Patients suffering with chronic diffuse pain who lack objective clinical and laboratory findings (e.g., fibromyalgia) frequently are dismissed as not having real pain, which only perpetuates their illness.
There are four principal categories of pain: nociceptive pain, neuropathic pain, chronic pain of complex etiology, and psychogenic pain.
Pain assessment should include attention to possible psychological and sociocultural factors that could be contributing to the pain experience.
Diagnostic waffling, the ordering of frightening tests, excessive use of physical therapy modalities, activity limitation after minor trauma, and overly liberal work release are among the important factors that can convert what should be a selflimited acute pain condition into a chronic pain syndrome.
If the clinician suspects fibromyalgia, validation of the patient’s pain is important.
Pharmacologic agents that may be useful in the management of individual pain syndromes include nonsteroidal anti-inflammatory drugs, opioids, muscle relaxants, antidepressants, antiepileptic medications, and topical agents.
■ Physical therapy, cognitive-behavioral therapy, aerobic exercise, and complementary and alternative medicine approaches may all be useful in the management of pain in selected patients.
KeywordsChronic Pain Neuropathic Pain Irritable Bowel Syndrome Complex Regional Pain Syndrome Chronic Pain Syndrome
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