Pain Syndromes

Pain Syndromes

Chronic/Complex Regional Pain Syndrome (Type 1)

·        = Reflex Sympathetic Dystrophy

·        =Algodystrophy

·        Can develop as a consequence of trauma affecting the limbs with or without obvious nerve lesion 

·        Cause: ?peripheral sympathetic over-activity, pathological interaction of sympathetic and afferent systems

·        Presentation:

o   Pain

o   Abnormal blood flow (cold or hot) and sweating (including distal to the trauma)

o   Structural changes eg muscle wasting (over months to years can ® contractures)

·        Treatment: difficult: pain relief, rehabilitation, physio, early refer to pain management clinic

Fibromyalgia

·        Aetiology: unknown

·        Presentation:

o   Diffuse musculoskeletal pain (over all 4 quadrants and axial) but normal muscle power

o   Morning stiffness

o   Paraesthesia

o   Tender points over the body

o   Skin fold tenderness

o   Sleep disturbance, fatigue and vertigo

·        ESR usually normal

·        Associations: Raynaud‟s phenomenon, anxiety/depression, IBS

·        Diagnosis: based on finding a number of separate, defined tender points

·        Treatment: analgesics and exercise