By John Pilbeam, Chris Rodgerson, Derek Tribble
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Most pain behavior is unconscious. Pain and disability often involve all of these aspects of pain. Treatment of pain-as-a-signal fails to address these other dimensions of pain, which is why it is often unsuccessful. Loeser’s (1980) model begins to give us a better picture of clinical pain, but has a fundamental problem. It uses the word pain in two very different ways: we have the single element of painas-a-signal, but we also have pain as the whole experience, in all its complexity. On second thoughts, perhaps this is an accurate reflection of our dilemma.
We must now deal with the whole pain syndmme. Assessment of pain Assessment of pain is a routine and basic part of clinical practice (Turk & Melzack 2001). Yet once we accept the complexity of pain, it should be no surprise that assessment is difficult and often inadequate. Assessment of pain 0 0 0 0 anatomic distribution timecourse severity quality. For all the reasons we have discussed, only the patient can really assess his or her pain. Clinical assessment is only an attempt to put the patient's report into medical terms.
There is experimental evidence for all of these events. These changes may be lasting, which could explain how pain may persist after the original stimulus has stopped. They could also account for spread, so that pain seems to affect a wider area. Many pain lectures give the impression that these neurophysiologic changes are irreversible, but that is untrue, as shown by the relief of chronic pain after joint replacement. Yet even the best neurophysiology cannot fully explain human pain. Neurophysiology is about the CNS, even the brain, but it is not the mind.
Adromischus by John Pilbeam, Chris Rodgerson, Derek Tribble