eMedicine Specialties > Physical Medicine and Rehabilitation > Medical Diseases

Chronic Pain Syndrome: Follow-up

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
Coauthor(s): Jashvant Patel, MD, Medical Director, Department of Pain Medicine and Comprehensive Rehabilitation, Medical College of Pennsylvania Hahnemann University; 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; Director, Pain Management Service, Philadelphia Veterans Affairs Medical Center
Contributor Information and Disclosures

Updated: Jun 29, 2009

Follow-up

Further Inpatient Care

Hospitalization usually is not required for patients with chronic pain syndrome, but it depends on how invasive the treatment choice is for pain control and on the severity of the case.

Further Outpatient Care

Patients with chronic pain syndrome generally are treated on an outpatient basis and require a variety of health care professionals to manage their condition optimally.

Complications

Chronic pain may lead to prolonged physical suffering, marital or family problems, loss of employment, disability, and various adverse medical reactions from long-term therapy.

Patient Education

The patient and family should have a good understanding about the multifactorial nature of chronic pain and the benefits of a multidisciplinary comprehensive management plan.⁵
Avoid uncomfortable stressful positions and bad posture.
Regular exercise, good sleeping habits, and balanced meals are helpful in maintaining good health.
The patient may benefit from instruction in biofeedback and relaxation techniques.
For excellent patient education resources, visit eMedicine's Mental Health and Behavior Center, Muscle Disorders Center, and Back, Ribs, Neck, and Head Center. Also, see eMedicine's patient education articles Chronic Pain, Fibromyalgia, Chronic Fatigue Syndrome, and Pain Medications.

Miscellaneous

Medicolegal Pitfalls

Good rapport, tolerance, and an open-minded approach are important when evaluating any patient with chronic pain.
A patient with chronic pain syndrome may exhibit exaggerated pain behavior. Sensations may seem to be hysterical or appear nonanatomic or nonphysiologic, but these patients always should be taken seriously and appropriate conservative steps should be taken.
Obtaining a thorough past history is important to avoid repeating invasive and expensive procedures.
Consultation with a neurologist, obstetrician-gynecologist, urologist, psychologist, gastrointestinal specialist, or other appropriate specialists is very important, especially before considering invasive or aggressive management.

Special Concerns

Appropriate caution must be taken during treatment of patients who exhibit any of the following behaviors:
- Poor response to prior appropriate management
- Unusual unexpected response to prior specific treatment
- Avoiding school, work, or other social responsibility
- Severe depression
- Severe anxiety disorder
- Excessive pain behavior
- Physician shopping
- Noncompliance with treatment in the past
- Drug abuse or dependence
- Family, marital, or sexual problems
- History of physical or sexual abuse

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

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Keywords

chronic pain syndrome, pain management, pain relief, fibromyalgia, chronic pain, muscle pain, arthritis pain, pain medicine, TENS, TENS unit, pain meds, pain treatment, pain therapy, nerve block, pain medications, treatment for pain, chronic pain treatment, chronic pain relief, pain relievers, neuropathic pain, chronic pain management, spinal cord stimulation, nerve stimulation, nerve blocks, chronic regional pain syndrome, transcutaneous electrical nerve stimulation, chronic benign pain syndrome, chronic intractable benign pain syndrome

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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; 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.

Medical Editor

Martin K Childers, DO, PhD, Associate Professor, Department of Neurology, Wake Forest University Health Services
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

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

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.

CME Editor

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
Disclosure: Nothing to disclose.

Chief Editor

Denise I Campagnolo, MD, MS, Director of Multiple Sclerosis Clinical Research and Staff Physiatrist, Barrow Neurology Clinics, St Joseph's Hospital and Medical Center; Investigator for Barrow Neurology Clinics; Director, NARCOMS Project for Consortium of MS Centers
Denise I Campagnolo, MD, MS is a member of the following medical societies: Alpha Omega Alpha, American Association of Neuromuscular and Electrodiagnostic Medicine, American Paraplegia Society, Association of Academic Physiatrists, and Consortium of Multiple Sclerosis Centers
Disclosure: Teva Neuroscience Honoraria Speaking and teaching; Serono-Pfizer Honoraria Speaking and teaching; Genzyme Corporation Grant/research funds investigator; Biogen Idec Grant/research funds investigator; Genentech, Inc Grant/research funds investigator; Eli Lilly & Company Grant/research funds Novaritis; Novaritis Novaritis; MSDx LLC Grant/research funds investigator; BioMS Technology Corp Grant/research funds investigator; Avanir Pharmaceuticals Grant/research funds investigator

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