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2 results

  • Chapter 8 - Musculoskeletal and Neurogenic Pain

  • from Section 2 - Common Neurologic Presentations: A Symptom-Based Approach
  • Edited by Thomas P. Campbell, Allegheny Health Network, Pittsburgh, Kevin M. Kelly, Allegheny Health Network, Pittsburgh
  • Book:
    Handbook of Emergency Neurology
    Published online:
    10 January 2024
    Print publication:
    17 August 2023, pp 94-107

  • Summary

    Pain is one of the most common presenting complaints in the emergency department (ED), both acute pain and exacerbation of chronic pain syndromes. Acute pain is accompanied by anxiety and sympathetic hyperactivity, whereas chronic pain is often associated with affective symptoms of depression. Nociceptive (musculoskeletal, inflammatory, or somatic) pain involves activation of the peripheral receptors secondary to tissue damage from trauma or heat. Neuropathic pain involves direct activation of either sensory nerves or ganglia by nerve injury or disease. Differentiation between nociceptive and neuropathic pain in the ED can be difficult, but should be considered for successful management of the pain.

  • Chapter 20 - Opioids

  • from Section 6 - The Management of Neuropathic Pain
  • Edited by Cory Toth, Dwight E. Moulin
  • Book:
    Neuropathic Pain
    Published online:
    05 December 2013
    Print publication:
    07 November 2013, pp 240-248

  • Summary

    Nerve root compression can occur from osteophyte formation, disc herniation, or a combination. As only 1-2% of patients with back pain have a nerve root or spinal cord compression, an accurate diagnosis of the causes of painful radiculopathy relies on a thorough history and physical exam. It is important to note that many asymptomatic individuals have abnormalities such as disc herniations and foraminal stenosis on CT and MRI. Therefore, the imaging findings must be correlated with the history and examination findings. Surgery for spinal stenosis and neurogenic claudication is indicated if severe pain is present, and can provide sustained relief. Since the spinal cord terminates at the L1-2 vertebral level, lumbar pathology below this level may compress the distal nerve root, causing a cauda equina syndrome. A lesion affecting the lumbosacral plexus (LSP) can present with pain in the low back, hip or pelvis, or with sciatica pain.