Dr. Jack Tsao, a Navy neurologist with the Uniform Services University, was looking for ways to help soldiers like Paupore. He remembered reading in graduate school a paper by Dr. V.S. Ramachandran that talked about an unusual treatment for amputees suffering "phantom limb pain," using a simple $20 mirror.

The mirror tricks the brain into "seeing" the amputated leg, overriding mismatched nerve signals.

Here's how it works: The patient sits on a flat surface with his or her remaining leg straight out and then puts a 6-foot mirror lengthwise facing the limb. The patient moves the leg, flexing it, and watches the movement in the mirror. The reflection creates the illusion of two legs moving together.

They say necessity is the mother of invention. While improvements in armor technology have kept more soldiers alive than ever before, many of those saved are coming home as amputees. We've explicitly asked the question before, and the number of posts we've done on the subject serves as evidence: for better or worse, the Iraq and Afghanistan wars are driving major advancements in medical research and technology.

More from CNN...

Photo Credit: michiyoemi

The company says that its PatchPump™ works using a "novel solid-state battery cell which gradually expands in a stable manner under electronic control."

A couple of nuggets about the technology and capabilities of device as provided by the company:

The ECell™ merges the two major components of disposable pumps -- the power source and the motor -- into one simple miniature part, enabling the fabrication of very flat and simple devices.

The key advantages of the technology are as follows:

Rock-steady drug-delivery using non-gassing mechanism

Self-powered as battery cell expands as it is depleted

Unaffected by changes in temperature or pressure

Very low cost

Lightweight

No MEMS or other exotic manufacturing technologies required

The expanding battery cell will be produced on a battery production line

SteadyMed's product range enables:

Delivery of basal and bolus combinations as required

A range of drug volumes: 5cc, 3cc, 2cc, 1cc, 0.5cc

Typical operation time 48 hours to 7 days

Penetration methods include SubQ, IV and microneedles

Integration of soft cannula insertion mechanism into the device

No MEMS or other exotic manufacturing technologies required

Varying levels of sophistication of electronic controller, from simple and disposable to re-usable and sophisticated

Videos: How the Patch Works; How the Battery Works

Product page: PatchPump ...

(hat tip: ISRAEL21c)

The press release is to follow later on today.

In the largest experiment on acupuncture for back pain to date, more than 1,100 patients were randomly assigned to receive either acupuncture, sham acupuncture or conventional therapy. For the sham acupuncture, needles were inserted, but not as deeply as for the real thing. The sham acupuncture also did not insert needles in traditional acupuncture points on the body and the needles were not manually moved and rotated.

After six months, patients answered questions about pain and functional ability and their scores determined how well each of the therapies worked.

In the real acupuncture group, 47 percent of patients improved. In the sham acupuncture group, 44 percent did. In the usual care group, 27 percent got relief.

More from the AP article...

Here's how it works. A patient logs in to keep a record of his pain with all kinds of associative descriptions, factors and modifiers: standard pain score, pain distribution, terms describing his/her pain, modifiers like meds taken, physical activity performed, etc. The site is based on AJAX, the same technology that GMail is using, hence there is a two way communication with a server without many page reloads. The interface is intuitive on both patient and physician's ends. It should also be noted, that Fred Eberlein, founder and CEO of ReliefInsite.com, tells Medgadget that their service is in full compliance with HIPAA, and is extremely secure.

During the conference and at home, we checked out all of the ReliefInsite service modules:

The website also features reminders, as well as powerful standard and fully customizable reports that one can view, print or save on the computer.

In terms of expense, the site is free for MDs/DOs. Everything is included: case management, reports, etc. The basic patient diary is also free. Premium service for patients is a reasonable $6.95 for 1 month; $29.95 for 6 months; or $49.95 for 1 year.

Your correspondent, an anesthesiologist, felt that such a service can simplify your clinical life, whether by improving patient care through improved productivity, or by allowing patients to take charge and record a very subjective vital sign, pain. Also, what I liked was the ability to run reports and always to come back in time and to show a patient's previous pain levels, drugs taken, etc, and to adjust meds or therapies based on hard data from the past.

We highly recommended this sophisticated service for pain docs, surgeons, OB-Gyn specialists, spine care docs, oncologists, and everyone in between.

Take the tour: ReliefInsite ...

SnowWorld, developed at the University of Washington HITLab in collaboration with Harborview Burn Center, was the first immersive virtual world designed for reducing pain. SnowWorld was specifically designed to help burn patients. Patients often report re-living their original burn experience during wound care, SnowWorld was designed to help put out the fire. Our logic for why VR will reduce pain is as follows. Pain perception has a strong psychological component. The same incoming pain signal can be interpreted as painful or not, depending on what the patient is thinking. Pain requires conscious attention. The essence of VR is the illusion users have of going inside the computer-generated environment. Being drawn into another world drains a lot of attentional resources, leaving less attention available to process pain signals. Conscious attention is like a spotlight. Usually it is focussed on the pain and woundcare. We are luring that spotlight into the virtual world. Rather than having pain as the focus of their attention, for many patients in VR, the wound care becomes more of an annoyance, distracting them from their primary goal of exploring the virtual world.

In our preliminary case study (Hoffman, Doctor, Patterson, Carrougher and Furness, 2000), two patients with severe burns went into SpiderWorld. They saw a virtual kitchen complete with kitchen countertops, a window with a partly cloudy sky, as well as 3-D cabinets, and doors that could be opened and shut.
Patients could pick up a teapot, plate, toaster, plant, or frying pan by inserting their cyberhand into the virtual object, and clicking a grasp button on their 3-D mouse. Each patient also physically picked up a virtual wiggly-legged spider possessing solidity and weight, using a mixed-reality force feedback technique developed by one of our team members. Patient 1 had 5 staples removed from a burn skin graft while playing Nintendo, and six staples removed from the same skin graft while in VR. He reported dramatic reductions in pain during VR.

Patient 2 showed a similar large but less extreme pattern (reduction of pain during wound care while in VR compared to while playing a video game). The results of these two patients are described in a clinical note in the March 10th, 2000 issue of the medical journal PAIN. Clinical notes are inconclusive by nature, and larger studies are needed (and underway).

In a related preliminary clinical study that is now completed, (Hoffman, Patterson and Carrougher, 2000), have found additional support for the efficacy of VR for pain control. Twelve patients with severe burns at Harborview reported highly significant reductions in pain levels during physical therapy when in VR compared to no VR (conventional treatment). In addition to distracting the patients, VR can likely be used to motivate patients to perform desired stretching motions, using behavioral reinforcement techniques (e.g., they could get more gas for their jet by gripping and ungripping their healing hand 10 times).

A direct result of this research program was the development of the Neurovasc, a unique vacuum device that restructures the superficial components of the body. The Neurovasc eradicates pain by lifting and separating the layers of injured tissue, releasing entrapped nerves that cause pain. According to Brooks, the treatment also influences patients' brain chemistry and allows them to regain control over their lives when acute and chronic pain is relieved. With lower pain levels, patients report reduced stress, depression and anxiety levels; this also facilitates reducing patients' dependency on caffeine, alcohol and/or medication.

"Pain and stress compounded with substance abuse will eventually kill you," Brooks says. "The very tragic event involving Anna Nicole Smith focused public attention on this issue."

Alas, there are no pictures of this incredible technology, just a link to the Brooks Center -- dedicated to "Pursuing the Dynamic Fusion of Human Potential" -- whatever that means.

We learned a little more about this device from the "Articles" tab at the Brooks Center website (only one article is listed). The Article is not exactly peer reviewed, and rests heavily on a series of press releases from University of Michigan (though elsewhere on in the paper, the researchers are said to work at Michigan State).

A pseudoscience spectacular awaits as we begin reading the paper, which was written by Ron Brooks -- and Michael Prior, who is listed as a PhD but labeled as "General Council" -- it sounds like he was going for "General Counsel" but got the wrong doctorate. The paper opens with tripe like this:

In early 2007 we all witnessed what we consider a very tragic event involving Anna Nicole Smith. She gave birth to a daughter and lost her son all in a moment. There is no greater trauma than a loss of a child. This was obviously compounded by the abuse of some powerful medications; can you imagine what the poor woman's brain chemistry was doing? Perhaps this explains some of the bizarre behavior we saw before her subsequent overdose and death. This sequence of events is being played out in our country on a daily basis.

We now know that the brain has neurons that are correctly programmed to produce, send, and receive a specific biochemical. Each biochemical, called neurotransmitters, travels along a different nerve pathway, resulting in a variety of physical processes. The pain signal comes into the brain and is processed by different parts of the brain for responses. The body's anti-pain system is activated and at the same time the chemical dopamine is released which acts as interface between stress and emotions.

Finally, they get to the point:

At this time in our research program we began to look at all of the available mechanical devices used for soft tissue manipulation. We tried these without success. Finally, we discovered an existing vacuum device used in the esthetics business, called Eureduc. At the time this device was used to reduce irregular bumps (cottage cheese) on women's thighs. We began to use this device in conjunction with cryotherapy and vasopump, and immediately found we could reduce the "Hydraulic Effect". This made it much easier to decompress the tissue. The upward force of the vacuum was also considerably more comfortable for the patient than the pressure from manipulating the tissue by hand.

We look forward to the clinical trials that demonstrate how decades-old anti-cellulite device can provide lasting changes to brain chemistry and the body's perception of pain. But we won't hold our breath. Perhaps the secret is that the Brooks Center researchers apply the vacuum directly to the patient's brain, sucking out all the neurons responsible for signaling pain. To continue to fool the public, however, these charlatans will have to target our brains' centers of reasoning.

The researchers felt that the pain and bruising caused by previously-developed jet injectors was caused by the deep penetration of jets into the skin, creating negative reactions of nerves and capillaries. The pulsed mircrojets engineered by the researchers combine high velocity (more than 100 meters per second) with very small jet diameters (between 50 and 100 micrometers), delivering only 2 to 15 nanoliters of liquid drug at a time. The research showed that the pulsed microjet system could be used to effectively deliver drugs for local and systemic applications without using needles.

"The microjet system delivers precise doses into superficial skin layers, thereby mitigating pain," says Samir Mitragotri, a professor of chemical engineering at UCSB and a lead author of the paper. The system was designed as an alternative to the macro-scale systems that had been causing pain and bruising. "We realized that we had to find a way to stop the jets from going deep into the skin," says Mitragotri. "Speeding the delivery, combined with using extremely small jet diameters and less liquid per pulsation, was shown to be more effective."

Link @ UC Santa Barbara

Flashback: Vitajet™ 3

Dr Frank Seebacher and Dr Shauna A Murray from Sydney University's School of Biological Sciences have shown that reptiles possess a family of genes that code for proteins which act as external heat sensors as well as providing an internal thermometer. These proteins, 'transient receptor potential ion channels', are closely linked with sensory nerves at the animal's surface as well as in their liver, heart, and muscles.

In the paper, entitled Transient Receptor Potential Ion Channels Control Thermoregulatory Behaviour in Reptiles, published in the most recent issue of the online journal PLoS ONE, the Sydney team say that information about internal temperatures and environmental conditions is fed back to the brain via these receptors. The brain is then able to direct the behaviour of the animal depending on how warm or cold it is relative to the environment.

'Until now it was unknown exactly how cold-blooded (ectothermic) animals sensed heat in their environment, which is an important step in our understanding of the biological functions governing an animal's ability to regulate their body temperature,' said Dr Seebacher. 'This capacity to sense environmental and internal temperatures is a prerequisite for the evolution of the kind of thermal regulation we find in warm-bodied (endothermic) animals, such as ourselves.'

'The functioning of all organisms depends on temperature, and we as humans know very well that when our body temperature deviates by only 3-degrees centigrade from normal we are in serious trouble. Other animals are more tolerant, but must still regulate their body temperature so that their cells and organs can function effectively,' said Dr Seebacher.

'Interestingly, similar proteins exist in mammals where among other things they are responsible for "tasting" the heat in chillies. Hence, the detection of environmental heat and "hot" chillies depends on the same mechanism, and both are closely linked to perception of pain,' said Dr Seebacher. 'Transient receptor potential ion channels are therefore of enormous interest to medicine because they could be the target for new pain relieving drugs,' he said.

Read more @ Sydney University: Discovery of crocs temperature regulator could lead to major pain relief . . .

Research Publication . . .

The game is called SnowWorld, and when young burn victims put on its high-tech helmet and get involved in playing, they lose sight of the nurses, equipment and other fearful sights and sounds around them. Instead, they're immersed in an Arctic world where they lob virtual snowballs at penguins, snowmen and roaring woolly mammoths while speeding through hairpin turns in a canyon of ice.

SnowWorld's designer, Hunter Hoffman, the director of the University of Washington's Virtual Reality Analgesia Research Center in Seattle, explained that burn victims often re-experience the sensation of getting burned as their wounds are handled during daily care.

"So, our idea was to create this 'cool' scenario -- imagery of snowflakes, an icy world of snowmen and penguins -- things that are the antithesis of fire," he said.

Pediatric burn victims, especially, need some form of non-medicinal pain control during their treatment. That's because methods commonly used in adult patients -- drugs like morphine, or artificially induced comas -- are simply too risky for use in children.

"In fact, all they could give Nathan was a light dose of oxycontin," Heidi Neisinger said.

Hoffman knew from his own research, and others' as well, that pain requires sustained attention from the brain. He figured, then, that distraction might help ease it. That's the theory behind SnowWorld, the first-ever use of virtual reality to help treat severe pain.

Hoffman, a psychologist, teamed up with Seattle-based virtual reality designers Ari Hollander and Howard Rose to perfect the latest version of the game.

"Designing a great virtual world is all about maximizing presence," Hollander explained. "Trying to make you feel like you are really in that virtual environment."

Helping kids block out their immediate environment to avoid the anticipatory aspect of pain is key, the experts said.

Read more from The Washington Post . . .

More from the American Pain Society . . .

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