title: Towards an understanding of chronic pain mechanisms: the use of psychologic tests and a refined differential spinal block.
abstract: Forty patients with chronic pain below the waist level were evaluated in a multidisciplinary pain clinic using a refined differential spinal block (DSB) technique. The refinements consisted of verbal instructions to prevent biasing the patients, coupled with a thorough evaluation of verbal and physiologic responses to the block. When demographic and psychologic data were assessed according to pain mechanisms, a pattern of patient groups emerged along a chronic pain continuum. Stress, anxiety, depression, and hysteria, as well as the neurophysiologic and demographic factors, modified the responses to the block. Long-term follow-up of these patients, including repeat DSB procedures and confirmatory anatomic blocks of sympathetic and somatic nerves, validated these impressions. The findings indicate a link between pain mechanisms and psychosocial factors that may directly influence responses to DSB.
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000775:Anesthesia, Spinal; D001007:Anxiety; D001340:Autonomic Nerve Block; D002908:Chronic Disease; D003863:Depression; D004644:Emotions; D006801:Humans; D007046:Hysteria; D008875:Middle Aged; D010146:Pain / Q000503:physiopathology / Q000523:psychology*; D010551:Personality; D011581:Psychological Tests; D013315:Stress, Psychological; D013564:Sympathetic Nervous System / Q000503:physiopathology