by E.K. ZSIGMOND, M.D. Department of Anesthesiology University of Illinois Chicago U.S.A. It is, indeed, a distinct honor and privilege to be invited by the authors to write a preface to this monumental monograph, Regional Opioid Analgesia. Regional Opioid Analgesia is a colossal undertaking by Drs. De Castro, Meynadier and Zenz shortly after the introduction of this revolutionary approach to pain relief which opened a new epoch in analgesiology. This is, indeed, the first authentic and comprehensive textbook encompassing the current knowl edge on this novel approach to pain relief. We are indebted to the authors for introducing the new opioids to regional analgesia with the scientists, who de veloped the potent short and ultrashort acting opioids with high therapeutic indices, which many researchers dreamt about but never before materialized. The side effect liabilities of these new opioids are minute as compared to morphine and meperidine. Regional Opioid Analgesia could not have been more authentically written than by Drs. De Castro, Zenz and Meynadier, who have conducted daily clinical investigations on all known opioids for regional analgesia as well as for neurolept analgesia. Therein lies the great value of this monograph: it is the most authentic work on this topic."

Bladder Pain Syndrome: A Guide for Clinicians provides a comprehensive update in the pathophysiology, epidemiology, terminology, evaluation and treatment of patients with pelvic pain perceived to be related to the urinary bladder. The volume covers the tremendous evolution during the last decade in our understanding of pain syndromes and their diagnosis and treatment. It is now clear that Bladder Pain Syndrome belongs to the family of pain syndromes, and therefore treatment has moved from the treatment of the bladder to the treatment of a pain syndrome with the special problems this presents when the pain syndrome involves urinary symptoms. Interstitial Cystitis was poorly defined and the interpretation and patient selection differed enormously around the world in many ways making exchange of information unreliable and confusing. Bladder Pain Syndrome is clearly defined and the result is a much better patient selection. This volume provides state of the art background for making a correct evaluation and diagnosis of patients with pelvic pain and voiding problems resulting in a more focused treatment to the benefit of the patients. The volume also covers the close relationship between different pain syndromes including those outside the pelvis.Bladder Pain Syndrome: A Guide for Clinicians will be of great utility to urologists, gynecologists and all health professionals dealing with patients with pelvic pain.

One might think working as a physician would lead to disrespect for the human body. After all, most of the bodies we see are broken or malfunctioning in some way. In my case, however, the opposite is true. My practice as a pain specialist (particularly chronic pain) has drawn me into areas beyond the usual options for medical treatment. In the process, that has led to a fascination with the human brain and its myriad properties. I think it's safe to say that most of us take our brains for granted. If we think about them at all, it's in terms of comparative mental accomplishment (in our prime of life) or dysfunction (beyond our prime). Rarely do we stand in awe of all that this eight-pound organ does for us. With this book, I'm hoping to do my part to change that. The focus is on the brain's relationship with pain, but discussing that opens a door to broader considerations. Meanwhile, the potential readership is literally universal -- all of us have brains, and almost all of us (except for those with a rare condition described in the book) have felt pain. What most of us may not realize is that research into the causes of pain began thousands of years ago. The ancient Egyptians pondered the question, and Greek philosophers such as Aristotle, Plato, and Galen made it an important part of their overall philosophies. Hippocrates was laying the foundation for modern brain and pain study as early as the late fifth century and other scientific icons, such as Rene Descartes and Charles Sherrington, built on what he had discovered and postulated. By the 20th century, some new revelation about pain and its possible treatment was being reported in the scientific journals nearly every month. That has only accelerated over the past few years, which makes the study of the brain and pain one of the livelier medical specialties. Meanwhile, there has been a significant change in the attitude toward pain by 20th century physicians, researchers and hospital personnel. Previously, pain was simply linked to whatever condition might be afflicting a patient, leading to the belief that when that condition was cured or managed, the pain would automatically disappear. Now, though, it has become apparent that pain might be more than just a symptom. In some cases, it becomes a condition all to itself. Since pain is literally a product of the brain, which announces it after being warned by a small army of nocioceptors stationed throughout the body, it is also open to glitches in that process. Chronic pain often occurs when the brain "remembers" pain, even though the condition that caused it may have been dealt with. This book has a clinical core, but I have broadened the scope to include not only research history but touch on several peripheral issuers involving pain. That includes a chapter on masochism and congenital insensitivity to pain, another on the opioid epidemic.

· When can anxiety be good? · How can I change my pain experience? · How does trauma change the way our brains work? · Why can't we tickle ourselves? This collection of science-based graphic medicine comics addresses these questions (amongst many others) and makes complex human experiences accessible, engaging and gently humorous. Written by Steve Haines, a bodyworker and creative storyteller, and illustrated by Sophie Standing, who specializes in human sciences, these comics explore topics that make us fundamentally human - anxiety, pain, trauma, and touch: Anxiety is Really Strange Pain is Really Strange Trauma is Really Strange Touch is Really Strange This special boxset also includes a useful and beautifully illustrated wallchart.

Chronic and persistent pain, which is a problem for the individual who suffers and the society that has to deal with it, has become increasingly appreciated. Over the last three decades, several books and journals have been specifically devoted to the topic of pain, especially chronic and persistent pain. It has been increasingly recognized that chronic and persistent pain, unlike acute pain, involves significant psychosocial factors and requires treatment strategies that deal with these issues. All measurements and factors that affect improvement seem to be in the psychosocial area rather than the medical/ biological/physical areas. Psychosocial conveys the importance of the environmental and interpersonal factors of the patient's functioning. The writing of this book has brought together some of the leading researchers and clinicians in the area of managing the patient with chronic pain. The authors express their opinions based on experience and review of the literature available to date. Each of the chapters focuses on an important element of the assessment and/or treatment intervention utilized for the individual with chronic pain. The concluding chapter summarizes the status of the assessment and treatment strategies for those patients.

Within the past few years, it has become recognized that the immune system communicates to the brain. Substances released from activated immune cells (cytokines) stimulate peripheral nerves, thereby signaling the brain and spinal cord that infection/inflammation has occurred. Additionally, peripheral infection/inflammation leads to de novo synthesis and release of cytokines within the brain and spinal cord. Thus, cytokines effect neural activation both peripherally and centrally. Through this communication pathway, cytokines such as interleukin-1, interleukin-6 and tumor necrosis factor markedly alter brain function, physiology and behavior. One important but underrecognized aspect of this communication is the dramatic impact that immune activation has on pain modulation. The purpose of this book is to examine, for the first time, immune-to-brain communication from the viewpoint of its effect on pain processing. It is aimed both at the basic scientist and health care providers, in order to clarify the major role that substances released by immune cells play in pain modulation. This book contains chapters contributed by all of the major laboratories focused on understanding how cytokines modulate pain. These chapters provide a unique vantage point from which to examine this question, as the summarized work ranges from evolutionary approaches across diverse species, to the basics of the immune response, to the effect of cytokines on peripheral and central nervous system sites, to therapeutic potential in humans.

Offering highly visual, easy-to-read coverage of the full range of anesthesia equipment in use today, this authoritative reference is your go-to text for objective, informed answers to ensure optimal patient safety. Anesthesia Equipment, 3rd Edition, provides detailed information on the intricate workings of each device or workstation, keeping you fully up to date and helping you meet both equipment and patient care challenges. Remains unequalled in both depth and breadth of coverage, offering readable, concise guidance on all aspects of today's anesthesia machines and equipment. Details the latest machines, vaporizers, ventilators, breathing systems, vigilance, ergonomics, and simulation. Improves your understanding of the physical principles of equipment, the rationale for its use, delivery systems for inhalational anesthesia, systems monitoring, hazards and safety features, maintenance and quality assurance, special situations/equipment for non-routine adult anesthesia, and future directions for the field. Includes ASA Practice Parameters for care, and helps you ensure patient safety with detailed advice on risk management and medicolegal implications of equipment use. Highlights the text with hundreds of full-color line drawings and photographs, graphs, and charts. Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices.

Pain is universal. This can be traced from the first toothache evidence in fossil remains of a human jawbone to today's pharmacies packed with a huge spectrum of over-the-counter medications. Millions of people seek treatment for pain every year. In "Pain Management Solutions," author Debra S. Cole explores issues related to different types of pain and offers a visionary five-stage approach to pain management."

Cole provides a holistic process to help patients address pain issues due to injury or medical conditions. A comprehensive tool, Pain Management Solutions addresses current pain treatments and considers the various stages of the process of dealing with pain:

The crisis stage of pain

The fix-it stage

The management stage

The rebuilding stage

The resolution stage

Presented in a complete and easy-to-understand manner, Cole offers strategies for coping with pain to help patients rebuild their lives. This guide provides hope and inspiration for anyone who struggles with both physical and emotional pain.

Using sample administrative and clinical protocols that any hospital can use, this book gives a detailed account of how to set up and run an observation unit and reviews all medical conditions in which observation medicine may be beneficial. In addition to clinical topics such as improving patient outcomes and avoiding readmissions, it also includes practical topics such as design, staffing, and daily operations; fiscal aspects, such as coding, billing, and reimbursement; regulatory concerns, such as aligning case management and utilization review with observation; nursing considerations; and more. The future of observation medicine, and how it can help solve the healthcare crisis from costs to access, is also discussed. Although based on US practices, this book is also applicable to an international audience, and contains instructions for implementing observation in any setting or locale and in any type of hospital or other appropriate facility.

This method of local anaethesia, developed by a dermatologist and a pharmacologist, is presented to demonstrate its use in cosmetic liposuction and other procedures. Richly illustrated to show details of the technique and with serialphotographs of many clinical cases, the book explains the advantages of this new technique and provides practical instruction in how to perform it.

A HISTORY OF MALIGNANT HYPERTHERMIA Malignant hyperthermia (MH) is a hereditary disorder of muscle. Undoubtedly, individuals have possessed this trait since time immemorial. However, because the trait is usually only unmasked in the presence of potent inhalational anaesthetic agents or non-depolarizing skeletal muscle relaxants, the existence of malignant hyperthermia was not suspected until we" after the dawn of the modern anaesthetic era. In the early years of ether and chloroform anaesthesia, monitoring was minimal. Body temperature was never measured. A finger on the pulse, and observation of respirations and skin colour were the most that could be expected. Death was not infrequent and usually unexplained (1). By the beginning of the twentieth century, reports of fulminant fever and tachycardia (rapid heart rate) during or immediately after anaesthesia often ending in death, were being described with increasing frequency in the medical literature (2-6). As a number of cases from New York had occurred during summer months, they were initially thought to be a form of heat stroke due to overly hot operating theatres (2-6). However, one enterprising anaesthetist (5: ' checked the weather reports for the days on which some of these so called "heat strokes" had occurred. He found that on the days i'n question the ambient 0 temperature had never been in excess of 72 F. Environmental heat, therefore, could not have been a cause of at least some of these reactions.

Thousands of articles and many books have been published on the acquired immunodeficiency syndrome (AIDS). There are, however, no studies or case reports and only several articles published on the anesthetic considerations for a person with AIDS or in pain with AIDS. There is no literature on the pain management of AIDS patients. Writing on this subject must be considered trailblazing. The reason anesthesiologists should know about AIDS has rapidly extended from concern over transmission of infection to anesthetic and analgesic considerations. The anesthesiologist may also be part of a pain management team on either an acute or a chronic pain service. The requirement may be to treat an HIV -positive or AIDS patient acutely postoperatively or in consult to a psychiatric, medical, or surgical service. In a pain clinic setting, the anesthesiologist may be concerned with diagnosis, treatment, or referral for other multidisciplinary consultation. The earlier question of central nervous system involvement in AIDS is now moot, rapidly replaced with the knowledge that the eNS, if not primarily infected, is so shortly thereafter. Protected by the blood-brain barrier, the eNS becomes both a sanctuary and reservoir for HIV. Because neurologic complications of HIV are common, and since knowledge of the nervous system is essential for anesthetic and pain management, it is important to review HIV infection of the nervous system.

The pain center/clinic is in the stage of transition. It has come a long way since chronic pain was a nonexistent entity and patients with difficult pain problems did not receive well-deserved attention or were lost in the busy practices of vari ous specialty clinics. Thirty-five years ahead of the rest of us, John]. Bonica was the first physician who had a clear vision of a pain center's potential. Twenty years later, in response to loud public demands for relief of chronic pain, this idea was put into practice by a number of others on a somewhat larger scale. A team of specialists from various disciplines, trained in the management of chronic pain, now offer approaches ranging from simple outpatient care to inpatient hospital ization for comprehensive care including drug detoxification, behavior modi fication, and total rehabilitation of these patients. Hospitals have entered this arena with renewed enthusiasm. The pain center/clinic is now an established, ac cepted, and expanding method of providing care for chronic pain patients. The chapters in this book are based on examples of multidisciplinary projects that deal comprehensively with management of chronic pain. Aimed primarily at the pain center/clinic in the university hospital setting, this book ranges from his torical perspectives to current pain centers with their less orthodox methods of re lieving chronic pain to the future of algology as a specialty."

This book provides a detailed overview of the current state of knowledge regarding the pathophysiology of both primary headaches - migraine, tension-type headache (TTH), and cluster headache - and the very important and frequent type of secondary headache, medication overuse headache (MOH). After an introductory chapter describing relevant neuroanatomy and vascular anatomy, the evidence gained from animal models regarding the pathophysiology of migraine and the other primary headaches is reviewed. Knowledge of the genetic component in the different types of headache is then examined with reference to recent evidence, for example regarding the implication of the trigeminovascular system and cortical spreading depression in migraine. Detailed information is provided on insights into primary headaches from imaging studies, including functional magnetic resonance imaging and positron emission tomography and on their neurophysiology and biochemistry. A further series of important chapters describe present knowledge of the pathophysiology of each specific type of headache and consider future directions. Written by acknowledged experts in their fields from Europe and the United States, clinicians and students will find Pathophysiology of Headaches to be an excellent source of up-to-date information on why patients experience headaches. In addition, it will be of value for pain researchers investigating the underlying mechanisms of headache.

The highly successful Reviews of Physiology, Biochemistry and Pharmacology continue to offer high-quality, in-depth reviews covering the full range of modern physiology, biochemistry and pharmacology. Leading researchers are specially invited to provide a complete understanding of the key topics in these archetypal multidisciplinary fields. In a form immediately useful to scientists, this periodical aims to filter, highlight and review the latest developments in these rapidly advancing fields.

In an interesting survey amongst doctors, fibromyalgia was considered the least prestigious disease. Although this survey was done in a Scandinavian country and was done more than 13 years ago, the grim situation is still the same today all over the world. Patients suffering with fibromyalgia feel that they are not believed and they are not listened to. Despite knowledge being gathered on this disease for a few centuries, and having definite diagnostic criteria and management pathways, the healthcare system still fails many patients who are left without a diagnosis or treatment plan. Fibromyalgia is a disease that causes widespread pain in many areas of the body and has significant accompanying symptoms like fatigue, waking unrefreshed and cognitive symptoms. Fibromyalgia affects patients as a whole including their cognitive performance, physical skills, psychological status, ability to work and social life. It can present as a part of the spectrum of functional pain syndromes, often accompanied by other systemic conditions such as irritable bowel syndrome, headaches and chronic fatigue. It is estimated that 1 in 20 can suffer with this debilitating condition. This textbook will cover the condition in great detail and is written in an easy-to-understand style. Doctors, nurses, medical students, physiotherapists, occupational therapists, psychologists, and other healthcare professionals will find this book informative. Patients who suffer from fibromyalgia will also find it useful to understand their medical condition; the book will help to direct them to specific treatment strategies, explaining the benefit and risk in detail. As this is a common chronic pain presentation, it will be of immense use to candidates preparing for examinations conducted by the Royal College of Anaesthetists, UK (FRCA), Faculty of Pain Medicine, UK (FFPMRCA), American Board of Anesthesiology (AB), College of Anaesthesiologists of Ireland (FCAI), European Society of Anaesthesiology and Intensive Care (EDAIC), Australian and New Zealand College of Anaesthetists (FANZA), World Institute of Pain (FIPP/CIPS), Canadian Board exams, National Board of Examinations of India (Dip NB) and other competitive exams across the globe. The author is a senior consultant in pain medicine practising in the United Kingdom and is consulted by thousands of chronic pain patients every year. He has won many educational awards including a national innovative award in pain medicine. One of his innovations is published in the list of examples of excellence by the Faculty of Pain Medicine, London. He has lectured at many international, national and regional meetings, and is a regular invited expert lecturer in public groups and fibromyalgia patient support groups. He has also published many articles and textbooks on pain medicine.

Here is the perfect text you need to provide your learners with real-life clinical scenarios that are ideal for Case-Based Learning and Discussion. Presents real-world patients in a real-world clinical setting, making learning fun and engaging. The Case-Based Learning approach focuses learners and clinicians on the key elements for each diagnosis and helps develop a deep understanding of how to diagnose and treat each condition. Covers everyday clinical problems such as arthritis, deltoid ligament strain, Achilles tendinitis and tendon rupture, bunion and bunionette pain, plantar fasciitis, metatarsalgia, and more. Cases unfold just the way they do in your clinic. Each case is accompanied with thoughtful clinical commentary and key messages from the author. Each chapter uses high-quality radiographic images, clinical photos, and full-color drawings to facilitate a clear, easy-to-understand approach to evaluation and diagnosis. An ideal self-assessment and review tool for pain medicine practitioners and trainees, as well as those preparing for the American Board of Anesthesiology Pain Medicine certification and recertification exam. Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices.

Now divided into four parts, the second edition of Cancer Pain delivers broad coverage of the issues that arise in the management of malignancy-related pain, from basic science, through end of life care and associated ethical issues, to therapies, both medical and complementary. Part One reviews basis considerations in cancer pain management, including epidemiology, pharmacology, history-taking and patient evaluation and teamworking. Part Two brings together the drug therapies for cancer pain, their underlying basis, and potential side-effects. Part Three covers the non-drug therapies, including nerve blocks, stimulation-induced analgesia, radiotherapy, complementary therapies and psychological interventions. The control of symptoms other than pain, so critical to cancer patients, is also considered here. Part Four describes special situations. Cancer pain management in children and older patients, and in the community setting, and pain in the dying patient and the cancer survivor are all covered here.

Here is the perfect text you need to provide your learners with real-life clinical scenarios that are ideal for Case-Based Learning and Discussion. Presents real-world patients in a real-world clinical setting, making learning fun and engaging. The Case-Based Learning approach focuses learners and clinicians on the key elements for each diagnosis and helps develop a deep understanding of how to diagnose and treat each condition. Covers everyday clinical problems such as costosternal syndrome, Tietze's syndrome, devil's grip, fractured ribs, post-thoracotomy pain, acute and chronic pancreatitis, diverticulitis, and more. Cases unfold just the way they do in your clinic. Each case is accompanied with thoughtful clinical commentary and key messages from the author. Each chapter uses high-quality radiographic images, clinical photos, and full-color drawings to facilitate a clear, easy-to-understand approach to evaluation and diagnosis. An ideal self-assessment and review tool for pain medicine practitioners and trainees, as well as those preparing for the American Board of Anesthesiology Pain Medicine certification and recertification exam. Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices.

For more than 30 years, Practical Management of Pain has offered expert guidance to both clinicians and trainees, covering every aspect of acute and chronic pain medicine for adult and pediatric patients. The fully revised 6th Edition brings you fully up to date with new developments in patient evaluation, diagnosis of pain syndromes, rationales for management, treatment modalities, and much more. Edited by a team of renowned pain clinicians led by Dr. Honorio Benzon, this authoritative reference is a comprehensive, practical resource for pain diagnosis and treatment using a variety of pharmacologic and physical modalities. Presents a wealth of information in a clearly written, easily accessible manner, enabling you to effectively assess and draw up an optimal treatment plan for patients with acute or chronic pain. Takes a practical, multidisciplinary approach, making key concepts and techniques easier to apply to everyday practice. Shares the knowledge and expertise of global contributors on all facets of pain management, from general principles to specific management techniques. Discusses the latest, best management techniques, including joint injections, ultrasound-guided therapies, and new pharmacologic agents such as topical analgesics. Covers recent global developments regarding opioid induced hyperalgesia, neuromodulation and pain management, and identification of specific targets for molecular based pain. Includes current information on the use of cannabinoids in pain management and related regulatory, professional, and legal considerations. Includes the latest guidelines on facet injections and safety of contrast agents. Provides new, evidence-based critical analysis on treatment modality outcomes and the latest information on chronic pain as a result of surgical interventions. Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices.

This book deals with the management of labour, guiding the readers to recognize problems by keen monitoring, based on anatomical and physiological understanding of labour. In this era of technology, this book revives the fading art of identification of clinical signs and symptoms. The chapters are well-structured, covering different aspects from suspicion to identification of the problems by recognizing subtle warning signals by the fetus and the uterus. Operative deliveries and common obstetric emergencies with their appropriate management are also covered. It provides practical points to prevent, anticipate, recognize, and manage problems during labour. Key Features Helps to identify clinical signs and symptoms that infuses the reader with confidence to identify and manage abnormal situations during labour and childbirth through the feel of their fingers and awakened understanding. A must have book for all postgraduate trainees and practitioners of obstetrics, eager to learn the fundamentals of labour management. Features illustrated cases helpful in learning management of normal labour and pick abnormal labour, at the earliest possible deviation from normalcy.

Linking theory to practice through the use of authentic clinical cases, Dr. Steven D. Waldman's Pain Medicine: A Case-Based Learning Series helps readers acquire the valuable skill of effective diagnostic thinking in daily practice. The Knee volume uses an in-depth case format, preparing you to correctly analyze clinical vignettes and formulate a clinically sound, evidence-based approach to realistic patient scenarios. This highly effective leaning and assessment tool provides practical clinical insights into the best methods for diagnosis and treatment for the successful management of patients with knee-related pain. Presents real-world patients in a real-world clinical setting, making learning fun and engaging. The Case-Based Learning approach focuses learners and clinicians on the key elements for each diagnosis and helps develop a deep understanding of how to diagnose and treat each condition. Covers everyday clinical problems such as Osteoarthritis and Rheumatoid Arthritis of the Knee; Medical and Lateral Meniscal Tear, Anterior Cruciate Ligament Tear, Jumper's and Runner's Knee, Bursitis, Osgood Schlatter Disease, Hamstring Tendinitis, and more. Cases unfold just the way they do in your clinic. Each case is accompanied with thoughtful clinical commentary and key messages from the author. Each chapter uses high-quality radiographic images, clinical photos, and full-color drawings to facilitate a clear, easy-to-understand approach to evaluation and diagnosis. An ideal self-assessment and review tool for pain medicine practitioners and trainees, as well as those preparing for the American Board of Anesthesiology Pain Medicine certification and recertification exam. Enhanced eBook version included with purchase. Your enhanced eBook allows you to access all of the text, figures, and references from the book on a variety of devices.

In this issue of Anesthesiology Clinics, guest editors Drs. Alison J. Brainard and Lyndsay M. Hoy oversee the topic of Total Well-being. Articles in this issue highlight perspectives from across multiple subsets of anesthesiology, including nutrition, arts and humanities, coaching, and the inequalities of medicine. The editors' goal is that readers will come away inspired, informed, and excited to create an approach for total well-being that can be tailored to their workplace and lives. Contains 19 practice-oriented topics including women in anesthesiology; parenting/lactation in anesthesia; intensivists and wellness, post-pandemic; early-career physician burnout; integrating antiracism into MedEd with health humanities program; and more. Provides in-depth clinical reviews on total well-being, offering actionable insights for clinical practice. Presents the latest information on this timely, focused topic under the leadership of experienced editors in the field. Authors synthesize and distill the latest research and practice guidelines to create clinically significant, topic-based reviews.

Phantom pain is an intriguing mystery that has captured the imagination of health care providers and the public alike. How is it possible to feel pain in a limb or some other body part that has been surgically removed? Phantom pain develops among people who have lost a limb or a breast or have had internal organs removed. It also occurs in people with totally transected spinal cords. Unfortunately, phantom pain is a medical night mare. Many of the people reporting phantom pain make dispropor tionately heavy use of the medical system because their severe pains are usually not treated successfully. The effect on quality of life can be devas tating. Phantom pain has been reported at least since 1545 (Weir Mitchell as related by Nathanson, 1988) and/ or experienced by such diverse people as Admiral Lord Nelson and Ambroise Pare (Melzack & Wall, 1982; Davis, 1993). The folklore surrounding phantom pain is fascinating and mirrors the concepts about how our bodies work that are in vogue at any particu lar time. Most of the stories relate to phantom limbs and date from the mid-1800s. The typical story goes like this: A man who had his leg ampu tated complained about terrible crawling, twitching feelings in his leg. His friends found out where the leg was buried, dug it up, and found maggots eating it. They burned it, and the pain stopped. Another man complained of a swollen feeling with frequent stinging or biting pains."