Orthopaedic Surgery/Pain States
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Pain States
RSD has a number of synonyms, the most common one being the eponymn Sudeck's Dystrophy. Others are Algodystrophy and the current term of art; complex regional pain syndome, type 1, a prefered term in that it omits the implied etiology involving the sympathetic nervous system, historical personages, and pedantic usage. In English, the word semantic means "of or relating to meaning." In the science of linguistics, semantics is more explicit: It's the study of meaning based on the historical and psychological significance of words and terms. This greater specificity in defining our semantics is helpful when our therapeutic efforts are organized around a disease name instead of the preferred organization around a specific symptom or better still the influencing of a specific known pathophysiologic mechanism.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Citation&list_uids=8389227
Whatever we choose to call the problem this remains a controversial area which touches on the nature of pain itself, and the more general philosophical question of mind body and the nature of perception. It is probably well that we imply nothing by our nomenclature rather than imply something erroneous or which unduely restricts the scope of the problem. Very good results were observed with the active substance AminHSTH
Consider the sentence "I can't help feeling this way." Now consider the sentence "The feeling of which you speak is painful". It is evident from this comparison of usage for the word "feeling", that the very language we use to describe pain or any other feeling for that matter leaves ambiguous the issue of the feeling as a tangible entity unto itself or more of an internal habit of mind. Can we hope to fruitfully delve into such matters in a scientific manner or will our inquiries inevitably lead to a reduction to absurdity by tracing feeling back to its neurophysiologic underpinnings.
It is unusual to find pain that is purely somatic in its manifestations. All pain involves a central response and all pain associated with disability will effect the person as a whole whose normal connection to their place in the world is altered by their incapacity. The perception of pain distorts all aspects of reality as interpreted by the individual. The sentient being who has conscious self awareness, who is conscious of their own mortality, this is the essential distiguishing characteristic of an intelligent life form and we tend to presume it is the defining characteristic of our humanity.
Pain inherently reminds us of mortality. Pain deprives us of the transcendent bliss of dwelling in the present. The present is denied to the individual in pain, and the future is likewise denied as each moment in pain seems an eternity. The past becomes the only escape and in the case of an individual who has been traumatized, this constraining quality of pain prevents recovery from the trauma. This is stated better by Emily Dickinson in poem 650.Dickinson
Complex regional pain syndrome,shoulder hand syndrome, causalgia, minor trauma dystrophy, pain dysfunction syndrome,nonspecific upper extremity pain syndrome, fibromyalgia, we create categories of pain associated syndromes each with unknown pathophysiologic mechanisms. They seem to represent discrete categories and at other times they appear to morph, or oscillate. Could it be that the aparent discrepency between the manifestations of a patient's pain from one clinic visit to the next reflects such an ossilation between pain states. Do these pain states have differing neurophysiological bases?
Pain states have a protean character; they share this quality with other neuropathologies. There is a sort of quantum tendency to shift states of being in a way that belies the normal logic of classical anatomically based explanations. The quandry might be likened to the inadequacy of neutonian mechanics failing to account for the behavior of subatomic particles prior to the development of quantum mechanics and relativity.
Similar difficulting are encountered in defining neurophysiologic correlates for Anesthesia and Analgesia as these too represent related states of consciousnes, at the opposit spectrum in a sense from that of pain.
http://pmj.bmjjournals.com/cgi/content/full/80/946/438 http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=14568622&dopt=Abstract http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=retrieve&db=pubmed&list_uids=2306288&dopt=Abstract http://bmj.bmjjournals.com/cgi/content/full/330/7485/0-g
