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MANAGEMENT OF PATIENTS WITH CHRONIC PAIN

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Chronic pain is a painful condition that lasts longer than 3 months, pain that persists beyond the reasonable time for an injury to heal, or pain that persists 1 month beyond the usual course of an acute disease. Complete eradication of pain is not a reasonable endpoint in most cases. Rather, the goal of therapy is pain reduction and a return to functional status.

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Clinical Features

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Signs and symptoms of chronic pain syndromes are summarized in Table 8-1. Many of these syndromes will be familiar to emergency physicians.

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Table Graphic Jump Location
Table 8-1

Signs and Symptoms of Selected Chronic Pain Syndromes

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Complex regional pain type I, previously known as reflex sympathetic dystrophy, and complex regional pain type II, previously known as causalgia, may be seen in the emergency department (ED) 2 weeks or more after an acute injury. These disorders should be suspected when a patient presents with classic symptoms: allodynia (pain provoked with gentle touch of the skin) and a persistent burning or shooting pain. Early associated signs during the disease include edema, warmth, and localized sweating.

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Diagnosis and Differential

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The most important task of the emergency physician is to distinguish chronic pain from acute pain that heralds a life- or limb-threatening condition. A complete history and physical examination should confirm the chronic condition or point to the need for further evaluation when unexpected signs or symptoms are elicited.

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Rarely, a provisional diagnosis of a chronic pain condition is made for the first time in the ED. The exception is a ...

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