Neurology Edited by Professor Emeritus Desire' Dubounet, IMUNE

obtained history, a thorough medical and neurological examination, andappropriate laboratory aids, the physician should characterize the pain,discomfort, and loss of sensation occurring in the areas innervated by theaffected nerve, and also the degree of muscle strength and fine motorcontrol that has been lost.Pain: The pain associated with peripheral spinal nerve impairment, andparticularly with that of the median nerve, sometimes has a constantburning quality. This pain is described as a major or a minor causalgia inaccordance with its severity, and it is evaluated on the same percentagebasis as are other types of pain. Major causalgia that persists despiteappropriate treatment can result in loss of function of the affectedextremity and impairment that is as great as 100%.In evaluating pain that is associated with peripheral spinal nervedisorders, the physician should consider: (a) how the pain interferes withthe individual’s performance of the activities of daily living; (b) to whatextent the pain follows the defined anatomical pathways of the root,plexus, or peripheral nerve; and (c) to what extent the description of thepain indicates that it is caused by a peripheral spinal nerve abnormality.That is, the pain should correspond to other kinds of disturbances of theinvolved nerve or nerve root.Complaints of pain that cannot be characterized as above are notconsidered within the scope of this section (for a discussion of categoriesof pain and their characterization, see Appendix B). The examiner mustdetermine whether the sensory or motor deficit is due to involvement of