Chronic Pain Conditions
What are chronic pain conditions?
Complex regional pain syndrome(CRPS) is a broad term that is used with reference to chronic pain mostly involving the limbs which is persistent and not in proportion to the preceding injury and is associated with sensory, motor, autonomic and tropic changes. Patients may present with varying signs and symptoms like pain, swelling, skin changes, nail changes, motor weakness. There are multiple pathologies involved like post traumatic, post surgery, autoimmune, sympathetic mediated. These patients suffer from prolonged chronic pain and hence treatment requires multimodal treatment in form of physcological counselling, vocational therapy, pain killers, nerve blocks, physiotherapy. New techniques in management of CRPS like spinal cord stimulator, intrathecal pumps have also proven to be beneficial.
What is fibromyalgia?
Fibromyalgia is a chronic pain condition affecting muscles and soft tissues. It is associated with 14 tender points all over the body , lack of sleep, agitation, day time drowsiness, irritability, anxiety, stiffness of body. Pain in fibromylagia is present through out the day ,waxing and wanning, stabbing or shooting pain along with other different symptoms. Identification and treatment of of fibromyalgia is not only difficult but also essential to treat because if left untreated it affects the quality of life, leads the patient towards depression. Management of fibromyalgia requires multidisciplinary approach. Pain killers, antineuropathic drugs, trigger point injections, cognitive behavioral therapy, physiotherapy.
Myofascial pain syndrome:
Myofascial pain syndrome is a chronic pain, tenderness and spasm of muscles. The pain is localised to a particular group of muscles and is usually associated with a tender point. This occur due to any trauma, overuse of muscles, anxiety or stress. If left untreated it may progress to fibromyalgia, disturbed sleep , depression. Treatment in form of pain killers, trigger point injections, muscle relaxations, TENS therapy is done.
Phantom limb pain:
Phantom limb pan implies pain in the missing body part, seen after amputation of the limbs or fingers. This pain is usually at the site of amputation and is associated with certain movements or on touching that part, emotional stress, pressure, cough, defecation. Patient will complaint of burning ,throbbing, stabbing pain. This pain has multifactorial components , involving brain, spinal cord and periphery. The nerve fibers at the amputed area undergo degeneration and send pain signals to the brain, brain undergo lots of reorganization changes , all leading to perceptionof having pain. Multimodal approach to the management of phantom limb pain includes behavioral therapies, TENS therapies, mirror therapy, drugs like over the counter pain killers, opioid group of drugs, antineuropathic drugs. Spinal cord stimulator, motor cord stimulators are new modalities of treatment for phantom limb pain.
Spinal cord central pain states:
Spinal cord injury due to trauma, infection, cancers, leads to pain in the limbs, abdomen, perineum,anal region . These pains are severe, exacerbated by touch, pressure, temperature changes and associated with tingling and numbness. There are many drugs like over the counter pain killers, antineuropathic drugs, spinal cord stimulators, deep brain stimulators which are effective in management of these pain.