Introduction

Throughout history, physicians believed that the perception of pain could be explained by a single, simplified physiologic pathway (Loeser et al. 2001a). Their theories described pain as its own sensory apparatus, independent of touch and other senses, or as a result of excessive stimulation from the touch sensation. While the exact mechanisms were unknown, most physicians agreed that pain required a triggering stimulus and that removal of the stimulus should relieve pain. More recently, practitioners focus on pain that occurs during the absence of tissue damage or other organic pathology. While most pain experienced may have an initial inciting event, continuation of pain after removal of the stimulus indicates that many factors and biological pathways interact to cause the sensation of pain. Hence, the initial assessment of an individual's pain is important in determining the underlying cause and the possible treatments available for that individual (Loeser et al. 2001b, c; Garratt et al. 1993).

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