Commonly-Reported Pain Conditions

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Dr Anthony_Pg 17By: Manonmani Antony, MD.

Part-Two
(This article is continued from the October/November 2011 Issue.)

Complex Regional Pain Syndrome

Complex regional pain syndrome (CRPS) is a chronic pain disorder (also called RSD).  CRPS usually begins after trauma such as an injury to the tissue, bone or nerves of your arm or leg.  Although the symptoms vary greatly from one person to the next, there is one symptom that all people with CRPS have.  Everyone has pain that feels much worse than you would expect for the injury and that continues long after the injury should have healed.

The pain you feel in your CRPSinvolved limb may be burning, throbbing, shooting or sharp.  People with CRPS can have a wide variety of symptoms that may come and go in the early stages of the disorder: Skin color changes, Skin temperature changes, Abnormal sweating, Overly sensitive skin — this is also called allodynia.  Your CRPS-involved limb may be so sensitive that even a light touch or cool/warm air can cause pain.  Hyperalgesia — this is the medical term for feeling pain in a more extreme way than normal.  Joint problems, Muscle problems — your involved muscles may have spasms, tremors or weakness.  Hair, Nail and Skin changes — the hair and nails on your CRPS-involved limb may grow faster or slower.  Your nails may become thick and brittle.  Your skin may become thin and shiny.  Swelling — your CRPS-involved limb may be swollen.

There is no specific test that can show or prove that you have CRPS.  Thus, your pain specialist may need to use the results from a number of tests to diagnose CRPS.  While CRPS is mysterious and often not diagnosed properly, there are pain specialists who understand and know how to treat it.

You may need a combination of treatments including medications, psychosocial interventions, physical rehabilitation, injection and infusion therapies and implantable devices.

Be an active part of your care team

If you are living with a painful condition like CRPS, it is important that you are actively involved in your care.  In addition to getting formal counseling, learn about CRPS and chronic pain management.  This will help you to make the best decisions about your care and empower you to teach others — including health care providers and insurers — about CRPS.

Fibromyalgia

For people living with fibromyalgia, the pain is very real.  The chronic, widespread pain and tenderness is persistent and debilitating and can impact a person’s life.  Some fibromyalgia patients may also experience other symptoms, which can prevent them from sleeping well, performing everyday tasks and enjoying life to its fullest.

Clinical understanding of fibromyalgia, its origins and treatment options, has improved in recent years.  It is now thought that fibromyalgia is related to changes in the central nervous system that cause the brain to process pain signals abnormally, increasing sensitivity to pain—or put another way—the “volume control” for pain is turned up, so even a hug or handshake can be painful for someone with fibromyalgia.

Five things you need to know about fibromyalgia

  1. Pain isn’t the only sign. Chronic, widespread pain that lasts for at least three months is a classic sign of fibromyalgia.  You may wake up with stiff muscles, find that you are fatigued, or having trouble remembering things.  Fibromyalgia can also coexist with other health conditions, such as arthritis, chronic fatigue syndrome and mood or sleep disorders.
  2. Diagnosis may be challenging. Clinicians must rely on your symptoms and medical history to make a diagnosis, since there is no lab test or x-ray to confirm the disorder.  Your doctor may ask you to react to specific “tender points” on your body, 11 out of 18 tender points may indicate fibromyalgia.
  3. Fibromyalgia isn’t just a woman’s disease—men get it too.
  4. Be persistent about getting help. Many people with fibromyalgia have encountered skeptics, i.e. co-workers who may not understand why you have trouble getting out of bed, family members who may not appreciate why you’re so tired and doctors who may not have much experience diagnosing the disorder.  Nevertheless, trust your instincts and seek medical advice. Find a doctor who listens to you.
  5. You can live well with fibromyalgia. “There’s a misconception on the part of patients that there’s nothing you can do to alleviate your pain.  But that’s not true,” says Dr. Antony.  The best first step is to get an accurate diagnosis.  Then, take charge of your treatment plan by participating in comprehensive Pain Management and Managing the stress and fatigue that may be associated with your pain.

Painful Peripheral Neuropathy (PPN)

Peripheral neuropathy describes damage to the peripheral nervous system.  Some people may experience temporary numbness, tingling, and pricking sensations (paresthesia), sensitivity to touch, or muscle weakness.  Others may suffer more extreme symptoms, including burning pain (especially at night), muscle wasting, and paralysis.  PPN may be either inherited or acquired.  Causes of acquired PPN include physical injury (trauma) to a nerve, tumors, toxins, autoimmune responses, nutritional deficiencies (thiamine), alcoholism, and vascular and metabolic disorders.  Diabetes Mellitus, Kidney disorders and HIV /AIDS are leading causes of PPN in the United States.  Diagnosing peripheral neuropathy is often difficult because the symptoms are highly variable.  A thorough neurological examination is usually required and involves taking an extensive patient history, performing tests that may identify the cause of this disorder, and conducting tests (EMG/NCV, nerve or skin biopsy) to determine the extent and type of nerve damage.  As for treatment of PPN, any underlying condition is treated first, followed by symptomatic treatment with comprehensive pain management.

Shingles & Post-Herpetic-Neuralgia (PHN)
Shingles is a disease caused by the same virus that causes chickenpox.  Up to half of the nearly 1 million shingles cases in the U.S. each year occur in people 60 years and older.  The first signs of shingles may include itching, tingling and burning.  Within a few days, a rash of blisters appears; the blisters may take 2 to 4 weeks to heal.  Shingles rashes can be painful; for most people, the pain from shingles rash lessens as it heals.  However, for some people, after the rash heals, shingles may lead to pain that can last for months or even years; this longterm nerve pain, called post-herpetic neuralgia or PHN, occurs because the virus that causes shingles may damage certain nerves.  Treatment is centered on pain reduction and improvement in function.  As with any pain condition caused by injured nerves (neuropathic pain), often more than one treatment option is required.  Commonly used medications may include opioids, anticonvulsants, antidepressants, Lidoderm or Capsaicin patches.

Dr. Manonmani Antony is a board certified anesthesiologist and fellowship trained pain management physician from University of Maryland.  She specializes in treating acute pain, chronic non-malignant pain and cancer pain.  Dr. Antony believes in educating her patients about their condition.  “Explaining a patient’s condition and treatment options is the most important part of a patient’s care.” – Dr. Antony

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