Article Text

Painful stimulation
  1. D BOWSHER
  1. Pain Research Institute, University Hospital Aintree, Lower Lane, Liverpool L9 7AL, UK
  1. pri{at}liv.ac.uk

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Once again, the meaningless term “response to pain” has been allowed to appear in the Journal.1

In this particular instance, the patient was unconscious and the brain stem was separated from higher centres. The stimulus may have beennoxious, but there is no evidence whatsoever that it was painful. Furthermore, as it is insisted, rightly, that other sensory stimuli be fully and accurately described, why is “pain” permitted without qualification? This often means pricking with a pin. Unless the pin or needle is driven in and twisted, the modality tested is in fact sharpness discrimination and not pain—the two are dissociated in some lesions. Mechanical noxious stimulation, which is interpreted as painful in the intact and fully conscious person, may be brought about by skinfold pinch or various other manoeuvres; thermal and chemical noxious stimulation also, of course, exist. But unless the nature of the stimulus is specified, the expression noxious stimulation (letpain and painful stimulation be forever abolished) is not only almost devoid of relevance, but misleading.

It also seems unfortunate that the recent Journal of Neurol ogy, Nurosurgery, and Psychiatry/Association of British Neurologists supplement on stroke did not mention central poststroke pain. This difficult neurological sequel occurs in some 8%–10% of survivors of stroke2 3 (6000–7000 new cases/year in the United Kingdom). Its correct diagnosis, treatment, and possible prevention should be a matter of great concern to neurologists.

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