Some current problems in pain research and therapy (including needle puncture, "acupuncture") (Part II of the second John J. Bonica lecture)

Trigeminal neuralgia: neurosurgical management options

The lancinating facial pain of trigeminal neuralgia usually responds to medical treatment. However, in some patients, trigeminal neuralgia is refractory to drug therapy. In addition, some patients are unable to tolerate the side effects of medication. In these cases, several safe and effective surgical procedures are available for the treatment of this common facial pain syndrome.

What is being stimulated in acupuncture: evaluation of the existence of a specific substrate

This review surveys the available publications from within and without China on the question of "What is being stimulated in acupuncture?" Although a definite answer is not yet forthcoming, indirect evidence is available to afford a few speculations. By far, the most convincing results indicate that expression of acupuncture effects definitely involves the nervous system. Answers to how acupuncture is linked to the nervous system, however, are still equivocal. On one extreme, acupuncture is equated to direct nerve stimulation. On the other, circumstantial evidence from biophysical, physiologic and pathologic approaches implicates some form of specificity for the acupuncture points, although no well-defined anatomic entity is available. It is proposed that an open-minded attitude towards acupuncture is essential for establishing the valid aspects of this practice.

Pain measurement and experience

Issues and developments in clinical pain assessment will be considered. The focus will be on measuring pain, rather than degree of relief. Three main response channels may be distinguished: subjective, behavioral and physiological, although the latter will not be elaborated upon here. The measurement of subjective report of pain, although an anathema to behaviorists, continues to be one of the most widely used measures. Recent developments in assessing verbal report, of the form of questionnaires and ratings derived from psychophysical scaling methods, will be reviewed. Although behavioral indices at first sight lend themselves to well-established methods of measurement, issues in establishing rather than assuming the reliability and validity of such measures will be considered. Parallel monitoring across response channels, as well as attending to questions concerning the psychometric adequacy of measures employed, will both further our understanding of pain mechanisms and provide sound indications as to treatment efficacy.