Pain Conditions
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      2. Pain Conditions

      Chronic Pain Syndrome

      Brief Overview: Chronic Pain Syndrome (CPS) refers to persistent pain lasting >3–6 months that is disproportionate to any identifiable cause and is associated with functional impairment, emotional distress, and reduced quality of life. Unlike pain from an acute injury, CPS often persists despite healing and may involve central sensitization of the nervous system.

      Prevalence: According to UpToDate, “Approximately 30 percent of patients in developed countries report moderately severe or severe pain that persists longer than six months.”

      Etiology:

      • Often multifactorial:
        • Past injury or surgery that led to chronic pain
        • Nervous system sensitization (amplified pain signaling)
        • Psychological factors (depression, anxiety, trauma)
        • Medical conditions (arthritis, diabetes, cancer, neuropathy)
      • In many cases, no single cause is identified (idiopathic)

      Risk Factors:

      • Genetics
      • Age
      • Previous injury, trauma
      • Physically demanding job
      • Stress, anxiety, PTSD, depression
      • Tobacco use
      • Obesity

      Commonly Associated Conditions:

      • Depression, anxiety, sleep disorders
      • Fibromyalgia, myofascial pain syndrome
      • Arthritis
      • Endometriosis
      • Cancer
      • Chronic fatigue syndrome
      • Substance use disorders

      Common Medications:

      • Analgesics: acetaminophen, NSAIDs (short-term, caution in some)
      • Neuropathic agents: gabapentin, pregabalin, duloxetine, amitriptyline
      • Antidepressants (SNRIs, TCAs): for pain modulation and mood
      • Topical agents: lidocaine patches, diclofenac gel
      • Opioids: last resort, short-term only; can be high risk in seniors
      • Muscle relaxants: generally avoided long-term in older adults

      Common Labs, Imaging, and Tests:

      • X-ray, MRI, CT

      Common Symptoms:

      • Widespread or localized chronic pain (>3–6 months).
      • Pain disproportionate to physical findings.
      • Fatigue, poor sleep, cognitive difficulties (“brain fog”).
      • Emotional distress: irritability, depression, anxiety.
      • Decreased physical activity, avoidance behaviors.
      • Functional decline (difficulty walking, dressing, socializing).

      Common Treatments:

      • Non-Pharmacologic (cornerstone):
        • Physical therapy, gentle exercise, stretching
        • Cognitive-behavioral therapy (CBT), mindfulness-based stress reduction
        • Patient education on pain neurobiology (“pain does not always equal damage”)
        • Multidisciplinary care (PT, OT, psychology, pain specialists)
        • Support groups and peer support
      • Pharmacologic:
        • As above (analgesics, neuropathic agents, antidepressants, topical agents)
        • Avoid long-term opioids if possible
      • Interventional:
        • Nerve blocks, injections, spinal cord stimulation (in refractory cases)

      Physical Findings:

      • Often minimal or inconsistent with reported pain severity
      • Localized tenderness, muscle tension, or trigger points
      • Stiffness or limited range of motion due to disuse
      • No objective neurological deficits unless comorbid condition present

       

      Potential Complications and Contraindications:

      • Complications:
        • Disability and loss of independence
        • Depression, anxiety, social withdrawal
        • Medication overuse (especially opioids, NSAIDs)
        • Falls and deconditioning
        • Increased healthcare utilization
      • Contraindications:
        • Long-term opioid therapy (dependency, falls, confusion)
        • Chronic NSAID use in patients with kidney, GI, or cardiovascular risk
        • Caution with muscle relaxants (sedation, falls, confusion)

      General Health and Lifestyle Guidance:

      • Encourage regular low-impact exercise (walking, swimming, tai chi, yoga). Ask your healthcare provider what exercises are recommended for you.
      • Maintain a healthy sleep routine; avoid daytime over-napping.
      • Balanced diet with anti-inflammatory foods (fruits, vegetables, whole grains, omega-3s) may be helpful. Ask your healthcare provider if there are any dietary modifications recommended for you.
      • Stress management: meditation, relaxation, counseling
      • Social engagement to reduce isolation and depression
      • Use assistive devices if needed for mobility/safety
      • Encourage pacing of activities to avoid flare-ups

      Suggested Questions to Ask Patients:

      • How long have you been experiencing pain, and how does it affect daily life?
      • Is the pain constant, or does it come and go?
      • How do pain and fatigue affect your sleep, mood, and activities?
      • What medications or treatments have you tried? Did they help?
      • Do you use pain medication daily? How often?
      • Have you noticed depression, anxiety, or loss of interest in activities?
      • Do you have support at home with daily tasks?
      • What are your goals for managing your pain (e.g., walking more, better sleep, less fatigue)?

      Suggested Talking Points:

      • Chronic pain syndrome is real, even if we don’t see obvious damage/evidence on tests.
      • Pain can persist because the nervous system stays sensitized, even after an injury heals.
      • The best results often come from combining exercise, counseling, and safe medication use.
      • Staying active and pacing yourself can help prevent pain from worsening.
      • Generally, you want to try to avoid relying on opioids long-term.
      • Managing stress, mood, and sleep is just as important as treating the pain itself.

      Sources:

      This content was created with the assistance of AI. Any AI-generated content was reviewed by a Nurse Practitioner.