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Book and Media Reviews
October 20, 2010

Physical Diagnosis of Pain: An Atlas of Signs and Symptoms

JAMA. 2010;304(15):1725-1726. doi:10.1001/jama.2010.1524

With its theme of “When all else fails, examine the patient,” this superb atlas points readers toward the weakest but most exciting aspect of pain medicine, ie, that there is no objective approach to pain, which is a fundamentally subjective and extremely individual phenomenon. Therefore, pain medicine has come under much pressure to justify its approach, because modern evidence-based medicine is based on the belief in images and technologies and leaves less room for the subjective dimension of pain. Systematic clinical functional examination offers an attractive way out of this dilemma. Not only does it generate additional objective insights, but its relationship aspect can hardly be overestimated. This aspect is characterized by physical contact as well as psychological appreciation and thus may already be the starting point for symptom alleviation or even healing.

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