The Pharmacologic Approach in Differential Diagnosis of Chronic Pain

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Abstract
Chronic pain of unknown cause below waist level was evaluated in 100 patients by using the differential spinal block (DSB) in a multidisciplinary pain clinic setting. The classic DSB approach, refined for better control of psychologic variables, was a safe and effective means of differentiating various pain mechanisms. Of all patients tested, 55% has pain of central or psychogenic origin and 30% had sympathetically mediated pain, as compared with 15% who had somatic pain. A long-term follow-up of these patients confirmed this impression. These results substantiated the importance of psychologic variables, indicating the necessity for use of behavioral-based therapies in conjunction with the routine use of the refined diagnostic DSB procedure in patients with chronic pain.

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