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Examines in Physical Medicine and Rehabilitation: Open Access

Overlooked Symptoms of Chronic Pain

Nelson Howard Hendler*

Former assistant professor of neurosurgery, Johns Hopkins University School of Medicine, USA

*Corresponding author: Nelson Hendler, Former assistant professor of neurosurgery, Johns Hopkins University School of Medicine, USA

Submission: September 20, 2022; Published: September 23, 2022

DOI: 10.31031/EPMR.2022.03.000570

ISSN 2637-7934
Volume3 Issue4


Pain is a poorly understood component of medicine. Despite the fact that pain is one of the most common reasons a patient seeks medical assistance, there is limited understanding of this process. Pain often produces a great deal of anxiety for patient because it signals that something is wrong within the body. This is further complicated and compounded by the fact that pain is a totally subjective experience. There is no way to accurately and consistently measure pain. However, one of the first questions most physicians ask a patient is “How much pain do you have?” This inanity has been perpetuated by the advent of the most useless of all medical assessments which is an attempt to quantify this subjective experience-the fifth vital sign. Nowadays, a physician asks a patient “How much pain do you have on a scale of one to ten?” and then dutifully records the answer. This has no diagnostic value.

Research from Johns Hopkins University School of Medicine documents that 40%-80% of chronic pain patients are misdiagnosed [1]. An extreme example of this mislabeling of patients is fibromyalgia. In one recent study, the authors found that 37 of 38 patients (97%) told they had fibromyalgia did not meet the diagnostic criteria for this disorder. In the 37 patients who really did not have fibromyalgia, the authors found 133 other medical disorders, documented by objective medical tests, who needed surgery to improve [2]. Likewise, 71% to 80% of patients told they had Complex Regional Pain Syndrome (CRPS) or Reflex Sympathetic Dystrophy (RSD) were found to have just undiagnosed nerve entrapment syndromes [3,4]. As the result of being misdiagnosed and having chronic and persistent pain, patients go through four stages of psychological responses, spanning 3-12 years [5]. Eighty-nine percent of these patients get depressed, and the suicide rate in this patient group is 2 to 3 times higher than the general population [6,7]. To address this high rate of misdiagnosis in chronic pain patients, researchers from Johns Hopkins University School of Medicine developed an “expert system” diagnostic program, which produces diagnoses with a 96% correlation with diagnoses of Johns Hopkins Hospital doctors [8]. This system can also predict with 100% what a neurosurgeon will find when he operates [9]. This system used pattern recognition, and Bayesian analysis to interpret the 2008 possible answers to the 72 questions asked by the “expert system.” [8]. The system is available on several websites, including, www.AILabsPS. com, and Outcome studies document that when this “expert system” is used, narcotic use is reduced 89% of the time, tranquillizer and hypnotic use is reduced 85% of the time, and there is a 45% reduction in doctors’ visits [10]. The system is available to physicians for use in research without costs. Email Nelson Hendler, MD, MS at to received free access.


  1. Hendler N (2018) Why 40%-80% of chronic pain patients are misdiagnosed and how to correct that. Nova Science Publishers, pp. 216-217.
  2. Hendler N, Romano T (2016) Fibromyalgia over-diagnosed 97% of the time: Chronic pain due to thoracic outlet syndrome, acromo-clavicular joint syndrome, disrupted disc, nerve entrapments, facet syndrome and other disorders mistakenly called fibromyalgia. Anesth Pain Med 1(1):1-7
  3. Dellon AL, Andronian E, Rosson GD (2009) CRPS of the upper or lower extremity: Surgical treatment outcomes, J. Brachial Plex Peripher Nerve Inj 4(1): 1.
  4. Hendler N, Raja S (1999) Chapter 39-Relex Sympathetic Dystrophy and Causalgia. In: David Tollison C, Williams, Wilkins Baltimore, (Eds.), Handbook of Pain Management.
  5. Hendler N (1982) The four stages of pain. In: Long D, Wise T, Johm Wright (Eds.), Chapter 1: Diagnosis and Treatment of Chronic Pain, USA.
  6. Hendler N (1988) Validating and treating the complaint of chronic back pain: The mensana clinic approach. In: eds. Black P, Alexander E, Barrow D, (Eds.), Lippincott Williams & Wilkins Publishers, USA, 35: 385-397.
  7. Fishbain DA (1999) The association of chronic pain and suicide. Semin Clin Neuropsychiatry 4(3): 221-227.
  8. Hendler N, Berzoksky C, Davis RJ (2007) Comparison of clinical diagnoses versus computerized test diagnoses using the mensana clinic diagnostic paradigm (expert system) for diagnosing chronic pain in the neck, back and limbs. Pan Arab Journal of Neurosurgery, pp. 8-17.
  9. Landi A, Davis R, Hendler N, Tailor A (2016) Diagnoses from an on-line expert system for chronic Pain confirmed by intra-operative findings. Journal of Anesthesia & Pain Medicine 1(1): 1-7.
  10. Hendler N (1988) Validating and treating the complaint of chronic back pain: The mensana clinic approach. In: Black P, Alexander E, Barrow D, (Eds.), Clinical Neurosurgery, Williams and Wilkins Company, 35: 385-397.

© 2022 Nelson Howard Hendler. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and build upon your work non-commercially.