Physical findings in patients with chronic intractable benign pain of the neck and/or back.
Chronic intractable benign pain (CIBP) is defined as non-neoplastic pain of greater than 6 months duration without objective physical findings and known nociceptive peripheral input. To test the CIBP concept, 283 consecutive chronic pain patients were examined independently by a neurosurgeon and physiatrist and only congruent physical findings were coded. Because they did not fit the CIBP definition, patients with the following primary treatment diagnoses were eliminated: degenerative disease of the spine and spinal stenosis; degenerative disease of the hips; radiculopathy; malignancy; deafferentation pain; and miscellaneous. Eliminated, also, were patients with any one finding indicative of a root compression syndrome, leaving 90 low back and 34 neck patients. These patients had abnormal physical findings in 7 categories: tender points/trigger points; decreased ranges of motion in back or neck; non-anatomical sensory loss; rigid musculature; decreased range of hip motion; gait disturbance; and miscellaneous non-neurologic signs. Low back CIBP patients had the following distribution among the 7 categories: 0% had findings of all 7; 1.1% had 6; 13.3% had 5; 24.4% had 4; 25.6% had 3; 26.7% had 2; 8.9% had 1; and 0% had none. Neck CIBP patients, in which only the first 4 categories of physical findings were applicable had the following distribution: 2.9% had 4; 41.2% had 3; 35.3% had 2; 20.6% had 1; and 0% had none. It was concluded that CIBP patients do have abnormal physical findings indicative of musculoskeletal disease: possibly fibrositis and/or specific myofascial syndromes, as sources of peripheral nociception. These findings question the validity of the CIBP concept and point to the need for a careful, all-inclusive physical examination as a basic initial requirement in the classification of chronic pain patients.
Rosomoff
Hubert L
HL
Department of Neurological Surgery, University of Miami School of Medicine, and Comprehensive Pain and Rehabilitation Center at South Shore Hospital, Miami, FLU.S.A. Department of Psychiatry, University of Miami School of Medicine, and Comprehensive Pain and Rehabilitation Center at South Shore Hospital, Miami, FLU.S.A. Department of Psychology, University of Miami School of Medicine, and Comprehensive Pain and Rehabilitation Center at South Shore Hospital, Miami, FLU.S.A. Department of Nursing, University of Miami School of Medicine, and Comprehensive Pain and Rehabilitation Center at South Shore Hospital, Miami, FLU.S.A.
Fishbain
David A
DA
Goldberg
Myron
M
Santana
Ramon
R
Rosomoff
Renee Steele
RS
D000328:Adult; D001416:Back Pain / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009069:Movement Disorders / Q000150:complications; D009132:Muscles / Q000503:physiopathology*; D009333:Neck / Q000503:physiopathology*; D010148:Intractable Pain / Q000150:complications / Q000503:physiopathology*