The human sexuality education of physicians in North American medical schools.

Individuals seeking treatment for sexual problems frequently would like to turn to a source they consider knowledgeable and worthy of respect, their doctor. The objective was to assess how well the 125 schools of medicine in the United States and the 16 in Canada prepare physicians to diagnose and treat sexual problems. A prospective cohort study was carried out. The main outcome results were description of the medical educational experiences, teaching time, specific subject areas, clinical programs, clerkships, continuing education programs in the domain of human sexuality in North American medical schools. The results were as follows. There were 101 survey responses (71.6%) of a potential of 141 medical schools (74% of United States and 50% of Canadian medical schools). A total of 84 respondents (83.2%) for sexuality education used a lecture format. A single discipline was responsible for this teaching in 32 (31.7%) schools, but a multidisciplinary team was responsible in 64 (63.4%) schools (five schools failed to respond to the question). The majority (54.1%) of the schools provided 3-10 h of education. Causes of sexual dysfunction (94.1%), its treatment (85.2%) altered sexual identification (79.2%) and issues of sexuality in illness or disability (69.3%) were included in the curriculum of 96 respondents. Only 43 (42.6%) schools offered clinical programs, which included a focus on treating patients with sexual problems and dysfunctions, and 56 (55.5%) provided the students in their clerkships with supervision in dealing with sexual issues. In conclusion, expansion of human sexuality education in medical schools may be necessary to meet the public demand of an informed health provider.

The mystery of phantom pain: growing evidence for psychophysiological mechanisms.

The direct, and much of the indirect, evidence supporting the existence psychophysiological mechanisms for phantom limb pain is reviewed. Phantom pain is shown to be a symptom class composed of different, but similarly described problems, each having its own underlying mechanisms. At least some descriptive types of phantom pain probably have mainly peripheral, as opposed to only central, origins. Although much of the direct data are preliminary, burning phantom pain is probably related to decreased blood flow in the residual limb, while cramping phantom pain is mainly related to spikelike muscle spasms in the major muscles of the residual limb. Little support is provided for psychological causes for phantom pain, but the expression of phantom pain does appear to be influenced by psychological mechanisms similarly to the ways other chronic pain conditions are influenced. The importance of a careful psychophysiological assessment of patients to treatment success is discussed. Because several different mechanisms are involved, no one treatment is likely to be effective for all of the different types of phantom pain. Appropriate combinations of self-regulation strategies aimed at controlling the underlying physiological problems are likely to be effective in reducing the incidence and severity of burning and cramping types of phantom pain.

Phantom pain: a lesson in the necessity for careful clinical research on chronic pain problems.

Recent findings suggest that major misunderstandings concerning the prevalence, characteristics, etiology, and treatment effectiveness of phantom pain have led to the widespread mismanagement of amputees throughout the history of modern medicine. For years it has been believed that phantom pain is relatively rare, is of unknown etiology, and probably has a psychological basis. Research results over the last few years, however, suggest that phantom pain is widely prevalent among individuals with amputations and most likely has a physiological basis. Although many different treatments have been introduced recently, few, if any, have yet been documented as effective due to lack of rigorous follow-up studies. Future progress in clinical treatment and increased scientific understanding of phantom pain will require an examination of some of the factors that have led to past confusion regarding scientific research on and clinical treatment of phantom pain.

Differences between trunk heat patterns shown by complete and incomplete spinal cord injured veterans.

Thermograms showing heat patterns in the trunk of the body were taken of ten intact subjects, seven subjects with incomplete spinal cord injuries (SCI), and fifteen subjects diagnosed as having complete SCIs. Fourteen of the subjects with complete SCIs had a thermal demarcation line across the trunk. This line represented a temperature gradient of one to 2.5 degrees Celsius between a relatively warm upper level where sensations were normal and a relatively cool lower level in which sensations were either absent or different from pre-injury sensations. The transition zone was narrow and sharp for ten of the complete SCI subjects but was wide and gradual for the other five complete SCI subjects. The shape and width of the thermal transition zone corresponded to the location and degree of abruptness with which sensations changed from normal to abnormal. One of the subjects diagnosed as having a complete SCI failed to show a significant transition zone. The temperature difference between the upper and lower portions of his trunk was less than one degree Celsius. None of the intact or incomplete SCI subjects produced the transition zone. Only one incomplete SCI subject showed even a minimal difference in temperature between the normal sensation and abnormal sensation levels. A panel blind to the subjects' conditions was unable to differentiate between intact and incomplete SCI subjects but was able to sort complete from incomplete SCI subjects in all but the case with an indistinct transition zone.

Relationships between near surface blood flow and altered sensations among spinal cord injured veterans.

Ten patients with clinical diagnoses of complete transverse spinal cord tissue destruction were interviewed about any sensations they felt below the level at which normal feelings were evident. All ten reported experiencing various feelings most of the time and nine reported that some of those feelings were usually quite painful. Videothermographs showing differences in skin temperature of 0.1 degrees celsius were taken to evaluate blood flow patterns to a depth of 1.5 cm. Changes in blood flow patterns were found to correlate highly with the level at which sensations changed from normal to abnormal and to correlate virtually exactly with the locations of pain reported from supposedly desenate areas.