What Are The Chronic Pain Syndromes ? - Human & Disease

What Are The Chronic Pain Syndromes ?


CHRONIC PAIN SYNDROMES


CHRONIC PAIN SYNDROMES Pain can be categorized by location or syndrome. In most persons with the complaints described below, usually the pain, not the underlying pathology, prevents them from achieving a productive and satisfying lifestyle. What is the gold standard for pain assessment ? A Numerical Rating Scale (NRS) ranging from 0 to 10 ( 0 no pain ... 10 maximum pain ) which is based on patient's self report , is the gold standard for pain assessment for patient who express their pain intensity. What are the 5 most widely reported types of chronic pain ? 5 common types of chronic pain : - Low back pain - Headache - Myofascial pain syndrome - Fibromyalgia - Chronic pain secondery to physical disability Other types : - Nerve pain - Joint pain - Cancer pain
Chronic pain syndrome







Pain can be categorized by location or syndrome. In most persons with the complaints described below, usually the pain, not the underlying pathology, prevents them from achieving a productive and satisfying lifestyle.
 
What is the gold standard for pain Assessment ?
 
A Numerical Rating Scale (NRS) ranging from 0 to 10 ( 0 no pain ... 10 maximum pain ) which is based on patient's self report , is the gold standard for pain assessment  for patient who express their pain intensity.

What are the 5 most widely reported types of chronic pain ?

5 common types of chronic pain : 

- Low back pain 

- Headache 

- Myofascial pain syndrome

- Fibromyalgia

- Chronic pain secondery to physical disability

Other types : 

- Nerve pain 

- Joint pain

- Cancer pain 



Low Back Pain:

Most persons receiving physical therapy for pain complain of low back pain (LBP).15 Approximately 3 to 7% of the population in Western industrialized countries experience chronic LBP. The impairment and disability associated with LBP often results in job absenteeism, loss of productive activity, and decreased participation.

CHRONIC PAIN SYNDROMES Pain can be categorized by location or syndrome. In most persons with the complaints described below, usually the pain, not the underlying pathology, prevents them from achieving a productive and satisfying lifestyle. What is the gold standard for pain assessment ? A Numerical Rating Scale (NRS) ranging from 0 to 10 ( 0 no pain ... 10 maximum pain ) which is based on patient's self report , is the gold standard for pain assessment for patient who express their pain intensity. What are the 5 most widely reported types of chronic pain ? 5 common types of chronic pain : - Low back pain - Headache - Myofascial pain syndrome - Fibromyalgia - Chronic pain secondery to physical disability Other types : - Nerve pain - Joint pain - Cancer pain









The most common causes of LBP are injury or stress resulting in musculoskeletal and neurologic disorders in the lumbosacral region (e.g., disc lesions, muscle spasm, sciatica).

Pain may also result from infections, degenerative diseases, malignancies, and aging. Poor posture may cause spinal disk degeneration and thus lead to LBP. LBP tends to improve spontaneously over time.

Headaches:

CHRONIC PAIN SYNDROMES Pain can be categorized by location or syndrome. In most persons with the complaints described below, usually the pain, not the underlying pathology, prevents them from achieving a productive and satisfying lifestyle. What is the gold standard for pain assessment ? A Numerical Rating Scale (NRS) ranging from 0 to 10 ( 0 no pain ... 10 maximum pain ) which is based on patient's self report , is the gold standard for pain assessment for patient who express their pain intensity. What are the 5 most widely reported types of chronic pain ? 5 common types of chronic pain : - Low back pain - Headache - Myofascial pain syndrome - Fibromyalgia - Chronic pain secondery to physical disability Other types : - Nerve pain - Joint pain - Cancer pain

Migraine and tension headaches are very common chronic pain complaints. Approximately 28 million Americans, roughly 18% of women and 6% of men, experience recurrent migraine headaches. Experimental evidence supports the role of serotonin in migraine. Stress, attention, and mood (e.g., anxiety) affect these headaches. In contrast, tension headaches are generally considered to be muscular in origin. There is not sufficient evidence, however, for a specific pathophysiology.


Myofascial Pain Syndrome:

Myofascial pain syndrome (MPS) refers to a large group of muscle disorders characterized by highly sensitive trigger
points within muscles or connective tissue. Myofascial pain is predominant and is perceived as a continual dull ache often located in the head, neck, shoulder, and low back areas. The trapezius muscle is one of the most commonly affected muscles. Myofascial pain may result from an acute strain caused by a sudden overload or overstretching of the muscle.

CHRONIC PAIN SYNDROMES Pain can be categorized by location or syndrome. In most persons with the complaints described below, usually the pain, not the underlying pathology, prevents them from achieving a productive and satisfying lifestyle. What is the gold standard for pain assessment ? A Numerical Rating Scale (NRS) ranging from 0 to 10 ( 0 no pain ... 10 maximum pain ) which is based on patient's self report , is the gold standard for pain assessment for patient who express their pain intensity. What are the 5 most widely reported types of chronic pain ? 5 common types of chronic pain : - Low back pain - Headache - Myofascial pain syndrome - Fibromyalgia - Chronic pain secondery to physical disability Other types : - Nerve pain - Joint pain - Cancer pain










Fibromyalgia:


CHRONIC PAIN SYNDROMES Pain can be categorized by location or syndrome. In most persons with the complaints described below, usually the pain, not the underlying pathology, prevents them from achieving a productive and satisfying lifestyle. What is the gold standard for pain assessment ? A Numerical Rating Scale (NRS) ranging from 0 to 10 ( 0 no pain ... 10 maximum pain ) which is based on patient's self report , is the gold standard for pain assessment for patient who express their pain intensity. What are the 5 most widely reported types of chronic pain ? 5 common types of chronic pain : - Low back pain - Headache - Myofascial pain syndrome - Fibromyalgia - Chronic pain secondery to physical disability Other types : - Nerve pain - Joint pain - Cancer pain









The prevalence of fibromyalgia ranges from 0.7 to 3.2% in the adult population.Fibromyalgia should not be confused with MPS. 

Although MPS and fibromyalgia may overlap clinically, they are two distinct pain syndromes. Skeletal muscles have been implicated as the cause of fibromyalgia, but no specific abnormalities have been identified. Abnormalities of the neuroendocrine system, autoimmune dysfunction, immune regulation, sleep disturbances, and cerebral blood flow difficulties have also been suggested.


Chronic Pain Secondary to Physical Disability:

Only recently has pain been investigated in persons who already have a physical disability. Chronic pain is a common problem following spinal cord injury (SCI). A recent community survey indicated 79% of adults with SCI reported a recurrent pain problem. Pain may occur above, at, or below the level of injury in both complete and incomplete injuries. Neuropathic or central pain is the most frequent type of chronic pain in SCI and is believed to originate from abnormal processing of sensory input owing to damage to the central nervous system. Musculoskeletal pain complaints may result from a variety of factors, including wheelchair use.

A typical consequence of amputation is phantom limb pain (PLP). As many as 85% of persons who undergo limb amputation will experience phantom limb pain. Residual limb pain (“stump pain”) was reported by 72% of community-dwelling adults with lower limb amputations. Back pain has also been identified as a significant problem among many individuals with lower limb amputation.

CHRONIC PAIN SYNDROMES Pain can be categorized by location or syndrome. In most persons with the complaints described below, usually the pain, not the underlying pathology, prevents them from achieving a productive and satisfying lifestyle. What is the gold standard for pain assessment ? A Numerical Rating Scale (NRS) ranging from 0 to 10 ( 0 no pain ... 10 maximum pain ) which is based on patient's self report , is the gold standard for pain assessment for patient who express their pain intensity. What are the 5 most widely reported types of chronic pain ? 5 common types of chronic pain : - Low back pain - Headache - Myofascial pain syndrome - Fibromyalgia - Chronic pain secondery to physical disability Other types : - Nerve pain - Joint pain - Cancer pain









Adults with cerebral palsy frequently experience recurrent pain. Sixty-seven percent of a community sample reported
chronic, bothersome pain. Low back and leg were identified as the most frequent sites. Pain has been associated with spasticity, scoliosis, and bony deformity resulting from spasticity.


VIEWS OF PAIN
 
Because pain is viewed as being multidimensional and subjective, numerous theories and models exist to explain pain. Ideally, theories and models of pain transmission explain the range of pain phenomena.

CHRONIC PAIN SYNDROMES Pain can be categorized by location or syndrome. In most persons with the complaints described below, usually the pain, not the underlying pathology, prevents them from achieving a productive and satisfying lifestyle. What is the gold standard for pain assessment ? A Numerical Rating Scale (NRS) ranging from 0 to 10 ( 0 no pain ... 10 maximum pain ) which is based on patient's self report , is the gold standard for pain assessment for patient who express their pain intensity. What are the 5 most widely reported types of chronic pain ? 5 common types of chronic pain : - Low back pain - Headache - Myofascial pain syndrome - Fibromyalgia - Chronic pain secondery to physical disability Other types : - Nerve pain - Joint pain - Cancer pain









1- Specificity Theory

The specificity theory was an initial attempt to explain the way the nervous system processes nociceptive (noxious stimuli) information. In 1894, Von Frey proposed that the sensation of pain resulted from a direct communication from specific pain receptors in the periphery to a central pain center in the brain.

Physical characteristics of the pain stimulus (e.g., sharp quality) are transmitted from the pain receptors (free nerve endings) along specific peripheral nerve fibers (A-delta and C fibers) to the spinal cord. In the spinal cord, these impulses are conducted via the anterolateral spinothalamic tract to the brain (thalamus and higher centers), where they are then perceived as pain. Recently this theory has been criticized given current, observed clinical phenomena.


The specificity theory assumes a direct relationship between stimulus intensity and perceived pain, yet the same stimulus may evoke varied responses in different individuals or even in the same individual under different conditions. In addition, interruptive surgical procedures like rhizotomy do not consistently eliminate pain despite interrupting this theoretical route of pain transmission.

2- Pattern Theory

The pattern theory of pain transmission was proposed to address some of the limitations of the specificity theory. In 1894, Goldschneider suggested that it is not the direct stimulation of specific receptors, but the transmission of nerve impulse patterns coded at the periphery which causes the pain sensation. This theory proposes all nerve endings are alike, and the perception of pain is produced by intense stimulation of nonspecific receptors. The combination of direct stimulus added to other sensory inputs inform the central nervous system that pain is present.

A key concept of this theory is the explanation it provides for phenomena such as phantom limb pain, in which the pain sensation continues to occur after the cessation of local stimulation. Several authors have criticized the pattern theory because it ignores evidence of receptor-fiber specialization such as the potential success of surgical procedures like cordotomy.


3- Gate Control Theory

Melzack and Wall offered a variation of the pattern and specificity theories to explain pain transmission. They suggested that skin receptors have specific physiologic proper ties by which they may transmit particular types and ranges of stimuli in the form of impulse patterns. According to this theory, pain is modulated by a “gating” mechanism located in the spinal cord that can increase or decrease the flow of nerve impulses to the brain. Afferent impulses can travel to the dorsal horn along large (A fiber) and small diameter (A-delta or C fiber) nerves associated with pain impulses.

At the dorsal horn, these impulses encounter a gate thought to be substantia gelatinosa cells, This gate, which may be presynaptic or postsynaptic, can be closed, partially opened, or opened. When the gate is closed, pain impulses cannot proceed. When the gate is at least partially open, impulses stimulate T (transmission or trigger) cells in the dorsal horn which then ascend the spinal cord to the brain and pain perception results.

CHRONIC PAIN SYNDROMES Pain can be categorized by location or syndrome. In most persons with the complaints described below, usually the pain, not the underlying pathology, prevents them from achieving a productive and satisfying lifestyle. What is the gold standard for pain assessment ? A Numerical Rating Scale (NRS) ranging from 0 to 10 ( 0 no pain ... 10 maximum pain ) which is based on patient's self report , is the gold standard for pain assessment for patient who express their pain intensity. What are the 5 most widely reported types of chronic pain ? 5 common types of chronic pain : - Low back pain - Headache - Myofascial pain syndrome - Fibromyalgia - Chronic pain secondery to physical disability Other types : - Nerve pain - Joint pain - Cancer pain






Once the pain impulses are perceived, higher central nervous system structures (i.e., brainstem, thalamus, and cerebral cortex) can then modify pain by influencing T-cell activity. These structures can alter attention, memory, and affect, thereby contributing to individual’s unique pain perception.


Although the anatomic and physiologic bases of the gate remain controversial, this theory has been instrumental in furthering multidimensional pain evaluation and intervention. The gate control theory of pain implies psychology has much to offer in both understanding and treating pain. Motivational and cognitive processes thereby are examined in terms of their contribution to the pain experience.


4- Loeser’s Model

Loeser proposed a biopsychosocial model of pain that suggests the phenomenon of pain can essentially be divided into four domains: nociception, pain, suffering, and pain behavior. Nociception is the detection of tissue damage by transducers in the skin and deeper structures and the central transmission of this information by A-delta and C fibers in the peripheral
nerves.

Pain thereby is the perception and interpretation of the nociceptive input by the highest parts of the brain. Suffering is the negative affective response to pain. 

It may be difficult to differentiate suffering from fear, anxiety, isolation, or depression. Lastly, pain behavior is what an individual says or does (e.g., taking medications) or does not say or do (e.g., job absenteeism), which leads others to believe that individual is suffering from noxious stimuli. Only pain behaviors are observable and measurable. Culture and environmental consequences influence pain behaviors.
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