Chronic Pain Syndrome

CHRONIC PAIN SYNDROME CHIEF COMPLAINT Chronic pain syndrome HPI SYMPTOM LIST •Chronic pain SEVERITY •Mild •Moderate •Severe •Normal •Increased •Decreased •Stable •No significant change from prior visit ONSET •Sudden •Gradual DURATION •Recent •Few days •Many days •Few weeks •Many weeks •Few months •Many months •Few years •Many years FREQUENCY •Intermittent •Continuous

AGGRAVATED BY RELIEVED BY NOTES HISTORY (PMFSH) PAST HISTORY •Psychological disorders o Bipolar personality disorders o Depression o Porphyria o Sleep disturbances o Anxiety disorder o Somatization o Physical or sexual abuse o Drug abuse/dependence o Family, marital, or sexual problems •Musculoskeletal disorders o Osteoarthritis/degenerative joint disease/spondylosis o Rheumatoid arthritis o Lyme disease o Reiter syndrome o Disk herniation/facet osteoarthropathy o Fractures/compression fracture of lumbar vertebrae o Faulty or poor posture o Fibromyalgia o Polymyalgia rheumatica o Mechanical low back pain o Chronic coccygeal pain o Muscular strains and sprains o Pelvic floor myalgia (levator ani spasm) o Piriformis syndrome o Rectus tendon strain o Hernias o Abdominal wall myofascial pain (trigger points) o Chronic overuse syndromes (eg, tendinitis, bursitis) •Neurological disorders o Brachial plexus traction injury

Cervical radiculopathy Thoracic outlet syndrome Spinal stenosis Arachnoiditis Metabolic deficiency myalgias Polymyositis Neoplasia of spinal cord or sacral nerve Cutaneous nerve entrapment in surgical scar Postherpetic neuralgia (shingles) Neuralgia Polyneuropathies Polyradiculoneuropathies Mononeuritis multiplex Chronic daily headaches Muscle tension headaches Migraine headaches Temporomandibular joint dysfunction Temporalis tendonitis Sinusitis Atypical facial pain Trigeminal neuralgia Glossopharyngeal neuralgia o Nervous intermedius neuralgia o Sphenopalatine neuralgia o Referred dental or temporomandibular joint pain o Abdominal epilepsy o Abdominal migraine •Urologic disorders o Bladder neoplasm o Chronic urinary tract infection o Interstitial cystitis o Radiation cystitis o Recurrent cystitis o Recurrent Urethritis o Urolithiasis o Uninhibited bladder contractions (detrusor-sphincter dyssynergia) o Urethral diverticulum o Chronic urethral syndrome o Urethral carbuncle o Prostatitis o Urethral stricture o o o o o o o o o o o o o o o o o o o o o

o Testicular torsion o Peyronie disease •Gastrointestinal disorders o Chronic visceral pain syndrome o Gastroesophageal reflux o Peptic ulcer disease o Pancreatitis o Chronic intermittent bowel obstruction o Colitis o Chronic constipation o Diverticular disease o Inflammatory bowel disease o Irritable bowel syndrome •Reproductive disorders (extra uterine) o Endometriosis o Adhesions o Adnexal cysts o Chronic ectopic pregnancy o Chlamydial endometritis or salpingitis o Endosalpingiosis o Ovarian retention syndrome (residual ovary syndrome) o Ovarian remnant syndrome o Ovarian dystrophy or ovulatory pain o Pelvic congestion syndrome o Postoperative peritoneal cysts o Residual accessory ovary o Subacute salpingo-oophoritis o Tuberculous salpingitis o Reproductive disorders (uterine) o Adenomyosis o Chronic endometritis o Atypical dysmenorrhea or ovulatory pain o Cervical stenosis o Endometrial or cervical polyps o Leiomyomata o Symptomatic pelvic relaxation (genital prolapse) o Intrauterine contraceptive device ALLERGY-Drugs -Environment

FAMILY HISTORY •Diabetes •Hypertension •Sinusitis •Migrane •Depression •Bipolar disorders SOCIAL HISTORY •Habits o Tobacco o Alcohol o Drugs •Occupation ROS PHYSICAL EXAMINATION TESTS TO BE ORDERED •CBP •Hb% •Serum electrolyte •RA factor •ANA •C-reactive protein •Urinalysis •Urine culture •Renal function test •Liver function test •Thyroid function test •Urine toxicology •Blood toxicology •X-ray skull •X-ray sinus •X-ray chest •X-ray bones •USG •MRI

•CT scan ASSESSMENT/PLAN & INSTRUCTIONS/EDUCATION •Apply hot or cold applications •Do stretching exercises

•Apply traction •Massage the effected part •Apply transcutaneous electrical nerve stimulation (TENS) •Surgical Intervention o Sympathetic blocks including stellate ganglion and lumbar sympathetic blocks commonly are used. o Spinal cord stimulation is used to treat neuropathic pain •Psychophysiological therapy o Give reassurance, counseling, relaxation therapy, stress management programs, and biofeedback techniques. MEDICATION •Paracetamol •Ibuprofen •Aspirin •Tizanidine •Amitriptyline •Nortriptyline •Fluoxetine •Paroxetine •Sertraline •Doxepin •Desipramine protriptyline •Buspirone •Duloxetine •Venlafaxine •Gabapentin •Oxycodone •Fentanyl •Acetaminophen •Pregabalin •Naproxen sodium FOLLOW UP

•Avoid uncomfortable stressful positions and bad posture. •Regular exercise, good sleeping habits, and balanced meals are helpful in maintaining good health.