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August 1977

Pain Mechanisms: A Physiologic Interpretation of Causalgia and Its Related States

Arch Neurol. 1977;34(8):521. doi:10.1001/archneur.1977.00500200081025

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This is an unabridged republication of Livingston's monograph first published in 1943. It is most appropriate that this classic be brought to the attention of a younger generation. It is a concise, very human, compassionate appraisal of chronic pain problems. With present day popularity of the gate theory for pain, this book takes on even more importance. Here, the origin of that theory is articulated. Repeatedly, it is emphasized that of necessity there must be a modulation of afferent pain impulses in an "internuncial neuronal pool" probably located in the dorsal horn. Also, the balance between the A fibers and C fibers is discussed.

The central thesis of this monograph is "that a peripherally situated trigger point is capable of initiating a pathologic state characterized by spreading reflexes, and probably dependent upon a disturbed physiologic status of the spinal centers." Therapeutic alternatives to the usual destructive procedures of rhizotomy

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