As our understanding of the mechanisms of the brain and nervous system that underlie the conscious experience of pain has increased over the past 60 years, so too has the field of pain management. What began as almost exclusively the domain of anaesthetists has become multidisciplinary, and now comprises many other specialisms including neurology, psychology, nursing, occupational therapy and physiotherapy. This spate of activity has been paralleled by a similar growth in research: in neurophysiology, psychology and pharmacology as well as clinical medicine. Simultaneously, the pharmaceutical industry has spent billions of pounds and dollars in the search for better drugs for relieving pain. This ground-breaking book is compiled by former contributors to The Special Interest Group for Philosophy and Ethics of the British Pain Society. The issues discussed include satisfactory relief of chronic pain, the inadequacy of scientific biomedicine in offering answers, and ethical problems arising in pain medicine. 'Suffering cannot be found in a laboratory test or imaging study; it is only observable by communicating with the sufferer. The eleven chapters in this book approach this conundrum from vastly different perspectives, some highly personal and others broadly social. Issues such as the interface between the physician and the pharmaceutical industry are also presented. Each chapter describes a facet of the problems of suffering and some of the available paths to recovery.' John D Loeser in the Foreword

Primary sensory neurons respond to peripheral stimulation and project to the spinal cord. Specifically, the population of neurons which respond to damaging stimuli terminate in the superficial layers of the dorsal horn. Therefore, the dorsal horns constitute the first relay site for nociceptive fibre terminals which make synaptic contacts with second order neurons. It has recently become clear that the strength of this first pain synapse is plastic and modifiable by several modulators, including neuronal and non-neuronal regulators, and studies on the fundamental processes regulating the plasticity of the first pain synapse have resulted in the identification of new targets for the treatment of chronic pain. This book will be of interest to a wide readership in the pain field.

The success of a neural electrode is often measured by its performance in the selective stimulation of or recording from individual fascicles within a peripheral nerve without damaging the nerve. Neural prostheses are limited by the availability of peripheral neural electrodes that can be used to record the user's intention or to provide sensory feedback through functional electrical stimulation for an extended duration. Improvement in future neural prostheses may be achieved through the availability of multichannel, bidirectional neural interfaces, such as the transverse intrafascicular multichannel electrode (TIME). The aim of this thesis was to investigate the biofunctionality, biostability, and biosafety of the TIME in an animal model that bears a close neuroanatomical resemblance to the human. To this end, four research questions were formulated: 1) Is the pig model neuro-anatomically suitable for the simulation of the actions and reactions of a neural electrode in a large human-sized peripheral nerve? This question was addressed in study 1 in which a comparative morphology study was performed on the median and ulnar nerves of Danish landrace pigs and Gottingen mini-pigs. Nerve specimens were selected at different levels for analysis. The number of fascicles in each nerve was counted, and the fascicle diameters were measured. 2) How selective is the TIME compared to other intrafascicular electrodes, such as the thin-film longitudinal intrafascicular electrode (tfLIFE)? Study 2 was performed to address this question. A comparative stimulation selectivity study was performed in Danish Landrace pigs with the TIME and tfLIFE. Electrodes were implanted in the median nerve, and sequential electric stimulation was applied to individual contacts. The compound muscle action potentials of seven forelimb muscles were recorded to quantify muscle recruitment. 3) Is the TIME biostable and biofunctional for long-term implantation? This question was addressed in study 3 in which the chronic stimulation selectivity of the TIME was evaluated on Gottingen mini-pigs. 4) Does the TIME fulfil the criteria of biocompatibility and chronic stability? Study 4 was conducted to address this question. Immunohistological analysis was conducted on nerve specimens from chronic experiment pigs that had been implanted with TIMEs in study 3.

In anesthesiology, pain medicine, and critical care, practitioners at all levels need help to stay current with the continually evolving drug knowledge-base, and trainees need tools to prepare for in-training and board exams that increasingly test their knowledge of pharmacology. This practical book is aimed at both readerships. It features a unique and practical chapter on the United States Food and Drug Administration (FDA) "black box" warnings that describe what safety precautions should be taken with commonly used drugs. The editors and contributors are pharmacology experts representing a cross-section of clinical specialties and institutions in the United States and include pharmacologists, pharmacists, as well as physicians.

Myofascial pain is the most common pain; it is estimated that 60-70 per cent of all pain is of myofascial origin. There are many common diagnoses - such as sciatica, lumbago, tendinitis, arthrosis, bursitis, tennis elbow, and frozen shoulder - that have a myofascial origin. They are not life threatening, but they abate the quality of life and reduce functional capacity, creating stress and depression. They are also a big sanitary cost and cause for early retirement. There is a regrettable lack of knowledge surrounding myofascial pain and the existing possibilities to cure. With this manual, I try to spread my long experience in treating and curing these pains with my combination method. For the manual techniques, videos are included on the companion DVD to make the study easier.

Over 100,000 people have died from provider opioid prescriptions in the last 10 years. The rate is increasing and probably will be 250,000 in another 10 years. We need to separate truth from chronic long- term pain and change the definition of pain so we can reduce the supposed indications for opioid prescriptions.

There is nothing charismatic about chronic pain regardless of its source. Pain is greedy and demanding. It consumes our time, our relationships, and our function, and it threatens everything that is important in our lives, our character and our dignity. The winter season is often compared to death. In this case, it is the dying off of old thoughts and behaviors. It is a season that offers the experience of many feelings and the opportunity to be born into a new way of thinking. Winter Devotions provides the necessary tools to fight the grotesque monster that plays on fear, agony, loneliness, and resentment. As patient and professional, the authors use their practical advice for coping. Their readers start with a blank canvas as white as the pure driven snow, full of possibilities. Offering a blend of integrative therapies and day by day tidbits of wisdom and famous quotes, the authors help their readers finalize a picture worth a thousand words, encouraging them to explore their unique, and sometimes, universal experience. Readers have the opportunity to devise their own plan bringing hope to the challenges of living with chronic pain. Come with us as we walk the barren winter land appreciating that it is necessary to rid ourselves of previous conceptions in preparation for the spring season of rebirth.