Diagnosis of Pain and Paresthesias
Definitions
Neuropathic pain: lesion of the peripheral or central nervous system.
Somatic pain: stimulation of peripheral nerve endings by lesions in a ligament, joint capsule, muscle or bone.
Paresthesias: spontaneous abnormal sensations (“pins-and-needles”) or lack of sensation (numbness). Abnormality anywhere along sensory pathway from peripheral nerves to sensory cortex. Persistent paresthesias imply likely neurologic abnormality.
Dysesthesias: disagreeably abnormal sensations evoked when area of abnormal sensation is touched; may be present with paresthesia.
Neck Pain
Hints that neck pain is neurologic: (a) pain limited to neck but with abnormal neurologic signs; (b) radiation down ulnar or radial aspect of arm (radicular distribution), sometimes to fingers; (c) weakness and wasting of hand muscles innervated by affected root; (d) abnormal gait, bladder symptoms, loss of tendon reflexes in arms and overactive reflexes in legs (cervical spinal cord compression); (e) pain affected by movement of head and neck, exaggerated by Valsalva maneuvers (sneezing, coughing, straining during bowel movements).
Etiology
Isolated neck pain: bony abnormalities (e.g., cervical osteoarthritis) or local trauma.
Neck pain with neurologic symptoms or signs: cervical spondylosis most common. Before age 40: tumors, spinal arteriovenous malformations, congenital anomalies of the cervical-occipital region more common.
Diagnosis
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