Pain Syndromes

Pain Syndromes

Management of chronic pain has become a significant challenge for primary care providers, and the population of patients with chronic pain is expected to increase. Common syndromes seen in the primary care setting include myofascial pain syndrome, fibromyalgia, chronic postsurgical pain, complex regional pain syndrome, and painful diabetic neuropathy. Pain syndromes overlap in clinical features and share the same treatments. We have grouped them together in treatment categories:

Fibromyalgia

FM is a common disabling physical functional pain syndrome. FM is a misnomer because it is not due to connective tissue or pure muscle pathology. Incidence rates in developed countries remain high, indicating a significant economic burden. Our understanding of the genetic factors associated with FM and the resulting functional changes is advancing. Currently, management options continue to focus on symptom control.

Reflex Sympathetic Dystrophy (RSD) Syndrome

RSD is an older term used to describe one form of Complex Regional Pain Syndrome (CRPS). Both RSD and CRPS are chronic conditions characterized by severe burning pain, most often affecting one of the extremities (arms, legs, hands, or feet). There are often pathological changes in bone and skin, excessive sweating, tissue swelling and extreme sensitivity to touch, known as allodynia.

RSD is sometimes called Type I CRPS, which is triggered by tissue injury where there is no underlying nerve injury, while Type II CRPS refers to cases where a high-velocity impact (such as a bullet wound) occurred at the site and is clearly associated with nerve injury. Type II used to be called “causalgia” and was first documented over 100 years ago by doctors concerned about the pain that Civil War veterans suffered even after their wounds had healed. RSD is unusual in that it affects the nerves, skin, muscles, blood vessels and bones at the same time.

Neuropathic pain

Neuropathic pain can happen if your nervous system is damaged or not working correctly. You can feel pain from any of the various levels of the nervous system—the peripheral nerves, the spinal cord and the brain. Together, the spinal cord and the brain are known as the central nervous system. Peripheral nerves are the ones that are spread throughout the rest of your body to places likes organs, arms, legs, fingers and toes.

Damaged nerve fibers send the wrong signals to pain centers. Nerve function may change at the site of the nerve damage, as well as areas in the central nervous system (central sensitization).

Neuropathy is a disturbance of function or a change in one or several nerves. Diabetes is responsible for about 30% of neuropathy cases. It is not always easy to tell the source of the neuropathic pain. There are hundreds of diseases that are linked to this kind of pain.

Abdominal pain

Abdominal pain is pain that you feel anywhere between your chest and groin. This is often referred to as the stomach region or belly. Almost everyone has pain in the abdomen at some point. Most of the time, it is not serious.

How bad your pain is does not always reflect the seriousness of the condition causing the pain.

For example, you might have very bad abdominal pain if you have gas or stomach cramps due to viral gastroenteritis.

However, fatal conditions, such as colon cancer or early appendicitis, may only cause mild pain or no pain.

Other ways to describe pain in your abdomen include:

Generalized pain — This means that you feel it in more than half of your belly. This type of pain is more typical for a stomach virus, indigestion, or gas. If the pain becomes more severe, it may be caused by a blockage of the intestines.

Localized pain — This is pain found in only one area of your belly. It is more likely to be a sign of a problem in an organ, such as the appendix, gallbladder, or stomach.

Cramp-like pain — This type of pain is not serious most of the time. It is likely to be due to gas and bloating and is often followed by diarrhoea. More worrisome signs include pain that occurs more often, lasts more than 24 hours, or occurs with a fever.

Colicky pain — This type of pain comes in waves. It very often starts and ends suddenly and is often severe. Kidney stones and gallstones are common causes of this type of belly pain.

Facial Pain

Facial pain is pain felt in any part of the face, including the mouth and eyes. Although it’s normally due to an injury or a headache, facial pain may also be the result of a serious medical condition.

Most causes of facial pain are harmless. However, if you have facial pain that seems to come without any known cause, call your doctor for an evaluation.

Doctors often categorize facial pain into one of several types, including:

  • Dental pain, which relates to problems with the teeth and gums
  • Nerve pain, or neuralgia, which relates to conditions that affect the facial nerves
  • Temporomandibular pain, which relates to the temporomandibular joint (TMJ) and the muscles of the jaw
  • Vascular pain, which occurs due to issues with blood vessels and blood flow

Causes of facial pain-Facial pain can be due to anything from an infection to nerve damage in the face. Common causes of facial pain include:

  • an oral infection
  • an ulcer, or open sore
  • an abscess, such as a collection of pus under the surface tissue in the mouth
  • a skin abscess, which is a collection of pus under the skin
  • headache
  • a facial injury
  • toothache

More serious causes of facial pain include:

People often describe facial pain as cramp-like, stabbing, or achy. Pain from other areas in the body, such as the ears or head, may radiate or spread to your face.

Central pain Syndromes

Central post-stroke pain (CPSP) is a neuropathic pain syndrome that can occur after a cerebrovascular accident. This syndrome is characterised by pain and sensory abnormalities in the body parts that correspond to the brain territory that has been injured by the cerebrovascular lesion. The presence of sensory loss and signs of hypersensitivity in the painful area in patients with CPSP might indicate the dual combination of deafferentation and the subsequent development of neuronal hyperexcitability. The exact prevalence of CPSP is not known, partly owing to the difficulty in distinguishing this syndrome from other pain types that can occur after stroke (such as shoulder pain, painful spasticity, persistent headache, and other musculoskeletal pain conditions). Future prospective studies with clear diagnostic criteria are essential for the proper collection and processing of epidemiological data. Although treatment of CPSP is difficult, the most effective approaches are those that target the increased neuronal hyperexcitability.

Headaches and Chronic Migraines

Migraine is the most common disabling brain disorder. Chronic migraine, a condition characterized by the experience of migrainous headache on at least 15 days per month, is highly disabling. Patients with chronic migraine present to primary care, are often referred for management to secondary care, and make up a large proportion of patients in specialist headache clinics. Many patients with chronic migraine also have medication overuse, defined as using a compound analgesic, opioid, triptan or ergot derivative on at least 10 days per month. All doctors will encounter patients with chronic headaches. A basic working knowledge of the common primary headaches, and a rational manner of approaching the patient with these conditions, allows a specific diagnosis of chronic migraine to be made quickly and safely, and by making this diagnosis one opens a substantial number of acute and preventive treatment options.

Groin Pain

The groin is an area of your hip between your stomach and thigh. It is located where your abdomen ends, and your legs begin. The groin area has five muscles that work together to move your leg. Groin pain is any discomfort in this area. The pain typically results from an injury caused by physical activity, such as sports. A pulled or strained muscle in the groin area is one of the most common injuries among athletes.

The most common cause of groin pain is a muscle, tendon or ligament strain, particularly in athletes who play sports such as hockey, soccer and football. Groin pain might be worsened by continued use of the injured area.

Less commonly, a bone injury or fracture, a hernia, or even kidney stones might cause groin pain. Although testicle pain and groin pain are different, a testicle condition can sometimes cause pain that spreads to the groin area.

Hip and Joint Arthritis Pain

Hip arthritis is cartilage damage in the hip joint. It’s a common condition that can be painful and worsen over time, affecting your mobility and quality of life. Hip arthritis is deterioration of the cartilage of the hip joint. The hip is a ball-and-socket joint with the ball at the top of the thighbone (the femoral head). The ball is separated from the socket (the acetabulum) by cartilage. The cartilage acts as a slippery coating between the ball and the socket that allows the ball to glide and rotate smoothly when the leg moves. The labrum, a strong cartilage that lines the outer rim of the socket, provides stability.

When cartilage in the hip is damaged, it becomes rough. Thinning of cartilage narrows the space between the bones. In advanced cases, bone rubs on bone, and any movement can cause pain and stiffness. When there is friction at any point between bones, it can also lead to bone spurs — bone growths on the edges of a bone that change its shape.

Osteoarthritis is a degenerative joint disease, which means it causes gradual damage to the joint. It is the most common form of hip arthritis and can affect other joints. Hip osteoarthritis is typically caused by wear and tear related to aging and worsens over time. The breakdown of cartilage leads to pain and inflammation.

Hip osteoarthritis may develop faster in some people due to irregular shape of the bones forming the hip joint.

Phantom Limb Pain

Phantom pain is pain that feels like it’s coming from a body part that’s no longer there. Doctors once believed this post-amputation phenomenon was a psychological problem, but experts now recognize that these real sensations originate in the spinal cord and brain.

Most people who’ve had a limb removed report that it sometimes feels as if the amputated limb is still there. This painless phenomenon, known as phantom limb sensation, isn’t the same as phantom pain.

For some people, phantom pain gets better over time without treatment. For others, managing phantom pain can be challenging. You and your doctor can work together to treat phantom pain effectively with medication or other therapies.

Diabetic Neuropathy

Diabetic neuropathy is a type of nerve damage that can occur if you have diabetes. High blood sugar (glucose) can injure nerves throughout the body. Diabetic neuropathy most often damages nerves in the legs and feet.

Depending on the affected nerves, diabetic neuropathy symptoms include pain and numbness in the legs, feet and hands. It can also cause problems with the digestive system, urinary tract, blood vessels and heart. Some people have mild symptoms. But for others, diabetic neuropathy can be quite painful and disabling.

Diabetic neuropathy is a serious diabetes complication that may affect as many as 50% of people with diabetes. But you can often prevent diabetic neuropathy or slow its progress with consistent blood sugar management and a healthy lifestyle.

HIV- related pain

Pain is common in people living with HIV. One study found that more than half of women living with HIV had pain in the last six months. Pain can occur at all stages of HIV disease and can affect many parts of the body. Usually pain occurs more often and becomes more severe as HIV disease progresses. But each individual person is different. While some people may experience a lot of pain, others have little or none. The good news is that, as HIV treatments have improved, fewer people living with HIV are experiencing pain.HIV-related pain may be:

  • A symptom of HIV itself
  • A symptom of other illnesses or infections
  • side effectof HIV drugs

Regardless of its cause, pain should be evaluated and treated to help you have a good quality of life. Chronic widespread pain is a common comorbidity of HIV infection and is associated with decreased quality of life and a high rate of disability. Chronic pain in people with HIV is multifactorial and influenced by HIV-induced peripheral neuropathy, drug-induced peripheral neuropathy, and chronic inflammation.

Postherpetic neuralgia

Post-herpetic neuralgia is a lasting pain in the areas of your skin where you had shingles.

Around one in five people with shingles will get post-herpetic neuralgia. People aged 50 and over are particularly at risk.

Many people with post-herpetic neuralgia make a full recovery within a year. But symptoms occasionally last for several years or may be permanent.

Symptoms of post-herpetic neuralgia are-

The main symptom of post-herpetic neuralgia is intermittent or continuous nerve pain in an area of your skin previously affected by shingles.

The pain may come and go or be continuous. It can be described as burning, stabbing, shooting, aching, throbbing or like electric shocks.

The affected area may also:

  • Feel intensely itchy
  • Be more sensitive to pain than usual
  • Feel painful as a result of something that would not normally hurt, such as a light touch or cool breeze

Sickle Cell Pain

Sickle cell anaemia is one of a group of inherited disorders known as sickle cell disease. It affects the shape of red blood cells, which carry oxygen to all parts of the body.

Red blood cells are usually round and flexible, so they move easily through blood vessels. In sickle cell anaemia, some red blood cells are shaped like sickles or crescent moons. These sickle cells also become rigid and sticky, which can slow or block blood flow.

There’s no cure for most people with sickle cell anaemia. Treatments can relieve pain and help prevent complications associated with the disease.

Symptoms-

Signs and symptoms of sickle cell anaemia usually appear around 6 months of age. They vary from person to person and may change over time. Signs and symptoms can include:

  • Sickle cells break apart easily and die. Red blood cells usually live for about 120 days before they need to be replaced. But sickle cells typically die in 10 to 20 days, leaving a shortage of red blood cells (anaemia). Without enough red blood cells, the body can’t get enough oxygen, and this causes fatigue.
  • Episodes of pain. Periodic episodes of extreme pain, called pain crises, are a major symptom of sickle cell anaemia. Pain develops when sickle-shaped red blood cells block blood flow through tiny blood vessels to your chest, abdomen and joints.
  • The pain varies in intensity and can last for a few hours to a few days. Some people have only a few pain crises a year. Others have a dozen or more a year. A severe pain crisis requires a hospital stay.
  • Some adolescents and adults with sickle cell anaemia also have chronic pain, which can result from bone and joint damage, ulcers, and other causes.
  • Swelling of hands and feet. The swelling is caused by sickle-shaped red blood cells blocking blood circulation in the hands and feet.
  • Frequent infections. Sickle cells can damage the spleen, increasing vulnerability to infections. Infants and children with sickle cell anaemia commonly receive vaccinations and antibiotics to prevent potentially life-threatening infections, such as pneumonia.
  • Delayed growth or puberty. Red blood cells provide the body with the oxygen and nutrients needed for growth. A shortage of healthy red blood cells can slow growth in infants and children and delay puberty in teenagers.
  • Vision problems. Tiny blood vessels that supply the eyes can become plugged with sickle cells. This can damage the retina — the portion of the eye that processes visual images — and lead to vision problems.

For any Pain Treatment Services please get in touch with Dr. Junaid Kamal of 21st Century clinic situated at Sugarland Area, 1628 Crabb River Road, Suite A Richmond, Texas 77469

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