Associate Professor Milton Cohen - St Vincent's Campus, Sydney

Why is a distinction made between musculoskeletal pain and neuropathic pain "syndromes", which implies that they are alternatives? In fact, as "musculoskeletal" describes the region in which the conscious subject appreciates the pain and "neuropathic" implies a mechanism of production of pain, it follows that the two terms are complementary. Furthermore, they provide the basis for a rational nomenclature based on recent insights gained from the neurobiology of nociception and pain.

The ground rules for this exercise in nomenclature are:

1. pain itself cannot be the diagnosis;
2. a distinction must be made between features which constitute a "syndrome" and those which allow inference of a mechanism;
3. the adjective "neuropathic" is itself problematic in this context, as its common usage extends well beyond its noun, neuropathy.

    

   The task of the clinician when confronted with a patient's painful body part is to infer the site of origin of the pain and its mechanism of production, rather than impose a spurious diagnostic label. We propose the following matrix: [inferred mechanism] + [site of pain]. For example, a painful, warm, swollen wrist, conventionally labelled arthritis of the wrist, would be better termed [wrist] [inflammation] (noun-noun) or [inflammatory] [wrist impairment] (adjective-noun). But how do we label a mechanically sensitive, painful wrist without other signs of inflammation, implying neuropathic mechanism - [neuropathic] [wrist impairment] or [wrist] [x] ? As yet there is no noun derived from "neuropathic" analogous to "inflammation" from "inflammatory". We suggest "neurosensitisation", which incorporates current concepts of nociception. Thus we could label the problem [wrist] [neurosensitisation].

   Further examples of the rational application of this matrix will be presented and the advantages and limitations of such a rubric discussed.

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   Time of Presentation:

   Saturday 3 May 2003 - 1545-1558

    

   Additional Authors:

   • Dr John Quintner - Wyllie Arthritis Centre, Perth, WA

    

   Biography:

   Milton Cohen is Vice-Dean and Education Officer of the Faculty of Pain Medicine. His interests are rational assessment and management of chronic pain, placebo theory and the structure of medical knowledge.