Chronic pain syndromes - Symptoms, Causes, Images, and Treatment Options

Diseases

Highlights & Basics

Key Highlights

Chronic pain is one of the most common reasons for seeing a primary care physician.
Classification of chronic pain may be based on major pain features or by body region: myofascial, musculoskeletal (mechanical), neuropathic, fibromyalgia, and chronic headache syndromes.
One in three patients over the age of 65 years is affected by chronic pain, often due to arthritis, osteoporosis with fractures and/or lumbar spinal stenosis. These conditions are treatable and should not be considered part of the normal aging process. Untreated chronic pain in older patients can result in depression, poor quality of life, and loss of independence.
Some treatments, such as stretching exercises, relaxation techniques, antidepressants, and anticonvulsant drugs, are beneficial for a wide variety of chronically painful conditions.
Opioids should not be used as first-line or routine therapy for chronic pain; evidence for effectiveness is limited, and they are associated with risk of adverse events such as overdose, misuse, fractures from falls, hormonal changes, and increased sensitivity to pain.

Quick Reference

History & Exam
- Key Factors
- Other Factors
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Diagnostics Tests
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Treatment Options
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Definition

Epidemiology

Etiology

Pathophysiology

Images

Acute pain occurs with trauma or illness, decreasing during healing and resolving within 3 months. Chronic pain persists after healing is completed, due to continued activation of neural pain pathways and muscle spasm
Patients should be asked to complete a pain drawing to determine whether pain is localized or widespread by shading all painful areas, using the following key: ///// = pain; ::::: = numbness; *** = burning or hypersensitivity to touch
Headache diagnostic algorithm

Citations

Key Articles

Headache Classification Committee of the International Headache Society (IHS). The international classification of headache disorders, 3rd edition. Cephalalgia. 2018 Jan;38(1):1-211.[Abstract][Full Text]
American Chronic Pain Association; Stanford Medicine. ACPA and Stanford resource guide to chronic pain management: an integrated guide to medical, interventional, behavioral, pharmacologic and rehabilitation therapies. 2021 edition. 2021 [internet publication].[Full Text]
World Health Organization. Guidelines on the management of chronic pain in children. December 2020 [internet publication].[Full Text]
Williams ACC, Fisher E, Hearn L, et al. Psychological therapies for the management of chronic pain (excluding headache) in adults. Cochrane Database Syst Rev. 2020 Aug 12;(8):CD007407.[Abstract][Full Text]
Cruccu G, Garcia-Larrea L, Hansson P, et al. EAN guidelines on central neurostimulation therapy in chronic pain conditions. Eur J Neurol. 2016 Oct;23(10):1489-99.[Abstract][Full Text]

Other Online Resources

BMJ: medical cannabis or cannabinoids for chronic pain: a clinical practice guideline

Referenced Articles

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