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    Pain Analysis: A Guide to Diagnosis
    Pain Analysis: A Guide to Diagnosis
    Pain Analysis: A Guide to Diagnosis
    Ebook216 pages1 hour

    Pain Analysis: A Guide to Diagnosis

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    Pain Analysis: A Guide to Diagnosis describes the morphology of pain receptors. This book is composed of 12 chapters that discuss the triggering and conduction of the pain stimulus. Some of the topics covered in the book are the localization, different types, development and course of stimulus, and characteristics of pain, as well as the conditions that produce the stimulus. Other chapters deal with the diagnosis of head and facial pain, neuralgia, cephalalgia, trunk and extremities pain, thoracic and acute abdominal pain, and colic. The discussion then shifts to the role of acute abdomen situation in metabolic diseases, the pain analysis in diseases in the retroperitoneal space, and lower abdomen that generates the feeling of pain. A chapter is devoted to the pain due to peripheral arterial occlusion. The final chapters focus on the special pain analysis in the newborn and infants. The book can provide useful information to doctors, students, and researchers.
    LanguageEnglish
    PublisherElsevier Science
    Release dateOct 22, 2013
    ISBN9781483183350
    Pain Analysis: A Guide to Diagnosis

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      Book preview

      Pain Analysis - Rudolph Janzen

      PAIN ANALYSIS

      A Guide to Diagnosis

      RUDOLPH JANZEN

      Director of the Neurological Clinic and Polyclinic of the University of Hamburg

      Table of Contents

      Cover image

      Title page

      Copyright

      PREFACE

      CONTRIBUTORS

      PUBLISHER’S NOTES

      Chapter 1: PAIN

      Publisher Summary

      Chapter 2: MORPHOLOGY OF PAIN RECEPTORS

      Publisher Summary

      Chapter 3: SUPERFICIAL AND DEEP PAIN: TRIGGERING AND CONDUCTION OF THE STIMULUS

      Publisher Summary

      Referred and Projected Pain

      Chapter 4: ELUCIDATION OF SOME TERMS

      Publisher Summary

      Neuralgia in the Strict Sense—Dolor Projectus

      Zona Algetica

      Melalgia and Prosopalgia

      Chapter 5: PRINCIPLES OF CLINICAL PAIN ANALYSIS

      Publisher Summary

      Localization of the Pain

      Development and Course

      Character of the Pain

      Changes in Character

      Conditions

      Accompanying Phenomena

      Chapter 6: HEAD AND FACIAL PAIN

      Publisher Summary

      Zones of Referred Pain—Zona Algetica Doloris Translati

      Neuralgia in the Strictest Sense

      Prosopalgia

      Cephalalgia

      Cephalea

      Chapter 7: PAIN IN THE TRUNK AND EXTREMITIES

      Publisher Summary

      Chapter 8: THORACIC PAIN

      Publisher Summary

      Thoracic Wall Pain

      Visceral Thoracic Pain

      Remote Pain

      Chapter 9: ANALYSIS OF ACUTE UPPER ABDOMINAL PAIN AND COLIC

      Publisher Summary

      Acute Abdomen in Metabolic Diseases

      Acute Abdomen due to Other Causes (often with Symptoms of ‘Colic’)

      Chapter 10: LOWER ABDOMINAL PAIN

      Publisher Summary

      Pain Analysis in Diseases in the Retroperitoneal Space and the Pelvic Region

      Pains in the Right Lower Abdomen

      Pains in the Left Lower Abdomen

      Chapter 11: CARDIAC AND VASCULAR PAIN

      Publisher Summary

      Pain due to Peripheral Arterial Occlusion

      Cardiac Pain of Vascular Origin (Angina Pectoris)

      Venous Diseases

      Chapter 12: PAIN ANALYSIS IN CHILDHOOD

      Publisher Summary

      Consideration of the Peculiarities of Reaction in Different Stages of Development

      Special Pain Analysis

      INDEX

      Copyright

      COPYRIGHT NOTICE

      © JOHN WRIGHT & SONS LTD., 1970

      All Rights Reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the copyright owner.

      Distribution by Sole Agents:

      United States of America: The Williams & Wilkins Company, Baltimore

      Canada: The Macmillan Company of Canada Ltd., Toronto

      First German edition, 1966

      Second German edition, 1968

      First English edition, 1970

      ISBN 0 7236 0246 8

      PRINTED IN GREAT BRITAIN BY JOHN WRIGHT AND SONS LTD.

      AT THE STONEBRIDGE PRESS, BRISTOL, BS4 5NU

      PREFACE

      This book has a long past history and is based on great medical tradition.

      Those experienced masters of their subject, who open the grateful pupils′ eyes to problems, are not our only teachers; illnesses, which force us to continually modify the traditional teachings, are also our teachers.

      If the basic illness of a patient is known, complaints about pain may be registered, but only as an unproblematical additional phenomenon. Pain is never without problems. Too flippant an attitude to pain can cause us to overlook important developments and complications of the disease. These are indicated by a change in localization or character of the pain. All too often, we encounter patients, in whose cases the pain which first led them to the doctor is forgotten, because of other interesting findings. Diagnoses are made on these findings, pain indicating a different illness is silenced by symptomatic treatment, and the physician has failed in his real duty.

      Pain is often a complaint for which no satisfactory cause can be found.

      We must always examine critically whether a finding may also explain the carefully analysed pain of the patient. The explanation must be adequate and beyond doubt. If this is not so, one must, in diagnosis and therapy, first consider the obvious, but still regard the case as not satisfactorily cleared up. If one does not depart from this rule, one will frequently run up against the limits of one’s knowledge. These limits become even more distinct when pain is the only or the presenting symptom. His own mistakes and the errors of others teach every doctor that the old theme ‘pain analysis as a guide to diagnosis’ is still most topical. The editor of this booklet has, as a clinical neurologist, been able to gather various experiences on this theme. As President of the North West German Society for Internal Medicine, he had to suggest a theme for the meeting in January, 1965. He chose ‘Pain Analysis’ to the joy of H. H. Berg, who had for years been canvassing on behalf of this seriously neglected subject. In the congress report (Hansisches Verlagskontor, Lübeck, 1965), brief summaries were presented; now, after many discussions, we submit the detailed report. We hope that it may fulfil its role to the advantage of our colleagues.

      On studying the literature, it is amazing how differently the concepts are used, not only in different linguistic regions, but even within the different disciplines of medicine. Convenient concepts and habits created as the ‘small change’ of everyday life, are long-lasting. Terms such as ‘rheumatism’, ‘neuralgia’, ‘migraine’, and others, which in conversation with the patient have become so convenient as a result of tradition, are frequently used in an ill-defined manner. This we must be aware of.

      If a linguistic analysis of the origins and real significance of the concepts were carried out here, a voluminous work would be necessary in order to prove that certain terms should be newly defined and others described as useless, at least, useless as scientifically clinical terms. The editor, as a neurologist, has concerned himself with these questions for many years of his life, tested his ideas in his clinical work and his teaching, and now, without literary discussion and without tabulation of evidence, submits the result. The expert will discover what clinical work, what thoughts and literary studies are hidden in many a simple sentence which might otherwise have developed into chapters.*

      This limitation is imposed to agree with our plan. What is aimed at is a useful and, above all, a readable booklet on the principles of pain analysis. The booklet cannot be read at a glance; the concentration of the subject matter and the considerations is also reflected in the style. Because of the lack of case histories and a survey of the literature it is not a reference work. It was a question of recognizing the principles and making a synopsis of them. Therefore references to literature have been limited to the minimum. Our choice makes no criticism of the value of the views of those authors that have not been quoted.

      If our booklet is to provide something useful and to stimulate both the beginner and, we hope, the experienced doctor, then this can only be achieved if, despite differences in training and origin of the authors, a definite attitude to the problem is upheld throughout. If this is—fortunately—not quite uniform, then this arises from the fact that individual disciplines regard the prime points of interest differently.

      The editor wishes to thank all his colleagues warmly for their continued assistance in discussing and criticizing this work.

      Hamburg, Spring, 1966

      R.J.

      Many critics have misunderstood the work in its entirety because they have missed this or that detail. Others, who have obviously read carefully, have stimulated us to introduce this or that ‘frequent’ experience. We committed an error in not taking account of the peculiarities of children’s reactions, especially those of small children and the newborn. An experienced paediatrician was found ready to take on this task, together with the far from simple one of blending the new material with the overall theme.

      We thank all critics who have praised the book and thereby spurred us on to greater consistency. Those who criticize the lack of specific research results in the booklet have misinterpreted our intentions. They should have recognized that we have taken account of present academic research in so far as it has already been of significance in clinical work. On the other hand, results of long-standing clinical research, which are by no means universally good, are presented straightforwardly.

      I owe renewed thanks to my co-authors, as well as to many people connected with the clinic for their unassuming work, especially the librarian Frau Karin Holst v. Liliencron and the secretary Frau Annelene Osterrieth.

      Hamburg, Spring, 1968.

      R.J.

      *Although the editor has himself written the chapters on neurological problems, he has quoted his associates as co-authors, because they have supported him for years in the evaluation of his experiences: Priv.-Doz. Dr. Dieckmann in the field of special neuralgias and the sympathetic and vasomotor cephalgias; and Priv.-Doz. Dr. Puff in the field of disturbances of peripheral nerves and in the retroperitoneal space. They also gave the appropriate reports at the North West German Congress of Internal Medicine. This is mentioned to emphasize that the statements are based on considerable clinical material.

      CONTRIBUTORS

      Prof. Dr. med. F. ANSCHÜTZ,     Director of the Clinic of Internal Medicine, Städtische Krankenanstalten, Darmstadt

      Dr. med. H. BOEHNCKE,     Head of the Hochallee Children’s Hospital, Hamburg

      Priv.-Doz. Dr. med. H. DIECKMANN,     First Assistant at the Neurological Clinic and Polyclinic, University of Hamburg

      Dr. med. H. FICK,     First Assistant at the Hamburgisches Krankenhaus, Wintermoor, Hamburg

      Prof. Dr. med. K. FLEISCHHAUER,     Professor of Neuro-anatomy, Anatomical Institute of the University of Hamburg

      Dr. med. K. HOFFMANN,     Medical Head, Hamburgisches Krankenhaus, Wintermoor, Hamburg

      Prof. Dr. med. H. HORNBOSTEL,     Head of the Second Medical Division of the Allgemeines Krankenhaus, Hamburg-Harburg

      Prof. Dr. med. Dr. phil. R. JANZEN,     Director of the Neurological Clinic and Polyclinic of the University of Hamburg

      Priv.-Doz. Dr. med. K.-H. PUFF,     First Assistant at the Neurological Clinic and Polyclinic of the University of Hamburg

      Prof. Dr. med. F. STELZNER,     First Assistant at the Surgical Clinic of the University of Hamburg

      Priv.-Doz. Dr. med. CHR. WEISS,     Head of the Department at the Physiological Institute of the University of Hamburg

      PUBLISHER’S NOTES

      THE major work of this translation was undertaken by Mr. K. Eckstein, M.A. While the first edition of this book was in the course of translation, a second German edition was published. The major alterations were a new chapter (Chapter 12) and substantial revisions in Chapter 11. The Publishers wish to express their thanks to Dr. G. Hopkinson, M.D., D.P.M., of the Department of Psychiatry, Liverpool University (now at the Memorial University of Newfoundland, Canada), who kindly undertook the translation of the additional matter. We are also grateful to Dr. J. Jancar, M. B., B. Ch., B.A.O., D.P.M., Consultant Psychiatrist, Stoke Park Hospital, Bristol, for his critical reading of the proofs.

      1

      PAIN

      R. JANZEN

      Publisher Summary

      Theology, philosophy, psychology, anthropology, and psychiatry have frequently viewed the problem of pain in its psychophysical context and produced thoughtful contributions. However, the study of the structural and physiological basic phenomena requires urgent and renewed efforts. Pain is neither a quality of the object nor it can be reproduced in the imagination. This chapter describes pain as a sensation that only exists in an abstract situation, that is, during examination. A sensation must inform one about the nature of the environment, but the information must be precise. A sensation shows no tendency to irradiation, that is, it does not spread to regions of the nervous system. Sensations only release to a small extent phenomena of summation, tracking, inhibition, or change. Change, inhibition, and tracking are, however, aroused by feeling. In an animal or infant, pain stimuli are followed by elementary or complicated defence reactions, together with movements of expression. Movements of expression and emotion correspond to each other as soon as the brain matures. However, there is no psychic correlation to the movement of expression in an infant.

      Pain—is for the doctor a principium cognoscendi.

      Pain—is for the patient a principium agendi.

      The doctor must interest himself in pain, as he is called on to ease it. The thinking doctor recognizes in pain a ‘limit of human behaviour’ (Plessner), which has fundamental significance for all kinds of anthropology. Heidegger saw in pain ‘an access to the blueprint of being’. Whilst pleasurable sensations are mostly experienced as unproblematical, ‘being impotently delivered to pain causes in man its reflexive effect,

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