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MANAGEMENT OF PATIENTS WITH CHRONIC PAIN

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.

Clinical Features

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

Table 8-1

Signs and Symptoms of Selected Chronic Pain Syndromes

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.

Diagnosis and Differential

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.

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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