In 2022, the CDC reported that chronic pain significantly impacts the daily lives of an estimated 50 million-plus people each year. Developing one of the pain syndromes can significantly impair the quality of daily living. Health care professionals caring for a person with chronic pain are challenged to help reach positive outcomes for the patient. 

What is chronic pain?

The generally accepted definition of chronic pain syndromes (CPS) is non-cancer-related pain that lasts three to six months or more. The CDC also states that the complexity of diagnosing the CPS condition is that it is not unusual to have overlapping pain from other conditions. 

Also associated with these syndromes is the development of depression, unemployment, substance abuse and a higher risk of suicide.

WebMD.com and other sources describe possible causes of CPS, with most starting with an injury or presence of other chronic conditions. (See “Potential causes of chronic pain,” top of next column.) 

CPS is not age-specific and occurs in both men and women, but is more common in women. People with major depression and other mental illnesses are more likely to develop CPS.

There is a large amount of medical literature devoted to CPS and much is beyond the scope of this article. I will briefly describe recognized distinct CPS conditions. They have differing treatment protocols that have shown promise in improving outcomes for some conditions.

Fibromyalgia

This is a common chronic pain syndrome affecting up to 12 percent of the population. It is defined as pain affecting at least four of five body regions. There are no blood tests to diagnose this condition. 

The American College of Rheumatology has scoring symptoms that include a description of generalized pain, duration, pain indexing and symptom-severity scores.

Much of the treatment involves exercise, psychological therapies, acupuncture and neurostimulation, use of non-opioid pain medication (e.g. acetominophen), massage and the use of antidepressants. Some people report benefits from using topical THC cannabis oils. New drugs are being evaluated, but it is too soon to tell how successful that treatment would be. 

Myofascial Pain Syndrome (MPS)

MPS is a regional muscle pain condition that is stimulated by trigger points. In this syndrome, there is a defined area of pain as compared to fibromyalgia, which has multiple areas. The cause of MPS is thought to be sustained muscle contraction. It can be a stand-alone condition or overlap with other chronic pain syndromes.

Treatment is centered around topical treatments and the use of nonsteroidal anti-inflammatories. Muscle relaxants have a role here, with a new drug—tizanidine—showing promise. Other treatments include manual manipulation, dry needling, TENS and extracorporeal shockwave therapy. Also being studied is the use of botulinum toxin injections (FP Essential, www. aafp.org/fpe).

Complex Regional Pain Syndrome (CRPS)

This type of CPS presents as severe pain, usually in the body area that experienced trauma. There are inflammatory changes to the skin over the affected area. Pain usually begins in an extremity or in the area that receives repeated trauma. 

CRPS is usually diagnosed when pain exists beyond normal healing.

To treat CRPS, patient education is important, along with tactile desensitization. Aquatic therapy could help. Cognitive behavior therapy, acupuncture and chiropractic manipulation have also been tried. Medication to lessen the pain includes NSAIDs, bisphosphonates and gabapentin. Vitamin C is used by some pains management specialists to prevent the development of CRPS after severe trauma to extremities. 

(source: Multiple studies reported by Foot and Ankle Surgery)

Chronic neuropathic pain

This condition affects 7 to 10 percent of the population and is associated with diseases of the nervous system. It has been associated with having a stroke or a spinal cord injury. Again, diagnosis is often clinical and not made by lab or scans. Many medications have been tried, along with the use of non-pharmacological treatments with variable success.