Pain and communication

It is frequently said that pain is incommunicable and even that it destroys language. This paper offers a phenomenological account of pain and then explores and critiques this view. It suggests not only that pain is communicable to an adequate degree for clinical purposes, but also that it is itself a form of communication through which the person in pain appeals to the empathy and ethical goodness of the clinician. To explain this latter idea and its ethical implications, reference is made to the writings of Emmanuel Levinas.

Art, pain, children: utopian and dystopian discourses in picture books

It is often assumed that picture books are intended for young children and that they are therefore mainly concerned with safe and reassuring stories, say, about home and family, friends and starting school. There are many picture books which fit within this category, but the form itself, a 32-page format which developed during the 1960s from illustrated books, has always been peculiarly open to experimentation and has enlarged its audience to include older children and adults. Unlike the novel, the picture book is not weighed down by the practices and conventions of the past; and the combination of verbal and visual texts makes for a particularly complex genre as it constructs ideas through dialogical relations between words and pictures.

The problem of postoperative pain: issues for future research

Uncontrolled postoperative pain continues despite abundant research in the area. The purposes of the paper are to review how past research influences our understanding of pain in the postsurgery context and to argue for a methodological shift towards naturalistic inquiry. Such a shift incorporates the complexities of pain assessment and management in the clinical practice environment. Decisions regarding pain are often examined outside of the contextual concerns of clinical practice. Research approaches have involved analyses of nurse and patient-related factors associated with pain. These approaches do not account for complex interactions that occur between nurses, patients and the dynamic environment in which these interactions take place. The failure of research to address the context of pain decisions has several implications. It limits our understanding of why pain continues despite ongoing research and it does not enable evaluation of clinical strategies to improve pain decision-making and pain outcomes for patients.

Determination of glyphosate mono-isopropylamine salt in process samples using flow injection analysis with tris(2,2`-bipyridyl)ruthenium(II) chemiluminescence detection

The mono-isopropylamine salt of glyphosate was selectively determined directly in industrial and commercial formulations using flow injection analysis with tris(2,2′-bipyridyl)ruthenium(II) chemiluminescence detection without the need for separation. Glyphosate and its mono-isopropylamine salt furnished detection limits of 7×10⁻⁹ and 3.5×10⁻¹⁰ M and relative standard deviations of 0.4% at 1×10⁻⁷ M and 0.8% at 5×10⁻⁸ M, respectively. The methodology is robust and reliable with samples subjected only to aqueous dilution prior to analysis.

Determination of proline in wine using flow injection analysis with tris(2,2`-bipyridyl)ruthenium(II) chemiluminescence detection

Flow injection methodology is described for the determination of proline in red and white wines using tris(2,2′-bipyridyl)ruthenium(II) chemiluminescence detection. Selective conditions were achieved for proline at pH 10, while other amino acids and wine components did not interfere. The precision of the method was less than 1.00% (R.S.D.) for five replicates of a standard (4 × 10⁻⁶ M) and the detection limit was 1 × 10⁻⁸ M. The level of proline in white and sparkling wines using the developed methodology was equivalent to those achieved using HPLC-FMOC amino acid analysis. SPE removal of phenolic material was required for red wines to minimize Ru(bipy)₃³⁺ consumption and its associated effect on accuracy.

Comparison of soluble manganese(IV) and acidic potassium permanganate chemiluminescence detection using flow injection and sequential injection analysis for the determination of ascorbic acid in vitamin C tablets

The limits of detection (3s) for ascorbic acid were 5×10⁻⁸ M with acidic potassium permanganate using both flow injection analysis (FIA) and sequential injection analysis (SIA) whereas the soluble manganese(IV) afforded 1×10⁻⁸ M and 5×10⁻⁹ M for FIA and SIA, respectively. Determinations of ascorbic acid in Vitamin C tablets were achieved with minimal sample pretreatment using a standard additions calibration and gave good agreement with those of iodimetric titration.

Determination of psilocin and psilocybin using flow injection analysis with acidic potassium permanganate and tris(2,2’-bipyridyl) ruthenium(II) chemiluminescence detection respectively

A simple, rapid and sensitive method for the determination of psilocin and psilocybin is described. This is the first report on the determination of psilocin and psilocybin using flow injection analysis with acidic potassium permanganate and tris(2,2′-bipyridyl)ruthenium(II) chemiluminescence. The limits of detection (signal-to-noise ratio = 3) are 9 × 10⁻¹⁰ M and 3 × 10⁻¹⁰ M for psilocin and psilocybin, respectively.A concise synthetic route for psilocin in three steps from readily available starting materials is also described. The structures were elucidated on the basis of spectroscopic data.

Rapid determination of carbohydrates in heroin drug seizures using capillary electrophoresis with short-end injection

A simple and rapid method for the analysis of carbohydrates in heroin samples by capillary electrophoresis utilizing a borate complexation method is described. Separations were performed using an uncoated fused silica capillary, 50 cm × 50 mm I.D. × 360 mm O.D. with an effective separation length of 9 cm. The system was run at 60°C with an applied voltage of -8 kilovolts. Injection of each sample was for 1 sec at -50 mbar. UV detection was employed with the wavelength set at 195 nm. The background electrolyte consisted of 65 mM borate, pH 12.0. Samples and standards were prepared in the run buffer containing 2 mg/mL of mannose as an internal standard. Under these conditions a test mixture containing glucose, sucrose, lactose, mannitol and mannose as an internal standard was resolved within 5 min. The method was used to determine the concentration of carbohydrates in heroin seizure samples and synthetic heroin samples. The results were in good agreement with the reported values.

The rapid analysis of heroin drug seizures using micellar electrokinetic chromatography with short-end injection

A simple and rapid method for the analysis of heroin seizures by micellar electrokinetic chromatography with short-end injection is described. Separations were performed using an uncoated fused silica capillary, 50 cm×50 mm I.D.×360 mm O.D. with an effective separation length of 8 cm. The system was run at 25°C with an applied negative voltage of –25 kilovolts. Injection of each sample was for 2 s at –50 mbar. UV detection was employed with the wavelength set at 210 nm. The background electrolyte consisted of 85:15 (water:acetonitrile, v/v) containing final concentrations of 25 mM SDS and 15 mM sodium borate, pH 9.5. Samples and standards were prepared in 0.1% v/v acetic acid and diluted in the run buffer containing 1 mg/ml of N,N-dimethyl-5-methoxytryptamine as an internal standard. Under these conditions a text mixture containing caffeine, paracetamol, morphine, codeine, heroin, and acetylcodeine was resolved within 1.5 min. The method was used to determine the concentration of heroin in heroin seizure samples, and the results were in good agreement with those obtained by a validated gas chromatographic method.

Giving content to the principle of proportionality: happiness and pain as the universal currency for matching offence seriousness and penalty severity

The principle of proportionality prescribes that the punishment should equal the crime. It is one of the most important principles of sentencing. Yet, despite its widespread acceptance it offers no meaningful guide to sentencing. Hence penalty levels fluctuate greatly between jurisdictions and within jurisdictions. This is because there is no universally agreed criterion for measuring offence seriousness or penalty severity. This article suggests that the appropriate criteria for matching offence seriousness and penalty severity is the level of unhappiness or pain stemming from each of these impositions. Thus, for example, the level of pain meted out to a rape offender should equal the level of pain caused to a rape victim. Emerging scientific studies on human well-being and happiness show that human beings are similarly built in terms of the experiences that are either conducive or inimical to well-being. This commonality provides a strong foundation to be confident to make reasonably accurate predictions concerning the extent to which adverse events, such as being the victim of a criminal offence or subjected to a form of criminal sanction will stifle human flourishing. This will then allow us to match accurately offence seriousness and penalty level.

The determination of morphine in the larvae of calliphora stygia using flow injection analysis and HPLC with chemiluminescence detection

Selective determination of morphine in the larvae of Calliphora stygia (Fabricius) (Diptera: Calliphoridae) using acidic potassium permanganate chemiluminescence detection coupled with flow injection analysis and high-performance liquid chromatography (HPLC) is described. Larvae of C. stygia were reared on minced meat substrates that had been spiked with varying concentrations of morphine. Morphine concentrations were chosen to reflect typical levels in human tissues from opiate overdose victims. After maturing on substrates, larvae were analyzed for the presence of morphine using chemiluminescence detection coupled to flow injection analysis and a rapid HPLC method. Analysis of the larval matrix by flow injection analysis with chemiluminescence detection indicated the presence of interferants capable of generating chemiluminescence. A rapid chromatographic separation with a monolithic column allowed selective determination of morphine in larvae using postcolumn chemiluminescence detection. Larvae of C. stygia reared on substrates containing morphine at concentrations of 500 and 1000 ng/g did not sequester morphine at detectable concentrations. Larvae reared on substrates containing morphine concentrations of 2500, 5000, and 10,000 ng/g tested positive for the drug at concentrations of 765, 2720, and 3010 ng/g, respectively.

Pain during mammography: implications for breast screening programmes

Pain experienced during mammography can deter women from attending for breast cancer screening. Review of the current literature on pain experienced during mammography reveals three main areas of interest: reports of the frequency of pain, identification of predictors of pain and strategies for responding to pain. Implications of this literature for breast screening programmes include the need for appropriate measurements of pain during mammography that are valid for screening populations, a further understanding of organizational factors involved in screening programmes that may be predictors of pain and for the development of valid strategies for responding to pain within breast screening programmes.

Neovascularization and pain in abnormal patellar tendons of active jumping athletes

Objective: The aim of this study was to investigate tendon pain in abnormal patellar tendons with and without neovascularization.

Study design: Comparative design.

Setting: Multidisciplinary tendon study group at a competitive volleyball venue.

Participants: One hundred eleven volleyball players volunteered to participate in the study.

Main Outcome Measures: Subjects' patellar tendons were imaged with ultrasound, with and without Doppler. Tendons that were imaging abnormal were categorized according the presence of tendon neovascularization. Subjects completed 3 pain scales that examined function (Victorian Institute of Sport Assessment score, 100-point maximum), pain with tendon load (decline squat, visual analogue scale, 100-mm maximum), and maximum pain for the previous week (visual analogue scale, 100-mm maximum). A 1-tailed Mann-Whitney U test compared pain scores in abnormal tendons without neovascularization to abnormal tendons with neovascularization.

Results: Functional scores were lower (Victorian Institute of Sport score, median, 78; P = 0.045) and pain scores under tendon load were greater (decline squat pain, median, 19; P = 0.048) in subjects with abnormal tendons with neovascularization than subjects with abnormal tendons without neovascularization (Victorian Institute of Sport Assessment score, median, 87; decline squat pain, median, 0).

Conclusions: This study indicates that the presence of neovascularization in abnormal patellar tendons is associated with greater tendon pain compared with abnormal tendons without neovascularization in active jumping athletes.

Patellar tendons with normal imaging and pain: change in imaging and pain status over volleyball season

Objective: Patellar tendon injury commonly presents as abnormal imaging with pain or abnormal imaging without pain. Normal imaging with pain has also been reported clinically, but little is known about the behavior of these tendons over time. This study investigated the behavior of tendons with normal imaging and pain over a volleyball season.

Design: Prospective study.

Setting: Institutional.

Participants: One hundred and one male and female volleyball players.

Main outcome measurements: At the beginning and end of the season ultrasound determined imaging status and the single leg decline squat test determined pain. The imaging and pain status at follow-up of tendons with normal imaging and pain at baseline was reported and contrasted to the imaging and pain status of the other patellar tendon injuries.

Results: Tendons with normal imaging and pain [relative risk (RR) 15.1], abnormal imaging without pain (RR 14.6), and abnormal imaging with pain (RR 51.5) had a greater risk of having abnormal imaging with pain at the end of the season when compared with normal tendons (P < 0.01). Among tendons with normal imaging and pain at baseline, 27% had abnormal imaging without pain and 21% contained abnormal imaging with pain at the end of the season.

Conclusions: Patellar tendons with normal imaging and pain at the beginning of a volleyball season are equally as likely to have abnormal imaging and pain at the end of the season as tendons with abnormal imaging without pain. Normal imaging with pain may represent a clinically relevant patellar tendon injury.