October 9, 1967

Ouantitation of Abdominal Pain

Author Affiliations

San Lorenzo, Calif

JAMA. 1967;202(2):152. doi:10.1001/jama.1967.03130150120033

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To the Editor:—  In the Aug 14 issue (201:558, 1967) a "Technique for Quantitating Abdominal Pain" is described. Quite obviously it is tenderness, rather than pain, which the author is attempting to quantitate, and the difference in significance of the two terms is not an academic quibble, but an important point in diagnosis.Moreover, since the technique does not take into account variations in abdominal muscle tonus it could result in misleading and paradoxical pressure readings. For example, in progressive intra-abdominal disease irritation of the parietal peritoneum will cause involuntary localized splinting and a temporary increase in the amount of pressure necessary to cause discomfort. Because the cuff is interposed between the patient and the examiner's hand, the area of localized muscle spasm might go unrecognized.Dr. Shafer's aim is a worthy one but his proposed technique is potentially misleading.In patient-side diagnosis nothing can replace the thoughtful application