Monthly Archives: January 2010

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The Truth About Building Muscle – The Truth About Building Muscle Fast For Men Over 40

January 27, 2010 – 7:40 pm

The Truth About Building Muscle

I as to tell people that the BMI scale is off if you are a person builder. I feel proper when I justify my weight rank ratio to my doctor. Sure I pump iron and cycle, do yoga and hit the heavy bag but in the last few ages I’ve found overly I use the excuse a little too often.

If you are over 40 and are still telling people that your weight is primarily muscle but the body fat calculator says differently, you need to begin to accept the fact that it’s time to review your diet and workout routine. There are a lot of issues for men over 40 that contribute to lower muscle density, the important thing to remember is that you need to work your muscles more after 40 to keep them in shape as much as you need to watch calories to maintain your weight or lose fat. Sarcopenia

The term might not be familiar but your body knows what it is. This is the gradual loss of muscle density that occurs in middle age and onwards. This is the reason why you must consistently work your cardiovascular as well as your musculoskeletal systems daily. Sarcopenia accelerates with lack of load bearing activities and contributes to the increase of fat in the body of sedentary individuals. You can bet that if you are an American male pushing 50, living in an urban or suburban environment, you are more likely to be overweight and unhealthy than your rural counterpart. The Truth About Building Muscle

Here are a few tips for reversing the ravages of Sarcopenia – Eat more small meals more frequently; instead of eating 3 big meals each day and feeling tired after each one, eat 6 small snacks a day and stay away from dense calorie foods. Eat light to get lighter. Use strength training to build your muscles at least three times a week. This might be a simple as using bodyweight exercises like push ups, squats and lunges. If you are currently working out in a gym and you get your body fat tested, you’ll want to stay under 12 percent for maximum fitness.

If you find that you’re creeping up in fat percentage, watch your diet and cut 500 calories from your daily intake. Once you go back down, monitor your food intake and activity level. You might be in need of more protein or your testosterone level might be dropping. This can simply be your body’s signal that you need more rest and recovery time. Start taking action to gain your muscles by Getting Your The Truth About Building Muscle eBook now!



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Pain

Eight Tips for Managing Pain

January 27, 2010 – 6:32 am

Perhaps the hardest part of having arthritis or a related condition is the pain that usually accompanies it. Managing and understanding that pain, and the impact it has on one’s life, is a big issue with most arthritis sufferers. The first step in managing arthritis pain is knowing which type of arthritis or condition you have, because that will help determine your treatment. Before learning different management techniques, however, it’s important to understand some concepts about pain.

No. 1: Not All Pain is Alike

Just as there are different types of arthritis, there are also different types of pain. Even your own pain may vary from day to day.

No. 2: The Purpose of Pain

Pain is your body’s way of telling you that something is wrong, or that you need to act. If you touch a hot stove, pain signals from your brain tell you to pull your hand away. This type of pain helps protect you. Chronic, long-lasting pain, like the kind that accompanies arthritis, is different. While it tells you that something is wrong, it often isn’t as easy to relieve.

No. 3: Causes of Pain

Arthritis pain is caused by several factors, such as (1) Inflammation, the process that causes the redness and swelling in your joints; (2) Damage to joint tissues, which results from the disease process or from stress, injury or pressure on the joints; (3) Fatigue resulting from the disease process, which can make pain worse and more difficult to bear; and (4) Depression or stress, which results from limited movement or no longer doing activities you enjoy.

No. 4: Pain Factors

Things such as stress, anxiety, depression or simply “overdoing it” can make pain worse. This often leads to a decrease in physical activity, causing further anxiety and depression, resulting in a downward spiral of ever-increasing pain.

No. 5: Different Reactions to Pain

People react differently to pain. Mentally, you can get caught in a cycle of pain, stress and depression, often resulting from the inability to perform certain functions, which makes managing pain and arthritis seem more difficult. Physically, pain increases the sensitivity of your nervous system and the severity of your arthritis. Emotional and social factors include your fears and anxieties about pain, previous experiences with pain, energy level, attitude about your condition and the way people around you react to pain.

No. 6: Managing Your Pain

Arthritis may limit some of the things you can do, but it doesn’t have to control your life. One way to reduce your pain is to build your life around wellness, not pain or sickness. This means taking positive action. Your mind plays an important role in how you feel pain and respond to illness.

Many people with arthritis have found that by learning and practicing pain management skills, they can reduce their pain. Thinking of pain as a signal to take positive action rather than an ordeal you have to endure can help you learn to manage your pain. You can counteract the downward spiral of pain by practicing relaxation techniques, regular massage, hot and cold packs, moderate exercise, and keeping a positive mental outlook. And humor always has a cathartic effect.

No. 7: Don’t focus on pain.

The amount of time you spend thinking about pain has a lot to do with how much discomfort you feel. People who dwell on their pain usually say their pain is worse than those who don’t dwell on it. One way to take your mind off pain is to distract yourself from pain. Focus on something outside your body, perhaps a hobby or something of personal interest, to take your mind off your discomfort.

No. 8: Think positively. What we say to ourselves often determines what we do and how we look at life. A positive outlook will get you feeling better about yourself, and help to take your mind off your pain. Conversely, a negative outlook sends messages to yourself that often lead to increased pain, or at least the feeling that the pain is worse. So, “in with the good, and out with the bad.”

Reinforce your positive attitude by rewarding yourself each time you think about or do something positive. Take more time for yourself. Talk to your doctor about additional ways to manage pain.

Bruce Bailey, Ph.D.

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Pain

Hypnosis is a Method to Eliminate Upper Pain and Other Pain

January 27, 2010 – 5:35 am

You can really eliminate pain with hypnosis. The saying “no pain, no gain” is really not true. Do you remember all of the times pain has hindered you from taking part in activities that you enjoy? Partaking in sports and even sitting can be unbearable when you are in pain.

However, to say that “pain is all in your head” can really be true. If that is the case then the cure should be all in your head too! With help of self-hypnosis, pain can completely disappear. Despite what most people think, hypnosis is simply a mental state where messages can connect with the unconscious easier. The state of hypnosis is characterized by very deep relaxation. With regular practice of a hypnosis pain elimination regimen, you will feel more peaceful over all.

Pain signals that something in your body is amiss so pain is technically a good thing. Make sure a doctor check you out to ensure that the pain is not indicating a harmful condition. Then it’s time to manage and even eliminate the pain.

There is really no danger in a self-hypnosis pain relief program. It is not true that you can “get stuck” in a hypnotic state. The worst that might happen when you use hypnosis for upper pain reduction is that you could fall into a natural state of sleep for half an hour. Compare to all of the nights that discomfort has prevented you from sleep!

One can’t say that a hypnosis pain management system is the same as sleep though. That is probably the biggest misconception about hypnosis. When you are asleep, you are unconscious, and if you are unconscious you cannot hear anything. If you can’t hear anything, the hypnotist cannot help you. On the contrary, hypnosis is actually a state of keen awareness.

Being consciously aware of everything, a hypnosis pain management program can help both physical and mental causes and lead to many successful avenues to do away with pain. As you know, medications merely block the reception of the physical symptoms of pain on a temporary basis. Hypnosis pain regimens can in fact lessen the amount and strength of pain signals that you perceive. You can actually reprogram your body to send less pain-inducing chemicals to your receptors. This means that you can use fewer pain killing drugs, often no medications at all.

You have probably heard of endorphins, the opiate-like chemicals that are generated in our brains. Endorphins are the chemicals that cause people who train to get a high when they workout hard. Using hypnosis, you can also learn how to program your brain to create pain-relieving endorphins on demand! And send them to the painful part of your body where they are required.

With help of endorphins, the brain is capable of inducing analgesia, which is a mild anesthesia, as well as full anesthesia (numbness). Medical journals are full of accounts both in modern times, as well as in pre-anesthesia days, when invasive surgery has been done under hypnoanesthesia.

Hypnosis can also work to program the mind to direct your attention away from pain. In this way you will perceive far less discomfort. Also, hypnosis pain management programs can help our mind realize and understand that the pain is there, but not to let us suffer from it. A certified hypnotherapist will be familiar with how to fully address additional hypnotic suggestions that will aid in your recovery.

A really effective hypnosis pain remedy lies in neuro linguistic programming, NLP. No doubt that after living with chronic pain or left side pain, you may be cynical that a hypnosis pain program will help. In many cases, NLP methods really work far better for modern thinkers than traditional hypnosis does. It was actually developed for people like you who are brought up to analyze and question everything. Analyzing can mean that we tend to put up barriers to the acceptance of hypnotic suggestions.



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Tramadol

My Very Own Tramadol Experience!

January 26, 2010 – 9:46 pm

Usually when you hear of someone taking opioid pain-relievers you do not expect a happy ending. But that is not always the case and this is why I feel like I need to tell my part of the story. Far from being just another story, I am convinced that anyone listening to what I have to say will understand better the consequences of taking medication like Tramadol and learn certain precautions. After all, there is nothing better than leading a long and healthy existence.

My Tramadol experience is not dramatic, nor something predictable. I took it simply because I need something to relieve the pain after being involved in a car accident. The injuries I had suffered were not serious but I was left with a pain in the right shoulder that did not go away, not even after three months. At the recommendation of the doctor I had undergone multiple tests, including a CT scan and diverse X-rays. They all turned out to be perfectly fine and the cause of the pain was left unidentified.

I was to present to the doctor for routine check-ups, take the medication as prescribed and see how it goes. The dosage of Tramadol was settled somewhere around 75 mgs/day and I was more than pleased to have the pain under control. I went back to work, returned to an active life and kept on hoping that there was some way to escape the treatment, that they will eventually discover the cause for my pain. In the meantime, the dose was increased to 100 mg/day and I was more than conscious that I could call myself a person dependent on pain-relieving medication.

Surrounded by a loving family and close friends, I started to consider other possibilities. Looking on the Internet, I found a clinic in Austria that had performed intensive studies on patients taking Tramadol and published their findings. They were welcoming other patients as well and there it was: another possibility. It is not easy to take such a decision but I had to do something. Arriving at the medical clinic in Graz, one of the most important cities in Austria, I was immediately enlisted for clinical trials and it was discovered that I needed a higher dosage of Tramadol. I felt the need to ask if a higher dose won’t make me even more of an addict and the answer was yes but things were kept under control.

During a period of one month, I experienced all of the symptoms everyone mentioned regarding Tramadol and which I never believed to be true. Sweating, nausea, vomiting, headaches, chest pains, insomnia and crossness were just of the few that were more intense but they almost all of them intensified at some moment. Further tests – angiography – revealed that the pain in my shoulder was in fact caused by a tiny lesion in the brachial plexus, affecting one of the major nerves passing near the glenoid capsule and that surgical intervention was indeed a solution.

By discussing with the doctor back home (on the phone) and also with the specialists at the clinic I agreed to undergo the operation they suggested and hoped for full recovery. The intervention lasted somewhere around two hours and the doctors announced me that they had repaired the damage. I was to remain on Tramadol for few more weeks, the dose continuing to decrease until I had completely healed from surgery.

What I want everyone to understand is that I took Tramadol when I needed it and that at no moment I exceeded the dosage prescribed. I never had the behavior of an addict or went so far to consider taking it as my only priority. I sought medical assistance when I felt it to be necessary and luckily for me I had the support of family and friends. The experience has taught me that being healthy and strong is the most important thing in life just like having someone there for you. I recommend Tramadol despite the many critics and potential side effects but please, take it as prescribed and not as you consider!

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Butalbital

Understanding Migraine

January 26, 2010 – 9:00 pm

Migraine is a neurological syndrome that causes several symptoms, the most prominent symptom being the headache. Usually, migraine causes severe or moderate one-side and pulsating headache, which may last from four to seventy two hours. The other symptoms may include nausea and vomiting and a great sensitivity to bright lights and noise. A majority of the people having migraine experience a preceding aura, which gives a strange light and unpleasant smell.

Migraine can be classified into four types depending upon the intensity of the headache namely, no pain, mild pain, moderate pain and severe pain. Mild pain is the one that does not disturb the usual day-to-day activities, moderate pain exists but does not fully prevent usual activities and the severe pain disturbs all activities. The most commonly occurring type of headache is the migraine without aura wherein the patients suffer from headache with unilateral location and moderate or severe headache along with nausea and or high sensitivity to bright lights and sound.

Migraine without aura can be diagnosed if there are at least five attacks fulfilling the criteria such as untreated headache for six to forty eight hours, at least two symptoms of unilateral location, moderate or severe pain, obstructing routine physical activity, and pulsating quality. While experiencing a migraine without aura, there must be nausea or vomiting, or sensitivity to light or sound.

The next common type of headache is migraine with aura and people suffering from migraine with aura may also experience without aura. Migraine with aura is characterized by at least two attacks with visual symptoms, sensory symptoms and speech disturbance which are all fully reversible. The visual and sensory symptoms may affect just one side of the body and each symptom may last from 5 to 60 minutes.

Acephalgic migraine is a type of migraine in which the patient may experience other symptoms but not headache. Other types of migraine are abdominal migraine and menstrual migraine. The signs and symptoms of migraine vary from one patient to another and therefore, cannot be generalized. But still, there are four phases of migraine namely, prodrome, which occurs hours or days before the headache, the aura, which is just before the headache, the pain phase, which is the headache and the post drome.

The causes of migraine, known as triggers, can be many. They may be due to environment, behavior, infection, diet and so on. The treatment for migraine headaches may vary from simple remedies like applying hot or cold water to the head, getting adequate rest in a dark and silent room or a cup of coffee at the right time to over-the-counter medications. Naproxen is found to be effective in aborting migraine headache and a light or moderate headache can be controlled through paracetamol. A simple analgesic combined with caffeine may be of great relief.



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Butalbital

Get Rid of Migraines

January 26, 2010 – 7:49 pm

Migraine is a type of headache and a recognised medical condition. Migraine is widespread in the population. In the U.S., 18% of women and 6% of men report having had at least one migraine episode in the previous year. Migraines afflict about 30 million people in the United States. They may occur at any age, but usually begin between the ages of 10 and 40 and diminish after age 50. Some people experience several migraines a month, while others have only a few migraines throughout their lifetime. Approximately 75% of migraine sufferers are women. Migraines’ secondary characteristics are inconsistent. Triggers precipitating a particular episode of migraine vary widely. The efficacy of the simplest treatment, applying warmth or coolness to the affected area of the head, varies between persons, sometimes worsening the migraine. Migraines are classified as either “with aura” or “without aura.” Migraine is a neurological disorder that generally involves recurring headaches. Other symptoms may occur with the headaches. Migraines are often classified based on whether they include an early symptom called an aura. Visual aura is the most common of the neurological events.

Migraine is a true organic neurological disease. Migraine with aura is characterized by a neurological phenomenon (aura) that is experienced 10 to 30 minutes before the headache. Most auras are visual and are described as bright shimmering lights around objects or at the edges of the field of vision (called scintillating scotomas) or zigzag lines, wavy images, or hallucinations. Migraine without aura is the most prevalent type and may occur on one or both sides (bilateral) of the head. Tiredness or mood changes may be experienced the day before the headache. Nausea, vomiting, and sensitivity to light (photophobia) often accompany migraine without aura. Migraine headaches affect about 11 out of 100 people. They are a common type of chronic, recurring headache. They most commonly occur in women and usually begin between the ages of 10 and 46. In some cases, they appear to run in families. A migraine is caused by abnormal brain activity, which is triggered by stress, food, or some other factor.

Migraine-specific therapies are designed specifically to treat migraine attacks. Ergotamine preparations are no longer readily available. Several medications may need to be tried before you find one that works. A class of drugs known as triptans can relieve a migraine once it starts. Rest in a quiet, darkened room. Drink fluids to prevent dehydration, especially if vomiting occurs. Several medications may help relieve symptoms. However, the effectiveness of migraine medications is highly variable in different people. Some medicines can prevent migraines. These include propranolol, amitriptyline, ergonovine, cyproheptadine, clonidine, methysergide, calcium channel antagonists, valproic acid, carbamazepine, topiramate (Topamax), and many others. Ergotamine tartrate preparations constrict the arteries of the head and may be used alone or in combination with other drugs such as caffeine (Cafergot), phenobarbital, or Fioricet. Propoxyphene or other medications that relieve pain or inflammation may provide relief for some people. Nausea should be treated early with Reglan, Compazine, or other anti-emetics.

Migraines Treatment Tips

1. Conventional treatment focuses on three areas: trigger avoidance, symptomatic control, and preventive drugs.

2. Moderation in alcohol and caffeine intake, consistency in sleep habits, and regular meals may be helpful.

3. Triptans are a mid-line treatment suitable for many migraineurs with typical migraines.

4. Ergot drugs can be used either as a preventive or abortive therapy, though their relative expense.

5. Sumatriptan and related selective serotonin receptor agonists are now the therapy of choice for chronic migraine attacks.

6. Anti-emetics by suppository or injection may be needed in cases where vomiting dominates the symptoms.

7. Amidrine is sometimes prescribed for migraine headaches.

8. Intravenous chlorpromazine has proven very effective in treating status migrainosus—intractable and unremitting migraine.

9. Diet, visualization, and self-hypnosis are also alternative treatments and prevention approaches.

10. Massage therapy and physical therapy are often very effective forms of treatment to reduce the frequency and intensity of migraines.

11. Massage therapy of the jaw area can also reduce such pain.

12. Botox is being used by many headache specialists for patients with frequent or chronic migraines with encouraging results.

13. Try to avoid any factors that have triggered a migraine in the past.



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Butalbital

Learning About Migraine Treatments

January 26, 2010 – 4:11 pm

If you suffer from migraine headaches you know how debilitating they can be. You have probably tried a number of migraine treatments with little or no relief as well, which makes you feel like banging your head against the wall.

Why not, it couldn’t hurt any worse, right? You dread the moment you get the first sign, or aura, of a migraine coming on. You start to see spots, feel sensitive to light, smells, or sounds, and may feel dizzy or nauseated.

You just want to find a dark room and tuck yourself into bed somewhere. Migraine sufferers are unable to function at work, school, or anywhere else for that matter. According to The National Migraine Association, also known as MAGNUM (http://www.migraines.org), reports that 36 million people in the United States suffer from migraine headaches.

With improved recognition of symptoms and diagnosis by health care providers, a 60% increase in migraine sufferers has been noted over the past decade. Migraines are different in each individual and not everyone experiences the same symptoms, which is why some migraine treatments are more effective than others, making the process somewhat complicated.

Migraine headaches are a neurological disease with biological causes that are often hereditary. Migraine treatments have improved immensely over the years, but are not effective for everyone, not to mention the side effects that some people experience.

Migraine treatments are divided into separate group. There are preventive or prophylactic medications and alternative therapies for migraine treatment, and there are those that work to ward off symptoms once a migraine has ensued. Prescribed medications used in migraine treatment are beta blockers, calcium channel blockers, anti-depressants, and Depakote (an anti-seizure drug).

Alternative prophylactic migraine treatments include feverfew leaf, butterbur root, vitamin B12, and magnesium supplementation. New research is also looking to the gut, which may be the origin of migraine headaches in some sufferers.

If preventive therapy is not completely effective, prescription medications such as Imitrex, Maxalt, Zomig, Relpax, Midrin, and Migranal can be used which lessen the severity and duration of migraines by initiating cerebral vasoconstriction.

If migraine treatment is sought in a physician’s office or emergency room, a narcotic injection can be administered, such as Stadol, Phenergan, or Vistril, which are non-vasoconstricting agents used in the event other treatments are contraindicated.

These are all effective migraine treatments, but remember that not all will help every migraine sufferer. Other alternative treatments such acupuncture, biofeedback, and chiropractic manipulation have also proven to be effective migraine treatments in some patients.

Avoiding certain migraine triggers is an important intervention that can be used by all “migrainuers”, such as avoiding certain foods and alcoholic beverages than have caused migraines in the past, and wearing sunglasses in bright sunlight.

If you suffer from migraine headaches and you are not getting relief from your current migraine treatment regimen, then schedule a consultation with your health care provider. It is possible to get better relief and have fewer episodes, which will greatly improve your emotional outlook and quality of life.



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Fioricet

Headache Types – What Kind Do You Have?

January 26, 2010 – 11:51 am

Nearly two-thirds of all Americans suffer from chronic habitual headaches. From migraines, sinus and cluster headaches, to ones induced by stress and hormones, it can matter which type of headache the patient sufferers with, in order to treat them properly and get fast relief. Some of the most common headache types experienced by sufferers include:

Tension Headaches:

Felt by more than 80% of the adult population, tension-type headaches are the most common headache, and seem to be slightly more common among women, than men.

Believed to be caused by a chemical or neuronal imbalance in the brain, tension headaches have also been linked to a tightening in the back, neck and/or scalp. The pain is a pressing or tightening of both sides of the head, temple and neck, and feels much like a vice. Pain from this type of headache can be very mild, or excruciatingly severe.

Daily recurrences of tension-type headaches have been linked to depression, and other emotional problems. Changes in sleep patterns or insomnia, as well as ongoing fatigue can also cause tension headaches. Symptoms usually begin early in the morning or late in the day, and last for several hours. Analgesics seem to help the mild sufferer, but chronic and severe tension headaches may require a stronger prescription therapy.

Migraines:

The most severe of all headaches, and are experienced by 13 percent of the population. Their throbbing head pain, usually located on just one side of the face, neck and head, characterizes them. The combination of disabling pain and associated symptoms such as nausea, auras (bright lights, blind spots, etc), dizziness, and more, can seriously impede the quality of life for the chronic sufferer. There are many treatment options now available to migraine sufferers including daily preventative medications, massage therapy, relaxation techniques, as well as a myriad of homeopathic remedies now on the market.

Organically Caused Headaches:

The most serious of all the headache categories, organically caused headaches is not a disease itself, but rather, a symptom of a more serious disorder. This type of headache can be caused by high blood pressure, diabetes, tumor, blood clots and aneurysms, to name a few. When headaches become progressive with the pain worsening with each attack, a sufferer loses consciousness, is confused, or is taking over the counter medications on a daily basis, prompt medical attention is required to rule out an organic cause.

Hormone Headaches:

More than 60% of female migraine sufferers have linked their attacks to their menstrual cycle. Fluctuations in hormone levels during menstruation, pregnancy and menopause can all trigger mild to severe headache symptoms. As estrogen spikes and dips throughout a woman’s monthly, as well as life, cycles, headaches may become more frequent and more severe. Hormone therapy seems to work best for post-menopausal migraine sufferers.

Sinus Headaches:

Caused when one or more of the body’s four sinus becomes infected due to blockage from a cold, allergies, the flu or some other physical ailment, sinus headaches generally cause a gnawing pain over the nasal area, and increases in severity throughout the day. A feeling of pressure and fullness is often accompanied by fever as the infection worsens. Treatment includes antibiotics, analgesics and nasal sprays. Chronic sinusitis may require surgery to remove polyps that continue to block nasal passages, or to repair a deviated septum.

Allergy Headaches:

Most commonly experienced in earl spring and late fall, allergy headaches are typically accompanied by nasal congestion and watery eyes. Antihistamines are most commonly prescribed to help alleviate symptoms.

No matter what type of headache a sufferer experiences, it is always important to seek medical treatment if they persist or worsen, as this may be a sign of an underlying cause that needs further treatment.



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January 26, 2010 – 6:49 am

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Pain

Diagnosing Low Back Pain

January 26, 2010 – 3:24 am

The diagnosis of lumbar back pain is difficult and uncertain due to the various conditions which can present with this problem. Effective back pain management depends on identifying what kind of back pain problem is present, and many people have suggested that there are many back pain subtypes which need to be identified before treatment can be well targeted. The variations in diagnoses for low back pain and related symptoms include: postural pain; trigger point pains; nerve root compression; neuropathic pain; facet joint pain; disc related pain and lumbar stenosis.

The spinal facet joints, intervertebral discs, muscles and ligaments are all potential sources of mechanical back pain, a pain derived from the damaged or injured tissues and transmitted by the nervous system. When the nervous system is damaged or injured it can start generating pain itself, leading to the production of what is termed neuropathic pain. Typical diagnoses of this kind of pain are post-shingles pain, phantom pain, nerve root damage pain and diabetic neuropathy pain. Patients suffer badly with this kind of unpleasant pain and it is difficult to treat.

A recent study performed by researchers from Massachusetts General Hospital in Boston and Addenbrooke’s Hospital in Cambridge, UK, has investigated this difficulty. They recognised that the assessment by taking a score of pain intensity does not reflect the reality of the complex nature of pain processes by which pain is generated. They set out to design an assessment which would take these complexities into account, allowing the clearer identification of the diagnosis and thereby a potentially more accurate treatment. They developed a standardised tool to use in the assessment of chronic pain with the aim of delineating differing pain subtypes.

130 people with peripheral neuropathic pain and 57 people with mechanical low back pain were surveyed and given a standardised assessment. An interview with 16 questions was then applied followed by a specific series of twenty-three physical tests. A list of words applicable to pain descriptions was provided and patients were asked to indicate which ones most accurately described their pain. In chronic pain patients often have an alteration in the ability to feel touch, vibratory and pin prick stimuli so the ability to discriminate these sensibilities is tested.

In neuropathic pain patients it was possible to identify six sub-groups and in non neuropathic patients two further subgroups were noted. Researchers were also able to distinguish the 6 questions and 10 physical tests which were best suited to making the most accurate discrimination between the pain subtypes. Testing this tool on one hundred and thirty seven further patients allowed the researchers to see it worked effectively and that patient acceptability was good. A particular group of neuropathic pain subtypes could be elucidated by a relatively low number of signs and symptoms which were not related to the presenting causative conditions.

The recording of the symptoms was less sensitive in distinguishing the neuropathic nature of the pains than the physical examination. The pain quality was less important than often noted and the pinprick testing more helpful. The researchers tried to link the pain subtypes with specific underlying biological mechanisms, with spontaneous pain of a burning nature linked to spontaneous discharges in heat sensitive pain nerves and pain from brushing related to increased sensitivity of cells in the dorsal horn of the spinal cord.

The physical examination was more sensitive in delineating neuropathic diagnoses of pains than the recording of the types and nature of symptoms.  The qualities of the pain were less helpful and the testing of pinprick more helpful. The researchers attempted to connect the underlying neural mechanisms with the pain subtypes. The heat sensitive pain nerves were linked to burning pains of a spontaneous type and heightened sensitivity of the spinal cord dorsal horn cells was linked to increased pain from brushing over the skin.



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