Lower extremity hyperalgesia and allodynia: a case review for evidence based pain diagnosis

The clinical presentation of pain may be influenced by multiple etiological factors. It is a clinician’s most important responsibility to determine the underlying causes of the patient’s symptoms with differential assessment based on sound multidimensional clinical reasoning. The aim of this case review is to describe evidence based pain diagnosis of the patient present with lower quarter hyperalgesia and allodynia. A 42-year old female was referred for physiotherapy with severe low back pain with progressive burning sensation in the left lower limb and left waist since three months. She had a past history of cervical spine myelomalacia (central cord syndrome) and right parital lobe epilepsy. During routine musculoskeletal evaluation, we found Grade I spondylolythesis at L5–S1 level, mild type II complex regional pain syndrome. Together with these findings the central cord syndrome and parital lobe epilepsy were considered as the major factors for developing the pain. She was found positive for psychosocial illness, which may also influence the pain. Based on the available evidence towards various models and classification of pain, the possible mechanisms for present ongoing pain were identified. The evidence for diagnostic options is reviewed. Sound clinical reasoning gave us a good explanation about the underlying causes of pain and helped us to concurrently think about prognosis with current medical management. Accordingly rehabilitative measures were tailored, considering a bio-psychosocial approach. This case reminded us that, the mechanism based pain diagnosis plays a major role in a broad understanding of pain, in order to effectively manage the clinical presentation of pain in musculoskeletal physiotherapy practice.