Debby Hamilton, MD, MPH: Research on Pain.

No Abstract Available.

Guia prático para o manejo da dor / Guia prático para o manejo da dor

O estudo da dor e suas particularidades é de grande importância para o tratamento de diversas patologias e para a melhora na qualidade de vida dos pacientes. A maioria das disfunções orgânicas tem a dor como um ponto importante da sua manifestação. Dessa maneira, é justificável a elaboração de conteúdo para auxiliar os profissionais da saúde no entendimento e tratamento das principais causas de dores agudas e crônicas. Este livro foi elaborado com o objetivo de servir como um guia prático para o manejo da dor por profissionais e acadêmicos de Medicina. Engloba temas como conceitos e aspectos biopsicossociais da dor, além de questões mais complexas como a fisiologia da dor e o tratamento medicamentoso com o arsenal terapêutico existente. Finalmente, também trata dos diversos tipos de dor mais prevalentes e o conhecimento básico que envolve seu manejo.

Pinpricks: Needling, numbness, and temporalities of pain.

Acupuncture analgesia appeared relatively straightforward. A patient laid awake as the practitioner needled selected sites on the body to induce numbness for surgery. Numerous reports emerging from China in the 1970s featured men and women resting on operating tables, smiling into the camera, surrounded by doctors who attended to the excised region-the esophagus, brain, gut, heart, or lungs. In the course of a decade, hundreds of news articles proclaimed acupuncture analgesia as embodying the spirit of Communist politics. While "acupuncture analgesia" was a heterogeneous practice that addressed a variety of disorders, it cohered visually in photographs of patients indifferent to their vivisected bodies, and it cohered discursively as a means for eliminating sensitivity to pain. Across these domains of representation, I argue that reports of obliterating pain with a single needle across clinical encounters collapsed the multiple temporalities of pain. Drawing on sources from an imagined community of researchers and physicians in parts of China, Singapore, Macau, Hong Kong, Britain, and the United States, this chapter explores the epistemic and ontological implications of numbness-a distinct sensation defined by the lack of sensation-in the absence of the brain.

"A kind of agonie in my thoughts": writing puritan and non-conformist women's pain in 17th-century England.

The relationship between pain as a physical and emotional experience and the concept of suffering as an essential aspect of sanctification for faithful believers was a paradoxical and pressing theological and phenomenological issue for puritan and non-conformist communities in 17th-century England. Pain allows the paradox of non-conformists' valorisation and suppression of corporeality to be explored due to its simultaneous impact on the mind and body and its tendency to leak across boundaries separating an individual believer from other members of their family or faith community. The material world and the human body were celebrated as theatres for the display of God's glory through the doctrines of creation and providence despite the fall. Pain as a concept and experience captures this tension as it was represented and communicated in a range of literary genres written by and about puritan and non-conformist women including manuscript letters, spiritual journals, biographies and commonplace books. For such women, targeted by state authorities for transgressing gender norms and the religion established by law, making sense of the pain they experienced was both a personal devotional duty and a political act. Three case studies comprise a microhistory of 17th-century English puritan and non-conformist women's lived experience, interpretation and representation of pain, inscribed in a series of manuscripts designed to nurture the spiritual and political activism of their communities. This microhistory contributes to a better understanding of pain in early modern England through its excavation of the connections that such writers drew between the imperative to be visibly godly, their marginalised subject position as a proscribed religious minority and their interpretation of the pain they experienced as a result.

[The phenomenon of pain in the history of music ­ observations of neurobiological mechanisms of pain and its expressions in western music]. / Der Schmerz in der Musikgeschichte. Betrachtungen über die neurobiologischen Mechanismen des Schmerzes und seine Darstellungen in der abendländischen Musik.

Purpose of this essay is to provide a historical overview how music has dealt with the emotion and sensation of pain, as well as an overview over the more recent medical research into the relationship of music and pain. Since the beginnings of western music humans have put their emotions into musical sounds. During the baroque era, composers developed musical styles that expressed human emotions and our experiences of nature. In some compositions, like in operas, we find musical representations of pain. During Romanticism artists began to intrude into the soul of their audience. New expressive harmonies and styles touch the soul and the consciousness of the listener. With the inception of atonality dissonant sounds where experienced as a physical pain.The physiology of deep brain structures (like thalamus, hypothalamus or limbic system) and the physiology of the acoustic pathway process consonant and dissonant sound and musical perceptions in ways, that are similar to the perception of pain. In the thalamus and in the limbic system music and pain meet.The relationships of music and pain is a wide open research field with such interesting questions as the role of dopamine in the perception of consonant or dissonant music, or the processing of pain during music listening. Musicology has not yet embarked on a general investigation of how musical compositions express pain and how that has developed or changed over the centuries. Music therapy, neuro-musicology and the performing arts medicine are scientific fields that offer a lot of ideas for medical and musical research projects.

On analgesic and narcotic plants: Pliny and his Greek sources, the history of a complex graft.

Grafting is an important concept in the study of Pliny the Elder, who is a compiler of written sources. We intend to examine how this grafting works in Pliny's discussion of analgesic and narcotic plants, especially the most famous: opium poppy, henbane, mandrake, and hound's berry. We will study Pliny's use of Greek sources and ask how he took up his predecessors' works while integrating the changes that took place during the centuries in the diagnosis and treatment of pain. This cultural graft remains elusive because we do not have access to all of Pliny's Greek sources. When Pliny speaks about these plants, he sometimes copies out information, adding or removing details, and occasionally makes significant mistakes. The graft was particularly difficult in this case because these analgesic plants were considered so special and poisonous that they were sometimes rejected or even condemned. Nevertheless, we can say that this cultural graft succeeded, despite some obstacles, because Pliny assimilated and adapted these old Greek materials to his own time, society, and project.

Some (mostly Scottish) local anaesthetic heroes.

In 1884 a young Viennese doctor, Carl Koller, was the first to recognise the significance of the topical effects of the alkaloid cocaine and thus introduced drug-induced local anaesthesia to clinical practice. Most subsequent development took place in Europe and the United States, with British interest not becoming apparent for over twenty years. This is surprising because a number of doctors working in Scotland, or with Scottish connections, had made important contributions to the earlier evolution of local anaesthetic techniques. This paper reviews the relevant work of James Young Simpson, Alexander Wood, James Arnott, Benjamin Ward Richardson and Alexander Hughes Bennett and the role of John William Struthers in the later promotion of the techniques.

Life satisfaction in chronic pain patients: the stress-buffering role of the centrality of religion.

Chronic pain (CP) is a stressful condition that severely impacts individuals' lives. Researchers have begun to explore the role of religion for CP patients, but the literature is scarce, especially for West European populations. Drawing from the transactional theory of stress, this study examined the associations between the religious meaning system and the life satisfaction for a group of CP patients who were members of a Flemish patients' association. To take into account the religious landscape of West European countries, the centrality of one's religious meaning system, rather than religious content, was the focus. Results from the questionnaires completed by 207 patients suggest that the centrality of a meaning system is an important factor in the promotion of life satisfaction for this group, above and beyond the influence of several control variables. Furthermore, the centrality of the religious meaning system moderated or buffered the detrimental influence of pain severity on life satisfaction.

Sujeto y dolor: introducción a una filosofía de la medicina / Subject and pain: introduction to a philosophy of medicine

El dolor no se puede explicar. Su comprensión no es posible si no lo es desde la más ingrata de las posiciones: su padecimiento. Así, en el intento por explicar sus múltiples apariciones, significados y mecanismos, surge como imprescindible el desarrollo de una filosofía del dolor. El acercamiento a estas cuestiones por parte de la medicina occidental tradicional, no ha tenido en cuenta el lenguaje particular en el que éstas se enmarcan, el cual se ve atravesado por una doble subjetividad: la que él mismo representa y la que encuadra a la relación entre los agentes por la que este lenguaje circula. La articulación de la medicina científica tradicional con disciplinas sociales, antropológicas y artísticas permitiría conformar una respuesta satisfactoria a esta doble subjetividad, con un profundo cambio enlas terapéuticas actuales del dolor.(AU)

Pain cannot be explained. It may only be understood from the most unpleasant of positions: suffering it. Thus, in the attempt to account for its multiple occurrences, meanings and mechanisms,developing a philosophy of pain appearsto be essential. The approach to these issues by traditional occidental medicine has not considered the particular language in their background, which contains a double subjectivity: the subjectivity it represents itself, and that which frames the relationship between the agents where this language circulates. Articulating traditionalscientific medicine with social, anthropological, and artistic disciplines would allow for a satisfactory response to this double subjectiveness, resultingin a deep change in current pain therapies.(AU)

Sujeto y dolor: introducción a una filosofía de la medicina / Subject and pain: introduction to a philosophy of medicine

El dolor no se puede explicar. Su comprensión no es posible si no lo es desde la más ingrata de las posiciones: su padecimiento. Así, en el intento por explicar sus múltiples apariciones, significados y mecanismos, surge como imprescindible el desarrollo de una filosofía del dolor. El acercamiento a estas cuestiones por parte de la medicina occidental tradicional, no ha tenido en cuenta el lenguaje particular en el que éstas se enmarcan, el cual se ve atravesado por una doble subjetividad: la que él mismo representa y la que encuadra a la relación entre los agentes por la que este lenguaje circula. La articulación de la medicina científica tradicional con disciplinas sociales, antropológicas y artísticas permitiría conformar una respuesta satisfactoria a esta doble subjetividad, con un profundo cambio enlas terapéuticas actuales del dolor.

Pain cannot be explained. It may only be understood from the most unpleasant of positions: suffering it. Thus, in the attempt to account for its multiple occurrences, meanings and mechanisms,developing a philosophy of pain appearsto be essential. The approach to these issues by traditional occidental medicine has not considered the particular language in their background, which contains a double subjectivity: the subjectivity it represents itself, and that which frames the relationship between the agents where this language circulates. Articulating traditionalscientific medicine with social, anthropological, and artistic disciplines would allow for a satisfactory response to this double subjectiveness, resultingin a deep change in current pain therapies.

Breve historia del dolor y de la analgesia / Brief history of pain and analgesia

El dolor ha acompañado al ser humano desde el mismo momento en que éste apareció sobre la tierra. Desde entonces, y a lo largo de toda su historia, el hombre ha tratado no sólo de buscar la razón del mismo, sino también de encontrar remedios para su alivio(AU)

Pain has accompanied human beings since the moment this species appeared on Earth. From that moment on, and throughout his long history, mankind has tried not only to look for the causes of pain but also to find remedies to relieve pain(AU)

Estratégias terapêuticas no tratamento da dor crônica: uma genealogia da clínica da dor / Therapeutic strategies in the treatment of chronic pain: a genealogy of the pain clinic

O objetivo desse trabalho é analisar a singularidade das estratégias terapêuticas introduzidas pelo modelo das Clínicas da Dor, através de um estudo genealógico desse projetoterapêutico e sua contextualização no âmbito da racionalidade científica moderna. Mais especificamente, pretende-se analisar as transformações na racionalidade médica que permitiram, sucessivamente, a apreensão da dor pelo discurso médico, a concepção da dorcomo uma doença e a construção e a consolidação do modelo terapêutico das Clínicas da Dor. Para tal, inicialmente, analisamos o modelo terapêutico desenvolvido pelo médico anestesista John Bonica, idealizador do modelo das Clínicas da Dor, destacando as ferramentas conceituais que possibilitaram a compreensão da dor crônica como doença e como fenômenobiopsicossocial. Num segundo momento, realizamos uma descrição e análise dos principais eventos que permitiram a consolidação da medicina da dor como uma prática específica e multidisciplinar, dando destaque à inserção deste modelo no contexto do Sistema Único de Saúde Brasileiro. Finalmente, a partir de uma experiência clínico-institucional buscamos refletir sobre os limites e possibilidades da aplicação prática deste modelo, lançando luz sobre os impasses da clínica e tensões oriundas da problematização do dualismo mente e corpo e das práticas terapêuticas interdisciplinares.

Ensayo clínico aleatorizado en pacientes con cervicalgia mecánica en atención primaria: terapia manual frente a electroestimulación nerviosa transcutánea / Randomised clinical trial for primary care patients with neck pain: manual therapy versus electrical stimulation

Objetivo. Comparar la efectividad de la terapia manual frente a electroestimulación nerviosa transcutánea en la disminución de la intensidad del dolor en pacientes con cervicalgia mecánica subaguda o crónica atendidos en unidades de fisioterapia de atención primaria (UFAP). Diseño. Ensayo clínico aleatorio. Emplazamiento. Se incluyeron 13 UFAP de 4 áreas de salud de la Comunidad de Madrid. Participantes. Formaron parte del estudio 90 pacientes atendidos con cervicalgia mecánica subaguda o crónica. Se produjeron 3 pérdidas tras la intervención. Intervenciones. Se asignaron aleatoriamente 47 pacientes al tratamiento con terapia manual y 43 a recibir electroestimulación nerviosa transcutánea. Mediciones principales. Se midieron las características sociodemográficas y las variables pronóstico por grupo de intervención, así como la intensidad del dolor antes y después de la intervención con la media de los valores de la escala analógica visual (momento presente, promedio y peor dolor de las últimas 2 semanas) y los efectos adversos. Resultados. La diferencia en la intensidad del dolor antes-después fue de 21,83 mm (intervalo de confianza [IC] del 95%, 13,71-29,95) para el grupo tratado con electroestimulación nerviosa transcutánea y de 22,87 mm (IC del 95%, 17,11-28,64) para la terapia manual. La diferencia de medias comparando la mejoría obtenida con uno y otro procedimiento fue de 1,04 (IC del 95%, de -8,66 a 10,75). Conclusiones. Se ha observado una reducción en la intensidad del dolor percibida por los pacientes, si bien no se encontraron diferencias entre ambos tratamientos (electroestimulación nerviosa transcutánea y terapia manual). Este estudio no permite establecer la alternativa de tratamientos fisioterapéuticos en la cervicalgia mecánica atendida en atención primaria

Objective. To compare the effectiveness of manual therapy (MT) versus transcutaneous electrical nervous stimulation (TENS) in reducing the intensity of pain in patients with subacute or chronic neck pain (NP) attended at primary care physiotherapy units (PCPU). Design. Randomised clinical trial. Setting. Thirteen PCPU in 4 health districts of the Community of Madrid, Spain. Participants. Ninety patients with subacute or chronic NP attended. Lost after intervention: 3. Interventions. At random, 47 patients were allocated to MT treatment and 43 to TENS. Main measurements. Social and demographic characteristics and prognosis variables in the intervention groups were measured. Intensity of pain before and after intervention was calculated by mean values on the analogue visual scale (present moment, average and worst pain of the last 2 weeks). Side-effects were also measured. Results. Difference between before-and-after pain was 21.83 mm (95% CI, 13.71-29.95) for the group treated with Transcutaneous electrical nervous stimulation and 22.87 mm (95% CI, 17.11-28.64) for manual therapy. The difference in averages on comparing the 2 procedures for improvement was 1.04 (95% CI, -8.66% to 10.75%). Conclusions. TENS and MT significantly reduce patients' perceived intensity of pain, although there were no differences between the 2 groups.There are no conclusive results for the alternative physiotherapy treatments that determine a clear strategy of intervention

[Changing methods of pain- and fear-relief in dental treatments based on reports published in 'Fogorvosi Szemle']. / A fájdalom- és félelemmentes fogászati kezelés módszereinek alakulása a Fogorvosi Szemlében megjelent dolgozatok tükrében.

In the dental practice--for more than a 100 years--it has been a vital topic how to prevent, eliminate, or at least relieve pain and fear associated with dental treatments. 'Fogorvosi Szemle,' the scientific journal of the Hungarian Dental Association is now a 100 years old. Authors present how the approaches and methods of relieving pain and fear have changed in the past century, based on the reports published in this journal. The reports are grouped in three main topics: local anaesthetics and sedatives; ambulatory narcosis and sedative analgesia; hypnosis and hypnotherapy. Based on the publications of the last one hundred years, it can be concluded that the Hungarian dental practice has followed the trends and principles of the well-known international dental schools.

[From willow bark to the coxibs. Development of antiphlogistic analgesics]. / Von der Weidenrinde zu den Coxiben. Entwicklung der antiphlogistischen Analgetika.

Antiphlogistic analgesics comprise the most widely used class of drugs worldwide. These compounds derive more or less directly from three prototypes which were discovered about 130 years ago in Central Europe: acetylsalicylic acid (aspirin), acetanilide (the forerunner of acetaminophen), and phenazone. All of them are still available. Attempts to improve their effect/side effect spectrum and enhance their analgesic activity led to the development of animal models of inflammatory pain which allowed for the screening and discovery of the so-called aspirin-like drugs, also termed nonsteroidal antiinflammatory drugs (NSAIDs) or cyclooxygenase inhibitors. This group presently dominates the market despite the fact that all these compounds imply the risk of unwanted drug effects, including gastrointestinal ulcers, renal dysfunction, inhibition of blood coagulation, pseudoallergic reactions, and possibly also accelerated development of atherosclerosis. Attempts to reduce these unwanted drug effects on the basis of molecular pharmacological insights resulted in the development of the so-called selective cyclooxygenase-2 inhibitors which are presently discussed ambiguously. These compounds appear to go along with less gastrointestinal toxicity, they do not inhibit blood coagulation, and have a reduced propensity for causing pseudoallergic asthmatic attacks. They may, on the other hand, cause more unwanted cardiovascular effects than the traditional NSAIDs. Hope for further reduction of unwanted drug effects comes from the recently discovered role of glycinergic spinal pain control. It is hoped that new classes of analgesic compounds may result from these new glycinergic mechanisms.