From pain analysis to diagnosis for pain in the musculoskeletal system

The clinical analysis of pain in patients is routine for almost all physicians. This article explains the term pain analysis on the basis of scientific research and concerning the neurophysiology of pain and pain processing. The aim is the diagnostic classification of pain and the introduction of a so-called mechanism-orientated pain therapy. The terms nocigenerator, somatopsychic reflectory response of the organism, mechanisms of pain chronification and pain inhibitory systems are introduced and projected to daily use by means of clinical case reports. The role of sensitization and metameral convergence of different afferents are discussed concerning pain in the musculoskeletal system. The "three level diagnosis" takes into consideration the point of view of the patient, the somatic allocation and psychosomatic context factors as the basis of therapeutic action. A therapeutic hierarchy is postulated which has been proven many times. The article follows criteria of evidence based medicine level D.