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Nanolume: A Pain Tracking App from Dr. Ron Harbut

A message from Dr. Ron Harbut:

Dear Dr. Kim,

I am a board-certified anesthesiologist with subspecialty training in pain management. I also have a PhD in pharmacology. I have been in clinical practice for over 25 years.

I immensely appreciate your information on the dangers and concerns related to elevated plasma homocysteine levels. Indeed, I offer and give your below link on homocysteine levels to all my interested colleagues, patients, family, and close friends to help educate them on the dangers of elevated homocysteine levels.

What you may (or may not) know is that elevated homocysteine levels can also worsen neuropathic pain by increasing the concentration of a breakdown product called homocysteic acid. Homocysteic acid can act as (or facilitate the transmission of) excitatory neurotransmitters that can worsen neuropathic pain (allodynia, burning, tingling, dysesthesias):

My area of special interest is neuropathic pain.

In my practice if patients present with generalized neuropathic symptoms — allodynia, burning, tingling, dysesthesias — I check their homocysteine levels and usually their B9 and B12 levels. In my experience, excessive elevations of homocysteine usually correlate with a deficiency of B9 or B12. Sometimes, homocysteine elevations might also be correlate with deficiency of B6 or B2.

Over the last 10 years, I needed to come up with a way to help patients “show” me exactly what the “textures” and “colors” of their pain are really like.

For years, to help me understand what they are suffering with, I had patients draw for me a picture of their pain using an outline (map) on paper of the front-side and back-side of the human body. I asked patients to use different symbols to “color” in what they felt and where they felt it.

As time went on, I realized that pencil and paper were not enough. Therefore, over the years, I saw a need to developed an app for mobile devices that patients could use to easily draw their pain and keep a precise record of what they felt (and how intense it was) day-to-day, where it was, and how each type of pain they were experiencing benefitted or changed every day with the treatments they were trying.

The app turned out to be very useful in helping me distinguish neuropathic pain versus nociceptive pain — and by helping me (and helping patients) follow exactly how the intensities and surface-areas of each type of pain we are treating changed (or didn’t) with time and treatment.

Using the app especially helps with my more complicated cases of persistent pain, because the pictures really are worth a thousand words in usually helping me see and understand the underlying pathology of chronic pain patients.

I am asking if you would take a look at the app I created and give me your thoughts on it.

I’d appreciate any feedback you would offer.


Ron Harbut, MD, PhD


Many thanks to Dr. Harbut for sharing his app with us. I believe that conscientious patients and physicians will find great value in using nanolume to track pain patterns. For more information on nanolume and how to use it, please feel free to visit one of the links provided above. - Ben Kim


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