Authoring Pain: Fragmentation and Autofiction in Maggie Nelson's Bluets.

This article analyzes Maggie Nelson's Bluets (2009) as a prominent example of the fragmentary narration that can result from the experience of pain and loss. I demonstrate how Nelson's disparate ruminations on her obsession for the color blue, her heartbreak, and her quadriplegic friend's chronic pain defy the superimposition of a teleological plot over these experiences, in favor of episodic reading and sporadic not-knowing. Still, the autofictional nature of the text-with its alternatively overbearing and elusive authorial presence-challenges any naïve emotional investment in it. Focusing on Nelson's narration of her quadriplegic friend's experience of chronic pain, I conclude by highlighting how Bluets calls for a reconsideration of the reader's stance vis-à-vis the description of suffering, as well as of simplistic critical approaches to illness narratives as life-writing.

Psychosurgery in the History of Stereotactic Functional Neurosurgery.

The paper invites to reappraise the role of psychosurgery for and within the development of functional stereotactic neurosurgery. It highlights the significant and long-lived role of stereotactic neurosurgery in the treatment of severe and chronic mental disorders. Stereotactic neurosurgery developed out of psychosurgery. It was leucotomy for psychiatric disorders and chronic pain that paved the way for stereotactic dorsomedial thalamotomy in these indications and subsequently for stereotactic surgery in epilepsy and movement disorders. Through the 1960s stereotactic psychosurgery continued to progress in silence. Due to the increased applications of stereotactic surgery in psychiatric indications, psychosurgery's renaissance was proclaimed in the early 1970s. At the same time, however, a public fearing mind control started to discredit all functional neurosurgery for mental disorders, including stereotactic procedures. In writing its own history, stereotactic neurosurgery's identity as a neuropsychiatric discipline became subsequently increasingly redefined as principally a sort of "surgical neurology," cut off from its psychiatric origin.

President John F Kennedy's medical history: coeliac disease and autoimmune polyglandular syndrome type 2.

President John F. Kennedy (JFK) had a complex medical history that is now thought to be an autoimmune polyglandular syndrome type 2 with Addison's disease and hypothyroidism. He also had gastrointestinal symptoms from adolescence, which now fit well with coeliac disease. In addition, he had a chronic back problem, which contributed to a chronic pain syndrome. This review looks at JFK's various diseases and focusses on the history of coeliac disease, as well as its presentation. JFK's Irish ancestry supports the hypothesis of a coeliac disease started early in his youth.

A recent history of opioid use in the US: Three decades of change.

BACKGROUND: The opioid epidemic in the United States is a problem that has developed over decades. While clinical, regulatory, and legislative changes have been implemented to combat this issue, changes will not be immediate. Moreover, the changes that have been carried out may have unintended negative consequences such as increased use of illicit opioids (e.g., heroin and synthetics) and challenges in effective and appropriate pain management. OBJECTIVES: This review focuses on the last three decades and presents key changes the United States has seen in the use of opioids. Conclusions/Importance: There have been numerous policy changes and programs aimed at decreasing opioid use and abuse in the United States; however, it will take a major shift in the mindset of clinicians, the general public, and policy makers to alleviate this epidemic.

Persistent Pain: Nursing Perspectives.

Pain has diligently been regarded by scholars of different disciplines, and yet the experience of pain for patients and families can be minimized and relegated to a more perfunctory place. Pain, particularly persistent pain, warrants attention and to not fully attend to pain betrays and does not honor human dignity warranted by patients and families cared for within nursing and the larger healthcare community.

John F. Kennedy's back: chronic pain, failed surgeries, and the story of its effects on his life and death.

The 35th president of the United States, John F. Kennedy (JFK), experienced chronic back pain beginning in his early 20s. He underwent a total of 4 back operations, including a discectomy, an instrumentation and fusion, and 2 relatively minor surgeries that failed to significantly improve his pain. The authors examined the nature and etiology of JFK's back pain and performed a detailed investigation into the former president's numerous medical evaluations and treatment modalities. This information may lead to a better understanding of the profound effects that JFK's chronic back pain and its treatment had on his life and presidency, and even his death.

Providing chronic pain management in the "Fifth Vital Sign" Era: Historical and treatment perspectives on a modern-day medical dilemma.

BACKGROUND: Over 100 million Americans are living with chronic pain, and pain is the most common reason that patients seek medical attention. Despite the prevalence of pain, the practice of pain management and the scientific discipline of pain research are relatively new fields compared to the rest of medicine - contributing to a twenty-first century dilemma for health care providers asked to relieve suffering in the "Fifth Vital Sign" era. METHODS: This manuscript provides a narrative review of the basic mechanisms of chronic pain and history of chronic pain management in the United States - including the various regulatory, health system and provider factors that contributed to the decline of multidisciplinary pain treatment in favor of the predominant opioid treatment strategy seen today. Multiple non-opioid pain treatment strategies are then outlined. The manuscript concludes with three key questions to help guide future research at the intersection of pain and addiction. CONCLUSIONS: The assessment and treatment of chronic pain will continue to be one of the most common functions of a health care provider. To move beyond an over reliance on opioid medications, the addiction and pain research communities must unite with chronic pain patients to increase the evidence base supporting non-opioid analgesic strategies.

Pain, objectivity and history: understanding pain stigma.

The primary claim of this paper is that understanding the stigma so commonly endured by chronic pain sufferers today in the USA and the UK is unlikely without proper appreciation of the history of pain. Ameliorating such stigma is an ethical imperative, and yet most approaches eschew even an attempt to trace connections between historical attitudes, practices and beliefs towards pain and the stigmatisation so many pain sufferers currently endure. The manuscript aims to help fill this gap by framing pain in the modern era in context of two crucial intellectual schemes that waxed in the 19th and 20th centuries: mechanical objectivity and somaticism. The analysis explains these frameworks and applies them to exploration of primary sources connected to contested pain conditions such as railway spine. By properly situating the historical roots of what it means to cite the 'subjectivity' of pain as a problem, the modern roots of stigmatising attitudes and practices towards chronic pain sufferers become much clearer. The manuscript concludes by suggesting that interventions expressly intended to target the root causes of such stigma are much more likely to be successful than approaches that proceed in ignorance of the historical forces shaping and driving pain stigma in the present.

Frida Kahlo: Portrait of Chronic Pain.

The Mexican artist Frida Kahlo (1907-1954) is one of the most celebrated artists of the 20th century. Although famous for her colorful self-portraits and associations with celebrities Diego Rivera and Leon Trotsky, less known is the fact that she had lifelong chronic pain. Frida Kahlo developed poliomyelitis at age 6 years, was in a horrific trolley car accident in her teens, and would eventually endure numerous failed spinal surgeries and, ultimately, limb amputation. She endured several physical, emotional, and psychological traumas in her lifetime, yet through her art, she was able to transcend a life of pain and disability. Of her work, her self-portraits are conspicuous in their capacity to convey her life experience, much of which was imbued with chronic pain. Signs and symptoms of chronic neuropathic pain and central sensitization of nociceptive pathways are evident when analyzing her paintings and medical history. This article uses a narrative approach to describe how events in the life of this artist contributed to her chronic pain. The purpose of this article is to discuss Frida Kahlo's medical history and her art from a modern pain sciences perspective, and perhaps to increase our understanding of the pain experience from the patient's perspective.

Psychological mislabeling of chronic pain: lessons from migraine in the 20th century.

Starting with Freud, psychoanalytically oriented practitioners described a complex of unconscious conflicts, desires and personality traits they believed to be the primary cause of a wide range of medical disorders. This was the psychogenic model. With the advance of basic research and pharmacotherapy, the psychogenic model was gradually replaced by a biopsychobehavioral model. This model treats chronic pain as a biologically based disorder that can be influenced by psychological factors and lifestyle. The present paper argues that many patients with chronic pain may not be significantly impacted by psychological factors, and that for those who are, cognitive-behavioral therapy is the treatment of choice.

Peggy's Pain and the Creation of Gone With the Wind.

Margaret Mitchell (1900-1949), author of the best-selling novel Gone With the Wind had chronic, widespread pain for most of her adult life. She was accident prone and sustained injuries leading to unexpectedly prolonged periods of recovery and had unusual illnesses that puzzled her physicians. Starting at an early age, Mitchell, or "Peggy" as she was called by family and friends, had a burning ambition to be a writer, and her painful, chronic illness created conditions that allowed her to achieve this goal. In this report, the details of her health problems are reviewed. During her life, her diagnoses were problematic and remain so now, but would most likely include fibromyalgia and irritable bowel syndrome.

A historical and clinical perspective endorsing person-centered management of fibromyalgia syndrome.

Fibromyalgia or fibromyalgia syndrome (FMS) is a complex chronic pain disorder of unknown causation frequently associated with debilitating fatigue, unrefreshing sleep, cognitive and affective symptoms. A fibromyalgia-type suffering was possibly described in the Book of Job. Analogous symptomatic conditions have been medically recognized since the early 1900s, when initially labeled as "fibrositis". Since the early 1980s, FMS has evolved and differentiated after its characterization in a controlled study. Since then, research has focused on multiple aspects of this disorder, including characterization and management of symptoms, psychophysiology, neuroendocrine-immune pathophysiology, including central sensitization mechanisms. The complex and multifaceted nature of FMS lends itself better to a holistic (integrative medicine) or biopsychosocial approach than the more specific bioscientific pathways typical for a pathologically-defined disease. A person-centered approach to evaluation and care more effectively addresses and encompasses the biopsychosocial aspects of this disorder than traditional bioscientific clinical methods. This review outlines a holistic multi-modal, patientcentered approach to evaluation and care as a framework for primary clinic settings. Future directions in research, diagnosis, and management of fibromyalgia patients should incorporate revised person-centered and other qualitative models of care for critical comparison to current conventional concepts and clinical practice. The more comprehensive personcentered services need to be compared to the current standardized practice in terms of their cost-effective outcomes, patient satisfaction, physician gratification, and practical logistics of providing long-term follow up and management.

Alexander Scriabin: his chronic right-hand pain and Its impact on his piano compositions.

Alexander Scriabin was an outstanding pianist and an avant-garde composer who influenced later generations with his innovative "multimedia" conceptions of aesthetic experience. As an adolescent, he was systematically trained as a concert pianist and received lessons from Vassily Safonoff, one of the founders of the legendary Russian Piano School. At age 20, Scriabin suffered an overuse injury of his right hand when attempting to improve the sound quality of his piano touch. This injury caused a deep crisis and influenced his later composition style in his piano works. From this time on, his works were frequently dominated by unusual virtuosic use and wide spans of his left hand. Rest, restricted repertoire, and an increased focus on composition contributed to recovery; however, he always remained anxious concerning the stamina of his right hand. The case report impressively demonstrates the stressors an aspiring young pianist had to cope with at the end of the nineteenth century. Furthermore, it is a convincing example of how resource-oriented behavior and intuition lead to the improvement of health status. Differential diagnoses and the modern concept of multimodal pain therapy in chronic overuse injury will be discussed from a historical perspective.

Galeata: chronic migraine independently considered in a medieval headache classification.

BACKGROUND: Chronic migraine is a quite recent concept. However, there are descriptions suggestive of episodic migraine since the beginning of scientific medicine. We aim to review main headache classifications during Classical antiquity and compared them with that proposed in the 11th century by Constantine the African in his Liber Pantegni, one of the most influential texts in medieval medicine. METHOD: We have carried out a descriptive review of Henricum Petrum's Latin edition, year 1539. RESULTS: Headache classifications proposed by Aretaeus of Cappadocia, Galen of Pergamun and Alexander of Tralles, all of them classifying headaches into three main types, considered an entity (called Heterocrania or Hemicrania), comparable to contemporary episodic migraine.In ninth book of Liber Pantegni, headaches were also classified into three types and one of them, Galeata, consisted on a chronic pain of mild intensity with occasional superimposed exacerbations. CONCLUSION: In Liber Pantegni we have firstly identified, as a separate entity, a headache comparable to that we currently define as chronic migraine: Galeata.