Killian's photographs: "Facies dolorosa", the countenance of pain.

The book "Facies dolorosa" by Hans Killian, first published in 1934 and later in 1956 and 1967 as extended and annotated versions, comprises ~ 70 photographs depicting facial expressions of patients suffering from various diseases. The photographs in black and white are analyzed and annotated by the author with the purpose of providing clinicians, and especially young doctors, with an insight into the medical and scientific value of facial expression of pain in the diagnosis, staging, and prognosis of severe disease. This historical review of a book no longer in print is part of a 2016 commemorative publication marking the 60th anniversary of the publication of the "Facies dolorosa" by Dustri Medical and Scientific Publications, Munich, Germany and Rockledge, USA.

Fibromyalgia diagnosis: a review of the past, present and future.

Diagnosis of fibromyalgia (FM) remains controversial even though diverse diagnostic criteria have been developed. This review looks at the history, evolution of diagnostic criteria, endless controversy, recent trends and future perspectives regarding FM diagnosis. Some have criticized that diagnosis of FM could lead to medicalization, whereas others have raised concerns of under-diagnosing FM. With the evolution of diagnosis criteria from American College of Rheumatology 1990 to modified American College of Rheumatology 2010, diagnosis of FM has become simpler. The recent trend of applying patient-reported questionnaires has also increased a simpler FM diagnosis. Reliable biomarkers will not be available for the foreseeable future, so diverse assessment tools will have to be used more pro-actively. After initial diagnosis, multiple and comprehensive assessment measures are needed during the course of treatment in order to better understand type and severity of FM symptoms. These, in turn, could help classify FM based on symptom domain, symptom severity, and comorbidity which would enable more personalized treatment.

Myofascial Trigger Points Then and Now: A Historical and Scientific Perspective.

The intent of this article is to discuss the evolving role of the myofascial trigger point (MTrP) in myofascial pain syndrome (MPS) from both a historical and scientific perspective. MTrPs are hard, discrete, palpable nodules in a taut band of skeletal muscle that may be spontaneously painful (i.e., active) or painful only on compression (i.e., latent). MPS is a term used to describe a pain condition that can be acute or, more commonly, chronic and involves the muscle and its surrounding connective tissue (e.g. fascia). According to Travell and Simons, MTrPs are central to the syndrome-but are they necessary? Although the clinical study of muscle pain and MTrPs has proliferated over the past two centuries, the scientific literature often seems disjointed and confusing. Unfortunately, much of the terminology, theories, concepts, and diagnostic criteria are inconsistent, incomplete, or controversial. To address these deficiencies, investigators have recently applied clinical, imaging (of skeletal muscle and brain), and biochemical analyses to systematically and objectively study the MTrP and its role in MPS. Data suggest that the soft tissue milieu around the MTrP, neurogenic inflammation, sensitization, and limbic system dysfunction may all play a role in the initiation, amplification, and perpetuation of MPS. The authors chronicle the advances that have led to the current understanding of MTrP pathophysiology and its relationship to MPS, and review the contributions of clinicians and researchers who have influenced and expanded our contemporary level of clinical knowledge and practice.

[Medicine and pain: history of a relationship]. / Médecine et douleur: histoire d'une relation.

The vagueness surrounding the terms "suffering" and "pain" invites us to reflect upon the relationships between a physiological fact and a constitutive dimension of the human experience. History shows a constant medical preoccupation facing pain as a clinical symptom, endowed with a rich terminology, many ways of relieving pain and speculations on its diagnostic value. In the contemporary era, pain is revealed as a proper scientific object. This development accompanies an evolution of medical practices on pain that, far from representing continuous progress, adopts rather uneven and sometimes surprising outlines. As a whole, medicine is characterised by an important ambivalence when confronting pain, valuating it as an useful auxiliary or on the contrary denying the painful experience.

[Childrens' pain, a complex entity to be explored]. / Douleur chez l'enfant, une complexité á explorer.

From unrecognized babies' pain, to new discoveries made on early emotional memory and sensory capacities, chronic pain in childhood remains a complex field still to be explored. Besides, the discovery of early fetal sensorial receptions is an opening to new understanding of the origin of psychological chronic pain from early childhood to adolescence. From the silent babies suffering of emotional regulation disorder to adolescents' chronic recurrent pains, a common point is the expression of a psychic disease through the body. Different therapeutic actions are described, because without treatment chronic or recurrent pains may lead to a real risk of intellectual, affective and drive impoverishment for the suffering child.

[From disability to the adunatos: some thoughts on disability and somatoform pain disorder]. / De l'invalide à l'adunatos: réflexions sur l'invalidité et le trouble somatoforme douloureux.

Disability, especially if related to a psychiatric disorder, such as somatoform pain disorder, is characterized by medical, psychological, relational, social and societal, as well as financial and political aspects. This manuscript, part of a PhD thesis which reflects on a possible dialogue between an ancient text and the modern conceptualization of disability, tries to address the phenomenological, historical and political dimensions of disability.

The rise and fall of the dolorimeter: pain, analgesics, and the management of subjectivity in mid-twentieth-century United States.

This article describes how two experimental technologies, the Hardy-Wolff-Goodell dolorimeter and the clinical trial, were involved in, and transformed by, American analgesic research. Introduced in 1940, the dolorimeter quickly became popular as an analgesic-testing technology. By the early 1950s, however, the main sources of funding for analgesic evaluation had shifted to Henry K. Beecher's clinical trial methodology. To explain both the initial popularity of the dolorimeter and its displacement by the clinical trial, I examine the demands and resources generated by those who participated-as sponsors, investigators, collaborators, or subjects-in analgesic research and evaluation. These actors linked methodological designs to material resources, social interactions, and epistemological values, changing how pain-relieving efficacy both should and could be evaluated. They also mediated the interaction between specific expectations of, and investments in, analgesic evaluation and broader ideas about the reliability of drug evaluation and the subjectivity of pain. My analysis thus connects the changing social and material configuration of analgesic evaluation to the rise of clinical trials as well as increasingly psychological understandings of pain in order to frame the rise and fall of the dolorimeter.

Assessing pain by facial expression: facial expression as nexus.

The experience of pain is often represented by changes in facial expression. Evidence of pain that is available from facial expression has been the subject of considerable scientific investigation. The present paper reviews the history of pain assessment via facial expression in the context of a model of pain expression as a nexus connecting internal experience with social influence. Evidence about the structure of facial expressions of pain across the lifespan is reviewed. Applications of facial assessment in the study of adult and pediatric pain are also reviewed, focusing on how such techniques facilitate the discovery and articulation of novel phenomena. Emerging applications of facial assessment in clinical settings are also described. Alternative techniques that have the potential to overcome barriers to the application of facial assessment arising out of its resource intensiveness are described and evaluated, including recent work on computer- based automatic assessment.

From pleasure to pain: The role of the MPQ in the language of phantom limb pain.

In opposition to the argument that pain is private, personal and unsharable, I propose that the intersubjectivity of pain is fundamental to it. Using the case of phantom limb, I show how a specific language of pain emerged and became concretized in the US circa 1975 with the advent of the McGill Pain Questionnaire (MPQ). Through widespread use of the MPQ, a language of pain materialized, one that was commonly used to describe the qualitative dimensions of phantom limb. After 1975, the terminology used within the medical literature was overwhelmingly consonant with the set of descriptors advanced by the MPQ. The utilization of a pain questionnaire to assess the qualitative dimensions of phantom limb effectively accentuated pain, and by 1980, what was once considered relatively rare became a common sequela of phantom manifestation.

Diagnosis versus dialogue: oral testimony and the study of pediatric pain.

Through the perspectives of the children, this essay examines the communication between pediatric pain patients and their doctors. Based upon the oral history responses of thirty-two patients with chronic pain present for evaluation at the Pediatric Pain Clinic at UCLA, oral testimony was employed to uncover a wide range of topics related to a child's experience with pain such as family dynamics, how and when pain became a life-changing factor, coping strategies, and external sources that contribute to the child's understanding of pain. Most important, children were encouraged to explain what it was like to be in pain, not only to describe symptoms but also to share their dreams and hopes, their fears and uncertainties -- as well as the place of pain in their world.