SYMPOSIUM ON MECHANISM AND MANAGEMENT OF PAIN SYNDROMES

Journal/Book: Proceedings of the Rudolf Virchow Medical Society in the City of New York Vol. 16. 1957. 1957;

Abstract: HANS J. BEHREND M. D. Attending Physician Physical Medicine and Rehabilitation Hospital for Joint Diseases New York N. Y. ; Director Physical Medicine and Rehabilitation Beth Abraham Home Bronx N. Y. ; Consultant in Physical Medicine and Rehabilitation Goldwater Memorial Hospital New York N. Y. Summary Moderator Dr. HANS J. BEHREND These have been four most instrutive contributions. In brief the outstanding inferences may be enumerated as follows: 1. It appears that all mechanisms underlying referred pain are enacted by the autonomic nervous system. 2. Autonomic dystonia can occur in various ways often on a constitutional basis. Sufficiently intense and persisting external stimuli will cause excitable tissues to react; pain results when the stimulus exceeds the threshold of pain which may be normal or may be lowered for one reason or another. Dysfunction of the autonomic system may be superimposed an organic pathology; or it may be caused by emotional stress. Any such dysfunction deprives the individual of the ability to control adequately the intensity direction and duration of responses to external and internal stimuli. This will result in various functional disturbances and a variety of symptoms. 3. German authors at present postulate a center of irritation which as a result of different etiologic factors may develop in any part of the body; such centers are held responsible for the various signs and symptoms which do not follow a segmental pattern. When originating from such a focus the pain syndrome can be treated successfully only by isolating or removing the "focus of physiologic irritation" (Steinbrocker). 4. Livingston's theory explains the interaction of somatic and visceral pain (and the often bizarre syndromes which result) an the basis of anatomic structure and physiologic action of both central and autonomic nervous system. It also explains the widespread distribution of trigger points. Many variations are possible. It appears premature to be guided by "typical patterns" of pain distribution since opinions still widely differ in this respect. It is hoped that agreement will be reached in the future. ... schö

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