20- Chronic Pain Syndromes

Question 1

What is chronic pain?

Answer 1

refers to pain that endures after the time normally required to heal the underlying injury. Although pain may be an indication of a serious underlying condition, chronic pain itself can become a diseased state. Chronic pain has a significant impact on relationships and that adds to the diseased state.

Question 2

What are the 2 ways to classify chronic pain syndromes?

Answer 2

Chronic pain is classified as either diffuse (fibromyalgia) or regional (complex regional pain syndrome).

Question 3

What are 2 major problems with treating pain with no objective findings?

Answer 3

The patient may be pretending to be ill or the patient may have unrelated musculoskeletal abnormalities that could be causing the problem (like a herniated disk causing referred pain). The patient should be given the benefit of the doubt and imaging studies should be indicative of msk abnormalities.

Question 4

What is fibromyalgia?

Answer 4

syndrome of diffuse msk pain, sleep disturbances, and exhaustion.

Question 5

What are the incidences of fibromyalgia in women?

Answer 5

Most common cause of generalized msk pain in women 20-55 years old.

Question 6

What are the causes of fibromyalgia?

Answer 6

Controversial in that it could be a manifestation of psychological processes or the organic causes are too subtle to detect.

Question 7

What are the Sx of fibromyalgia?

Answer 7

Chronic widespread pain on both sides of the body, above and below the waist, as well as pain in the cervical spine, anterior chest, thoracic spine, and/or lower back. Other symptoms associated are fatigue, stiffness, sleep disturbances, fluctuating symptoms with changes in weather, paresthesias, headaches, and anxiety.

Question 8

What is the most common psychological disease in a fibromyalgia patient?

Answer 8

Depression is more prevalent in patients with fibromyalgia than in the general population. It is not certain if depression causes fibromyalgia of if fibromyalgia causes depression.

Question 9

True or False: there are many methods of successfully treating fibromyalgia.

Answer 9

False. No single treatment is highly effective. Physicians should emphasize the benign nature of the disease, stressing that fibromyalgia is neither life threatening nor a deforming disease

Question 10

Studies report that about 25% of patients with fibromyalgia demonstrated significant improvement with use of what medication?

Answer 10

tricyclic antidepressents.

Question 11

What is Complex Regional Pain – Reflex Sympathetic Dystrophy (RSD)?

Answer 11

disorder of the extremities characterized by severe and continuous pain, decreased range of motion, and demineralization of adjacent bony structures. Vasomotor instability also occurs and causes swelling and changes in skin color and temperature.

Question 12

What are the Sx of complex regional pain syndrome?

Answer 12

Warmth of the skin –> coolness of the skin –> decreased mobility, trophic changes, decreased mobility, contractures, and chronic pain

Question 13

What are the 2 subtypes of complex regional pain syndrome?

Answer 13

Type 1 – no nerve lesion, but symptoms

Type 2 – nerve lesion causes symptoms

Question 14

What occurs during the acute stage of complex regional pain syndrome?

Answer 14

Pain in the limb, edema and vasomotor changes which may last for several months. Patients describe the pain as a burning or throbbing sensation, or they describe it as an ache. Extremity is sensitive to palpation or cold. Affected limb may differ in color and temperature. Increased hair and nail growth.

Question 15

What occurs during the middle stage of complex regional pain syndrome?

Answer 15

3-6 months after onset. Soft tissue edema, burning pain, change in temp, nail and hair growth ceases, thickening of skin, and early atrophy of surrounding muscles.

Question 16

What occurs during the late stage of complex regional pain syndrome?

Answer 16

continued changes in hair and nail formation with hair falling out and nails becoming brittle, limitations on movement, and fibrosis and contractures develop.

Question 17

What does an X-ray show for complex regional pain syndromes?

Answer 17

characteristic demineralization takes place during later stages. Severe osteoporosis, destruction of the joints and adjacent bones, subluxation, and evidence of new bone formation are all characteristics seen.

Question 18

What does an MRI show for complex regional pain syndromes?

Answer 18

Useful in acute and middle stages. Shows edema, involved tissues and muscle atrophy.

Question 19

What does an bone scan show for complex regional pain syndromes?

Answer 19

most useful in early stages. Reveals decreased perfusion in the affected areas.

Question 20

How can autonomic blocking Tx complex regional pain syndromes?

Answer 20

Since autonomics is involved in causing this disease, a sympathetic nerve block should help alleviate the symptoms and can also support the diagnosis of complex regional pain syndrome

Question 21

What are the roles of the autonomics in the complex regional pain syndromes?

Answer 21

Many of the clinical findings, such as temperature changes, cyanosis, mottling, hyperhidrosis and abnormal hair growth can be attributable to derangements of the autonomic nervous system. However, not all symptoms are associated with disruption of sympathetic nerve fibers, so it is a theory that the autonomic problems of the limb causes the patient to not use the limb, which will in turn causes disuse atrophy.

Question 22

Which drugs are used to treat complex regional pain syndromes?

Answer 22

NSAIDs and corticosteroids are most commonly used. Patients with active inflammation are more apt to respond to corticosteroid treatments. Prednisone has been shown to be effective.

Question 23

How can physical therapy help treat complex regional pain syndromes?

Answer 23

Aggressive physical therapy has been shown to decrease the risk of complex regional pain syndrome. Early mobilization of patients after trauma or a MI also decreases the chances of developing the disease.