21 July 2004

Pain research

Yesterday, when the steel door of our department unexpectedly slammed shut on my finger, I was fortunate to be able to conduct some research and empirical testing of my philosophical views on pain.

I'm pleased to say that things turned out well. One consequence of my view is that by relaxing and accepting a pain --in particular, by letting go of the urge to fight it (see: Nagel, Korsgaard) and trying to associate with it as part of one's self (see: me)-- the pain becomes much less bad.* Importantly, that's not to say that the sensory qualities of the pain change (much). In terms of phenomenology, the pain still felt pretty much the same, but there was a substantial change in its badness.

Unfortunately, I wasn't able to reconfirm my claim --arrived at mainly through broken fingers in the past**-- that certain pains have a distinctive character indicative of the injury. That is, broken fingers have a certain feeling to them. Its been awhile since I last broke a finger and thus I was curious whether I would recognize the alleged distinctive character again.***

*N.b., this is very different from trying to ignore the pain. Actively trying to put it out of your mind, I think, tends to make it worse.

**No, I'm neither a masochist nor particularly clumsy. All the broken bones resulted from martial arts injuries in my teenage years (when I viewed such injuries as a source of pride and badge of honor --now that I have arthritis at 27 and can reliably tell you when a storm's a comin', I'm a bit less proud).

***One must, I think, learn such pain identification through experience. Many traumas probably feel like broken bones to the naive injured patient; but many broken bones have a distinctive character to those of us with experience.

16 July 2004

Where migraines come from

I've mentioned the complexity of headaches several times. Don't believe me? A quick skim of this article covering just one of the potential etiologies should suffice to convince.

The pathogenesis of migraine headache is poorly understood but the trigeminovascular system seems to play an important role in it. The trigeminal nucleus caudalis is sensitised by noxious sensory stimuli, often from convergent afferents originating from a variety of tissues. In this paper, we review evidence to support the view that the cervical muscles play a role in the pathogenesis of the migraine headache as well by facilitating the mechanism of central sensitisation

By:Elliot Shevel1 and Egilius H. Spierings

DOI: 10.1007/s10194-004-0062-0

DOI links

I'm going to start linking to science articles using the DOI system. Here's a description of how the system works.

The digital object identifier (DOI) may be used to cite and link to
electronic documents. The DOI consists of a unique alpha-numeric
character string which is assigned to a document by the publisher upon
the initial electronic publication. The DOI will never change.
Therefore, it is an ideal medium for citing a document, particularly
Articles in Press because they have not yet received their full
bibliographic information.

The correct format for citing a DOI is shown as follows:


When you use the DOI to create URL hyperlinks to documents on the web, they are guaranteed never to change.

Complete the following steps to resolve a DOI:

  1. Open the following DOI site with your browser:


  2. Enter the entire DOI citation in the text box provided, and then click Go.

    The article that matches the DOI citation appears in your browser window.

The DOI scheme is administered by the International DOI Foundation. Many of the world's leading learned publishers have come together to build a DOI-based article linking scheme known as CrossRef.

Here's how we'll use it here. At the bottom of each post there will be a link that refers to an article with a DOI number. Copy the link target (it will be the DOI number). Then toward the top of this blog's sidebar, click on the DOI link to be taken to the DOI lookup page. Finally, paste the link target into the box and press enter. (This makes it seem harder than it actually is).

[update: Damn, I can't get blogger to list just the DOI number, so you need to delete the 'DOI' in the link target when you paste it in. Ugh, let me know if this is more trouble than its worth.]

ScienceDirect - Pain : Gender differences in post-operative pain and patient controlled analgesia use among adolescent surgical patients

ScienceDirect - Pain : Gender differences in post-operative pain and patient controlled analgesia use among adolescent surgical patients: "Gender differences in post-operative pain and patient controlled analgesia use among adolescent surgical patients

Deirdre E. Logan, , a and John B. Rosea, b

a The Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA
b University of Pennsylvania School of Medicine, Philadelphia, PA, USA

Received 13 October 2003; Revised 12 February 2004; accepted 23 February 2004 AIB-16500 Available online 21 April 2004.


The aim of this study was to explore gender differences in anticipatory emotional distress, coping strategies, post-operative pain perception, and patient-controlled analgesia (PCA) use among adolescent surgical patients. One hundred and two 12–18-year-old adolescents undergoing surgeries with overnight hospital stay were recruited. Participants completed pre-operative measures of anxiety and anticipated pain. Post-operatively, they reported on coping skills, post-operative anxiety, and pain. Data on PCA use were recorded from medical records. Girls reported higher levels of pre-operative state anxiety and anticipated more pain. After surgery, girls and boys differed on their lowest daily pain ratings and average daily pain ratings, with girls reporting more pain in both cases. Reports of highest daily pain were similar across genders. Gender was found to moderate the relationship between anticipatory distress and post-operative pain, such that higher anticipatory distress before surgery predicted more post-operative pain for girls, but not for boys. Patterns of PCA use did not vary by gender on post-operative days 0 or 1. Findings suggest that adolescent boys' and girls' pain experiences are different in several important respects, although somewhat less divergent than has been reported in samples of adult males and females. Results have implications for the development of targeted intervention strategies to help adolescents cope effectively with acute post-operative pain."

Alcoholic parents and chronic back pain

Chronic back pain is often weird in its sources. This may point to an interesting new variable.

Female Children of

Alcoholics and Chronic Back Pain.
By: Pecukonis, Edward V.. Pain
, Jun2004, Vol. 5 Issue 2, p196, 6p;
Abstract: . A case-controlled retrospective design was used in the present
investigation with adult women to explore the relationship between chronic and
persistent back pain and a history of being raised by an alcoholic caretaker. .
A sample of 112 females was obtained from a large university primary care
health center. Fifty-nine back pain patients served as cases, while 53 females
without histories of chronic pain served as controls. . Outcome measures
consisted of a seven-question physician back pain checklist. The independent
variable, being raised by an alcoholic caretaker, was measured by the Children
of Alcoholics Screening Test (CAST). . Chronic back pain patients scored significantly
higher than the nonpain group on the CAST. . The results suggest that
additional research should explore and further define the relationship between
a childhood history of being raised by an alcoholic parent and the development
of chronic back pain as an adult. [ABSTRACT FROM AUTHOR]; DOI:
10.1111/j.1526-4637.2004.04024.x; (
AN 13355886)

makes me curious about what the source might be. Some sort of
psychological stress? Being more likely to be beaten or engage in
activities which harm their spines and muscles when young? A genetic
predisposition to back pain and alcoholism? Interesting.

10 July 2004


Here's a (probably incomplete) of the pain science journals I try to check over every month.

The most important


Pain Reviews

The others (in no particular order)

Journal of Headache and Pain

Journal of Pain and Symptom Managment

Pain and Central Nervous System Week

Pain Medicine

Pain Practice

Internet Journal of Pain, Symptom Control, and Palliative Care

Journal of Pain and Palliative Care Pharmacotherapy

Practical Pain Management

04 July 2004


To my (5) loyal readers. My apologies for the spotty posting. As may be obvious from the distribution of posts, I do a survey of the recent pain science literature once a month for my own research. The fruits of that survey then trickle down here throughout the rest of the month, but mainly at the beginning.

I've been thinking about making a posting policy/schedule to keep myself on track and so readers know when to expect posts. I may end up just enshrining the current state of affairs (i.e., updating at the start of every month), or be more regular (e.g., every Monday). I'll decide and make an announcement soon.

Thanks for your continued patience as I work out some of the growing pains.