Chronic Pain Syndrome, CPS, is a common problem of unknown aetiology and patients with this condition often respond poorly to medical therapy. It is a behavioural disorder in which pain becomes the person’s primary focus. CPS is often defined using variable lengths of time that the patient experiences ongoing pain for – some state for 3 months, others state 6 months and many suggest that any pain persisting for longer than the expected healing time should be considered chronic. In CPS pain signals keep firing in the nervous system for weeks, months, or even years. There may have been an initial medical condition, for example a nerve damage during surgery, from which patients may have long recovered, however the pain persists and he develops into CPS.
Chronic Pain Syndrome includes symptoms such as:
- Aches and pain
- Throbbing and shooting pain
- Burning sensation
- Sore and stiff joints
- Tiredness, fatigue and lack of energy
- Loss of appetite
- Lack of sleep
- Mood changes
The pathophysiology of chronic pain syndrome (CPS) is very complex and compromises of many different factors and organ systems. It is poorly understood and commonly of an unknown aetiology. Even though some patients may know the initial reason behind their CPS, but the aetiology of their pain is still unknown. It is widely believed that CPS is due to a learnt behaviour – a behavioural syndrome – that provides the patient with a noxious stimulus to cause unresolved pain. Through this behaviour, these patients then acquire pain either internally or externally and believe that they can feel it. Thus, even if the stimulus is absent, they may still reinforce this pain behaviour and feel the pain. Internal stimuli that trigger this pain behaviour may be factors that would normally stress a person and make them feel sad. However, in patients with CPS, these factors trigger pain. These internal factors include personal issues, emotional problems, guilt, and fear of work, sex, responsibilities and other stressors in life. When the pain comes on, these patients seek external reinforces that can provide relief, which is based on what the patient perceive to be relieving. These may include factors such as attention from family members and friends, interaction with the physician, medications, compensation, and time off from work.
Patients with psychological problems are susceptible to developing CPS, and similarly patients with CPS may develop psychological issues such as major depression, somatization disorder, hypochondriasis, and conversion disorder. Hence, most patients with CPS are put on pain relief as well as anti-depressants. Pain is usually the chief complaint that makes them seek medical help and they usually know what they want. This is because they have set expectations about what helps their pain and nothing else will satisfy their needs.
Due to the complex aetiology of CPS it is important for the practitioner to use a systematic approach to assess the patient including questions targeted at the musculoskeletal, reproductive, gastrointestinal, urologic, and neuropsychological systems. Then it is important to ask them the type and location of the pain as pain management is the main priority of care. This includes obtaining information that would give us the pain location, precipitating factors, alleviating factors, quality, radiation and severity of his pain. Reassurance and attentive behaviour towards these patients is usually helpful along with medical treatment.
Patients with CPS do not normally respond to the common medical model of care. Their management is complex, and usually suggests the need for specific treatment such as nerve blocks, spinal cord stimulation and pain-relief, psychological attention, and physical therapy. The physical treatments that have proven to be benefical include hot or cold therapy, positioning, stretching exercises, massage therapy, transcutaneous electrical nerve stimulation and spinal manipulations.
References
Nijs, J., Meeus, M., & De-Meirleir, K. (2006). Chronic musculoskeletal pain in chronic fatigue syndrome: Recent developments and therapeutic implications. Journal of Manual Therapy, 1(1), 1-5. doi:10.1016/j.math.2006.03.008
Singh, M. K., Patel, J., & Gallagher, R. M. (2010, May 17). Chronic pain syndrome. Retrieved October 22, 2015, from http://emedicine.medscape.com/article
Dr Sarkaw Mohammad (Chiropractor)
www.hillcrestspinal.co.nz
