Chronic Pain

I have a chronic dull ache around the left side of my breastbone, which sometimes radiates to my shoulder. What could cause this, and what treatment would you recommend? There are many causes of chronic chest pain. Two of the most common are costochondritis (inflammation of the cartilage attaching the ribs to the sternum or breastbone) and intercostal myalgia (an irritation of the muscles between the ribs). These diagnoses are often difficult to establish because the pains are vague and there are no confirming lab tests.

WASHINGTON - Nearly a third of Americans experience long-lasting pain - the kind that lingers for weeks to months - and too often feel stigma rather than relief from a health-care system poorly prepared to treat them, the Institute of Medicine said Wednesday. The staggering tab: Chronic pain is costing the nation at least $558 billion a year in medical bills, sick days, and lost productivity, the report found. That's more than the cost of heart disease, the No. 1 killer. All kinds of ailments can trigger lingering pain, from arthritis to cancer, spine problems to digestive disorders, injuries to surgery.

The Bucks County commissioners approved a contract yesterday that would allow doctors to prescribe physical therapy, acupuncture, chiropractic services and other nonmedicinal treatment to prison inmates who suffer from chronic pain, despite strong reservations voiced by the chairman. County health officials, who oversee inmates' medical treatment, say the alternative treatment will save the county money because it will reduce physician fees and will cut the growing costs of prescription drugs.

DEAR ABBY: My best friend of 30 years, "Andrea," and her husband decided not to have children. They are happy with their dogs and cats. She recently adopted a 10-year-old rescue dog and changed the dog's name to "Monique. " Abby, Monique is my daughter's name! When I asked Andrea why she changed the dog's name, she said it is because no one in her family has that name. I am hurt that she would name her dog after my daughter, her godchild - so much so that I no longer wish to speak to this woman.

Cephalon Inc., of Frazer, said today that its oral medication to treat breakthrough cancer pain has received European regulatory approval. The medicine is an oral formulation of the pain therapy fentanyl for adult patients who already take an opioid medicine, such as morphine or Percocet, for underlying chronic pain. The drug, called Effentora in Europe, was approved in the United States in September 2006 under the name Fentora. Cephalon said that approval by the European regulatory commission means the biopharmaceuticals company can sell the treatment in the 27 states within the European Union.

It might be hard to believe, but only in the past 20 years has care based on evidence become a major focus for the medical community, said Jeffery Lerner, chief executive of Plymouth Meeting-based ECRI. The nonprofit research agency, which tests the claims of medical devices, research and practices, is looking for facts in the subjective realm of pain management. Starting today, ECRI is hosting a conference on the evidence, or lack thereof, in treating chronic pain and the use of such drugs as Oxycontin and other potentially addictive painkillers.

If you exercise and part of your body starts to hurt, it's wise to cool it two ways - figuratively with rest and literally with ice. That rule-of-thumb prescription generally works when something hurts, but because pain is so individual, it is important to evaluate the severity and duration of each particular pain. Basically, pain is an unpleasant feeling that results from an injury or infection. There are two general categories of pain. Acute pain is short-term pain, whether mild or severe, caused by an identifiable injury or trauma, such as breaking an arm or surgery.

Merck & Co. Inc. announced it would buy rights to promising compounds that treat pain and other neurological disorders - in a deal worth up to $475 million - from Neuromed Pharmaceuticals Ltd., a Conshohocken company developing pain medicines. The companies said yesterday that Merck would pay an initial $25 million for exclusive rights to Neuromed's experimental drugs, including Neuromed's lead compound, NMED-160, a calcium channel blocker to treat chronic pain in mid-stage Phase 2 clinical trials.

Lonnie Ali, the wife Muhammad Ali, denies a report in the London Evening Standard that said the former three-time world heavyweight champion, who is suffering from Parkinson's syndrome, had only months to live. The newspaper on Friday quoted an unnamed family friend, but Lonnie Ali labeled the report as "absurd and absolutely without foundation" in a statement released over the weekend. Craig Bankey, Ali's Los Angeles-based publicist, said the rumor initially was reported in the National Enquirer and picked up by the Evening Standard.

Many medical stories recently have discussed the issue of pain management. A Consumer Reports survey reported a particularly compelling finding: 97 percent of doctors polled thought they were at least somewhat effective at minimizing pain and discomfort. Within that group, 37 percent said they were "very effective. " Unfortunately, the difference between "very" and "somewhat" is anything but minor. Individual patients suffer needlessly, and that suffering has an effect on a larger scale.

NEW YORK - The Associated Press won a Pulitzer Prize for investigative reporting Monday for documenting the New York Police Department's widespread spying on Muslims, while the Patriot-News in Harrisburg, Pa. - and in particular, 24-year-old reporter Sara Ganim - were honored for local reporting that broke the Penn State sexual abuse scandal. David Wood of the Huffington Post won for national reporting for a look at the suffering endured by American veterans wounded in Iraq and Afghanistan.

Long-term pain in the jaw tied to general pain sensitivity People with long-term jaw pain disorders seem to be more sensitive than average to pain in other parts of their body, according to a study led by the University of Maryland School of Dentistry. Researchers gave questionnaires and physical exams to 1,600 healthy people and 185 who had suffered from temporomandibular joint disorders (TMJ) for at least six months. The University of Maryland team developed special tools for testing pain and sensory perceptions.

WASHINGTON - Nearly a third of Americans experience long-lasting pain - the kind that lingers for weeks to months - and too often feel stigma rather than relief from a health-care system poorly prepared to treat them, the Institute of Medicine said Wednesday. The staggering tab: Chronic pain is costing the nation at least $558 billion a year in medical bills, sick days, and lost productivity, the report found. That's more than the cost of heart disease, the No. 1 killer. All kinds of ailments can trigger lingering pain, from arthritis to cancer, spine problems to digestive disorders, injuries to surgery.

Many medical stories recently have discussed the issue of pain management. A Consumer Reports survey reported a particularly compelling finding: 97 percent of doctors polled thought they were at least somewhat effective at minimizing pain and discomfort. Within that group, 37 percent said they were "very effective. " Unfortunately, the difference between "very" and "somewhat" is anything but minor. Individual patients suffer needlessly, and that suffering has an effect on a larger scale.

It was the middle of August, between his third and fourth cortisone injections, when Placido Polanco first acknowledged that he probably would need surgery on his left elbow after the season. The Phillies third baseman was hit on the elbow by a Tim Hudson pitch in an April 21 game at Atlanta. That merely aggravated what was a chronic injury to Polanco's elbow, full of tendinitis and bone fragments. But he played through it, with his manager and the athletic training staff cringing every time Polanco was plunked on the elbow or had to make a diving play to his left at third.

DEAR ABBY: My best friend of 30 years, "Andrea," and her husband decided not to have children. They are happy with their dogs and cats. She recently adopted a 10-year-old rescue dog and changed the dog's name to "Monique. " Abby, Monique is my daughter's name! When I asked Andrea why she changed the dog's name, she said it is because no one in her family has that name. I am hurt that she would name her dog after my daughter, her godchild - so much so that I no longer wish to speak to this woman.

By George Ball We live in a time that merits a new edition of Extraordinary Popular Delusions and the Madness of Crowds , Charles Mackay's classic 1841 study of human follies and frenzies, including witch hunts, alchemy, and bursting financial bubbles. One delusion now in full bloom is the movement to legalize medical marijuana, which is proceeding apace without significant care or consideration on the part of the government, the medical and scientific community, or the public. With California leading, 14 states have legalized medical marijuana, and 11 others are considering doing so. New Jersey's governor and lawmakers recently wrangled over implementation of its new medical-marijuana law, while Philadelphia's current and former district attorneys argued about a push to lessen penalties for possession.

THRIVING WITH TYPE 1 CATHERINE MILLER, who is 26 and lives in West Chester, was diagnosed with Type 1 diabetes at age 15. "I wasn't really surprised because my mom has it, my grandmother and grandfather had it, a couple of my uncles have it, so it was inevitable for at least me or my brother to get it, and I was the lucky one. " It threw her for a loop initially. "I was 15 and they were giving me all sorts of medication," she says. "But I knew it was going to come. " Taking the time to eat right for blood-sugar control was her major challenge as a teenager.

Cephalon Inc., of Frazer, said today that its oral medication to treat breakthrough cancer pain has received European regulatory approval. The medicine is an oral formulation of the pain therapy fentanyl for adult patients who already take an opioid medicine, such as morphine or Percocet, for underlying chronic pain. The drug, called Effentora in Europe, was approved in the United States in September 2006 under the name Fentora. Cephalon said that approval by the European regulatory commission means the biopharmaceuticals company can sell the treatment in the 27 states within the European Union.

For 10 weeks, ever since Cpl. Raymond D. Hennagir was blown up, he had longed for this moment, this homecoming, when the rest of his platoon would return from Iraq. He missed them, his brothers. Hennagir, a 21-year-old Marine from Deptford, N.J., felt he had let them down by stepping on an improvised explosive device (IED), blowing off both legs and four fingers on his left hand - now, he said, in his darkest Marine humor, just "a pink mist and a memory. " Hennagir desperately wanted to mend enough so that the Marine Corps would let him travel to Camp Lejeune for this day, Aug 26. That wish motivated him, maybe even kept him alive, through the summer's 16 surgeries and three skin grafts.