27 August 2008

Suit of Armour

Skevington notes:
By supplying lists of pain adjectives, practitioners and researchers are effectively teaching their patients a pain language that...provides a legitimate lexicon that may be recycled in later consultations as the 'correct' descriptor to use. By supplying the words and following the prescribed instructions, we blinker ourselves to our patients' ability to describe pain in their own varied language, which in many cases is not reducible to a single word in the English language. For example, a patient with early synovitis who was asked to describe her pain said, 'it is like a suit of armour which is too tight'. The author is still struggling to translate this into a single descriptor from the McGill Pain Questionnaire. [p.52]

18 August 2008

Pain and self control

As some of you know, one of my abiding research interests is the relationship between pain and self-control. Thus I bring you this:

A scientist developing a prosthetic pain detection system to help lepers who had lost sensation in their limbs avoid damage describes its failure:

In the end we had to abandon the entire scheme. Most important, we found no way around the fundamental weakness in our system: it remained under the patient's control. If the patient did not want to heed the warnings from our sensors, he could always find a way to bypass the whole system. Why must pain be unpleasant? Why must pain persist? Our system failed for the precise reason that we could not effective duplicate those two qualities of pain. They mysterious power of the human brain can force a person to STOP! --something I could never accomplish with my substitute system. And 'natural' pain will persist as long as danger threatens, whether we want it to or not, unlike my substitute system, it cannot be switched off."

Brand, P. and P. Yancey. 1993. Pain: The Gift Nobody Wants. New York: Harper Collins. Pp.195-186

08 August 2008

Marijuana and HIV Neuropathic Pain

From the always informative Science Daily:

ScienceDaily (Aug. 7, 2008) — In a double-blind, placebo-controlled clinical trial to assess the impact of smoked medical cannabis, or marijuana, on the neuropathic pain associated with HIV, researchers at the University of California, San Diego School of Medicine found that reported pain relief was greater with cannabis than with a placebo.


The proportion of subjects achieving pain reduction of 30 percent or more was greater for those smoking cannabis than those smoking the placebo.

"Neuropathy is a chronic and significant problem in HIV patients as there are few existing treatments that offer adequate pain management to sufferers," Ellis said. "We found that smoked cannabis was generally well-tolerated and effective when added to the patient's existing pain medication, resulting in increased pain relief."


Using verbal descriptors of pain magnitude, cannabis was associated with an average reduction of pain intensity from 'strong' 'to mild-to-moderate' in cannabis smokers, according to Ellis. Also, cannabis was associated with a sizeable (46% versus 18% for placebo) proportion of patients reporting clinically meaningful pain relief.

The study's findings are consistent with and extend other recent research supporting the short-term efficacy of cannabis for neuropathic pain, also sponsored by the CMCR.

"This study adds to a growing body of evidence that indicates that cannabis is effective, in the short-term at least, in the management of neuropathic pain," commented Igor Grant, M.D., professor of psychiatry and director of the CMCR.

Grant noted that this is the fourth CMCR sponsored study to provide convergent evidence that cannabis can help in relieving these types of pain.