[Pain syndromes affecting the locomotor apparatus. Clinical signs, differential diagnosis and therapy.].

Clinical pain syndromes affecting the locomotor apparatus can become apparent not only in the form of nociceptive pain in the skeleto-mechanical system, but also as neurogenic pain emanating from lesions in the peripheral nerves or nerve roots or as referred pain resulting from disorders of visceral organs. The anatomical structure and basic innervation can contribute to the various characteristics of such deep pain. Within the spinal cord, visceral and somatic afferent fibres converge on nociceptive pathways, resulting in a uniform clinical pain syndrome. The differential diagnosis can be extremely difficult when attempts are made to evaluate its clinical relevance. Pain radiating from deep somatic tissues into the extremities is called "pseudoradicular" pain. Examples are encountered in the "facet syndrome" or the "myofascial pain syndrome". Various types of treatment are available for musculo-skeletal disorders, including physiotherapy, transcutaneous nerve stimulation (TENS) and trigger point infiltration. In clinical practice, however, drug therapy with peripheral analgesics and anti-inflammatory drugs is the form of therapy most often prescribed. There is no doubt that these drugs can help a great deal. However, they have only a symptomatic effect without any influence on the origin or course of the disease. Therefore, a critical evaluation of their benefits and risks is required before treatment with such drugs is instituted.