Patterns of Forensic Practice

Forensic pain medicine has provided an interesting survey of medico-legal practice patterns among pain specialists (1). Members of the New England Pain Association responded to a 20-item questionnaire addressing specific areas of practice including the completion of disability forms, letters, reports to lawyers, depositions, testimony in court, record reviews and return-to-work forms. Respondents were asked to distinguish the medico-legal activities for their patients from those that occurred for third parties. The participants who responded included pain specialists from a range of disciplines represented by the membership of this regional pain society. The response rate was 67% with a total of 144 surveys returned

Classification and Diagnosis of Fibromyalgia

Fibromyalgia was recently classified when a sleep disorder was described with diffuse musculoskeletal pain. The standard modern definition was reached on the basis of thorough analysis of pain patterns and characteristic tender points. The principles of classification are reviewed with respect to this diagnosis

Pain Disorder, Hysteria or Somatization?

Pain used to be a simple issue. It was caused by physical injury or disease and the sufferer had to rest and take opium. That was about two hundred years ago. A few scattered commentators from Jeremiah (Lamentations I:12-13) to Montaigne (1) had the idea that emotion could cause pain or influence it. The development of anatomical knowledge, closely followed by physiology and then pathology, produced a dilemma. There were many pains that could not be explained by the most modern physical methods of the nineteenth century. Hodgkiss (2) has tersely labelled the problem as "pain without lesion". The nineteenth century solution lay in a diagnosis of hysteria