Commentary on 'On the nature of nondermatomal somatosensory deficits'.

摘要

The review by Mailis and Nicholson, on nonderma-tomal somatosensory deficits (NDSDs) associated with chronic pain, is timely as it addresses a common and challenging clinical neurological display that has, as they say, "been relegated to the backburner of empirically founded pathophysiological and diagnostic assumptions". The subject is actually broader than NDSDs, as it encompasses nonanatomic rather than just nondermatomal sensory displays (dermatome is an area of skin innervated by sensory fibers from a single spinal nerve). In addition, the theme encompasses both negative and positive sensory phenomena, rather than just deficit (hypoesthesia). Moreover, associated negative and positive motor abnormalities are often present. Yet, very few clinicians will disagree with the authors' implicit message, that NDSDs signify psycho-genic dysfunction. Actually, this pathogenic category reflects more than what the authors pointedly emphasize, that is, hysterical conversion or somatization. Indeed, their review underplays the simulation of illness, that is, malingering. Both conversion or somatization and malingering profiles often feature somatosensory or somato-motor dysfunction, and the 2 conditions tend to coexist and supplement each other. When applied to characterize the clinical profile of these psychogenic displays, the term pseudoneurological is most appropriate, and is opportunely applied by Mailis and Nicholson in their review. For Shorter,1 the Canadian scholar, "the term pseudoneurological illness seems most appropriate for those patients who have the symptoms but not the pathology of an organic lesion of the nervous system... all of these labels designate some breakdown in the mind and body relationship...".