Treating Neuropathy and Nerve Painthe Feet

Let me start with I'm a diabetic. I developedneuropathy, which basically you lose all sensationthe feet, but it's over a period of time.It was very painful. I would have sensationsmy feet like I was standing on fire, walkingon glass. Last October it got so bad that I couldn't sleep at night. Then I met Bullard, because he's just a great physician. I wouldn't think twice, I'd recommendhim to anybody. Very compassionate, very thorough, I can't say enough about Bullard. He'sjust a great physician and I don't know if there's anything he couldn't do hecould probably move mountains if he wanted to!Glen, probably one of the biggest questions

people are asking you is what'd we do, what'shappened. Of course, you had a tremendous improvementyour pain and the tinglingand the numbness. Easiest explanation is, to tell everybody, that this big nerve here,which is on the inside part of your left foot, was getting strangled. There was a noose aroundit. What we did is we wentand loosened the noose, and that allows that nerve to beginto function and work like it's supposed to.Now, the sensation is coming back, it's something that's going to take time butI can feel more. My quality of life has greatly improved since I had the procedure done by Bullard. There's no other physician

that I would recommend.Glen,the next couple weeks, what we're going to do is make sure that the swellingis improving, hopefully begin to transition you out of your compression socks, becauseI know it's kind of hot right now, and then look at making sure that your shoe gear andthings like that are where they're supposed to be, fitting you well, protecting your feetand stuff. Ok? Very good. Thank you, I appreciate it, havea good weekend! You do the same. Alright, see ya.

Pathophysiology of Pain by Catherine Dowling RN MS CCRN for OPENPediatrics

Pathophysiology of Pain by Catherine Dowling. Hi. My name is Catherine Dowling. I'm a nurseat Chilen's Bostonthe Cardiac ICU. The objectives of this presentation are tounderstand the physiology of pain and its effects, and to identify the sources of pain. Introduction. Pain is defined as an unpleasant sensory andemotional experience associated with actual or potential tissue damage. Pain often occursin critical care patients, and is one of the

most allychallenging problems for criticalcare nurses. Pain Physiology. Pain receptors are free nerve endings thatrespond to painful stimuli. Pain receptors are found throughout all tissue except thebrain. And they transmit information to the brain. They are stimulated by biological,electrical, thermal, mechanical, and chemical stimuli. Pain perception occurs when thesestimuli are transmitted to the spinal cord and then to the central areas of the brain. Physiological indiors of pain can be expressedin many ways. Tachycardia, increased blood

pressure, tachypnea, diaphoresis, pallor,decreased peripheral circulation, and pupil dilation are all physical signs of pain. However,the majority of these signs can also be an indior of decreased cardiac output. Behavioral Cues to Pain. There are many ways a child will express hisor her pain. These cues are demonstrated by both verbal and nonverbal patients. Some of the ways a child may express theirpain are facial expressions, such as a grimace, crying or moaning, whining, clenching teethor lips, opening eyes wide, yelling or screaming,

restlessness and agitation, lying rigidly,touching the operative site, guarding or splinting, insomnia, combativeness, poor apite, andwithawal. Sources of Pain. There are many potential sources of pain,including incisions, invasive lines and tubes, procedures, positioning, physical discomforts,and emotional factors. Incision pain from surgical proceduresthe cardiac intensivecare unit differs depending on the type of procedure performed. For example, thoracotomyincisions tend to be the most painful due to rib manipulation.

Chest tubes also play a large rolediscomfortof the postoperative patient and should be consideredpain management, especiallywhen the patient is mobile. Patients with an inability to reposition themselves shouldbe frequently turned at a minimum of every two hours for comfort measures. Emotionalfactors and environmental stressors may also play a rolepostoperative pain management. If the environment of the room is loud andstressful, this may contribute to the patient's discomfort and increase their level of stress.Pain is always stressful, but stress is not necessarily painful. Both require assessment.

Pain Misconceptions. Many people have misconceptions about painin chilen. These myths still exist even though there is now evidence to support thatthey are not true. The most common myths about painchilen include the following: Infants do not feel pain due to incompletemyelinization of nerves, a child that can play or sleep does not have pain, pain isexperienced the sameevery patient, and patients who exaggerate their pain and itseffects are trying to manipulate others to obtain secondary gains.

Role for CalciumPain Signaling

This is Duke University. My name is Wolfgang Liedtke. I'm an associate professor of biologythe Duke University Pain s. Isee patients with facial pain andmy laboratory we study pain mechanisms. Pain is a physiological mechanism that's protective and that has evolved and given as a survival advantage.However, pain can also

become dysfunctional and chronic and become a disease that tormentspatients. As a model for facial pain, we investigated the ones pain behavior that relies on asingle neuron that is present on the anterior end of theworm. To investigate OSN9 ion channelsthese animals and theirrolepain behavior, we introduced mutations

the OSN9 channelorderto be able to understand it. Threedimensional conformation of OSN9 and as it functionsin pain: Normal OSN9 channels conductcalcium and sodium to pass from the outside ofthe cell to the inside. We have introduced changestheselectivity filter of the OSN9 channel that make these channels impermeable to calcium. These findings are ofimportance

for understanding the role of calcium ions how the nerve cell is triggering pain behavior and how the nerve cell isreprogrammed for later. This reprogramming hasimportance for understanding of chronic pain.Produced by Duke University online at