APS Annual Meeting Registration Is Open

Join us for the APS 30th Annual Scientific Meeting in Austin, TX, May 19–21. Be sure to register by March 31 to save $100! To register, visit the conference home page.

After a brief hiatus, the Kerr and Fordyce lectures will again have dedicated time within the Annual Meeting program. Plan to join us on Saturday, May 21, from 8:30–10 am. The morning's events will begin with "Pain Policy Update: The View from Washington," given by Robert Saner, JD. Arthur (Bud) DeWitt Craig, Jr., PhD, the 2011 recipient of the Frederick W.L. Kerr Basic Science Research Award, will discuss the topic of "The Significance of Insular Cortex for Human Awareness of Feelings from the Body," followed by Michael Rowbotham, MD, the 2011 Wilbert E. Fordyce Clinical Award recipient. Dr. Rowbotham's lecture is entitled "The Evolving Ethics of Clinical Research on Pain."

A shift in how doctors view chronic pain is occurring. It is no longer a symptom, but for many it should be considered a disease. With this approach to pain, more research is needed to better address pain as a disease and to find more effective treatments for pain patients. APS members were quoted in this powerful series on pain. Continue reading about the future of chronic pain and its treatments at TIME.com. The March 7 TIME issue has companion pain pieces, "Living with Pain" and "Beyond Drugs," about patients dealing with pain and alternative treatments.

Healthcare Reform in the Courts—Implications for Pain Care?

Robert Saner, JD

In late January, Federal Judge Roger Vinson in Pensacola, FL, held the 2010 health reform legislation to be unconstitutional. Unlike a previous ruling in Virginia, Judge Vinson invalidated the entire law, not just the "individual mandate," which requires Americans to obtain health insurance. The judge found the individual mandate to be so "inextricably intertwined" with other provisions that, if it was invalid, so too was the entire scheme. Given that parts of the Pain Care Policy Act, strongly supported by APS and others in the pain care community, were enacted with health reform, questions naturally arise as to their current status.

There are now five trial court decisions on health reform: three upholding the law (Western District of Virginia, Eastern District of Michigan, and District of Columbia), one finding the individual mandate unconstitutional but not the rest of the law (Eastern District of Virginia), and now, Judge Vinson's decision in the Northern District of Florida. Obviously this is an area of law where judges can differ. But where do the pain provisions stand while we wait for the appellate courts, and ultimately the Supreme Court, to weigh in?

First, none of the cases addresses the pain provisions specifically, nor do they address the other public health provisions that rode home with the health reform train.

Second, the status of the Florida case pending appeal is uncertain. Normally, a federal district court's ruling is only binding on the government in the court's area of jurisdiction, in this case northern Florida. However, 26 states joined the Florida challenge and many argue that the ruling applies in their states too. The Justice Department strongly disagrees and has gone back to Judge Vinson seeking clarification that the Administration remains free to continue its implementation efforts nationally, which it is doing anyway, not just in the other 24 states. However Judge Vinson rules on that point, appeals will follow, just as they followed his underlying decision.

Third, most commentators believe the weakest part of Judge Vinson's decision, and the most vulnerable on appeal, is the "inextricably intertwined" theory. The general rule in constitutional challenges to Federal legislation is to invalidate the minimum necessary and save the rest. Even if there is a good case to be made for a "domino effect" between the individual mandate and some of the other coverage and insurance reform provisions of the law, it is hard to see any nexus between the mandate and the pain policy sections of import to APS.

Fourth, when the judicial dust settles—likely years from now—one pain provision, the Institute of Medicine Conference on Pain, will have been consummated, and two others, addressing pain research at NIH and professional training at HRSA, should be largely implemented.

In summary, there is no current disruption to implementation of the pain provisions, and it appears likely that whatever the ultimate fate of health reform in the courts, the pain care community will reap the benefits of those provisions.

Bob Saner, JD, is a principal in Powers Pyles Sutter & Verville, PC, Washington, DC, and counsel to the Pain Care Coalition of which APS is a founding member.

Mayday Pain and Society Fellowship Call For 2011 Applications

The Mayday Fund, a New York City foundation dedicated to alleviating the incidence, degree, and consequence of human physical pain, announced that it will begin accepting applications for the 2011 Mayday Pain and Society Fellowship: A Media and Policy Initiative. This is the seventh year of the program, which is designed to equip physicians, nurses, pharmacists, social workers, scientists, policy experts, and legal scholars in pain management with the necessary skills to become effective advocates and spokespeople about pain issues in the United States and Canada.

Developing their communications skills through the Fellowship, the six experts chosen will be poised to move the field forward with their willingness to educate and work with the media, policymakers, advocates, and health and business leaders. Six Fellows are chosen each year, and the Fellowship program runs through 2012.

Once selected, the six Mayday Fellows will attend a 4-day training program in Washington, DC, October 24–27, 2011, to develop skills in connecting with local and national media, writing blogs and commentary, building relationships with university public affairs and government relations leadership, and talking with federal and state elected officials and other policymakers. They will also learn how to deliver messages through new online media. Each Fellow will have 5 months of coaching with a communications officer to track progress on their plans and engage in advocacy outreach.

The Fellows will develop skills to advocate and communicate on many of the pain issues they know most closely, including pediatric pain, chronic pain, the treatment of pain with prescription pain medications, non medical treatment for pain, the use of palliative care to treat pain, pain policy, clinical and basic science research on pain, disparities in treating pain, and providers' roles in assessing and treating pain.

Candidates must be accomplished experts, clinicians, or researchers in pain management and be able and willing to devote a significant amount of time to using the skills learned in the Fellowship. They must show an interest in going beyond their professional pursuits to inspire change and make an impact on the pain field. Those interested can apply online at www.MaydayFellows.org.

The Fellowship Advisory Committee selects the six winners each year. On the Advisory Committee for the Mayday Pain and Society Fellowship are APS members Russell K. Portenoy (Chair), MD; James N. Campbell, MD; Scott Fishman, MD; Kathleen M. Foley, MD; Sandra H. Johnson, JD; Patrick John McGrath, PhD; and Lonnie Zeltzer, MD.

Collaborating with CTSAs to Advance Pain Research

NIH's National Center for Research Resources and the Clinical and Translational Science Awards (CTSA) Pain Researchers Interest Group will jointly sponsor a 2-day meeting designed to encourage collaboration with the CTSA consortium to advance pain research, with an emphasis on pelvic and sickle cell pain. Collaborating with CTSAs to Advance Pain Research will take place April 15–16, 2011, at the Natcher Conference Center (Bldg. 45) at National Institutes of Health in Bethesda, MD. For additional information about the meeting, visit the event's webpage. This event will be held in conjunction with the Sixth Annual NIH Pain Consortium meeting.

Clinical Trials SIG at the Scientific Meeting

Join the Clinical Trials special interest group (SIG) at the 2011 APS Annual Meeting in Austin, TX. The SIG has two presentations planned for their meeting. James N. Campbell, MD, will speak on "Methodological Challenges with the Evaluation of Topical Treatments for Peripheral Neuropathic Pain," and Najib Babul, PharmD, will speak on "Recent Advances in Opioid Therapy for Chronic Pain."

2011 Clinical and Basic Science Data Blitz

Managing the Patient in Pain Seminar

A new educational opportunity, "Managing the Patient in Pain: A Visit-by-Visit Skills Seminar" is scheduled for Saturday, May 21, 2011, in Austin, TX. If you know someone who might be interested in learning more about treating pain patients in the primary care setting, please tell them about this great opportunity! The seminar will give primary care professionals these skills to use in their practice:

• Tools to assess and monitor the different types of pain seen in the primary care setting, including the assessment of fibromyalgia pain, neuropathic pain, chronic low back pain, and headache
• The ability to develop an individualized treatment plan to fit the patient's pain management needs, including how to apply principles of cognitive behavioral therapy during a 20-minute office visit
• The ability to assess the risk of prescribed medication misuse by pain patients so that primary care professionals can determine which patients should be treated and which should be referred to a pain specialist
• How to use nonopioid pain treatments, including the top-10 nonopioid medications for pain, when to use these medications, adverse effects, management, and cost, as well as when to consider invasive pain management procedures for patients
• How to prescribe opioids for the treatment of pain; guidelines to follow for safe prescribing, and tools to help with the determination of high-risk patients
• How to develop and use prescribing agreements with patients to ensure the most positive outcomes in the treatment plan.

Member Community Tip

Want Help Creating Your Member Community Profile?

After logging in to the APS member community, your first stop is the "My Profile" tab on upper left. This is your home page where you will be able to create and edit your profile, upload photos and set your preferences. If you have not created a log in with APS, you can do so on the APS website. Watch a video demonstration on how to create your member community.

What initially sparked your interest in working in your field? Briefly describe your career path.
Tears rolled down my daughter's face after surgery to repair her congenital heart defect and as her mother, I was helpless to comfort her: but, because I had completed 3 years of nursing school, I checked the IV pumps to see if an adjustment could be made. I was shocked to find that my daughter was on a paralytic but was receiving nothing for pain. I was warned by the nurses, intensivists, cardiologists, and administrators that pain medicines were too dangerous in her condition. Some even tried to tell me she didn't have pain and that the tears were merely a side effect from being intubated and on a ventilator. I insisted she be medicated for pain and the administrators insisted I leave. Someone finally called the surgeon. The doctor arrived around 10 pm, and simply stated something like "if the mother wants her to have something for pain, then give her something for pain."

My husband challenged me to finish school and fix this situation for other families—he believed only an "insider" could empower lasting change. With his support, I completed my BSN from Loyola University of Chicago and my MS in pediatric nursing from Rush University. I treated pain as a bedside pediatric nurse, then as a pediatric surgery clinical nurse specialist. Several years later, we requested my daughter's chart for record of an eye exam. In the notes, I was often referred to as "the young demanding mother." I'm not as young as I was, but I still demand optimal pain management.

In 1998, I was offered the opportunity to start the pain management service at Children's Medical Center Dallas. Ironically, one of my first projects was developing a new cardiac surgery analgesic protocol with another of my daughter's cardiologists! We have made dramatic progress in pediatric acute pain management. Yet, I remain concerned that clinicians at the bedside may still have to wait for someone more knowledgeable or powerful (like Dr. Idriss) or demanding to arrive to rescue a suffering child from a system of undertreatment of pain. I recently completed my PhD in nursing research at the University of Texas at Arlington. My program of research now explores system issues that positively influence or deter bedside clinicians from achieving optimal pain management for their pediatric patients.

What has been a highlight of your work? Perhaps you and your staff are proud of a certain project or accomplishment.
When we started the pain management service in 1998, we wanted to identify gaps in clinician's knowledge of pain management and opportunities for improvement. With permission, I modified Ferrell and McCaffrey's Nurses' Knowledge and Attitude Survey (PNKAS) Regarding Pain to create the Pediatric Nurses' Knowledge and Attitude Survey Regarding Pain. This tool has been used by more than 100 organizations in the United States, as well as international institutions. The tool has also been translated by researchers in China, Taiwan, Israel, Norway, Peru, Portugal, and Italy for use by pediatric nurses. The tool was further modified to eliminate reference to cancer pain for facilities that do not provide pediatric hematology/oncology care. The PNKAS (Shriners revision 2002) has been used in many organizations in the United States, and a cross-cultural validated version is available in German.

Is there a particular challenge that you've either overcome or hope to address soon?
Despite the amazing advances we have made in acute pediatric pain management, we do not know how long children require treatment at home with analgesics after common surgical procedures. We are challenged to ensure enough analgesics are prescribed to provide optimal pain management, but prevent a surplus that may be misused. We have a responsibility to safeguard controlled analgesics for use by patients with pain, and decrease the opportunity for diversion from our patients by their friends, neighbors, and relatives.

How has membership in APS been of value to you and your professional development?
APS members are a consistent source of inspiration and ideas. Networking with APS members has helped me treat individual patients, develop systems to improve pain management in my healthcare organizations, and advocate for evidence-based practice and public policy changes. Given the interdisciplinary nature of APS, I can count on members to enlighten me with their diverse expertise, help rethink a problem, and develop effective solutions.

One of the most challenging problems in long-term geriatric care is providing adequate pain management for patients with dementia who are unable to communicate verbally. For these individuals, facial expressions, involuntary movements, and other cues should enable relatives and other informal caregivers to gauge pain intensity levels. However, a new study in The Journal of Pain, reports that informal caregivers, even though they may spend a lot of time with the loved one, frequently misinterpret nonverbal communications and, as a result, often fail to intervene for pain treatment.

Researchers at the Centre on Aging and Health at the University of Regina in Canada sought to determine the extent to which informal caregivers of dementia patients understand nonverbal expressions for evaluating pain intensity. In previous studies with nonverbal infants and children, it has been shown there are high correlations between children's and parents' ratings of postsurgical pain. It is believed that insufficient pain management in dementia patients often is caused by failure to correctly interpret nonverbal cues.

The Canadian researchers hypothesized that caregiver ratings of pain would be predicted by nonverbal pain behaviors displayed by patients and self reports (where available) would be correlated with caregiver pain ratings and personal characteristics, such as age, sex, and overall empathy. Also, the researchers explored if caregiver depression interfered with recognizing nonverbal pain expressions.

For the study, long-term care facility residents were videotaped during potentially painful routine daily activities, such as transfers, walking, dressing, as well as at rest. A large majority of the participating residents had moderate-to-severe cognitive impairment. Immediately following the activities, participating residents were asked, using a Colored Analogue Scale (CAS), to indicate how much pain they experienced. Just one in four residents was able to complete the CAS. Caregivers were asked to complete measurements of depression and empathy.

For the segment of patients able to self report their pain, there was a significant relationship between caregiver and patient ratings of pain. However, for the remaining 60 percent who communicated their pain with nonverbal cues, none of the pain behaviors displayed were considered pain cues by the caregivers. Also, caregiver characteristics such as empathy, depression, age, and sex were not determined to be predictors of pain ratings.

The researchers concluded that the surprisingly weak relationships they discovered between nonverbal patient behaviors and caregiver assessments of pain intensity show that interventions designed to help informal caregivers recognize pain cues from dementia patients are essential for effective pain management. They also noted that very often caregivers are not aware that behavioral disturbances, such as aggression, can indicate increased pain in dementia patients. Further, some have argued that as cognitive functions deteriorate caregivers can develop perceptions of personhood erosion and, therefore, communication with the loved one tends to be one-sided and patient responses are disregarded.

The finding that nonverbal pain behaviors are not predictive of caregiver pain ratings in dementia patients helps explain the well-documented undertreatment of pain in this population, according to the authors. They concluded that interventions designed to help caregivers become more attentive to specific pain cues will be valuable and could lead to better pain management for patients with dementia.

Association Between Substance Use Disorder Status and Pain-Related Function Following Twelve Months of Treatment in Primary Care Patients with Musculoskelatal Pain

Benjamin J. Morasco, Kathy Corson, Dennis C. Turk, and Steven K. Dobscha; Portland VA Medical Center, Oregon Health and Sciences University and University of Washington

It is well established that a number of individuals suffering chronic non-cancer pain have substance abuse disorder and that some physicians are apprehensive about prescribing opioids for non-cancer pain due to concerns about potential misuse and abuse. Very little is known, however, about the long-term pain management outcomes in patients with substance abuse disorder versus pain patients with no history of substance abuse. In a recent study published in The Journal of Pain, researchers from Portland VA Medical Center and Oregon Health and Sciences University explored the association of comorbid substance abuse history and 12-month treatment outcomes for chronic non-cancer patients.

For their study, the team analyzed 362 chronic non-cancer pain patients treated in primary care practices, of which 20% had a history of substance abuse history. They were enrolled in a randomized trial of collaborative care intervention and treatment as usual programs to improve pain-related physical and emotional function. The researchers evaluated whether substance abuse history status was associated with clinically significant change over 12 months in overall pain-related function.

The results showed no significant difference in outcomes for patients with a history of substance abuse from others in the collaborative care group. However, in the treatment as usual group, patients with a history of substance abuse had poorer pain-related function and more severe psychological comorbidities. The authors noted that patients with a history of substance abuse would likely require more intensive interventions to attain clinically significant improvements.

In this retrospective chart review, investigators looked at the prevalence, mean age, and association of prevalence and age of lumbar internal disc disruption (IDD), facet joint pain (FJP), sacroiliac joint pain (SIJP), spinal and pelvic insufficiency fractures, interspinous ligament injury/Baastrup's Disease, and soft tissue irritation by fusion hardware in patients with low back pain (LBP).

A total of 378 cases from 358 patients in an academic spine center were reviewed. Of these, 170 cases from 156 patients (mean age 54.4 years [SD = 16.2]; median duration of LBP 12 months [IQR = 6-32]) with recalcitrant LBP (i.e., pain not responsive to spine-focused physical therapy, oral analgesics, and oral anti-inflammatory medications) were included. The patients underwent controlled diagnostic spinal procedures until the source of their pain was identified.

Depending on clinical presentation, the following interventions were performed: discography, dual diagnostic facet joint blocks, intra-articular sacroiliac joint injections, anesthetic injections of painful interspinous ligaments/opposing spinous processes/posterior fusion hardware, or percutaneous augmentation. Several patients underwent multiple diagnostic procedures until the source of their LBP was identified.

The investigators found that the prevalence of IDD, FJP, and SIJP was 42%, 31%, and 18%, respectively. They also compared the mean age among IDD, FJP, and SIJP cohorts to determine if age is significantly associated with prevalence of IDD, FJP, or SIJP. They found that patients with IDD were significantly younger than those with FJP or SJP.

The study's results confirm that the intervertebral disc is the most common etiology of chronic LBP in adults, and the younger the patient, the more likely LBP is discogenic in origin. The investigators conclude that "Accurate diagnosis of the specific source of chronic LBP will help break the futile cycle into which many patients are directed of ineffective spinal procedures."

A New Program in Pain Medicine for Medical Students: Integrating Core Curriculum Knowledge with Emotional and Reflective Development

Beth B. Murinson, Elizabeth Nenortas, Roberts Sam Mayer, Lina Mezei, Sharon Kozachik, Suzanne Nesbit, Jennifer A. Haythornthwaite, and James N. Campbell; Johns Hopkins Hospital and Johns Hopkins School of Medicine

There is a gap between basic science and clinical pain care that indicates change is needed in medical education. Evidence suggests that current pain education doesn't incorporate the more affective dimensions of pain that are so vital in effective treatment.

In this study conducted at Johns Hopkins School of Medicine, the authors designed and delivered a new course in pain that established a foundation in pain pathophysiology, highlighted discoveries in pain science, provided practical knowledge for clinical care, and also addressed the emotional development needed in pain care.

The course was offered in May 2010. The 18-hour, 4-day course for first-year medical students featured an active-learning educational design that included laboratory sessions, team-based learning, small group discussion with pain experts, incorporation of literary and artistic depictions of pain, exercises that focused on the affective dimensions of pain, and only 4 lecture hours.

A total of 118 medical students and one biomedical graduate student completed the course. All students received a passing grade, and a number of methods were used to assess performance, including multiple-choice tests of pain knowledge, attendance, reflective pain portfolios, and satisfaction measures.

In all, 24 contributing faculty members were involved directly in teaching and 67 faculty contact hours were committed to the 18-hour course. Preparation of course materials took place over 3 years.

The authors concluded that this course, which addressed both the affective and cognitive dimensions of pain, was an effective educational approach. The course "is associated with attainment of foundation knowledge, robust engagement in tasks addressing emotional development, and high levels of learner satisfaction." They believe that "Taken as a whole, the course represents a substantial advance toward inclusion of important pain-relevant learning objectives into the medical curriculum of our school."

The authors suggest that long-term advocacy to improve pain education as part of a patient-centered medical curriculum is needed in response to the widespread under treatment of pain.

Fibromyalgia has a prevalence rate of 2% to 4% of the general population and information about the factors that lead to the disorder is limited. Most research studies focus on what led to the development of fibromyalgia after its onset. In a study from PAIN, researchers looked to determine the causal factors of fibromyalgia before it developed.

Using the National Data Bank for Rheumatic Disease, researchers identified 9,793 patients with rheumatoid arthritis (RA) who have not already developed fibromyalgia or patients with high levels of fibromyalgia symptoms by using modified ACR 2010 diagnostic criteria. The purpose of the study was to determine rates and predictors for the future of development of the disorder. Researchers followed the 9,793 RA patients through 42,591 patient years of follow-up (the mean study time was 4.4 years [range 0.5–11 years]).

Based on the 42,591 patient years of follow-up, researchers found a rate of 4.1 and 5.7 per 100 patient years for men and women, respectively. According to the researchers, "at last follow-up, 7.0% of men and 8.1% of women satisfied fibromyalgia criteria" and from those 1,926 patients, 1,635 were identified for further observation. These patients had at least one observation in addition to satisfying the fibromyalgia criteria. Patients moved in and out of the criteria because of flares.

Predictors of fibromyalgia were examined in series using combinations of variables, including age, body mass index (BMI), smoking, household income, fatigue, and sleep, among many others. Limited data on predictive causal factors is available. One study with similar risk levels noted that a higher BMI could lead to the development of fibromyalgia; however, in this PAIN study, the researchers used BMI as an individual variable but found it to be a weak predictor. Other community studies relating to widespread pain predictors have similar outcomes and predictors to the fibromyalgia study performed—including fatigue, sleep problems, psychological distress, and somatic and psychosocial symptoms.

Limitations of the fibromyalgia study include the use of patient self-report for determining causal factors for development of this syndrome and can be affected by fibromyalgia patients reporting their symptoms and events as more severe. One of the most important findings of this study was that RA patients with sociodemographic disadvantages, psychosocial distress, comorbidity, more severe RA, and greater baseline fibromyalgia symptoms are more likely to develop fibromyalgia. Although the study found these factors to have a causal relationship with fibromyalgia characteristics, there is a need for more research on the correlation between the predictive factors and the development of fibromyalgia.

Persistent Ictal-Like Visual Cortical Excitability in Chronic Migraine

Wei-Ta Chen, Shuu-Jiun Wang, Jong-Ling Fuh, Ching-Po Lin, Yu-Chieh Ko, and Yung-Yang Lin; Taipei Veternas General Hospital and National Yang-Ming University

A patient experiencing episodic migraines will report having migraine attacks 1–6 times a month, while a chronic migraine patient will report ≥8 migraine attacks per month. Although there is no known mechanism, episodic migraines may evolve into a chronic migraine condition. Central excitability is a proposed mechanism for migraine and the abnormal excitability in the visual cortex that prompts migraine aura may be a part of the pathophysiology of migraine.

Chronic migraine is considered a major subtype of chronic daily headache and those suffering from chronic daily headache report headaches almost daily. According to a previous study, 14% of episodic migraine patients developed chronic daily headaches following a 1-year follow-up. The mechanism that causes the development of chronic migraine is still unknown and studies to determine migraine causes have yielded support of excitability in the visual cortex as a mechanism.

In this PAIN study, the authors hypothesized that an ictal-like central excitability persists in chronic migraines even in the absence of migraine attacks. Researchers divided 95 patients from the Headache Clinic of Taipei Veterans General Hospital into 4 groups: chronic migraine (n = 25), interictal episodic migraine (n = 29), ictal episodic migraine (n = 9), and healthy control (n = 23). Subjects were asked to complete a questionnaire on their first visits to help establish study demographics and headache profiles. During the study, researches analyzed visual evoked magnetic field (VEF) responses and reactions to visual stimulation.

The study was analyzed in two parts: first, researchers compared the chronic migraine, interictal episodic migraine, and control groups to determine differences in VEF alterations among the three groups with a focus on chronic migraine variation. Following the initial VEF comparisons, the ictal episodic migraine group was compared with chronic migraine subjects to further determine VEF trends.

Two major findings from the study were determined through VEF recordings, statistical analysis, and study review. Chronic migraine patients in the interictal state have an excitability change that is similar to ictal episodic migraine patients. This finding is supported by the increasing number of headaches in chronic migraine evolution. The second finding from the study was that the underlying mechanisms that spur chronic and episodic migraine disorders are different. By observing interictal excitability changes in chronic and episodic migraine patients, researchers concluded the excitability in the visual cortex is higher in chronic migraine patients because of lower phosphene thresholds and therefore chronic migraine can be characterized by an ictal-like central excitability of the visual cortex.

Welcome to Austin!

The APS Annual Scientific Meeting is taking place in Austin this year! Come for the meeting and everything else this great city has to offer. Austin celebrates the individual, reveling in the unique and sometimes weird. This small town turned big city is a welcoming and open place where you can just be yourself. Known for its live music and great atmosphere, Austin has something for everyone to enjoy, day or night. Boasting more than 200 music venues and thousands of musicians, the city offers any activity that moves you. Enjoy Austin—with its 300 days of sunshine a year—indoors and out. Take a historic walking tour or bike the miles of trails in Austin's 200-plus parks. Or just take in the sites of Lady Bird Lake in the center of town.

When it comes to food, Austin knows no limits! Any craving, from fusion cuisine to barbeque and comfort foods, will be met with satisfaction at one of Austin's popular eateries. Enjoy the culture and community that thrives in Austin. For additional information, visit www.austintexas.org. Sign up for Austin's e-newsletter or request a visitor's guide to get information about upcoming events, discounts, and fun ideas.

Pain in the Media

Study Says 2 Therapies Help Fight Chronic Fatigue Syndrome (BusinessWeek)

The End of Ouch? (TIME)

Treating Chronic Pain and Managing the Bills (New York Times)

Back pain university research helped by old bones (BBC)

Pain, Persistence, Family: Sickle Cell Disease (New York Times)