Computerised Axial Tomography or CAT scanning, also known as CT scanning, is a highly sophisticated X-ray technique which literally uses computers to take X-ray slices of parts of the body.

This technique is specifically indicated in the assessment of damage to the spinal column. It is particularly useful in assessing damage to the intervertebral discs. It also establishes whether there is pressure on the nerve structures relating to the spinal cord.

The value of such studies is at times questionable because up to one-third of patients without pain have abnormal findings with such tests.

EMG ( electromyographic testing)

Electromyograms are tests of nerve conduction to assess how well the nerve does its job. Together with physical examinations they are sometimes useful to pinpoint organic causes of pain complaints.

Such tests can be useful to find damage to nerves, muscle problems, joint inflammation, and imbalances of fluids in the body.

Many pain syndromes, however, are difficult to define and are not well described in medical textbooks. Some of these problems include the pain associated with inflammation of muscles or myofascial pain syndrome, temporo-mandibular joint or TMJ syndrome, and some of the severe pain syndromes caused by damage to the autonomic nervous system.

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Treatments which should certainly be considered prior to surgery, except in emergency cases, include TENS, acupuncture, hydrotherapy, physiotherapy and psychological methods of gaining coping skills.

Medications used in the treatment of back pain include antiinflammatory drugs, antidepressants to modify pain awareness, tranquillisers and other muscle relaxants and some simple pain relieving medications.

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The pain patient typically uses a number of pain-killing drugs simultaneously, and often a bewildering array of other medication. Chemical dependence is frequent — particularly with the use of pain-killers containing narcotic derivatives such as codeine and propoxyphene such as Digesic and Codral Forte. They have had usually more surgical procedures, often without success, and are constantly searching for a physical cure. Because the patient’s income is usually less than he or she would have earned, the standard of living is often reduced, which puts additional strain on the family.

The pain patient often uses their affliction to tyrannise the family, playing the role of a chronic invalid and arousing guilt feelings.

Pain’s toll in terms of human suffering is remarkable. Of course, there’s no way to price misery. But billions of dollars are spent on medical care or on lost productivity. The chronic pain patient has had medical and surgical costs ranging from $50,000 to $100,000.The record perhaps goes to a 40-year-old labourer, ‘Hector B’, who had 40 pain-operations costing $450,000 — all originating from an injured back which eventually led to:

• A cordotomy — a division of pathways in the spinal cord to give relief from intense pain.

• An amputated leg.

• Phantom limb pain.

• Cingulotomy — a brain operation that cuts nerve tracts in an attempt to control pain.

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In general, the relationship between injury and pain holds true — a pinch of a finger produces mild pain while a door slammed on it is excruciating! But there are many instances where the relationship fails to hold up. For example, about 65 per cent of soldiers who are severely wounded in battle and 20 per cent of civilians who undergo major surgery report feeling little or no pain for hours, even days, after the injury.

In contrast, no apparent injury can be detected in about 70 per cent of people who suffer from chronic low back pain. The importance of pain for mankind’s survival becomes clear when we consider what happens to people insensitive to pain. They learn with difficulty to avoid damaging themselves severely. But they survive because they develop a language to communicate a problem. Many of them sustain extensive burns, bruises and lacerations during childhood. These injuries ultimately lead to the loss of limbs or joint function simply because they have no pain defence to injury or accident. It has long been known that if the nerves in a joint are missing, or defective, a condition develops in which the joint surface is damaged and the ligaments and other tissues are stretched. This particularly happens to joints such as ankles, knees, wrists and elbows. But there is still a puzzle. Even with normal people, injuries sometimes occur without pain. How is it that a finger can be chopped off in an accident and no pain is felt? Those who have experienced the passing of a kidney stone describe it as painful beyond any expectation that pain could be so intense. Similarly, there is the pain after the healing of an injury.

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