Practical Guide to Chronic Pain Syndromes

hronic pain syndromes (CPS) are complex problems that present a major challenge to health care providers. They are biological, psychological, and sociological in nature, may have an unclear etiology, and, frequently, poor responses to
therapy. CPS, if treated in a typical mono- or bimodality manner may not give
the patient the best treatment outcome, but as things are now, that may be the
best that can be done for these difficult patients. Even the definition of a CPS (of
any kind) may be considered unsettled, as some look at it as pain that persists
more than three months, while others consider chronic pain to begin after six
months. Pain that persists after physiological healing has occurred, typically in
three months, posttreatment, for example, tells us nothing new—it becomes an
entity in and of itself. The best way to treat it is to understand the complex interactions of the pathophysiology of pain as well as the issues of the psychological
and sociological aspects of an individual patient’s pain, and deal with it all as
best as one can.
The purpose of this book is to give the practitioner the basics and more regarding a number of important, not uncommon, CPS that pain specialists, as well as
other medical specialists see. Sometimes the most difficult issue is diagnosis—
Clinically speaking, pain is what the patient says it is, and it is up to the clinician
to determine what the patient means. Then the treatment phase begins and this
may engender the use/need of chronic opioids, physical therapy, and psychological therapy—whatever it may take to help your patient’s chronic pain problems.
Chronic pain can be considered to be like diabetes or hypertension—a disease
that can be treated and controlled, but not necessarily cured.
Practical Guide to Chronic Pain Syndromes has been written for the noninterventional pain specialist as well as for other physicians who treat chronic pain of
one, two, or multiple types. All of the pain syndrome chapters have information
on a specific disorder, the pathophysiology, the treatment, any evidence-based
medicine issues and, of course, up to date references.
I have elected to place the largest section, “Neuropathic Pain,” first. This is
followed by a section on probably the most common pain problems: the soft
tissue pain syndromes including myofascial pain and fibromyalgia. One of the
most frequently missed problems in my longer than a quarter century of patient
care is the piriformis syndrome, which is also discussed in detail. Mechanical and
neuropathic low back pain are also discussed in detail.
Many times, pain specialists are asked to deal with visceral pain syndromes
such as interstitial cystitis and vulvovestibulitis, which are discussed by experts,
along with prostatiti