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Pain in its many forms is complex and non-intuitive. Information describing difficulties and uncertainties in diagnosing painful conditions. This seems to raise questions and suggest answers.
The traditional theory of pain is known as 'specificity theory'. It is described in virtually every textbook on neurophysiology, neurology and neurosurgery, and is often taught as fact rather than theory. It is presented as though we already have the major answers to pain problems, and all that remain are a few minor qu....
Melzack, R. and Wall, P. D., "The Challenge of Pain (Reprint of 1988 edition)", Penguin Books, 2008, 149-156
Persons with severe knee OA are more likely to report pain, and severe pain has been shown to predict radiographic changes in persons with knee OA. Studies of knee OA consistently highlight the relationship of older age, female sex (although this depends on age), and obesity with symptoms, associations that have also b....
McMahon, S. B., Koltzenberg, M., Tracy, I., and Turk, D. C., "Wall and Melzack's Textbook of Pain", Elsevier Saunders, 2013, 240
No other [aside from the McKenzie diagnostic approach related to centralization] assessment, including [MRI] or discography, could reliably identify the disc as the cause of pain and interventions to treat disc pain have proved disappointing.
Turk, Dennis, and Melzack, Ronald, "Handbook of Pain Assessment", The Guildford Press, 2011, 298
Vulvodynia occurs in the absence of any clinically identifiable physical or neurologic findings. Biopsies taken from the vulvar vestibule of sufferers revealed unique physiological characteristics such as increased immunoreactivity, nociceptor sensitivity, and even increased density of superficial nerve endings. (www.pe....
Jantos, Marek, "Understanding Chronic Pelvic Pain", Pelviperineology: 2007
[NOTE reference to "subliminal stimulation."] Such studies [comparing the reaction of chronic pain patients to non-patients] have been performed predominantly in patients with so-called functional pain syndromes, including fibromyalgia, IBS, and vulvovestibulitis. In line with the generalized hyperalgesia that is obser....
McMahon, S. B., Koltzenberg, M., Tracy, I., and Turk, D. C., "Wall and Melzack's Textbook of Pain", Elsevier Saunders, 2013, 122-3
...informal observation supports the view that some clinicians diagnose MFP in a very high proportion of patients with musculoskeletal pain, whereas others use the diagnosis much less frequently (and still others essentially do not consider MFP to be a legitimate medical diagnosis.) [MFP = myofascial pain]
Turk, Dennis, and Melzack, Ronald, "Handbook of Pain Assessment", The Guildford Press, 2011, 321
No one has developed a widely accepted framework in terms of which to conceptualize pain complaints that are not easily explained in terms of biological dysfunction, but a prudent physician should consider the following general categories: 1. The patient's pain may be a manifestation of a pathophysiological process that....
Turk, Dennis, and Melzack, Ronald, "Handbook of Pain Assessment", The Guildford Press, 2011, 437
[Discusses discovered genetic variation and engineered variation.]
Gatchel, R. J., Peng, Y. B., Peters, M. L., Fuchs, P. N., and Turk, D. C., "The BioPsychoSocial Approach to Chronic Pain: Scientific Advances and Future Directions", Psychological Bulletin, Vol. 133, No. 4: 2007 (Biopsychosocial Approach to Chronic Pain.pdf), 7-9
...although structural damage of the hip joint was evident in patients seen by primary care practitioners for hip pain, no association between the level of damage and impact on the individual's quality of life was found. However, nearly one-quarter of the individuals in the previous study who consulted with primary car....
McMahon, S. B., Koltzenberg, M., Tracy, I., and Turk, D. C., "Wall and Melzack's Textbook of Pain", Elsevier Saunders, 2013, 239
The individual's personal history, situational factors, interpretation of the symptoms and resources, current psychological state, as well as physcial pathology, all contribute to the patient's response to the question "How much does it hurt?"
Turk, Dennis, and Melzack, Ronald, "Handbook of Pain Assessment", The Guildford Press, 2011, xii
Leg pain is a regular feature associated with LBP. However, not all leg pain is indicative of nerve root pain. Pain in the muscles of the lower back can be associated with pain radiating into the legs.
Turk, Dennis, and Melzack, Ronald, "Handbook of Pain Assessment", The Guildford Press, 2011, 297
One possible factor contributing to the apparent lack of correlation among pathology, symptoms, and outcome [pain or disability level] is the observation that the reliability of many physical examination procedures is questionable.
Turk, Dennis, and Melzack, Ronald, "Handbook of Pain Assessment", The Guildford Press, 2011, 9
Following full-thickness skin wounds, hyperinnervation of the wound site by both myelinated A and unmyelinated C fibers is significantly greater in neonatal than in adult rats. This occurs independently of sensory neural activity and may depend on the release of neurotrophins from the damaged regions or a site-specific....
McMahon, S. B., Koltzenberg, M., Tracy, I., and Turk, D. C., "Wall and Melzack's Textbook of Pain", Elsevier Saunders, 2013, 155
[Medical evaluations tend to look for specific identifiable peripheral pathologies that can explain some or all symptoms.] In reality, medical evaluations of patients with chronic pain often yield ambiguous results, and do not lead to dramatically effective treatment [otherwise the symptoms wouldn't persist for seven y....
Turk, Dennis, and Melzack, Ronald, "Handbook of Pain Assessment", The Guildford Press, 2011, 191
...the experience of medical limbo (i.e., the presence of a painful condition that eludes diagnosis and that carries the implication of either psychiatric causation or malingering on the one hand, or an undiagnosed potentially disabling condition on the other) is itself the source of significant distress and can....
Turk, Dennis, and Melzack, Ronald, "Handbook of Pain Assessment", The Guildford Press, 2011, 188
[Chronic pain syndromes are a modern epidemic of mindbody origin which is not helped and may even be aided by medical standard care.] The persistence of the pain--the fact that it often lasts for months or even years--is explained by an ingenious idea conceived by behavioral psychologists many years ago. According to t....
Sarno, J. E., "The Divided Mind: The epidemic of mindbody disorders", Harper, 2006, 19-20
Mr. Smith was having great difficulty tolerating the physical examination. Despite the fact that he had few physical findings, Mr. Smith complained bitterly of chronic back pain. He flinched visibly when the examiner palpated his back. His movements were slow, and he limped in an exaggerated fashion when asked to wal....
Turk, Dennis, and Melzack, Ronald, "Handbook of Pain Assessment", The Guildford Press, 2011, 135
The pain, in these syndromes, cannot be attributed to any single cause. There are, instead, multiple contributions. The cutaneous input from the affected part of the body obviously plays an important role. However, inputs that result from sympathetic activity are also important. So too are inputs from the auditory and v....
McMahon, S. B., Koltzenberg, M., Tracy, I., and Turk, D. C., "Wall and Melzack's Textbook of Pain", Elsevier Saunders, 2013, 75-6
Furthermore, while the few short-term (only weeks in length) placebo-controlled trials conducted to date have found some support for the use of non-steroidal anti-inflammatory drugs (NSAIDs) and antidepressants in treating lower back pain, their results are usually not significant enough to reach the level of clinical e....
Apkarian, A. V., Baliki, M. N., and Geha, P. Y., "Towards a theory of chronic pain", PMC: 2008 (Towards a theory of chronic pain.html)
Patients, following initial assessment, are often classified as having "nonspecific LBP." There are many professional attributions for the cause of LBP and some would challenge the idea that LBP is ever "nonspecific," citing pain arising from the disc, muscle activity, and facet joint involvement. A recent review sugg....
Turk, Dennis, and Melzack, Ronald, "Handbook of Pain Assessment", The Guildford Press, 2011, 298
Some pains are best understood as a failure of control. When pain exists and a drug, a surgical lesion, physiotherapy or psychotherapy are initiated, the remaining control mechanisms will react in an attempt to re-establish the pain. This reaction may provide an explanation common to all eventual failures of therapy. A....
Melzack, R. and Wall, P. D., "The Challenge of Pain (Reprint of 1988 edition)", Penguin Books, 2008, 206
Tension headache is a common form of pain which ranges in intensity...there is no damage and no known explanation of the origin of the pain. It was widely believed that muscle tension was the cause, but no muscles have been found in contraction in spite of a very careful search. Another common headache, migraine, was as....
Melzack, R. and Wall, P. D., "The Challenge of Pain (Reprint of 1988 edition)", Penguin Books, 2008, 9
Collectively, the data show that a muscle spasm is not due to a painful lesion in that muscle but rather to a lesion in another structure. The original source of the pain may be located in another muscle, a joint that is moved by the muscle, or an internal organ. The rigid abdomen that may accompany an inflamed appendix....
McMahon, S. B., Koltzenberg, M., Tracy, I., and Turk, D. C., "Wall and Melzack's Textbook of Pain", Elsevier Saunders, 2013, 627
The influence of early pain experience on the developing CNS is likely to reach beyond the classic pain pathways. The overlap between pain and reward pathways suggests that neonatal pain experience may influence reward-related pathways and behavior in adulthood, and recent evidence in an animal model of motivational be....
McMahon, S. B., Koltzenberg, M., Tracy, I., and Turk, D. C., "Wall and Melzack's Textbook of Pain", Elsevier Saunders, 2013, 155
First, some patients (e.g., those with fibromyalgia or chronic headaches) may not have any unequivocally objective findings. Second, and far more important, even when patients have objective findings, the findings rarely explain the extent of the incapacitation the patients report. [Why would the 2nd item be far more i....
Turk, Dennis, and Melzack, Ronald, "Handbook of Pain Assessment", The Guildford Press, 2011, 436
We have reviewed evidence that prolonged tender states are produced by the massive release of peptides on to substantia gelatinosa cells. It has now been discovered that such compounds can produce striking changes of slow onset and very long duration, so that ionic channels in the nerve cell membrane and enzymes within....
Melzack, R. and Wall, P. D., "The Challenge of Pain (Reprint of 1988 edition)", Penguin Books, 2008, 107
[!!!!]Because of the failure of traditional surgical therapy, it has been suggested that the patients are in pain because of psychopathological personal needs. It is true that patients suffering phantom limb pain often have emotional disturbances such as anxiety about social adjustment. Indeed that intense, unrelenting....
Melzack, R. and Wall, P. D., "The Challenge of Pain (Reprint of 1988 edition)", Penguin Books, 2008, 68
The probability that the particular cause of back pain can be identified by radiographs is less than 1%
Apkarian, A. V., Baliki, M. N., and Geha, P. Y., "Towards a theory of chronic pain", PMC: 2008 (Towards a theory of chronic pain.html)
The widespread distribution of the neural mechanisms associated with these pain states is also indicated by the frequent failure to abolish pain by surgical methods. Surgical lesions of the peripheral and central nervous systems have been singularly unsuccessful in abolishing these pains permanently.
Melzack, R. and Wall, P. D., "The Challenge of Pain (Reprint of 1988 edition)", Penguin Books, 2008, 76-7
Sexual dimorphism in neuronal function has been demonstrated from fruit flies to humans and also has major effects on nociception. Females tend to have lower thresholds for heat-, mechanical-, inflammtion-, and chemical-induced pain. Some, but not all, studies have revealed that females are also more prone to the deve....
McMahon, S. B., Koltzenberg, M., Tracy, I., and Turk, D. C., "Wall and Melzack's Textbook of Pain", Elsevier Saunders, 2013, 109
As is frequently the case in medicine, when physical evidence and explanations prove inadequate to explain the symptoms, psychogenic alternatives are proposed. If the pain reported by a patient cannot be objectively confirmed, is judged to be disproportionate to objectively determined physical pathology, or if the compl....
McMahon, S. B., Koltzenberg, M., Tracy, I., and Turk, D. C., "Wall and Melzack's Textbook of Pain", Elsevier Saunders, 2013, 256
Reactivity [physiologic] is symptom-specific and not general, as has been shown by the assessment of additional physiological parameters, such as heart rate, blood pressure, and skin conductance.
Turk, Dennis, and Melzack, Ronald, "Handbook of Pain Assessment", The Guildford Press, 2011, 154
The essential feature of the somatoform disorders is the presence of physical symptoms that suggest a general medical condition but are not fully explained by a general medical condition....The somatoform disorders are distinguished from fictitous disorders and malingering in that the symptoms are not intentionally prod....
Turk, Dennis, and Melzack, Ronald, "Handbook of Pain Assessment", The Guildford Press, 2011, 407
The staff of the emergency room thought that 40 percent were making "a terrible fuss," nearly 40 percent were "denying" pain, and 20 percent gave the "appropriate" answer. It is obvious there is something fundamentally wrong here....
One crucial aspect is that patients are not only assessing their private misery but....
Wall, Patrick, "Pain: The science of suffering", Columbia University Press, 2000, 12
A significant percentage of individuals with persistent pain continue to experience distressing symptoms despite our increased knowledge of neurophysiology and the availability of an expanded treatment armamentarium. This set of circumstances had resulted in growing awareness of the important roles of cognitive, affecti....
Turk, Dennis C., and Flor, H., "The Cognitive-Behavioral Approach to Pain Management", Chapter 42 of McMahon et al. 2013, 2013, 592
As part of a comprehensive assessment, chronic pain patients were asked whether their symptoms were precipitated by trauma such as an automobile accident or whether they had an insidious onset. Approximately 50% of the patients attributed their symptoms to trauma.
Based on physical examination, there were no signif....
McMahon, S. B., Koltzenberg, M., Tracy, I., and Turk, D. C., "Wall and Melzack's Textbook of Pain", Elsevier Saunders, 2013, 258
...even if a diagnosis can be made, the diagnosed condition is usually compatible with a wide range of functional capabilities....The patients who come to the attention of pain physicians are those who demonstrate high levels of disability relative to the diagnosed medical condition. [Why would that be the case? Wouldn....
Turk, Dennis, and Melzack, Ronald, "Handbook of Pain Assessment", The Guildford Press, 2011, 200
Certain neurological conditions involve intense and frequent pain. One example is trigeminal neuralgia, also known as tic douloureux. The term neuralgia stands for pain with a neural origin, and the term trigeminal refers to the trigeminal nerve, the nerve which supplies face tissues and which ferries signals fr....
Damasio, Antonio R., "Descartes' Error: Emotion, Reason, and the Human Brain", Penguin Books, 1994, 265-6
End of included memoes/notes