eMedicine Specialties > Physical Medicine and Rehabilitation > Medical Diseases
Chronic Pain Syndrome: Differential Diagnoses & Workup
Updated: Jun 29, 2009
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Differential Diagnoses
Other Problems to Be Considered
Other musculoskeletal and neuropsychological diseases
Hernias (eg, obturator, sciatic, inguinal, femoral, perineal, spigelian, umbilical)
Neoplasia of the spinal cord or sacral nerves
Mononeuropathy and nerve entrapment
Abdominal epilepsy
Abdominal migraines
Pelvic floor pain syndrome
Rectus abdominis pain
Faulty posture and chronic pelvic pain
Bipolar disorders and depression
Chronic visceral pain syndrome
Chronic fatigue syndrome
Substance abuse
Reproductive system
Adenomyosis
Adhesions
Adnexal cysts
Cervical stenosis
Dyspareunia
Endocervical and endometrial polyps
Endometriosis and endosalpingiosis
Uterine leiomyomas
Ovarian retention syndrome
Ovarian remnant syndrome
Pelvic varicosities and pelvic congestion syndrome
Vulvodynia
Pelvic floor relaxation disorders
Accessory and supernumerary ovaries
Urinary system
Chronic and recurrent urinary tract infections
Urolithiasis
Pelvic floor dysfunction
Urethral diverticulum
Chronic urethral syndrome
Gastrointestinal system
Chronic intermittent bowel obstruction
Colitis
Chronic constipation
Diverticular disease
Inflammatory bowel disease
Irritable bowel syndrome
Peritoneal cysts
Workup
Laboratory Studies
- The decision to perform any laboratory or imaging evaluations is based on the need to confirm the diagnosis and to rule out other potentially life-threatening illnesses. Sometimes certain investigations are needed to provide appropriate and safe medical or surgical treatment. The recommended treatment should be based on clinical findings or changes in examination findings.
- Extreme care should be undertaken during diagnostic testing for chronic pain syndrome. Carefully review prior testing to eliminate unnecessary repetition.
- Routine CBC count, urinalysis, and selected tests for suspected disease are important. Urine or blood toxicology is important for drug detoxification, as well as opioid therapy.
Imaging Studies
- Several imaging studies (eg, radiographic studies, magnetic resonance imaging [MRI], computed tomography [CT] scanning) are important tools for the workup of a patient with chronic pain syndrome. (See images below and Images 1-3, 6, 7.)
Sagittal magnetic resonance imaging (MRI) scan of the cervical spine in a patient with cervical radiculopathy. This image reveals a C6-C7 herniated nucleus pulposus.
Axial magnetic resonance imaging (MRI) scan of the cervical spine in a patient with cervical radiculopathy. This image reveals a C6-C7 herniated nucleus pulposus.
Oblique view of the cervical spine demonstrates 2 levels of foraminal stenosis (white arrows) resulting from facet hypertrophy (yellow arrow) and uncovertebral joint hypertrophy.
T1-weighted sagittal magnetic resonance imaging (MRI) scan of the cervical spine in a patient with rheumatoid arthritis shows basilar invagination with cranial migration of an eroded odontoid peg. There is minimal pannus. The tip of the peg indents the medulla, and there is narrowing of the foramen magnum, due to the presence of the peg. Inflammatory fusion of several cervical vertebral bodies is shown.
More on Chronic Pain Syndrome |
| Overview: Chronic Pain Syndrome |
Differential Diagnoses & Workup: Chronic Pain Syndrome |
| Treatment & Medication: Chronic Pain Syndrome |
| Follow-up: Chronic Pain Syndrome |
| Multimedia: Chronic Pain Syndrome |
| References |
| Further Reading |
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References
Tang NK, Salkovskis PM, Hodges A, et al. Chronic pain syndrome associated with health anxiety: a qualitative thematic comparison between pain patients with high and low health anxiety. Br J Clin Psychol. Mar 2009;48:1-20. [Medline].
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[Best Evidence] Irving G, Jensen M, Cramer M, et al. Efficacy and tolerability of gastric-retentive gabapentin for the treatment of postherpetic neuralgia: results of a double-blind, randomized, placebo-controlled clinical trial. Clin J Pain. Mar-Apr 2009;25(3):185-92. [Medline].
Nijs J, Van Oosterwijck J, De Hertogh W. Rehabilitation of chronic whiplash: treatment of cervical dysfunctions or chronic pain syndrome?. Clin Rheumatol. Mar 2009;28(3):243-51. [Medline].
Durosaro O, Davis MD, Hooten WM, et al. Intervention for erythromelalgia, a chronic pain syndrome: comprehensive pain rehabilitation center, Mayo Clinic. Arch Dermatol. Dec 2008;144(12):1578-83. [Medline].
[Best Evidence] Ranoux D, Attal N, Morain F, et al. Botulinum toxin type A induces direct analgesic effects in chronic neuropathic pain. Ann Neurol. Sep 2008;64(3):274-83. [Medline].
[Best Evidence] Kroenke K, Bair MJ, Damush TM, et al. Optimized antidepressant therapy and pain self-management in primary care patients with depression and musculoskeletal pain: a randomized controlled trial. JAMA. May 27 2009;301(20):2099-110. [Medline].
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Forss N, Kirveskari E, Gockel M. Mirror-like spread of chronic pain. Neurology. Sep 13 2005;65(5):748-50.
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Maleki J, LeBel AA, Bennett GJ, Schwartzman RJ. Patterns of spread in complex regional pain syndrome, type I (reflex sympathetic dystrophy). Pain. Dec 1 2000;88(3):259-66. [Medline].
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Merskey H, Holzman AD, Turk DC, eds. Pain Management: A Handbook of Psychological Treatment Approaches. New York, NY: Pergamon Press; 1986.
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Further Reading
Related eMedicine topics:
Arthritis, Rheumatoid
Chronic Pelvic Pain
Chronic Pelvic Pain Syndrome and Prostatodynia
Corticosteroid Injections of Joints and Soft Tissues
Epidural Steroid Injections
Fibromyalgia [Pediatrics: General Medicine]
Fibromyalgia [Physical Medicine and Rehabilitation]
Fibromyalgia [Rheumatology]
Image-guided Stellate Ganglion Blocks
Osteoarthritis [Orthopedic Surgery]
Osteoarthritis [Physical Medicine and Rehabilitation]
Osteoarthritis [Rheumatology]
Osteoarthritis, Primary
Paraspinal Injections - Facet Joint and Nerve Root Blocks
Pathophysiology of Chronic Back Pain
Rheumatoid Arthritis [Physical Medicine and Rehabilitation]
Rheumatoid Arthritis [Rheumatology]
Therapeutic Injections for Pain Management
Virtual Reality Biofeedback in Chronic Pain and Psychiatry
Clinical guidelines:
Chronic pelvic pain. In: Guidelines on chronic pelvic pain. European Association of Urology - Medical Specialty Society. 2008 Mar. 55 pages. NGC:006454
Fibromyalgia treatment guideline. University of Texas at Austin School of Nursing, Family Nurse Practitioner Program - Academic Institution. 2005 May. 13 pages. NGC:004350
General treatment of chronic pelvic pain. In: Guidelines on chronic pelvic pain. European Association of Urology - Medical Specialty Society. 2008 Mar. 13 pages. NGC:006520
Management of fibromyalgia syndrome. American Pain Society Fibromyalgia Panel - Independent Expert Panel. 2004 Nov 17. 8 pages. NGC:004057
Prostatitis and chronic pelvic pain syndrome. In: Guidelines on the management of urinary and male genital tract infections. European Association of Urology - Medical Specialty Society. 2008 Mar. 10 pages. NGC:006494
Psychological factors in chronic pelvic pain. In: Guidelines on chronic pelvic pain. European Association of Urology - Medical Specialty Society. 2008 Mar. 8 pages. NGC:006519
Clinical trials:
Botulinum Toxin Type A for the Treatment of Male Chronic Pelvic Pain Syndrome (BTX-URO-01)
Efficacy of TMS in Chronic Idiopathic Pain Disorders
Neurotropin to Treat Chronic Neuropathic Pain
Supporting Effect of Dronabinol on Behavioral Therapy in Fibromyalgia and Chronic Back Pain
Transcranial Magnetic Stimulation for Treating Women With Chronic Widespread Pain
Keywords
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Differential Diagnoses & Workup: Chronic Pain Syndrome