Chronic pain syndromes

Last reviewed: 23 Apr 2022
Last updated: 06 Apr 2022

Summary

Definition

History and exam

Key diagnostic factors

  • duration of pain more than 3 months
  • physical comorbidity
  • psychological comorbidity
  • previous history of acute pain episodes
  • pain causing difficulty in performing routine activities of daily living
  • precipitating factors for myofascial pain
  • precipitating factors for musculoskeletal pain
  • herpes zoster infection
  • history of trauma or limb immobilization
  • medication use
  • muscle spasm
  • associated somatic symptoms
  • muscle tenderness to palpation
  • trigger-point tenderness
  • taut bands
  • twitch response
  • joint swelling and tenderness
  • tender points
More key diagnostic factors

Other diagnostic factors

  • precipitating factors for chronic headache
  • duration of headache pain
  • radiating pain
  • morning stiffness in joints
  • pain with prolonged walking, relieved with stooping or sitting
  • joint pain
  • burning quality of pain
  • allodynia
  • hyperalgesia
  • chronic headache associated with nausea, vomiting, and sensitivity to light and noise
  • intermittent pattern of chronic headache pain
  • bilateral chronic headache pain
  • unilateral chronic headache pain
  • limited range of motion (ROM)
  • painful or limited straight leg raising
  • symmetrical body pain distribution
  • worsening headache symptoms despite treatment
  • headache with posterior head or neck pain
  • excessive guarding of the painful extremity
  • diminution or loss of reflexes
  • tenderness over temporal artery distribution
Other diagnostic factors

Risk factors

  • age over 45 years
  • female sex
  • pregnancy
  • history of trauma or chronic pain
  • family history of chronic pain syndromes
  • acute back pain with neurologic signs
  • high-risk occupation
  • comorbid personality disorder/psychological distress
  • pain-related disability
  • cigarette smoking
More risk factors

Diagnostic investigations

Investigations to consider

  • plain x-rays of spine, bones, and/or joints
  • MRI of spine
  • electromyogram and nerve conduction studies
More investigations to consider

Treatment algorithm

ONGOING

myofascial pain

musculoskeletal pain

neuropathic pain

fibromyalgia

chronic headache

Contributors

Authors

Gaurav Chhabra, MBBS, FRCA, FFPMRCA

Consultant, Pain Medicine and Anaesthesia

North Bristol NHS Trust

Bristol

UK

Disclosures

GC has been sponsored by Boston Scientific, Abbott, Medtronic, and Nevro to attend cadaveric workshops relevant to neuromodulation.

Acknowledgements

Dr Gaurav Chhabra would like to gratefully acknowledge Dr Sarah Love-Jones and Dr Dawn A. Marcus, previous contributors to this topic. SLJ has received consultancy fees for Boston Scientific and Nevro Corporation (regarding spinal cord stimulation) and is an elected council member of the British Pain Society. DAM is an author of a reference cited in this topic.

Peer reviewers

J. David Sinclair, MD

Clinical Instructor

Department of Anesthesiology

University of Washington School of Medicine

Seattle

WA

Disclosures

JDS declares that he has no competing interests.

Joan Hester, MBBS, FRCA, LRCP, MRCS

Consultant in Pain Management

Pain Unit

King's College Hospital

London

UK

Disclosures

JH has chaired advisory boards for Napp Pharmaceuticals Ltd., chaired a symposium, is a principal investigator and has participated in advisory boards for Grunenthal Ltd., and has given lectures for Pfizer Ltd. JH attended the American Pain Society meeting in 2009 sponsored by Grunenthal.

Beverly J. Collett, MB BS, FRCA, FFPMRCA

Consultant in Pain Medicine

Pain Management Service

University Hospitals of Leicester

Leicester

UK

Disclosures

Not disclosed.

  • Differentials

    • Hypothyroidism
    • Polymyalgia rheumatica (PMR)
    • Giant cell arteritis (GCA)
    More Differentials
  • Guidelines

    • International statistical classification of diseases and related health problems, 11th revision (ICD-11)
    • 2021 American College of Rheumatology guideline for the treatment of rheumatoid arthritis
    More Guidelines
  • Patient leaflets

    Back pain (lower back)

    Breast pain

    More Patient leaflets
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer