Chronic pain syndrome, also called CPS, is a common medical problem that challenges the best of doctors. It has a complex history and often it is unclear as to the cause of the pain. People with chronic pain syndrome tend not to respond very well to medical therapy.
Chronic pain syndrome is often poorly defined. Most doctors consider the diagnosis of chronic pain to be any pain that is intermittent or ongoing for at least six months duration. Others feel that three months of pain is long enough to make the diagnosis of CPS.
Chronic pain syndrome is a collection of symptoms that respond poorly to the traditional medical model of care. It is best managed using a multidisciplinary team of doctors, physical and occupational therapists, psychotherapists, and holistic doctors who together use various modalities to manage the pain.
People who deal with those who have chronic pain syndrome must be open-minded when it comes to the diagnosis and management of the disease. There needs to be a careful history to identify the possible causes of the pain syndrome and a careful review of systems, including the musculoskeletal system, urologic system, reproductive system, gastrointestinal system, and the neuropsychological system.
A History of the Condition
The doctor caring for the person with CPS must perform a detailed pain history in order to identify the specific characteristics of the pain. Questions that must be answered include the following:
- The location of the pain. The patient should be asked about where the pain is located as this can help identify the identity of the pain syndrome.
- Precipitating factors. The doctor should ask about which things intensify or provoke the pain.
- Factors that alleviate the pain. The patient should be asked about which things help the patient feel better.
- Quality of the pain. Is the pain pounding, aching, throbbing, shooting, sharp, cutting, stinging, or any number of ways to identify pain?
- Where the pain radiates. Does the pain spread or radiate anywhere, such as is seen in neuropathy pain.
- Intensity of the pain. The doctor should use a standard pain scale to identify how severe the pain is at any given point of time.
In addition to a full review of systems, the doctor should get a psychosocial or psychosexual history, especially when organic disease has been excluded and psychiatric disorders are possible. Things like depression, somatization, past history of abuse, and anxiety should be assessed. Somatization is a common component of chronic pain syndromes, especially in women.
Common Characteristics of CPS
Characteristics of chronic pain syndrome include drug misuse, dependency, dramatization of complaints, depression, disuse or dysfunction, and disability. Because there are many emotional factors that play into the disease, there must be a great deal of tolerance, a good rapport, and an open-minded approach on the part of the healthcare provider taking care of the patient.
It should be noted that people with CPS commonly have exaggerated pain behavior with disability that is out of proportion to the objective findings found on the exam. This makes it difficult to diagnose the condition and identify its impact on the patient suffering from the pain.
Diagnosis of Chronic Pain Syndrome
There are many kinds of diagnoses that fall under the category of chronic pain syndrome. They include the following:
- Cancer of the spinal cord or sacral nerves
- Various types of hernias
- Abdominal migraines
- Chronic headaches
- Fibromyalgia
- Pelvic floor syndrome
- Nerve entrapment syndromes
- Chronic visceral pain syndrome
- Chronic fatigue syndrome
- Substance abuse
- Chronic arthritis
- Irritable bowel syndrome
- Urinary pain
- Carpal tunnel syndrome
- Spinal disc disease
- Post-herpetic neuralgia
Approach to Chronic Pain Syndromes
When dealing with chronic pain, life-threatening illnesses should be ruled out. This may involve x-rays and other diagnostic tests to make sure nothing serious is going on. When this has been done, a multidisciplinary approach should be used to address the physical, emotional, and psychosocial issues involved in the disease.
Management of chronic pain syndrome is complicated, involving simultaneous physical and psychological therapy. There should be a good relationship between the doctor and the patient so that the intricacies of management can better be handled.
The treatment of chronic pain syndrome should be individualized to the patient. The treatment should be focused on interrupting reinforcing patterns of the pain behavior and on modulating the pain response. A holistic approach to treating chronic pain syndrome is the best way to manage the various issues that go into this disorder.
