Brain and Spine Injury Law Blog

Brain and Spine Injury Law Blog

Brain Injury Association of America Legislative Update for May 2015

Posted in Legislation, The Human Brain, Traumatic Brain Injury (TBI)

The Brain Injury Association of America asked me to share this May 2015 Legislative Update.  Here it is:

National Institutes of Health Caucus formed in the United States Senate

On Tuesday, May 19, 2015, Sens. Lindsey Graham (R-S.C.) and Dick Durbin (D-Ill.) introduced the new National Institutes of Health (NIH) caucus. The Senators will co-chair the caucus and it will focus on bolstering support for federal research and to find a way to fund it. The NIH Director, Dr. Francis Collins and other researchers participated in the dedication ceremony this week. Since 2003, NIH has lost 25 percent of its purchasing power which the senators attribute to sequestration and flat budgets.

The 21st Century Cures bill in the House which was marked out of the Energy and Commerce Committee this week includes $10 billion for NIH. The nonpartisan legislation will help to modernize and personalize health care, encourage greater innovation, support research, and streamline the system to deliver better, faster cures to more patients. To learn more about TBI work at NIH click here. To learn more about the 21st Century Cures Act click here.

Enhancing the Stature and Visibility of Medical Rehabilitation Research at the National

Institutes of Health Act

BIAA along with the Disability and Rehabilitation Research Coalition (DRRC) is working to increase support for S. 800, a bill to enhance the stature and visibility of medical rehabilitation research at NIH. This legislation would specifically:

  • Clarifies the Respective Roles of the NCMRR Director, the Director of the Institute and the Director of NIH Regarding the Research Plan. The bills place the key subject matter expert (i.e., the NCMRR Director) at the helm of the Research Plan for conducting medical rehabilitation research at NIH while making it clear that the Director of the Center is exercising this authority on behalf of the Director of NIH and the Director of the Institute and in consultation with the Medical Rehabilitation Coordinating Committee (coordinating committee) and the National Advisory Board on Medical Rehabilitation (advisory board) established by statute.
  • Updates the Trans-NIH Rehabilitation Research Plan.  The bills specify that the Research Plan must include objectives, benchmarks, and guiding principles regarding the conduct, support, and coordination of medical rehabilitation research at NIH, consistent with the purpose of the Center. The Research Plan should be updated periodically or not less than every five years.
  • Adds an Annual Rehabilitation Research Progress Report.  The bills specify that the Director of NCMRR, in consultation with the Director of the Institute, must prepare an annual report for the coordinating committee and the advisory board describing and evaluating the progress made during the preceding fiscal year in achieving objectives, benchmarks, and guiding principles included in the Research Plan. In preparing the report, the Director of the Center and the Director of the Institute must consult with the Director of NIH and the report must reflect an assessment of the Research Plan by the Director of NIH.
  • Adds a Scientific Conference or Workshop on Medical Rehabilitation Research.  The bills specify that the coordinating committee periodically, or not less than every 5 years, host a “scientific conference or workshop on medical rehabilitation research” in connection with updating of the Trans-NIH Medical Rehabilitation Research Plan.  This policy ensures periodic review of the state of medical rehabilitation science and outreach to the research community in connection with revisions of the Research Plan.
  • Improving Stature of Medical Rehabilitation Science.  The bills specify that the coordinating committee includes the Director of the Division of Program Coordination, Planning, and Strategic Initiatives in the Office of the Director of NIH and the coordinating committee is chaired by the Director of the Center, acting in the capacity of a designee of the Director of NIH.  This policy is intended to maximize the likelihood that the trans-NIH nature of medical rehabilitation research is realized.
  • Clarifies Funding Among NIH Agencies. The bills specify that the Director of the Center, in consultation with the Director of the Institute, the coordinating committee, and the advisory board, must develop guidelines governing the funding of medical rehabilitation research by the Center and other agencies of the NIH. These guidelines should ensure that funding initiatives reflect the purposes of the Center and are consistent with the Research Plan. This policy is intended to establish funding grant procedures that focus on a common understanding of medical rehabilitation research needs.
  • Includes a Definition of Medical Rehabilitation Research.  Because current law does not include a definition of the term “medical rehabilitation research,” the bills specify a definition of this term as: “The science of mechanisms and interventions that prevent, improve, restore, or replace lost, underdeveloped, or deteriorating function (defined at the level of impairment, activity, and participation according to the World Health Organization in the International Classification of Function, Disability, and Health (2001).”  This definition is consistent with the Blue Ribbon Panel recommendations and would facilitate a consistent understanding of medical rehabilitation science at NIH.

BIAA, along with 21 other DRRC organizations sent a letter of support to Congress urging the passage of S. 800.

White House Names Disability Public Engagement Representative

The White House announced this week Maria Town is the new Disability Public Engagement Representative and she will be in this position until the end of President Obama’s Administration. Ms. Town will serve as Associate Director in the Office of Public Engagement in the White House.

Maria has been involved in the Disability Rights movement for many years and has worked in the Office of Disability Employment Policy (ODEP) in the Department of Labor. You can follow Ms. Town on Twitter: @maria_m_town

 

Preserving Rehabilitation Innovation Centers Act of 2015 Introduced

This week, Congressman Pete Olson of Texas introduced the Preserving Rehabilitation Innovation Centers Act of 2015. This legislation would amend title XVIII of the Social Security Act to preserve access to rehabilitation innovation centers under the Medicare program. To read the text of this legislation click here.

From Traumatic Brain Injury to Savant

Posted in Age & Alzheimer's Issues, Books, Articles, and Literature, Las Vegas Car Accident Attorney, Las Vegas Injury Attorney, Las Vegas Motorcycle Attorney, Las Vegas Negligent or Inadequate Security Attorney, Las Vegas Truck Accident Attorney, Las Vegas Wrongful Death Attorney, Personal Injury

I post blog items and information I come across regarding Traumatic Brain Injury.  While reading professional journals, articles, and Scientific literature, I share things of interest.  One of those topics includes the unique and rare situation where a concussion actually causes the brain to exhibit genius level processing.  (Of course that does not take away from the other negative signs, symptoms, and consequences of traumatic brain injury) Think of the popular movie Rainman: being cognitively impaired while displaying the ability to count a dropped and scattered box of toothpicks on the floor.  A concussion or stroke does not usually enhance cognitive ability.

Darold Treffert, a physician who has studied savantism for many years, has chronicled the ways that people with no artistic interest or talent can suddenly develop a passion for painting or music after experiencing head trauma or other types of brain insult.

The August 2014 issue of Scientific American, an article entitled  Accidental Genius was published. The articles talks about Jason Padgett who suffered a “severe head injury.” As a consequence, he was able to visualize and draw intricate geometrical shapes. He went on to develop a passion for math, physics, and drawing geometric shapes after he sustained a concussion following an assault.  Previously math-adverse, college dropout, Padgett, now takes advance courses in math to better understand the geometric shapes he can draw.

Neurologist, Bruce Miller, of the University of California, San Francisco, has been studying FTD.  FTD stands for frontal temporal dementia. It differs from Alzheimer’s dementia in that the degenerative process affects only the frontal lobes and not wider areas of the brain.

Researchers would like to unlock the key to obtaining acquired savantism, without the concussion.   How to bring out the inner-savant.   Various diagnostic tests including DTI, (diffuse tensor imaging), and DTT (Diffuse Tensor Tracking), as well as PET (Positron Emission Tomography) and NIRS (Near Infrared Spectroscopy) are able to capture brain activity during the carrying out of creative tasks.

The question is whether these studies are worth pursuing.

Acquired savantism provides strong evidence that a deep well of brain potential resides within all of us.  The challenge now is to find the best ways to tap into our inner savant – that little bit of Rain Man – while keeping the rest of our mental facilities intact.

Research Reveals Traumatic Brain Injury Can Be Reduced From Brain’s Ability To Heal Itself

Posted in Brain Injury News and Event Update, Las Vegas Injury Attorney, Personal Injury, The Human Brain, Traumatic Brain Injury (TBI)
Brain Lipids

 The Cure for Traumatic Brain Injury?

In an extensive opinion piece recently published online on Expert Opinion on Investigational Drugs, researchers make the case for pioneering work underway seeking to understand and repair brain function at the molecular level.

Also known as TBI, traumatic brain injury most commonly results from a sudden, violent blow to the head, in some cases driving broken bone into the brain, or from a bullet or other object piercing the skull and entering the brain.

This trauma sets off a complex constellation of reactions in the brain that can impair thinking and reasoning, behavior and movement.

Each year, at least 10 million TBIs that are serious enough to result in hospitalization or death occur around the world.

Most attempts at treatment have targeted the physical damage with drugs aimed at protecting neurons — the cells that carry messages from the brain to the rest of the body — from further damage. But while such attempts have shown promise in animal studies, they’ve all failed to help human patients.

Over the past three decades, more than 30 such clinical trials have ended in failure.

More recently, evidence has been amassed by researchers showing that the human brain has “a significant, albeit limited” ability to repair itself both physically and functionally, including:

Angiogenesis — the creation of new blood vessels.

Neurogenesis — the formation of new nerve cells.

Oligodendrogenesis — the development of several types of cells including those that make up the myelin sheath, a protective coating on parts of nerves.

• Axonal sprouting — the process of in which undamaged axons, threadlike parts of nerve cells that carry signals to other cells, grow new nerve endings to relink damaged neurons.

These findings will greatly assist physicians in treatment and care of those with traumatic brain injury.  This is great news!

Smell Test Helps Predict Traumatic Brain Injury In Blast Injury

Posted in Psychiatric & Psychological Issues, Soldiers, Veterans and Military Issues, The Human Brain, Traumatic Brain Injury (TBI)

Decreased ability to identify specific odors can predict abnormal neuroimaging results in blast-injured troops, according to a new study by Federal researchers released online in the journal Neurology, March 18, 2015.

The olfactory system processes thousands of different odors, sending signals to the brain which interprets the smell by linking it to a past memory. If memory is impaired, as is the case with Alzheimer’s disease, sleep deprivation, and acute traumatic brain injury, the task is not entirely possible. When the smell test was abnormal in a subject, those soldiers were all found to have abnormalities on their brain scans.

In the field, the battlefield, determining if an injured soldier sustains brain injury in explosive events, blast injuries, is predictive of what more involved tests requiring medical equipment in a medical setting, reveal later.  Taking care of veterans should be a government concern.

Concussions, Sports, Kids

Posted in Personal Injury, The Human Brain, Traumatic Brain Injury (TBI)
Youth Sports

Recent concussion laws that set out to prevent head injuries in American teenage athletes should be extended to include the activities of summer camps, travel teams and all-star teams. This will ensure that all children and youths who suffer head injuries receive appropriate care and education. So says Thomas Trojian of Drexel University College of Medicine, lead author of a study that showed a marked increase in the number of teenagers receiving medical treatment for sports-related concussions after laws pertaining to these injuries were passed in Connecticut in 2010. The findings are published in Springer’s journal Injury Epidemiology.

The number of sports-related concussions being treated in emergency departments among American high school athletes has increased over the past decade. This is, among other reasons, because of a greater awareness that athletes with related symptoms should receive appropriate treatment. Since 2014 it has become mandatory nationwide for athletes between the ages of 14 and 18 years to be removed from play when a concussion is suspected. In such cases an athlete must also be further evaluated by a licensed medical professional.

 

 

 

 

Protecting Our Rights in Nevada

Posted in Las Vegas Injury Attorney, Personal Injury

Preserving Your

Constitutional Right to

Protect You and Your

Family

This legislative session, bills have been introduced into the Nevada Legislature that threaten your constitutional right to protect you and your family. The 7th amendment in the Bill of Rights in our U.S. Constitution guarantees you the right to a trial by jury as recourse for harm done to any citizen. These proposed new laws, which are really new government regulations to severely limit your rights, are being rushed through the legislative process at unprecedented speed, with almost no time for public input.

Here are Just a Few Examples of Those Bills:

Legislation that would substantially erode the ability of homeowners to take legal action to get shoddy workmanship in their home repaired in a timely fashion. Legislation that would virtually take away the ability of an injured person to hold the seller of dangerous products accountable, which would have protected, for example, the companies responsible for the Hepatitis C outbreak in Clark County. Legislation that would give insurance companies an unfair advantage over consumers, depriving victims of their opportunity to recover their claims, which just puts more money in the pockets of insurance companies at the expense of the wronged party.  We need your help in fighting these threats to our fundamental rights. Our legislators need to hear that their constituents oppose these new government regulations to limit their constitutional rights. To learn more about these issues and how you can help by contacting your legislators, please visit:  www.protectingournevadarights.com

$5.2 Million Brain Injury Verdict Against Trucking Company Upheld on Appeal in Texas

Posted in Las Vegas Car Accident Attorney, Las Vegas Injury Attorney, Las Vegas Truck Accident Attorney, Personal Injury, The Human Brain, Traumatic Brain Injury (TBI)

I found this recent post about a trial verdict in a case of traumatic brain injury being upheld on appeal at $5.2 million in TEXAS (of all places).  It is interesting because the plaintiff was a driver/employee of trucking company-defendant.  This is a guest post by Starkeisha Tucker.

Texas Affirms $5.2 Million Brain Injury Verdict Against Trucking Company

Posted on February 24, 2015 by

shutterstock_224285425

The Texas appellate court ruled that an injured worker may keep a $5.2 million damage award for a brain injury sustained while working for a trucking company.

The Texas appellate court affirmed the trial court’s judgment, stating the employer was negligent in providing a safe place to work.

Robinson was injured when he fell head first from an unevenly loaded flatbed trailer in April 2007. He was attempting to cover the load with a tarpaulin in the shipping yard of West Star Transportation.

Charles Robison and his wife filed suit against West Star in 2009, arguing that West Star was negligent and failed to provide a safe work place.

On appeal, West Star argued unsuccessfully that the evidence was legally and factually insufficient as to the three specific theories of liability:

  1. Failure to provide fall equipment to assist with tarping.
  2. Failure to conduct a pre-planning meeting.
  3. Failure to implement their policy to refuse to tarp over-sized loads.

 

Worker’s comp “non subscriber”

West Star, based in Lubbock, TX, was a non-subscriber under the Texas Workers’ Compensation Act at the time of the accident. In Texas, employers may opt out of the state’s workers compensation program. Texas is one of few states that offer this alternative.

Non-subscribers manage their own employee injury claims through a company-sponsored employee benefit plan. According to USLAW.Org, non-subscribers increased when workers compensation rates went up.

As a non-subscriber, West Star does not have the defenses of contributory negligence, assumption of risk or negligence.

West Star’s only defense to the suit was to show it was not negligent and thus not the proximate cause of Robinson’s injuries. Alternatively, it could show whether the plaintiff was a guilty of some act of negligence.

West Star argued because Robinson was an experienced flat-bed operator he was not owed a duty to warn, train or supervise.

Unreasonable risk

The court disagreed stating West Star created an unreasonable risk of harm to its employee by accepting an unusually large load and failing to  provide necessary safety equipment.

West Star’s remaining issues on appeal were overruled by the court. It ruled that all evidence and testimony presented to the jury was legally and factually sufficient to support the verdict.

This case is West Star Transportation v. Robison, et al., case No. 07-18-00109-CV, Texas Court of Appeals Seventh District of Texas at Amarillo.

Kevin P. Parker, The Lanier Law Firm, represented Charles Robison

March is Brain Injury Awareness Month

Posted in Brain Injury News and Event Update

With all the news in Sports, Celebrity deaths, veterans conditions, and others, it is proper that a month a year be devoted to Brain Injury Awareness.  Well March is the month.  I ran across this post from a brain injury survivor who makes the announcement.

2015-02-25-TBImarch.jpg

I find it strangely interesting that this time last year, as I was enduring the beginning of my life with a TBI, I had no idea that March was National Brain Injury Awareness Month. This year I feel compelled to shout it from the rooftops (or the computer screen)! Over the next few weeks, I intend to share with you stories and journeys of those living with a traumatic brain injury (TBI) or caring for a loved one who is recovering from one. My hope is to educate those who aren’t familiar with TBI, and to help other TBI-ers understand that they are not alone, and that their symptoms are not just “in their head” (pun intended).

Let me start by offering you some statistics on TBI from BrainTrauma.org:

  • Traumatic brain injury (TBI) is the leading cause of death and disability in children and adults from ages 1 to 44.
  • Brain injuries are most often caused by motor vehicle crashes, sports injuries, or simple falls on the playground, at work or in the home.
  • Every year, approximately 52,000 deaths occur from traumatic brain injury.
  • An estimated 1.5 million head injuries occur every year in the United States emergency rooms.
  • An estimated 1.6 million to 3.8 million sports-related TBIs occur each year.
  • At least 5.3 million Americans, 2 percent of the U.S. population, currently live with disabilities resulting from TBI.
  • Moderate & severe head injury (respectively) is associated with a 2.3 and 4.5 times increased risk of Alzheimer’s disease.
  • Males are about twice as likely as females to experience a TBI.
  • Exposures to blasts are a leading cause of TBI among active duty military personnel in war zones.
  • Veterans’ advocates believe that between 10 and 20 percent of Iraq veterans, or 150,000 and 300,000 service members have some level of TBI.
  • 30 percent of soldiers admitted to Walter Reed Army Medical Center have been diagnosed as having had a TBI.
  • The number of people with TBI who are not seen in an emergency department or who receive no care is unknown.

There are three levels of traumatic brain injuries: mild, moderate and severe. Don’t let these names fool you. A mild TBI is just as serious as a moderate or severe one. The names refer to loss of consciousness and mental alteration as a result of the trauma. In my case, we think I was unconscious for only about a minute or so, therefore classifying me as “mild”. But like I said, don’t let the name fool you. The resulting damage can be the same for all three — a TBI does not discriminate.

A TBI changes you. Literally and figuratively. My personality is different. My energy levels and sleep patterns are foreign to me. The confused woman in the kitchen staring at the oven is someone I am just now starting to understand. The woman who has to write a Post-it note for every single task on her to-do list is no longer the multi-tasker she once was. The woman who used to type at 100 words per minute with zero mistakes now has to take her time and correct many keystroke errors as she goes because her brain gets confused with letters.

I am finally coming to terms with this “new me.” It has been just over a year since I fell on the ice, landing full force on my skull. In the beginning I was angry. I was confused. I was in a lot of pain, both physically and emotionally. People didn’t understand. Didn’t believe me. Couldn’t understand my hidden injuries. I didn’t have a strong support system, but what I did have was determination!

Life with an “invisible” injury or illness can be a real challenge. Since I posted my last blog, “Life With a Traumatic Brain Injury,” on The Huffington Post last month, I have made an entirely new circle of friends. I created a group on Facebook, affectionately named “The TBI Tribe.” This is a safe place where we can hang out, talk, vent frustrations, share in each other’s successes, and more importantly, have a place where we all feel like we fit in. I was craving an environment where others understood my struggles and didn’t pass judgement. I have found exactly that in this tribe!

I want to share with you a little bit about one of my new friends, Jennifer L. White from St. Louis, Missouri:

In July of 2000 Jennifer collapsed in her Atlanta, Georgia apartment. She called 911 and told them she was dying. She did, in fact, die in the ambulance on her way to the hospital. Fortunately medics were able to resuscitate her. Doctors determined that she had had a stroke and performed brain surgery to eradicate the brain bleed. She spent 10 days in the ICU followed by several months in a rehab facility. Overnight she went from the vice president of a large marketing firm, to unemployable and on disability. The massive stroke has left Jennifer with cognitive deficiencies, balance issues, and double vision. She jokes that she can, however, make a killer peanut butter sandwich! It’s important to have a good sense of humor when dealing with a TBI. Aside from her impairments, Jennifer looks completely healthy and “normal.” A few words from Jennifer:

The brain injury has affected me in a variety of ways. Emotionally, I am fragile but working hard to toughen my spirit.  I am much more introspective (I don’t know if this is from the actual brain injury or the fact I now have more time to be introspective). Things are just harder for me than most people.   I have to actually think seriously about where I am stepping.

I define my life in two ways: before and after the stroke.  It has certainly delivered me a tough blow. I have been advised not to have children. I am scared that I am predisposed to have something else happen to me, and I am sorry that I don’t find sweetness in the sweet things in life because I am more bitter than I want to be.  But call me crazy… I am glad to be alive.

I hope that you will join me this month as I share with you more stories and continue to bring awareness to the world about TBI.

Brain Injury Association of American Legislative Update Feb 2015

Posted in Brain Injury News and Event Update

The Brain Injury Association of America asked me to post this legislative update here.

February 27, 2015

Brain Injury Awareness Day on Capitol Hill

Please join the Congressional Brain Injury Task Force, chaired by Reps. Bill Pascrell, Jr. (D-N.J.) and Tom Rooney (R-Fla.), and the Brain Injury Association of America for Brain Injury Awareness Day on Capitol Hill on Wednesday, March 18, 2015. The schedule of events for the day:

10:00 a.m. – 2:00 p.m.         Brain Injury Awareness Fair

First Floor Foyer of the Rayburn House Office                                                             Building

2:30 p.m. – 4:00 p.m.           Briefing: Finding a “New Normal”: Post-Injury Supports and Services That Make a Difference

121 Cannon House Office Building

5:00 p.m. – 7:00 p.m.           Reception Celebrating Brain Injury Awareness                                                           Month

B-339 Rayburn House Office Building

Plan to attend to network with other national and federal agencies and to visit with your Members of Congress regarding key issues affecting brain injury. Please stay tuned to BIAA’s website under the government affairs for more information.

BIAA’s President/CEO Presents on behalf of the Coalition to Preserve Rehabilitation

Susan Connors, president/CEO of the Brain Injury Association of America, joined with members of the Coalition to Preserve Rehabilitation in presenting to attendees of the American Medical Rehab Providers Association spring meeting in Washington, D.C. Ms. Connors described the challenges individuals with brain injury and their family members experience when trying to access post-acute rehabilitation at inpatient rehabilitation hospitals and units as well as residential rehabilitation facilities and out-patient clinics.

BIAA serves on nine advocacy coalitions in Washington, D.C. and serves as a steering committee member for the Coalition to Preserve Rehabilitation (CPR). The CPR is a coalition of national consumer, clinician, and membership organizations with the goal of preserving access to rehabilitation services. CPR advocates for policies that ensure access to rehabilitative care so that individuals with disabilities, injuries, or chronic conditions may regain and/or maintain their maximum level of independent function. To learn more about BIAA’s coalition work, please click here.

Therapy Cap Repeal Legislation Introduced in the United States Senate

This week, a bill to amend title XVIII of the Social Security Act to repeal the Medicare outpatient rehabilitation therapy caps, S. 539, was introduced in the  by Sen. Ben Cardin (D-Md.). The bill is cosponsored by Sens. Susan Collins (R-Maine) and Mark Kirk (R-Ill.).

The House of Representatives recently introduced legislation to fully repeal the current monetary caps on Medicare therapy services. The Medicare Access to Rehabilitation Services Act, H.R. 755, led by Reps. Charles Boustany (R-La.), Xavier Becerra (D-Ca.), Marsha Blackburn (R-Tenn.), and Lois Capps (D-Ca.), would permanently remove the limits that Medicare places on physical and speech-language therapy combined and occupational therapy. While there is an exceptions process designed for medically necessary therapy, it has been a burden and insufficient to protect access to care.

The Brain Injury Association of America works with the Therapy Cap Coalition in Washington D.C. throughout the year to repeal the therapy cap. BIAA grassroots has played a key role in the work to repeal the therapy cap. Please contact your Member of Congress today and ask him or her to address a permanent solution to the Medicare therapy caps before March 31, 2015, when the current exceptions process will expire. You can reach your representative by calling the Capitol Switchboard at 202-224-3121.

Is Pain Measurable?

Posted in Attorney Selection, Personal Injury, Psychiatric & Psychological Issues, Spine Injury, Back Injury, Neck Injury and Bone Injury, The Human Brain, Traumatic Brain Injury (TBI)
PI Suit

The use of technology in the courtroom is routinely met with skepticism initially.  A new area where technology has offered the potential to objectively observe pain, a subjective complaint, in other people. fMRI has become useful in the area of proving brain injury in court, and now may be able to help us quantify pain. Most personal-injury cases settle out of court, so it is impossible to document how often brain scans for pain are being used in civil law. But the practice seems to be getting more common, at least in the United States, where health care is not covered by the government and personal-injury cases are frequent. Several companies have cropped up, and at least one university has offered the service. The approach is based on burgeoning research that uses fMRI to understand the nature of pain—a very subjective experience. Scientists hope that the scans can provide an objective measure of that experience, and they see potential applications, such as in testing painkillers. But many neuroscientists say that the techniques are still far from being accurate enough for the courtroom. Critics say that the companies using them have not validated their tests or proved that they are impervious to deception or bias. And whereas some think the technologies will have a place in legal settings, others worry that the practice will lead to misuse of the scans.

Only time will reveal whether this technology will be allowed into evidence in a court of law for the purpose of proving pain.  I will report any new developments here.