Sunday, May 17, 2020

Chronic Pain: Pain Without Purpose - Medscape and Stanford Pain Medicine audio

Chronic pain is physiologically distinct from long-lasting acute pain. In some cases, however, poorly managed acute pain can develop into a chronic pain condition.

In addition to the direct physical suffering that patients experience, the biopsychosocial nature of chronic pain affects their social lives, ability to work, and psychological well-being. The resulting economic burden of chronic pain is estimated to cost the United States over half a trillion dollars annually—more than diabetes, heart disease, and cancer combined.

In this three-part series, doctors at the Pain Management Center of Stanford University examine the impact of chronic pain on quality of life, the feedback loops that can convert acute to chronic pain, and rational strategies for the management of chronic pain as a biopsychosocial condition. The effectiveness of pain psychology is considered, as are different classes of analgesics.

Monday, March 30, 2020

Threepenny: Gao, My Right Arm

Last summer, I woke up one morning to find my right hand couldn't grab the doorknob to turn it open. The next thing I knew was that no matter how many times I shook it, it remained numb. Soon, on a hot June night, a furtive pain traveled from my right elbow to my palm, back and forth, through and through, like a fractious child jumping between hopscotch courts with his full body gravity, determined and ferocious.

I am a Chinese woman. Two things I am good at are self-diagnosing and self-preservation. I went to a Chinese massage place the next morning. The lady there told me it was "tennis elbow." Which seemed funny and unfair to me: I had never played tennis in my life. When I was eighteen and dreamed about my future self wearing a short white tennis skirt, running in a blue court, I signed up for a tennis class—and quit after the first session. My skinny right arm was not capable of holding a 9.4-ounce tennis racquet against a spinning ball. The lady at the massage place first used her arm, then her feet to dissolve the knots on my forearm. A day later, small black and blue bruises on my right arm left a message—there was pain; there was suffering. I consciously wore long sleeves to cover it up, afraid of being misunderstood as a domestic violence victim. But I would roll my sleeve up when I met my friends for coffee. It was show and tell: my pain needed to be noticeable to others as well.

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Monday, January 06, 2020

Scientists are unraveling the mysteries of pain

More than three decades ago, when Tom Norris was fighting cancer, he underwent radiation therapy on his groin and his left hip. His cancer disappeared and hasn't come back. But Norris was left with a piercing ache that burned from his hip up his spine to his neck.

Since then, Norris, now 70, has never had a single day free from pain. It cut short his career as an aircraft maintenance officer in the U.S. Air Force. It's been his constant companion, like the cane he uses to walk. On bad days, the pain is so excruciating, he's bedridden. Even on the best days, it severely limits his ability to move about, preventing him from doing the simplest chores, like taking out the garbage. Sometimes the pain is so overpowering, Norris says, that his breathing becomes labored. "It's like I'm drowning."

Norris, who lives in a Los Angeles suburb, spoke to me from a long, cushioned bench, which allowed him to go from sitting to lying flat on his back. A tall and genial man, he's become adept at wearing a mask of serenity to hide his pain. I never saw him wince. When his agony is especially intense, his wife of 31 years, Marianne, says she can tell by a certain stillness she sees in his eyes.

To ease his pain during surgery to remove a pin from his pelvis, Brent Bauer focuses on a virtual reality game called SnowWorld, which involves throwing snowballs at snowmen and penguins. Orthopedic trauma surgeon Reza Firoozabadi at UW Medicine's Harborview Medical Center in Seattle was testing the effectiveness of the game, developed by the University of Washington's Hunter Hoffman, a pioneer in VR for pain relief. Bauer broke numerous bones, including his pelvis, when he fell three stories.

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