Diseases of the nervous system / edited by Archibald Church.

Date:
1908
Catalogue details

Licence: In copyright

Credit: Diseases of the nervous system / edited by Archibald Church. Source: Wellcome Collection.

    1113/1256 (page 1071)
    rachialgia, a regional, spontaneous pain, appearing along the entire extent of the vertebral column or localized in some of its divisionsfurther, coccygal- gia or coccygodynia, sacralgia, mastalgia, etc. Hysterical cardialgia is also very common. Localization of the pain may sometimes imitate bladder or renal colic. I remember a case in which the symptoms so closely resembled hepatic colic that an operation was performed, but only normal relations were present. Limitation of the pain to a single extremity is also noted. In the head the pain is most frequent in the parietal region; more rarely it may have an occipital or temporal localization. It is also called clavus. Some- times it is median, at other times unilateral. The unilateral type, hysterical hemialgia, is less common than the regional form. On the other hand pains are often observed which, upon superficial examination, appear to follow accurately the distribution of a nerve trunk, therefore, resembling true neural- gia. If these hysterical pseudoneuralgias are carefully examined it is found that the pain is not limited to the distribution of a peripheral nerve, but that they are modified by the manner in which the physician investigates the sensory condition or by questions giving rise to that suggestion.1 Apparently these are, therefore, only regional, spontaneous pains of psyehogenous origin, topoalgias in our sense of the term. Hysterical intercostal and trigeminal neuralgias are most frequent. In my experience these pseudoneuralgias are never accompanied with herpes. The trigeminal neuralgia may be limited to one branch. When the pains are situated in the cardiac region they may radiate to the left arm and resemble angina pectoris, particularly since the pulse in these attacks of pain is rapid and labile. In a similar manner there may be a resemblance to sciatica. The first appearance of pain may be in connection with emotional shock or a spasmodic attack; sometimes it is actually due to some peripheral irrita- tion. Thus I have repeatedly seen an exceedingly tenacious topoalgia of the leg in connection with some gynecological affection, such as a hematocele. The irradiation of pain due to the latter condition is apparently the cause of the pseudoneuralgia and determines its localization. The pains are stated by the patient to be extremely intense. At times they are continuous, at other times paroxysmal. External irritation, such as cold, pressure, etc., which in true neuralgia and especially in neuritis, as a rule, produces an exacerbation, usually has no constant influence. But the significance of psychical factors is all the more noticeable. Diverting the attention is of decisive importance. I knew a married woman whose exceed- ingly tenacious neuralgia disappeared after she had procured a lover. Quite as characteristic is the influence of skilfully concealed suggestions. Sensation may be entirely intact in the region of the topoalgia; more often there is regional hyperesthesia and especially regional hyperalgesia.2 Clavus may be associated with a more or less extensive hyperalgesia of the scalp, hysterical coxalgia, i. e., hysterical arthralgia of the hip joint with hyperalgesia in the shape of “ half a loin cloth ” or with hyperalgesia of 1 Even an insignificant, actually subsistent organic pain may act in this sense. 2 In those cases in which hysterical topoalgia, as mentioned above, occurs in con- nection with an organic disease of the internal organs, the hyperalgesic zone may cor- respond to Head’s irradiation zones. In the main, however, the regional hyperalge- sias of hysteria have nothing in common with Head’s zones. 69