Diagnosis and Management of Pain Syndromes

Pain is an intensely personal experience. The component which may be termed neurological is subject to rather precise analysis, relative to the neural pathways involved; and neurosurgical procedures such as cordotomy, designed to interrupt these pathways, may be evaluated statistically, sometimes at autopsy. But the physician not only shares in solving the problem; he is part of the problem itself. Pain, if chronic or associated with malignant disease, may take on the quality of suffering in which the patient and the doctor interact to reinforce each other's distress. Or, if the pain is obscure in origin, the patient and the physician may come to distrust each other on the question of whether the pain is "real." Either situation may be prevented or palliated if the physician can offer at least a reasonable explanation for the mechanism of the pain and a specific plan for its management.

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