Chronic pain syndrome

• What is Chronic Pain Syndrome?
• Statistics
• Risk Factors
• Progression
• Symptoms
• Clinical Examination
• How is it Diagnosed
• Prognosis
• Treatment
• References

What is Chronic Pain Syndrome?

Chronic pain syndrome encompasses any pain that persists longer than the reasonable expected healing time for the involved tissues. The duration of pain is often arbitrarily set at 3 months duration. In contrast to acute pain, which is a vital protective mechanism, chronic pain serves no physiological role.
It is not a symptom, but rather a disease state. Some conditions that lead to chronic pain syndrome include:

• Low back pain (e.g. lumbar radiculopathy, spinal stenosis, facet syndrome, myofascial pain);
• Neck/shoulder pain (e.g. whiplash, cervical radiculopathy, fibromyalgia);
• Headache (e.g migraine, cluster, tension type, cervicogenic);
• Musculoskeletal pain (e.g. soft tissue injury, myofascial pain syndrome, fibromyalgia, arthritis);
• Neuropathic pain (e.g. post-herpetic neuralgia, chronic regional pain syndrome I and II, phantom limb pain, diabetic neuropathy);
• Chronic postoperative pain (e.g. post-thoracotomy pain, neuroma formation, neuropraxia).

Statistics

Chronic pain syndrome has been reported to effect up to 54% of the population at some stage.

Risk Factors

Chronic pain syndromes are more common in womens health than men health. People with depression or anxiety are also more likely to develop chronic pain syndromes. Some people who have chronic pain syndrome later develop anxiety or depression as a result of their illness.

Progression

Chronic pain syndromes often develop after an acute pain, such as an injury, but they may develop with no recognised preceding injury. Chronic pain is defined as pain that lasts for longer than the expected time for recovery of injured tissues, nominally 3 months.

Symptoms

The history of the pain varies greatly according to the type of pain, but can include

• Headaches;
• Pain;
• Back pain;
• Muscle pain;
• Neuropathic pain;
• Chronic postoperative pain.

Your doctor will ask you questions about how long the pain has been a problem, how it started, what treatments you have tried and which treatments were effective, what makes the pain better and what makes it worse as well as a general history on other body systems.

Clinical Examination

Results of the clinical (physical) examination is variable according to the cause of the pain.

How is it Diagnosed

Your doctor may order some investigations when determining the cause of your pain, however investigations are not useful once a chronic pain syndrome has been diagnosed.

Prognosis

The prognosis for chronic pain syndromes is extremely variable.

Treatment

Treatment for chronic pain syndrome can involve several different approaches. It is not always possible to get rid of chronic pain completely. When thinking about managing your pain, the goal may not be to be entirely pain free, but rather to be able to complete more of your daily activities than before (for example, be able to play golf or tennis again).
For more details on an approach to pain management, see Analgesia.

References

1. Bajwa ZH, Warfield CA. Definition, pathogenesis and evaluation of chronic pain [online]. Waltham, MA: UpToDate; 2006 [cited 12 April 2006]. Available from: URL link
2. Bajwa ZH, Warfield CA, Wootton RJ. Overview of the treatment of chronic pain [online]. Waltham, MA: UpToDate; 2006 [cited 12 April 2006]. Available from: URL link
3. Kumar P, Clark M (eds). Clinical Medicine (5th edition). Edinburgh: WB Saunders Company; 2002. [Book]
4. Singh MK, Patel J, Gallagher RM. Chronic pain syndrome [online]. Omaha, NE: WebMD eMedicine; 2006 [cited 12 April 2006]. Available from: URL link