Chronic Pain Syndrome Differential Diagnoses

  • Author: Manish K Singh, MD; more...
 
Updated: Feb 24, 2012
 
 

Diagnostic Considerations

Musculoskeletal and neuropsychological disorders

Musculoskeletal and neuropsychological diseases to consider in the differential diagnosis of chronic pain syndrome (CPS) include the following:

  • 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 disorders

Conditions related to the reproductive system to consider in the differential diagnosis of CPS include the following:

  • 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 disorders

Urinary conditions to consider in the differential diagnosis of CPS include the following:

  • Chronic and recurrent urinary tract infections
  • Urolithiasis
  • Pelvic floor dysfunction
  • Urethral diverticulum
  • Chronic urethral syndrome

Gastrointestinal system disorders

GI conditions to consider in the differential diagnosis of CPS include the following:

  • Chronic intermittent bowel obstruction
  • Colitis
  • Chronic constipation
  • Diverticular disease
  • Inflammatory bowel disease
  • Irritable bowel syndrome
  • Peritoneal cysts

Other differentials

Other conditions to consider in the differential diagnosis of CPS include the following:

  • Lateral epicondylitis
  • Lumbar degenerative disk disease
  • Lumbar facet arthropathy
  • Lumbar spondylolysis and spondylolisthesis
  • Mechanical low back pain
  • Medial epicondylitis
  • Meralgia paresthetica
  • Mononeuritis multiplex
  • Morton neuroma
  • Myofascial pain
  • Neoplastic brachial plexopathy
  • Neoplastic lumbosacral plexopathy
  • Osteoarthritis
  • Osteoporosis and spinal cord injury
  • Piriformis syndrome
  • Plantar fasciitis
  • Radiation-induced brachial plexopathy
  • Radiation-induced lumbosacral plexopathy
  • Rotator cuff disease
  • Spasticity
  • Thoracic outlet syndrome
  • Traumatic brachial plexopathy
  • Trochanteric bursitis

Differential Diagnoses

Proceed to Workup
 
 
Contributor Information and Disclosures
Author

Manish K Singh, MD  Assistant Professor, Department of Neurology, Teaching Faculty for Pain Management and Neurology Residency Program, Hahnemann University Hospital, Drexel College of Medicine; Medical Director, Neurology and Pain Management, Jersey Institute of Neuroscience

Manish K Singh, MD is a member of the following medical societies: American Academy of Neurology, American Academy of Pain Medicine, American Association of Physicians of Indian Origin, American Headache Society, American Medical Association, and American Society of Regional Anesthesia and Pain Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Jashvant Patel, MD  Medical Director, Department of Pain Medicine and Comprehensive Rehabilitation, Medical College of Pennsylvania Hahnemann University

Jashvant Patel, MD is a member of the following medical societies: Alberta Medical Association, American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American Medical Association, American Society of Regional Anesthesia and Pain Medicine, and Medical Society of the State of New York

Disclosure: Nothing to disclose.

Rollin M Gallagher, MD, MPH  Clinical Professor, Departments of Psychiatry and Anesthesiology, Director for Health Policy and Primary Care, Penn Pain Medicine, University of Pennsylvania School of Medicine; Director, Pain Management Service, Philadelphia Veterans Affairs Medical Center

Rollin M Gallagher, MD, MPH is a member of the following medical societies: Academy of Psychosomatic Medicine and American Academy of Pain Medicine

Disclosure: Nothing to disclose.

Additional Contributors

Martin K Childers, DO, PhD Professor, Department of Neurology, Wake Forest University School of Medicine; Professor, Rehabilitation Program, Institute for Regenerative Medicine, Wake Forest Baptist Medical Center

Martin K Childers, DO, PhD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Congress of Rehabilitation Medicine, American Osteopathic Association, Christian Medical & Dental Society, and Federation of American Societies for Experimental Biology

Disclosure: Allergan pharma Consulting fee Consulting

Richard Salcido, MD Chairman, Erdman Professor of Rehabilitation, Department of Physical Medicine and Rehabilitation, University of Pennsylvania School of Medicine

Richard Salcido, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Physician Executives, American Medical Association, and American Paraplegia Society

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

References

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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.
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Nerve irritation in the herniated disk occurs at the root (sciatic radiculitis). In piriformis syndrome, the irritation extends to the full thickness of the nerve (sciatic neuritis).
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