In many patients whom I see, in particular female patients (see our Women & Pain Clinic), the pain that they tell me about is one of a number of problems that they suffer across their body. In the study below, the authors identified that over 10% of those with complex regional pain syndrome had widespread pain. When you understand sensitisation and how this can manifest in the musculoskeletal system and other body systems, one can see how this pattern of seemingly unrelated pains is actually underpinned by the same mechanism, central sensitisation.
The functional pain syndromes that include irritable bowel syndrome, pelvic pain, migraine, chronic back pain, fibromyalgia and bladder dysfunction are underpinned by central sensitisation in many cases. When talking to a patient it is important to ask about other body systems and how they are functioning as it provides vital information about the way in which the neuroimmune system is responding.
Treatment and training programme design relies upon a full picture of the individual and the condition(s) presenting. Permitting the patient to express themselves via the narrative allows for the emergence of key pieces of information that guides thinking about the wisest action for that individual. We are seeking to desensitise, to develop confidence in moving that is dissociated from pain and to point the patient to wellness in its widest sense so that life’s meaning can be restored.
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Widespread Pain in Patients with Complex Regional Pain Syndrome.
Birley T, Goebel A. | Pain Pract. 2013 Jun 24.
Our goal was to ascertain the prevalence of widespread pain in our cohort of patients with complex regional pain syndrome (CRPS).
We conducted a retrospective analysis of clinical letters and notes. We assessed data from consecutive patients diagnosed with CRPS according to the Budapest criteria, after a referral to one consultant at a tertiary Pain Medicine referral center.
Between July 2007 and September 2012, 190 patients (149 females) received a diagnosis of CRPS according to the Budapest criteria, and an additional 26 patients received the diagnosis of CRPS NOS (not otherwise specified). The CRPS patients were an average of 44 years of age, and had a median disease duration of 18 months. Before the CRPS incident trigger, a third had already experienced other than everyday pains in the now CRPS-affected limb. Twenty-one patients (11.1%) experienced widespread pain in clinic, which was often not communicated in the referral letters. The types of triggering traumata and frequencies of Budapest signs and symptoms did not differ between patients with or without widespread pain. All patients considered their widespread pain as an important factor affecting their quality of life; for the majority it was of similar severity to the CRPS pain. Additional patients reported CRPS-concomitant regional pains, most commonly headaches/migraines, lower back pain, and irritable bowel syndrome.
In this systematic assessment of the incidence of widespread pain in a large cohort of patients with CRPS, important widespread pain affected > 10% of patients. Our data support the inclusion of routine enquiries about additional pains in the clinical assessment of patients with CRPS.