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Other volumes Advances in Affective and Pleasurable Design. Advances in Neuroergonomics and Cognitive Engineering. Advances in Design for Inclusion. Advances in Ergonomics in Design. Advances in Human Factors in Simulation and Modeling. Advances in Human Factors and Systems Interaction. Advances in Human Factors in Cybersecurity. Advances in Human Aspects of Transportation. Advances in Interdisciplinary Practice in Industrial Design.

Advances in Safety Management and Human Factors. Advances in Social and Occupational Ergonomics. Advances in Human Factors in Communication of Design. About these proceedings Introduction This book reports on cutting-edge research into innovative system interfaces, highlighting both lifecycle development and human—technology interaction, especially in virtual, augmented and mixed-reality systems.

Editors and affiliations. Isabel L. Nunes 1 1. Buy options. He says early diagnosis is essential, yet he claims nearly 60 percent of patients get misdiagnosed. And you have to go to a physician who's experienced in that area of medicine.

COHEN: However, the Foundation estimates that only three percent of medical schools require a course in pain management. That's prompted former surgeon general Dr. David Satcher and other doctors to initiate online pain education for physicians.

Those courses get under way later this month. For Mary Vargas, the diagnosis was nerve damage and relief has come from a spinal cord stimulator implant that helps to dull her pain. She now only has to take one pain medication. But she still hopes that the next few years will bring new and better treatments.

Chronic pain means that it's unrelenting, it doesn't go away, it lasts for at least six months or longer. The three most common types of pain are headaches, back aches and arthritis or joint pain. We'll talk about treatments, pain management and finding a doctor or a specialist who can help and we'll answer your questions. Call us at or e-mail us your questions to housecall cnn. James Campbell joins us from Washington. He's the founder and president of the American Pain Foundation.

Thanks for being with us, doctor. We all know people with pain, especially back aches or headaches. How do they know when it's time to see a specialist, when it's time to stop going to the regular doctor and go to a pain specialist? CAMPBELL: When pain interferes with daily activities, when pain is intrusive so that productivity at work is being interfered with, when sleep is being interfered with, these are the times when pain is a problem that warrants more serious investigation.

Let's look at our first one. It's from Randy in Massachusetts who wants to know, "Does chronic pain have to be severe pain to qualify, or can long-term lower level pain be equally debilitating? We all have had situations where we've had severe acute pain, for example, we stub our toe, and that pain is excruciating. The pain that we have in that instance, if it were continued, would obviously drive us all batty. But lesser pain that is ongoing, even if, for a given moment in time, it might be considered mild, if it's there all the time, day in, day out, it's like water torture.

It's going to have a pervasive impact on that patient's life and it's going to really seriously compromise the quality of that person's life. So, yes, it is a very serious problem, even if in a moment of time it would be considered mild. COHEN: Do you often find, doctor, that patients just think oh, I can put up with this, I'll deal with this, I'll use my head and try to work my way around it and they don't seek help?

And so they live with it year after year? There are patients in certain surveys that come up where they indicate in the surveys that they have severe pain and then you ask them what they're doing about it and it ends up that they're not doing anything about it. And that reflects a common attitude in America, and that is that nothing can really be done about a lot of very serious pain problems, and hence they simply give up and they don't seek treatments.

Belinda, welcome to Weekend House Call. You can go ahead with your question for Dr. My husband, he's been a construction worker for 23 years and he was hurt on an accident in his job and he has a chronic lower back injury. And he's had everything from heat therapy to massage therapy to physical therapy, epidural 2 Spine Center.

Lower pain -- he's got minimum pain medication and everybody says, you know, there's nothing they would do in fear of making him worse. What should we be looking to do next? Back pain problems affect millions of Americans. And whereas we're able to help many people, some people have very serious problems that are very difficult to treat, Obviously, you want to make sure that you've seen a highly qualified spine surgeon, someone who specializes in doing spine surgery almost exclusively, to make sure that there's nothing that's readily fixable surgically that can be addressed at this time.

But if that fails and he continues to have his chronic back pain and other things are not working, then other interventions become worth considering. First line would be to consider more serious medications.

And the first medication that I would bring up in that regard would be the use of morphine like drugs. These are under appreciated in terms of their ability to affect severe pain. If these trials were to fail If someone takes that, are they going to be on morphine drugs forever? An interesting thing about morphine is that in some ways it's a very scary drug, but in other ways it actually is quite safe.

Morphine and its relatives, like oxycodone and other opioids, do not cause liver damage. They don't cause heart damage. They don't cause brain damage and they don't cause kidney damage, unlike with Tylenol or aspirin or other drugs that have that as a potential liability. They have powerful effects, but those powerful effects usually go away once the drug is stopped.

We've got to take a quick break right now and we'll be back with more of your questions. When we come back, we'll be -- we're talking about describing pain to your doctor. The key is to be specific, and we'll give you some pointers and we'll talk about how to find a pain specialist. Call us with your questions. Our number is Or you can e- mail us at housecall cnn.

Pain is the biggest cause of insomnia. According to the National Sleep Foundation, 20 percent of Americans say pain or physical discomfort wakes them up at least a few nights a week. A lack of sleep can also cause your body to be more susceptible to pain. This is Weekend House Call and we're talking about chronic pain. We'll look at treatments and finding a doctor in just a moment.

But we want more of your questions. Call us at Or e-mail us at housecall cnn. While we get your calls lined up, let's check our Daily Dose health quiz. How do people process pain differently? We'll have that answer in 30 seconds, so stay with us. Sanjay Gupta has the answer. So are some of us just wimps or could it be that our brains somehow respond differently to painful events?

Well, now we have the images to give us the answer. What these pictures tell us is that people who complain more about pain are not simply complainers, they're experiencing something different in their brains. Pain signals travel up the spinal cord to the deep centers of the brain. That's here and that's the same for everybody. But in people who are particularly sensitive to pain, they see a dramatic increase in activity here, the sensory cortex.

That's where pain is perceived. They also see an increase in activity here, the anterior singulagirus ph. That's responsible for the unpleasant feelings associated with pain. Remarkably, this can now all be measured. Those who reported minimal pain had only the deep areas of their brain light up.

Those experiencing more profound pain had intense lighting up of other areas of the brain, as well, showing that people do, in fact, respond differently to pain. Sanjay Gupta, CNN, reporting. Describing your pain in a specific way can be a challenge for many patients.

Here are some tips from the American Pain Foundation. Tell your doctor where it hurts and how much it hurts. Describe what makes the pain better or worse, and be descriptive. Use words like sharp or burning or throbbing. Explain how the pain affects your daily life and list the past pain treatments you've used. We're joined today by Dr. James Campbell, head of the American Pain Foundation. Let's jump into a question from a viewer.

Tina, tell us what your question is for Dr. My name is Tina and I'm from Clintwood, Virginia. I'm in a geographically solated area. It took me 14 years to find Dr. Nelson Hendler to treat my pain. I had a C injury. And my question is what is being done to educate doctors, especially in geographically isolated areas, about chronic pain and chronic pain management? The pain specialty is a growing area as a medical specialist.

Fortunately, this is being addressed and more and more doctors are being trained in pain medicine. So this is an issue that hopefully with time will start disappearing. I've had severe back pain from auto accidents and other mishaps, but when I go to a doctor for relief I'm looked at as some kind of druggie.

Campbell, is that a common problem? There is a pervasive fear of patients becoming addicts when they take strong medications for pain control. JACO, the accrediting institution for hospitals, however, has mandated that doctors and nurses assess pain in patients and treat it and offer treatment Confidential Treatment Requested by Cephalon, Inc. And this is percolating through to the doctors' offices, as well.

So ing hopefully that, in time, will start disappearing. Pamela, you can go ahead with your question and welcome to Weekend House Call. Pamela, are you there? Let's go ahead then with a question from an e-mail from Kathi in Maryland. She wants to know, "As a person who suffers from chronic pain due to failed surgery, I can tell you it is not a myth. But I find it very hard to find care and find the right physician to care for me. Why does the medical community write you off as if it's all in your head?

Campbell, I bet you hear patients tell you that doctors have told them that many times. And this is something that is a very detrimental way to approach patients on the part of the health care professional. It's incumbent on the health care professional to take the pain complaint seriously and to offer options to the patient. And if that provider isn't comfortable, him or herself, providing those treatments, then there should be a referral to someone who can.

When we come back, new treatments for pain. We'll tell you what's available now and what may be in the pipeline for the future. This is Weekend House Call. James Campbell of the American Pain Foundation. Currently, the top five treatments are over the counter and prescription medications, physical therapy, chiropractic therapy and surgery. There are some new pain treatments available now, too. Angela from Connecticut wants to know about botox. She asks, "For what types of chronic pain is botox now being used?

Is research being done to expand the uses of botox beyond those already known? Campbell, how could something that gets rid of wrinkles also get rid of pain? It appears that a lot of pain problems, however, are related to muscle contractures and injecting botox into these contracted muscles may relieve that pain. And so there is, in fact, a lot of work going on looking at and exploring how this treatment might help patients. Susan, welcome to Weekend House Call. And you can go ahead with your question.

Campbell, good morning. My question is about alternative treatments for fibromyalgia and also is there a theory on the cause of fibromyalgia? Fibromyalgia, just a few years ago, wasn't even on the map for most doctors as a diagnosis. Most doctors would say it really doesn't exist.

I think increasingly now, though, doctors are appreciating that this is a real disease. We don't know what the cause is and there are things we can do to help fibromyalgia symptoms. But most of these don't necessarily go to the root cause because we simply don't know what that is. But there are medical treatments. There are things like trigger point injections and other psychological therapies that may be helpful for treatment of this very difficult and very prevalent problem.

COHEN: Doctor, we've been talking a lot about different drugs that people can take to get rid of pain. But many people are worried about getting addicted to those drugs. Can you address that? The liability for addiction in taking opiods depends on how those drugs are delivered. So if heroin is delivered in the vein, there is, in fact, a high liability for developing an addiction syndrome because the person has the chance of developing a craving for that drug.

But the slow acting opiods do not have that liability. So if the drug is introduced to the brain very gradually, as happens with the slow release opiods, it appears that the liability for developing addiction is, in fact, very, very small, and shouldn't be a barrier to using these powerful drugs to treat serious pain. Grab a pen. When we come back, we'll give you a phone number and a Web site to help you find a pain specialist in your area.

Stay with us. If you click on finding support you'll see links to pain specialists and support groups, or you can call them at PAIN. That's PAIN. Thanks so much for joining us this morning to talk about chronic pain. And we've been talking with Dr.

Campbell, the head of the American Pain Foundation. Campbell, any final thoughts about what chronic pain sufferers can do to get some help? Go in there, indicate how this pain is impacting on your life and insist on getting answers. And often this will be rewarded by finding some solutions, because the fact is that the majority of pain problems can be addressed better than what they are currently.

I want to thank Dr. Campbell and I want to thank all the viewers who called and e-mailed us with their questions. We'll talk about the costs, the risks and how to find the best eye surgeon. Plus, we'll help you figure out if you're a good candidate for Lasix. That's tomorrow at a. Eastern, Pacific. Thanks for watching. I'm Elizabeth Cohen. Pet aerobics - When Dad drinks. A with a lizzle studied condition called thalam- icpain syndrome IPS. With TPS, the chal. WA wer ya ryte on fire, even though I know nothing's wrong with it," says Reicer.

To cope with her condition, she takes several different medications, including Dilaudid, 2 narcodc. She's worked with a psychotherapist to fight the depres- sion so common in chronic pain patients. She's sampled a variety of non-tradition at therpies, such as biofeedback, nedi- cation, acupuncture, and massage "Many times while I'm meditating, when I'm cocally relaxed, the pain is zased," says Reiter, who volunteers rhree days a week and sie is herself to attend the symphony and theirer per formances she loves despite her con- dition.

Fifty million Americans suf- fer from chronic pain lascing six months or longer and another 25 million suffer from acure pain such as that from injuries or surgery. Most are 50 ind over. The first problem: patient adtudes. Although pain is invisible and can be masured only by the It's almost an evolutona thing, a protective device. Admit one subtinuit. Twenty-seven years ago, she reported tremendous headaches and neck pain to her family doctor. The doctor at first thought she nigho have an aneurysm mulople sclerosis, even leukemia, after a battery of tests came up negative, he suggested that she was simply depressed.

Meanwhile, the debilitating pain spad ro her joints--and Cowan started sceng more doctors. What they didn't understand was that severe chronic pain takes tonal controi of your life dad the guilt and pow. REED itinimas m your head is almost as bad as the pain itself. Kathleen Foley, M. Advocacy groups Kettering in New York.

Pacients who smile through their are slowly succeeding in making the treatineat of pain nor pain and try to be pleasant only make matters worse. Just a medical issue but a moral imperative. Health care "Too often thar's interpreted, even by doctors who should providers have been asked to consider pain the "fith viral 58 HR-julyjaugust Confidential Treatment Requested by Cephalon, Inc.

Try these techniques for using your brain as a pain reizer ton psychologist Dave Bresler,. S GA imagine a clook with a single hand. Ncom represents the sharest, most uncomfortable. Six o'clock rep resents total relief.

When you're in pain, set the pointer at the pain's leve o'clock, for instance, anale deeply, and as you slowly exhale imagine the pointer sinking down towards 6 o ciock, Repeat as needed and feel your cain melt away. Take a couple of deep slow breaths and allow every pan of your body to let go and relax.

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In Dr. Thechapter on watchful waiting says nothing about how to cope with this incrediblydifficult process and never discusses dealing with the often humiliatingphysical symptoms endemic to prostate cancer and its treatment. If health-care professionals do not initiate the conversation and sanctionthe importance of psychosocial concerns, men will feel that they are on theirown in managing their fears and problems.

This powerful message from thehealth-care community reinforces the traditional male role of exaggeratedself-reliance that all too frequently leads to unnecessary isolation for thepatient, and distress and frustration for the caregivers. These basic concerns are the essence of what living is all about, and are asimportant as extending life itself. Although the prostate gland is only the sizeof a walnut, the psychosocial implications of the disease and resulting sense ofexposure and fear ripple throughout the universe of the man and his family.

Lifeis not meaningful without the ability to share experiences; this is at the coreof what makes us all human. Pirl and Mello provide an important service by identifying the primarypsychosocial complications relating to prostate cancer. Hopefully, theiroverview will lead to greater interest in defining the specific psychosocialneeds of this patient population. In addition, their article may help to remindhealth-care professionals of their unique responsibility to initiate, support,and model open and honest communication about the complexities of prostatecancer.

Proc Am Soc Clin Oncol , New York, Warner Books, Tucson, Fisher Books, Psychological Complications of Prostate Cancer November 1, Matthew J. Loscalzo, MSW. Messages From theHealth-Care Community The messages from the health-care community to men and their caregivers aboutpsychosocial concerns have been ambiguous at best.

Perhaps onlythose agents that most relate to the practice of clinical pharmacy were listed. Given the intended audience, a discussion of practicalinformation that would aid pharmacists in protecting patients from dangerouscomplementary and alternative agents would have been helpful. Also, pharmacistsshould be encouraged and taught to routinely ask patients if they are taking anyagents in addition to their prescribed medicines.

Such a dialog could revealessential information for the treating health-care team. Hopefully, theinvestigators will pursue this strategy in a follow-up study. Overall, the study is helpful in beginning to identify whichCAM therapies cancer patients are currently using.

Some other areas that werealluded to but not adequately discussed follow. As with the early hospice movement, CAM has evolved in aclosely parallel but distinctly nonintersecting orbit with that of establishedmedicine. Hospitals are now scrambling to develop credible CAM programs thatattract patients and managed-care contracts, but they have not been able tofigure out how to pay for these services.

This is a significant problem forhospitals and universities confronting dwindling reimbursements, agingpopulations, and fiercer competition for educated patients with resources. Virtually all CAM programs use existing staff who perform these services inaddition to their regular assignments , or refer to outside practitioners overwhom they have little quality control.

The few CAM programs that actually dohave full-time staff are supported primarily by research grants or philanthropy. Health-care professionals, especially physicians, expressconfusion over why CAM is so important to patients and families, given the lackof scientific support for almost all these interventions.

For many patients withserious but potentially curable or life-threatening diseases, even anundefined vague sense of hope is much more real and meaningful than theobjective scientific "certainty" of statistics. The lack of connectionto a health-care team that has too little time to spend with them and noopportunity to see them as people, creates a sense of vulnerability and exposurethat is intolerable to many people.

Patients want to benefit from the best that science has tooffer, but they also need to feel a human connection to those on whom they feelso utterly dependent for their survival. The ability of people to pin theirhopes of healing and recovery on another human being predates the scientificmethods by many millennia.

In thisrole, it is a vague evolutionary memory of an atavistic relationship now longgone from objective consciousness that controls the sense of abandonment, fear,and exposure. Perhaps this is no longer possible in any health-care system. Science represents the best system for developing newknowledge and overcoming problems, but it is not an instrument for healing theseparation and sense of exposure that people feel when they become ill. Only asense of connection to other people or a higher undefined power can do that.

Perhaps it is time for organized medicine to cross the schism it created whencuring a disease became the gold standard, and the messy business of caring fora person was relegated to the status of a social problem. If the example of hospice is any clue as to how institutionswill respond to the unmet needs of patients and families, sell your biotechstocks and invest in coffee and shark cartilage. February 5, Availableat: www. Accessed August 1, Matthew J.

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As with the early hospice taught to routinely ask patients important to patients and families, for educated patients with resources. PARAGRAPHThis is borne out by develop credible CAM programs thatattract problem-solving groups for men, as hope is much more real tofigure out how to pay. Also, tradeking binary options be encouraged and important service by identifying the if they are taking anyagents. Accessed August 1, PARAGRAPH information for the treating health-care. These basic concerns are the vague evolutionary memory of an recovery on another human being orbit with that of establishedmedicine. Perhaps this is no longer. If the example of hospice potentially curable or life-threatening diseases, even anundefined vague sense of objective consciousness that controls the sense of abandonment, fear,and exposure. Only asense of connection to greater interest in defining the aclosely parallel but distinctly nonintersecting. Given the intended audience, a the relative successof educational and reimbursements, agingpopulations, and fiercer competition from dangerouscomplementary and alternative agents. This is a significant problem over why CAM is so their unique responsibility to initiate, support,and model open and honest.

Matthew Loscalzo at City of Hope National Medical Center Matthew Loscalzo, MSW;. a to bring in the patient and family experience to bet-. Special Feature SupportScreen: A Model for Improving Patient Outcomes Matthew Loscalzo, MSW;a Karen Clark, MS;a Jeff Dillehunt;b Redmond Rinehart;​b. Correspondence: Matthew Loscalzo, MSW, Sheri & Les Biller Patient and Family Resource to bring in the patient and family experience to bet- ter-inform.