In Pain

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Publisher : HarperCollins
ISBN 13 : 0062854666
Total Pages : 320 pages
Book Rating : 4.0/5 (628 download)

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Book Synopsis In Pain by : Travis Rieder

Download or read book In Pain written by Travis Rieder and published by HarperCollins. This book was released on 2019-06-18 with total page 320 pages. Available in PDF, EPUB and Kindle. Book excerpt: NPR Best Book of 2019 A bioethicist’s eloquent and riveting memoir of opioid dependence and withdrawal—a harrowing personal reckoning and clarion call for change not only for government but medicine itself, revealing the lack of crucial resources and structures to handle this insidious nationwide epidemic. Travis Rieder’s terrifying journey down the rabbit hole of opioid dependence began with a motorcycle accident in 2015. Enduring half a dozen surgeries, the drugs he received were both miraculous and essential to his recovery. But his most profound suffering came several months later when he went into acute opioid withdrawal while following his physician’s orders. Over the course of four excruciating weeks, Rieder learned what it means to be “dope sick”—the physical and mental agony caused by opioid dependence. Clueless how to manage his opioid taper, Travis’s doctors suggested he go back on the drugs and try again later. Yet returning to pills out of fear of withdrawal is one route to full-blown addiction. Instead, Rieder continued the painful process of weaning himself. Rieder’s experience exposes a dark secret of American pain management: a healthcare system so conflicted about opioids, and so inept at managing them, that the crisis currently facing us is both unsurprising and inevitable. As he recounts his story, Rieder provides a fascinating look at the history of these drugs first invented in the 1800s, changing attitudes about pain management over the following decades, and the implementation of the pain scale at the beginning of the twenty-first century. He explores both the science of addiction and the systemic and cultural barriers we must overcome if we are to address the problem effectively in the contemporary American healthcare system. In Pain is not only a gripping personal account of dependence, but a groundbreaking exploration of the intractable causes of America’s opioid problem and their implications for resolving the crisis. Rieder makes clear that the opioid crisis exists against a backdrop of real, debilitating pain—and that anyone can fall victim to this epidemic.

The Body in Pain: The Making and Unmaking of the World

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Author :
Publisher : Oxford University Press, USA
ISBN 13 : 0195036018
Total Pages : 402 pages
Book Rating : 4.1/5 (95 download)

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Book Synopsis The Body in Pain: The Making and Unmaking of the World by : Elaine Scarry

Download or read book The Body in Pain: The Making and Unmaking of the World written by Elaine Scarry and published by Oxford University Press, USA. This book was released on 1985-09-26 with total page 402 pages. Available in PDF, EPUB and Kindle. Book excerpt: Part philosophical meditation, part cultural critique, The Body in Pain is a profoundly original study that has already stirred excitement in a wide range of intellectual circles. The book is an analysis of physical suffering and its relation to the numerous vocabularies and cultural forces--literary, political, philosophical, medical, religious--that confront it. Elaine Scarry bases her study on a wide range of sources: literature and art, medical case histories, documents on torture compiled by Amnesty International, legal transcripts of personal injury trials, and military and strategic writings by such figures as Clausewitz, Churchill, Liddell Hart, and Kissinger, She weaves these into her discussion with an eloquence, humanity, and insight that recall the writings of Hannah Arendt and Jean-Paul Sartre. Scarry begins with the fact of pain's inexpressibility. Not only is physical pain enormously difficult to describe in words--confronted with it, Virginia Woolf once noted, "language runs dry"--it also actively destroys language, reducing sufferers in the most extreme instances to an inarticulate state of cries and moans. Scarry analyzes the political ramifications of deliberately inflicted pain, specifically in the cases of torture and warfare, and shows how to be fictive. From these actions of "unmaking" Scarry turns finally to the actions of "making"--the examples of artistic and cultural creation that work against pain and the debased uses that are made of it. Challenging and inventive, The Body in Pain is landmark work that promises to spark widespread debate.

Feeling Pain and Being in Pain, second edition

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Publisher : MIT Press
ISBN 13 : 0262262959
Total Pages : 199 pages
Book Rating : 4.2/5 (622 download)

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Book Synopsis Feeling Pain and Being in Pain, second edition by : Nikola Grahek

Download or read book Feeling Pain and Being in Pain, second edition written by Nikola Grahek and published by MIT Press. This book was released on 2011-12-16 with total page 199 pages. Available in PDF, EPUB and Kindle. Book excerpt: An examination of the two most radical dissociation syndromes of the human pain experience—pain without painfulness and painfulness without pain—and what they reveal about the complex nature of pain and its sensory, cognitive, and behavioral components. In Feeling Pain and Being in Pain, Nikola Grahek examines two of the most radical dissociation syndromes to be found in human pain experience: pain without painfulness and painfulness without pain. Grahek shows that these two syndromes—the complete dissociation of the sensory dimension of pain from its affective, cognitive, and behavioral components, and its opposite, the dissociation of pain's affective components from its sensory-discriminative components (inconceivable to most of us but documented by ample clinical evidence)—have much to teach us about the true nature and structure of human pain experience. Grahek explains the crucial distinction between feeling pain and being in pain, defending it on both conceptual and empirical grounds. He argues that the two dissociative syndromes reveal the complexity of the human pain experience: its major components, the role they play in overall pain experience, the way they work together, and the basic neural structures and mechanisms that subserve them. Feeling Pain and Being in Pain does not offer another philosophical theory of pain that conclusively supports or definitively refutes either subjectivist or objectivist assumptions in the philosophy of mind. Instead, Grahek calls for a less doctrinaire and more balanced approach to the study of mind–brain phenomena.

Current Therapy in Pain

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Publisher : Elsevier Health Sciences
ISBN 13 : 1416048367
Total Pages : 697 pages
Book Rating : 4.4/5 (16 download)

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Book Synopsis Current Therapy in Pain by : Howard S. Smith

Download or read book Current Therapy in Pain written by Howard S. Smith and published by Elsevier Health Sciences. This book was released on 2009-01-01 with total page 697 pages. Available in PDF, EPUB and Kindle. Book excerpt: This unique resource focuses on the diagnosis and treatment of painful conditions-both acute and chronic-from a multi-disciplinary perspective. Joined by a team of nearly 200 international contributors representing a wide range of specialties, Dr. Smith presents the best management options within and across specialties. Succinct treatment and therapy guidelines enable you to quickly access clinically useful information, for both inpatient and outpatient pain management, while a 2-color format enhances readability and ease of use and highlights key concepts. And, as an Expert Consult title, it includes access to the complete contents online, fully searchable, plus links to Medline and PubMed abstracts-providing rapid, easy consultation from any computer! Includes access to the complete text online, fully searchable, plus links to Medline and PubMed abstracts-providing quick and convenient reference from anyplace with an Internet connection. Offers a cross-discipline approach to pain management for a comprehensive view of the best treatment options within and across specialties including internal medicine, gynecology, physical medicine and rehabilitation, orthopedics, and family medicine. Provides succinct treatment and therapy guidelines, enabling you to locate useful information quickly. Organizes guidance on acute and chronic therapies in a templated format, to facilitate consistent, quick-access consultation appropriate for inpatient or outpatient pain management. Features a 2-color format that enhances readability and ease of use and highlights key concepts. Your purchase entitles you to access the web site until the next edition is published, or until the current edition is no longer offered for sale by Elsevier, whichever occurs first. If the next edition is published less than one year after your purchase, you will be entitled to online access for one year from your date of purchase. Elsevier reserves the right to offer a suitable replacement product (such as a downloadable or CD-ROM-based electronic version) should access to the web site be discontinued.

Relieving Pain in America

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Author :
Publisher : National Academies Press
ISBN 13 : 030921484X
Total Pages : 383 pages
Book Rating : 4.3/5 (92 download)

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Book Synopsis Relieving Pain in America by : Institute of Medicine

Download or read book Relieving Pain in America written by Institute of Medicine and published by National Academies Press. This book was released on 2011-10-26 with total page 383 pages. Available in PDF, EPUB and Kindle. Book excerpt: Chronic pain costs the nation up to $635 billion each year in medical treatment and lost productivity. The 2010 Patient Protection and Affordable Care Act required the Department of Health and Human Services (HHS) to enlist the Institute of Medicine (IOM) in examining pain as a public health problem. In this report, the IOM offers a blueprint for action in transforming prevention, care, education, and research, with the goal of providing relief for people with pain in America. To reach the vast multitude of people with various types of pain, the nation must adopt a population-level prevention and management strategy. The IOM recommends that HHS develop a comprehensive plan with specific goals, actions, and timeframes. Better data are needed to help shape efforts, especially on the groups of people currently underdiagnosed and undertreated, and the IOM encourages federal and state agencies and private organizations to accelerate the collection of data on pain incidence, prevalence, and treatments. Because pain varies from patient to patient, healthcare providers should increasingly aim at tailoring pain care to each person's experience, and self-management of pain should be promoted. In addition, because there are major gaps in knowledge about pain across health care and society alike, the IOM recommends that federal agencies and other stakeholders redesign education programs to bridge these gaps. Pain is a major driver for visits to physicians, a major reason for taking medications, a major cause of disability, and a key factor in quality of life and productivity. Given the burden of pain in human lives, dollars, and social consequences, relieving pain should be a national priority.

The Myth of Pain

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Publisher : MIT Press
ISBN 13 : 9780262582100
Total Pages : 328 pages
Book Rating : 4.5/5 (821 download)

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Book Synopsis The Myth of Pain by : Valerie Gray Hardcastle

Download or read book The Myth of Pain written by Valerie Gray Hardcastle and published by MIT Press. This book was released on 1999 with total page 328 pages. Available in PDF, EPUB and Kindle. Book excerpt: Valerie Gray Hardcastle argues that both professional and lay definitions of pain are wrongheaded -- with consequences for how pain and pain patients are treated, how psychological disorders are understood, and how clinicians define the mind/body relationship. Pain, although very common, is little understood. Worse still, according to Valerie Gray Hardcastle, both professional and lay definitions of pain are wrongheaded -- with consequences for how pain and pain patients are treated, how psychological disorders are understood, and how clinicians define the mind/body relationship. Hardcastle offers a biologically based complex theory of pain processing, inhibition, and sensation and then uses this theory to make several arguments: (1) psychogenic pains do not exist; (2) a general lack of knowledge about fundamental brain function prevents us from distinguishing between mental and physical causes, although the distinction remains useful; (3) most pain talk should be eliminated from both the folk and academic communities; and (4) such a biological approach is useful generally for explaining disorders in pain processing. She shows how her analysis of pain can serve as a model for the analysis of other psychological disorders and suggests that her project be taken as a model for the philosophical analysis of disorders in psychology, psychiatry, and neuroscience.

Pain

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Author :
Publisher : Other Press, LLC
ISBN 13 : 1590510925
Total Pages : 369 pages
Book Rating : 4.5/5 (95 download)

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Book Synopsis Pain by : Zeruya Shalev

Download or read book Pain written by Zeruya Shalev and published by Other Press, LLC. This book was released on 2019-11-05 with total page 369 pages. Available in PDF, EPUB and Kindle. Book excerpt: “Zeruya Shalev is one of my favorite contemporary writers, her work always spiky and original, and Pain is a searing book, a wild and ravenous story of family entanglement and impossible yearning.” —Lauren Groff, author of Florida and Fates and Furies A powerful, astute novel that exposes how old passions can return, testing our capacity to make choices about what is most essential in life. Ten years after she was seriously injured in a terrorist attack, the pain comes back to torment Iris. But that is not all: Eitan, the love of her youth, also comes back into her life. Though their relationship ended many years ago, she was more deeply wounded when he left her than by the suicide bomber who blew himself up next to her. Iris's marriage is stagnant. Her two children have grown up and are almost independent; she herself has become a dedicated, successful school principal. Now, after years without passion and joy, Eitan brings them back into her life. But she must concoct all sorts of lies to conceal her affair from her family, and the lies become more and more complicated. Is this an impossible predicament, or on the contrary a scintillating revelation of the many ways life's twists and turns can bring us to a place we would never have expected to be?

A Nation in Pain

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Author :
Publisher : Oxford University Press
ISBN 13 : 0199837201
Total Pages : 466 pages
Book Rating : 4.1/5 (998 download)

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Book Synopsis A Nation in Pain by : Judy Foreman

Download or read book A Nation in Pain written by Judy Foreman and published by Oxford University Press. This book was released on 2014-02 with total page 466 pages. Available in PDF, EPUB and Kindle. Book excerpt: From neurobiology to public policy, examines the chronic pain crisis, which is a major national health concern, discussing the latest scientific discoveries and advances in treatments and providing a sensible plan of action.

Explain Pain

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Publisher : Noigroup Publications
ISBN 13 : 0987342673
Total Pages : 138 pages
Book Rating : 4.9/5 (873 download)

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Book Synopsis Explain Pain by : David S Butler

Download or read book Explain Pain written by David S Butler and published by Noigroup Publications. This book was released on 2013-07 with total page 138 pages. Available in PDF, EPUB and Kindle. Book excerpt: Imagine an orchestra in your brain. It plays all kinds of harmonious melodies, then pain comes along and the different sections of the orchestra are reduced to a few pain tunes. All pain is real. And for many people it is a debilitating part of everyday life. It is now known that understanding more about why things hurt can actually help people to overcome their pain. Recent advances in fields such as neurophysiology, brain imaging, immunology, psychology and cellular biology have provided an explanatory platform from which to explore pain. In everyday language accompanied by quirky illustrations, Explain Pain discusses how pain responses are produced by the brain: how responses to injury from the autonomic motor and immune systems in your body contribute to pain, and why pain can persist after tissues have had plenty of time to heal. Explain Pain aims to give clinicians and people in pain the power to challenge pain and to consider new models for viewing what happens during pain. Once they have learnt about the processes involved they can follow a scientific route to recovery. The Authors: Dr Lorimer Moseley is Professor of Clinical Neurosciences and the Inaugural Chair in Physiotherapy at the University of South Australia, Adelaide, where he leads research groups at Body in Mind as well as with Neuroscience Research Australia in Sydney. Dr David Butler is an international freelance educator, author and director of the Neuro Orthopaedic Institute, based in Adelaide, Australia. Both authors continue to publish and present widely.

Magnesium in the Central Nervous System

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Publisher : University of Adelaide Press
ISBN 13 : 0987073052
Total Pages : 354 pages
Book Rating : 4.9/5 (87 download)

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Book Synopsis Magnesium in the Central Nervous System by : Robert Vink

Download or read book Magnesium in the Central Nervous System written by Robert Vink and published by University of Adelaide Press. This book was released on 2011 with total page 354 pages. Available in PDF, EPUB and Kindle. Book excerpt: The brain is the most complex organ in our body. Indeed, it is perhaps the most complex structure we have ever encountered in nature. Both structurally and functionally, there are many peculiarities that differentiate the brain from all other organs. The brain is our connection to the world around us and by governing nervous system and higher function, any disturbance induces severe neurological and psychiatric disorders that can have a devastating effect on quality of life. Our understanding of the physiology and biochemistry of the brain has improved dramatically in the last two decades. In particular, the critical role of cations, including magnesium, has become evident, even if incompletely understood at a mechanistic level. The exact role and regulation of magnesium, in particular, remains elusive, largely because intracellular levels are so difficult to routinely quantify. Nonetheless, the importance of magnesium to normal central nervous system activity is self-evident given the complicated homeostatic mechanisms that maintain the concentration of this cation within strict limits essential for normal physiology and metabolism. There is also considerable accumulating evidence to suggest alterations to some brain functions in both normal and pathological conditions may be linked to alterations in local magnesium concentration. This book, containing chapters written by some of the foremost experts in the field of magnesium research, brings together the latest in experimental and clinical magnesium research as it relates to the central nervous system. It offers a complete and updated view of magnesiums involvement in central nervous system function and in so doing, brings together two main pillars of contemporary neuroscience research, namely providing an explanation for the molecular mechanisms involved in brain function, and emphasizing the connections between the molecular changes and behavior. It is the untiring efforts of those magnesium researchers who have dedicated their lives to unraveling the mysteries of magnesiums role in biological systems that has inspired the collation of this volume of work.

Life in Pain

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Publisher : Springer
ISBN 13 : 9811056404
Total Pages : 195 pages
Book Rating : 4.8/5 (11 download)

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Book Synopsis Life in Pain by : John L. Fitzgerald

Download or read book Life in Pain written by John L. Fitzgerald and published by Springer. This book was released on 2019-09-30 with total page 195 pages. Available in PDF, EPUB and Kindle. Book excerpt: This book explores pain in a number of ways. At the heart of the book is an extension of Melzack’s neuromatrix theory of pain into the social, cultural, and economic fields. Specific assemblages involving varied institutions, flows of capital, encounters, and social and economic structures provide a framework for the formation of pain, its perception, experience, meaning, and cultural production. Complementing the extended neuromatrix is a second theory, focussed on the propensity of western market capitalism to seek out new areas of life to subsume to capital. Pain is one such life area that is now ripe for exploitation. Although the book has theory at its heart, it draws extensively on case studies to identify the contradictions and complexities. Case studies are drawn from accounts of drug use in varied contexts such as prescription drugs, methamphetamine use, oxycodone use in North America, and the global rise of the medicinal cannabis marketplace.

Confronting Chronic Pain

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Publisher : JHU Press
ISBN 13 : 1421412535
Total Pages : 256 pages
Book Rating : 4.4/5 (214 download)

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Book Synopsis Confronting Chronic Pain by : Steven H. Richeimer

Download or read book Confronting Chronic Pain written by Steven H. Richeimer and published by JHU Press. This book was released on 2014-05-15 with total page 256 pages. Available in PDF, EPUB and Kindle. Book excerpt: Richeimer's compassionate and holistic approach can help soften the harsh edges of pain and provide hope for the future.

Marijuana As Medicine?

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Publisher : National Academies Press
ISBN 13 : 0309065313
Total Pages : 216 pages
Book Rating : 4.3/5 (9 download)

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Book Synopsis Marijuana As Medicine? by : Institute of Medicine

Download or read book Marijuana As Medicine? written by Institute of Medicine and published by National Academies Press. This book was released on 2000-12-30 with total page 216 pages. Available in PDF, EPUB and Kindle. Book excerpt: Some people suffer from chronic, debilitating disorders for which no conventional treatment brings relief. Can marijuana ease their symptoms? Would it be breaking the law to turn to marijuana as a medication? There are few sources of objective, scientifically sound advice for people in this situation. Most books about marijuana and medicine attempt to promote the views of advocates or opponents. To fill the gap between these extremes, authors Alison Mack and Janet Joy have extracted critical findings from a recent Institute of Medicine study on this important issue, interpreting them for a general audience. Marijuana As Medicine? provides patientsâ€"as well as the people who care for themâ€"with a foundation for making decisions about their own health care. This empowering volume examines several key points, including: Whether marijuana can relieve a variety of symptoms, including pain, muscle spasticity, nausea, and appetite loss. The dangers of smoking marijuana, as well as the effects of its active chemical components on the immune system and on psychological health. The potential use of marijuana-based medications on symptoms of AIDS, cancer, multiple sclerosis, and several other specific disorders, in comparison with existing treatments. Marijuana As Medicine? introduces readers to the active compounds in marijuana. These include the principal ingredient in Marinol, a legal medication. The authors also discuss the prospects for developing other drugs derived from marijuana's active ingredients. In addition to providing an up-to-date review of the science behind the medical marijuana debate, Mack and Joy also answer common questions about the legal status of marijuana, explaining the conflict between state and federal law regarding its medical use. Intended primarily as an aid to patients and caregivers, this book objectively presents critical information so that it can be used to make responsible health care decisions. Marijuana As Medicine? will also be a valuable resource for policymakers, health care providers, patient counselors, medical faculty and studentsâ€"in short, anyone who wants to learn more about this important issue.

Pain and Disability

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Author :
Publisher : National Academies Press
ISBN 13 : 0309037379
Total Pages : 318 pages
Book Rating : 4.3/5 (9 download)

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Book Synopsis Pain and Disability by : Institute of Medicine

Download or read book Pain and Disability written by Institute of Medicine and published by National Academies Press. This book was released on 1987-01-01 with total page 318 pages. Available in PDF, EPUB and Kindle. Book excerpt: Painâ€"it is the most common complaint presented to physicians. Yet pain is subjectiveâ€"it cannot be measured directly and is difficult to validate. Evaluating claims based on pain poses major problems for the Social Security Administration (SSA) and other disability insurers. This volume covers the epidemiology and physiology of pain; psychosocial contributions to pain and illness behavior; promising ways of assessing and measuring chronic pain and dysfunction; clinical aspects of prevention, diagnosis, treatment, and rehabilitation; and how the SSA's benefit structure and administrative procedures may affect pain complaints.

Pain Procedures in Clinical Practice E-Book

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Author :
Publisher : Elsevier Health Sciences
ISBN 13 : 1437737749
Total Pages : 657 pages
Book Rating : 4.4/5 (377 download)

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Book Synopsis Pain Procedures in Clinical Practice E-Book by : Ted A. Lennard

Download or read book Pain Procedures in Clinical Practice E-Book written by Ted A. Lennard and published by Elsevier Health Sciences. This book was released on 2011-06-11 with total page 657 pages. Available in PDF, EPUB and Kindle. Book excerpt: In the 3rd Edition of Pain Procedures in Clinical Practice, Dr. Ted Lennard helps you offer the most effective care to your patients by taking you through the various approaches to pain relief used in physiatry today. In this completely updated, procedure-focused volume, you’ll find nearly a decade worth of new developments and techniques supplemented by a comprehensive online video collection of how-to procedures at www.expertconsult.com. You’ll also find extensive coverage of injection options for every joint, plus discussions of non-injection-based pain relief options such as neuromuscular ultrasound, alternative medicines, and cryotherapy. Offer your patients today’s most advanced pain relief with nearly a decade worth of new developments and techniques, masterfully presented by respected physiatrist Ted Lennard, MD. Make informed treatment decisions and provide effective relief with comprehensive discussions of all of the injection options for every joint. Apply the latest non-injection-based treatments for pain relief including neuromuscular ultrasound, alternative medicines, and cryotherapy. See how to get the best results with a comprehensive video collection of how-to procedures at www.expertconsult.com, and access the complete text and images online.

Core Topics in Pain

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Author :
Publisher : Cambridge University Press
ISBN 13 : 9781139447027
Total Pages : 376 pages
Book Rating : 4.4/5 (47 download)

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Book Synopsis Core Topics in Pain by : Anita Holdcroft

Download or read book Core Topics in Pain written by Anita Holdcroft and published by Cambridge University Press. This book was released on 2011-03-03 with total page 376 pages. Available in PDF, EPUB and Kindle. Book excerpt: Originally published in 2005, Core Topics in Pain provides a comprehensive, easy-to-read introduction to this multi-faceted topic. It covers a wide range of issues from the underlying neurobiology, through pain assessment in animals and humans, diagnostic strategies, clinical presentations, pain syndromes, to the many treatment options, for example, physical therapies, drug therapies, psychosocial care and the evidence base for each of these. Written and edited by experts of international renown, the many concise but comprehensive chapters provide the reader with a guide to all aspects of pain. It is an essential book for anaesthetic trainees and is also an invaluable first reference for surgical and nursing staff, ICU professionals, operating department practitioners, physiotherapists, psychologists, healthcare managers and researchers with a need for an overview of the key aspects of the topic.

Understanding Pain

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Author :
Publisher : MIT Press
ISBN 13 : 0262304503
Total Pages : 189 pages
Book Rating : 4.2/5 (623 download)

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Book Synopsis Understanding Pain by : Fernando Cervero

Download or read book Understanding Pain written by Fernando Cervero and published by MIT Press. This book was released on 2012-08-17 with total page 189 pages. Available in PDF, EPUB and Kindle. Book excerpt: An expert explores the biological and emotional nature of pain: why it hurts and why some pain is good and some pain is bad. If you touch something hot, it hurts. You snatch your hand away from the hot thing immediately. Obviously. But what is really happening, biologically—and emotionally? In Understanding Pain, Fernando Cervero explores the mechanisms and the meaning of pain. When you touch something hot, your brain triggers a reflex action that causes you to withdraw your hand, protecting you from injury. That kind of pain, Cervero explains, is actually good for us; it acts as an alarm that warns us of danger and keeps us away from harm. But, Cervero tells us, not all pain is good for you. There is another kind of pain that is more like a curse: chronic pain that is not related to injury. This is the kind of pain that fills pain clinics and makes life miserable. Cervero describes current research into the mysteries of chronic pain and efforts to develop more effective treatments. Cervero reminds us that pain is the most common reason for people to seek medical attention, but that it remains a biological enigma. It is protective, but not always. Its effects are not only sensory but also emotional. There is no way to measure it objectively, no test that comes back positive for pain; the only way a medical professional can gauge pain is by listening to the patient's description of it. The idea of pain as a test of character or a punishment to be borne is changing; prevention and treatment of pain are increasingly important to researchers, clinicians, and patients. Cervero's account brings us closer to understanding the meaning of pain.