuance of a Medication Guide to patients and a requirement for prescriber education regarding the appropriate use of opioid analgesics in the treatment of pain.

Source: U.S. Food and Drug Administration

Fibromyalgia Resource Center - Medscape

Monday, April 05, 2010

HubMed: recent pain articles

HubMed uses information from PubMed's database, provided by the NCBI through the EUtils web service, to produce a search interface focused on browsing, organising and gathering information from the biomedical literature. Searches can be conducted using the full range of operators available in Entrez/PubMed; when using the default search options, results will be identical to those those of a PubMed search.

Special features of HubMed include date- or relevance-ranked search results; web feeds for regular updates of published literature matching any search; clustering and graphical display of related articles; expansion of query terms; direct export of citation metadata in many formats; linking of keywords to external sources of information; manual categorisation (tagging) and storage of interesting articles.

Sunday, April 04, 2010

Helping Patients Face Death, She Fought to Live -

By the time she was 38, Dr. Desiree Pardi had become a leading practitioner in palliative care, one of the fastest-growing fields in medicine, counseling terminally ill patients on their choices.

She preached the gentle gospel of her profession, persuading patients to confront their illnesses and get their affairs in order and, above all, ensuring that their last weeks were not spent in unbearable pain. She was convinced that her own experience as a cancer survivor — the disease was first diagnosed when she was 31 — made her perfect for the job.

In 2008, while on vacation in Boston, she went to an emergency room with a fever. The next day, as the doctors began to understand the extent of her underlying cancer, "they asked me if I wanted palliative care to come and see me."

She angrily refused. She had been telling other people to let go. But faced with that thought herself, at the age of 40, she wanted to fight on.

While she and her colleagues had been trained to talk about accepting death, and making it as comfortable as possible, she wanted to try treatments even if they were painful and offered only a 2 percent chance of survival. When the usual cycles of chemotherapy failed to slow the cancer, she found a doctor who would bombard her with more. She force-fed herself through a catheter and drank heavy milkshakes to keep up her weight.

Over the last decade, palliative care has become standard practice in hospitals across the country. Born out of a backlash against the highly medicalized death that had become prevalent in American hospitals, it stresses the relief of pain; thinking realistically about goals; and recognizing that, after a certain point, aggressive treatment may prevent patients from enjoying what life they had left.

Dr. Pardi had gone into the field because she thought her experience as a patient would make her a better doctor. Now she came face to face with all the ambiguities of death, and of her profession.

She remembered patients who complained to her that she did not know them well enough to recognize that they were stronger than she had thought. Now she discovered that she felt the same way about her own doctors. "I think they underestimated me," she said in an interview last summer.

More ...

Saturday, April 03, 2010

Inside Chronic Pain by Lous Heshusius (Cornell University Press, 2009)

"With Lous Heshusius as a guide, pain patients can learn much about the perils of a modern health-care odyssey. Health professionals can learn how an articulate middle-class female white patient thinks (with all that thinking entails) when her world is irreversibly altered by pain. She does not promise happy endings. Chronic pain is like that. From the rare intersection in this text between patient narrative and physician response, however, readers may construct a dialogue on pain in our time that cannot fail to bring plentiful opportunities for personal insight and professional enlightenment."—from the Foreword by David B. Morris

Chronic pain, which affects 70 million people in the United States alone—more than diabetes, cancer, and heart disease combined—is a major public health issue that remains poorly understood both within the health care system and by those closest to the people it afflicts. This book examines the experience of pain in ways that could significantly improve how patients and practitioners deal with pain. It is the first volume of a new collection of titles within the acclaimed Culture and Politics of Health Care Work series called How Patients Think, intended to give voice to the concerns of patients about their own medical care and the formulation of health policy.

Since surviving a near-fatal car accident, Lous Heshusius has suffered from chronic pain for more than a decade, forcing her to give up her career as a professor of education. Inside Chronic Pain, based in part on the pain journal Heshusius keeps, is a stunning memoir of a life lived in constant pain as well as an insightful and often critical account of the inadequacies of the health care system—from physicians to hospitals and health insurance companies—to understand chronic pain and treat those who suffer from it. Through her own frequently frustrating experiences, she shows how health care providers often ignore, deny, or incorrectly treat chronic pain at immense cost to both the patient and the health care system. She also offers cogent suggestions on improving the quality and outcome of chronic pain care and management, using her encounters with exceptional medical professionals as models.

Inside Chronic Pain deals with pain's dramatic and destructive effects on one's sense of self and identity. It chronicles the chaos that takes place, the paralyzing effect of severe pain, the changes in personality that ensue, and the corrosive effects of severe pain on the ability to attend to day-to-day tasks. It describes how one's social life falls apart and isolation takes over. It also relates moments of happiness and beauty and describes how rooting the self in the present is crucial in managing pain. 

A unique feature of Inside Chronic Pain is the clinical commentary by Dr. Scott M. Fishman, president of the American Pain Foundation. Fishman has long tried to improve the lives of patients like Heshusius. His medical perspective on her very human narrative will help physicians and other clinicians better understand and treat patients with chronic pain.