Judgment Categories, Classification, Pain Mechanisms and Source

Mark presents his evolving list of judgment categories, starting with activity and participation capabilities and restrictions, and psychosocial factors. Classification can address pathology, syndromes, pain mechanisms or source. Pathology matters for precautions, but it is often asymptomatic and symptoms can occur without it, as in Maitland's permeable brick wall and the example of a finger bent back for too long. Three pain mechanisms are broadly recognized. Nociceptive pain is localized, mechanical and proportionate, with a clear history. Neuropathic pain follows a nerve distribution, with antalgic postures and signs of loss or gain such as reduced reflexes or allodynia. Nociplastic pain, or maladaptive central sensitization, is widespread, inconsistent and out of proportion, often persists beyond healing and fits the physical examination poorly. Clues to the source come from the area, description and depth of symptoms, the mechanism of onset, behavior, investigations, the physical examination and treatment response. Visceral referral, illustrated with Goodman and Snyder's diagrams, must stay in mind, and nociplastic features make structural findings less reliable.