Spinal pain syndromes: nociceptive, neuropathic, and psychologic mechanisms.
BACKGROUND
Pain continues to be the main symptom reported by patients. Frequently, clinicians incorrectly diagnose patients and resulting treatments are ineffective, which may promote the development of chronic pain. This situation may arise as a result of a lack of clarity in the literature regarding pain syndromes.


OBJECTIVE
To discuss the differences between nociceptive, neuropathic, and psychologic induction of pain and provide important clinical correlates to aid in diagnosis and treatment.


METHODS
The data were accumulated over a period of years by reviewing contemporary articles and books and subsequently retrieving relevant papers. Articles also were selected from MEDLINE searches and from manual library searches.


RESULTS
Nociceptive pain syndromes are responsible for the majority of pain complaints in clinical practice. Care must be taken to avoid the common mistake of the diagnosis of neuropathic pain, which can lead to inappropriate treatments.


CONCLUSIONS
Although the treatment of neuropathic pain is difficult, sufficient evidence in the literature demonstrates that the treatment of nociceptive pain should be multimodal and involve spinal manipulation, muscle lengthening/stretching, trigger point therapy, rehabilitation exercises, electrical modalities, a variety of nutritional factors, and mental/emotional support.
Seaman
D R
DR
Research and development of nutranalysis, Hendersonville, North Carolina.
Cleveland
C
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D000208:Acute Disease; D001416:Back Pain / Q000145:classification* / Q000209:etiology* / Q000503:physiopathology / Q000523:psychology; D001927:Brain Diseases / Q000150:complications / Q000175:diagnosis; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D010147:Pain Measurement; D010523:Peripheral Nervous System Diseases / Q000150:complications / Q000175:diagnosis; D011379:Prognosis; D012684:Sensory Thresholds; D013577:Syndrome