A 64-year-old school superintendent with known rheumatoid arthritis presents to the office with a recurrent episode of significant hand and wrist pain after having been virtually pain-free for about eight months on DMARD therapy as closely monitored by her rheumatologist. She questions the doctor as to how it could be that she has these painful chronic-recurrent flare-ups alternating with pain-free periods, all the while it seems that the "arthritis is getting better" with the medications. What would be the best explanation, based on the article by D. Marcus: "Treatment of Nonmalignant Chronic Pain?"
A. Central block of pain transmission along the spino-thalamic tract to the limbic system
B. Central neural plasticity
C. Near complete loss of nociception at the joints in the hands
D. Patient is emotionally more stable as she has accepted the disease
E. Significant atrophy of interneurons in the spinal cord
Answer: B
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Biomechanics
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