| Segmental Radiculopathic Model and Chronic Musculoskeletal Pain. |
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Kang Ahn, Sang Chul Lee |
1Chronic Pain Clinic, Kangnam Cha Hospital, Pocheon Joongmoon Medical College, Korea.
2Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Korea. 3484sangclee@hanmail.net |
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| Abstract |
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The term peripheral neuropathic pain has recently been suggested to embrace the combination of positive and negative symptoms in patients whose pain is due to pathological changes or dysfunction in peripheral nerves or nerve roots (including nerve trunk). Nerve root pain characteristically shows the tenderness following the course of the involved innervation area, whereas dysesthesia on locus is the pain felt in its peripheral sensory distribution. However, when pain of nerve origin is severe, it can be felt in regions outside the sensory distribution of the particular nerve. Careful examination of chronic musculoskeletal pain often reveals them to be the effects of nerve trunk dysfunction appearing in the musculoskeletal system. The underlying problem is malfunction of the peripheral nervous system due to chronic nerve root irritative injury, and pain is one possible result of downstream product of the neuropathy which is not inevitable. Some findings of neuropathic changes, which is not usually detected through conventional radiologic and laboratory methods, are present primarily in soft tissue (ie., tenderness over muscle motor point, tendon and ligament; palpable soft tissue contracture bands and restricted joint range). Therefore, careful evaluation must be performed and those soft tissue changes should be described. Neuropathy degrades the quality of collagen, causing it to have fewer cross-links; it is, therefore, become frailer than normal collagen. Careful palpation and physical examination is the important tool can detect all of these phenomena. |
| Key Words:
Nerve root; neuropathy; palpation |
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