Diagnostic Considerations
Musculoskeletal and neuropsychological disorders
Musculoskeletal and neuropsychological diseases to consider in the differential diagnosis of chronic pain syndrome (CPS) include the following:
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Hernias (eg, obturator, sciatic, inguinal, femoral, perineal, spigelian, umbilical)
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Neoplasia of the spinal cord or sacral nerves
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Mononeuropathy and nerve entrapment
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Abdominal epilepsy
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Abdominal migraines
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Pelvic floor pain syndrome
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Rectus abdominis pain
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Faulty posture and chronic pelvic pain
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Bipolar disorders and depression
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Chronic visceral pain syndrome
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Chronic fatigue syndrome
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Substance abuse
Reproductive system disorders
Conditions related to the reproductive system to consider in the differential diagnosis of CPS include the following:
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Adenomyosis
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Adhesions
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Adnexal cysts
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Cervical stenosis
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Dyspareunia
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Endocervical and endometrial polyps
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Endometriosis and endosalpingiosis
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Uterine leiomyomas
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Ovarian retention syndrome
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Ovarian remnant syndrome
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Pelvic varicosities and pelvic congestion syndrome
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Vulvodynia
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Pelvic floor relaxation disorders
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Accessory and supernumerary ovaries
Urinary system disorders
Urinary conditions to consider in the differential diagnosis of CPS include the following:
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Chronic and recurrent urinary tract infections
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Urolithiasis
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Pelvic floor dysfunction
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Urethral diverticulum
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Chronic urethral syndrome
Gastrointestinal system disorders
GI conditions to consider in the differential diagnosis of CPS include the following:
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Chronic intermittent bowel obstruction
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Colitis
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Chronic constipation
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Diverticular disease
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Inflammatory bowel disease
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Irritable bowel syndrome
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Peritoneal cysts
Other differentials
Other conditions to consider in the differential diagnosis of CPS include the following:
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Lateral epicondylitis
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Lumbar degenerative disk disease
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Lumbar facet arthropathy
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Lumbar spondylolysis and spondylolisthesis
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Mechanical low back pain
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Medial epicondylitis
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Meralgia paresthetica
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Mononeuritis multiplex
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Morton neuroma
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Myofascial pain
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Neoplastic brachial plexopathy
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Neoplastic lumbosacral plexopathy
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Osteoarthritis
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Osteoporosis and spinal cord injury
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Piriformis syndrome
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Plantar fasciitis
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Radiation-induced brachial plexopathy
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Radiation-induced lumbosacral plexopathy
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Rotator cuff disease
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Spasticity
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Thoracic outlet syndrome
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Traumatic brachial plexopathy
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Trochanteric bursitis
Differential Diagnoses
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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.
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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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Osteoarthritis of the knee, Kellgren stage III.
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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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Changes in the hand caused by rheumatoid arthritis. Photograph by David Effron MD, FACEP.
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Oblique view of the cervical spine demonstrates 2 levels of foraminal stenosis (white arrows) resulting from facet hypertrophy (yellow arrow) and uncovertebral joint hypertrophy.
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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.
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Schematic anatomical representations, sympathetic chain and stellate ganglion.
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Stellate block, important anatomical landmarks (surface and cross-sectional views).
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Pertinent anatomy for lumbar sympathetic block (cross-sectional view).
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Severe colitis noted during colonoscopy. The mucosa is grossly denuded, with active bleeding noted. This patient had her colon resected very shortly after this view was obtained.
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Active endometriosis with red and powder-burn lesions; adhesions from old scarring are present.
