Chronic pain syndrome
Chronic Pain Syndrome (CPS) is a common problem that is a major challenge to health-care providers because of its complex nature of poor etiology and poor response to therapy. Most consider ongoing pain of 3~6 months are diagnostic. A person may have two or more co-existing pain conditions or widespread generalized pain. This condition is managed best with a multidisciplinary approach.
Although CPS has been known to resolve completely with (and very rarely without) treatment, it is uncommon for full relief to be achieved. Therefore, patients should be encouraged to develop realistic goals for their pain treatment. Medications, surgeries, and alternative medicine treatments can reduce pain although their effectiveness varies by the patient and some may provide no relief at all to certain individuals. Occasionally CPS may become increasingly more painful over time regardless of attempted treatments. The prognosis is best for patients who begin pain treatment within 6 months of the onset of symptoms, after which the chance of remission plateaus at a very low level.
Atypical chronic pain syndrome is characterized by patients who will present to dermatologists with complaints of burning, pain, or dysesthesias in the skin or mucous membranes for which no identifiable pathology can be found.:393
Unlike pain due to acute physical injury, CPS pain is generally not well controlled by opioids alone, and shows nearly no response to anti-inflammatory agents. SSRIs, SNRIs, and NMDA antagonists combined with an opioid medication provide more significant relief, dual-acting opioids such as tramadol and tapentadol combine these mechanisms in one medicine and are therefor frequently used (off-label) in CPS treatment.
Patients are encouraged to try alternative treatments alongside (or in the place of) medication in order to obtain better relief. Desensitization physical therapy is often prescribed by the pain management physician and may provide significant relief if the patient does the exercises as recommended. Acupuncture, hypnosis, and meditation have been demonstrated to provide significant relief in some patients although others may experience little or no benefit from these therapies.
Some surgeries can provide pain relief to certain areas of the body. A stellate ganglion block may provide pain reduction to the upper extremities, neck, and face. Trigger-point injections are often employed to reduce pain in the back (particularly the lower back).
Although it does not relieve pain, psychotherapy is often employed to help CPS patients maintain a positive state of mind and manage the depression, anxiety, and isolation that tend to result from chronic pain. This is recommended for all chronic pain patients due to their significantly increased risk of suicidal behavior.
Approximately 35% of Americans have some element of chronic pain,and approximately 50 million Americans are disabled partially or totally due to chronic pain. Major effects on the patient's life are depressed mood, fatigue, reduced activity, excessive use of drugs, dependent behavior, disability, and in some cases suicidal thoughts/actions. Parental chronic pain increases the risk of internalizing symptoms, including anxiety and depression in adolescents.
- Freedberg, et al. (2003). Fitzpatrick's Dermatology in General Medicine. (6th ed.). McGraw-Hill. ISBN 0-07-138076-0.
- Gilron I, Wajsbrot D, Therrien F, Lemay J. Pregabalin for peripheral neuropathic pain: a multicenter, enriched enrollment randomized withdrawal placebo-controlled trial. Clin J Pain. Mar-Apr 2011;27(3):185-93.