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Pain of uncertain etiology

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incierta PAIN OF UNCERTAIN AETIOLOGY

Complex regional syndromes
  • Complex regional pain syndrome type 1 (algodystrophy, reflex sympathetic dystrophy, Sudek's atrophy)
  • Complex regional pain syndrome type 2 (Causalgia)

The IASP agreed to group together a series of diagnoses characterised by pain, limited mobility and adjacent tissue disorders that occur in patients with no prior injury or else are disproportionate to the injury. These diagnoses, algodystrophy, Sudek's atrophy, reflex sympathetic dystrophy, are grouped together as Complex regional pain syndrome Type 1.

The Complex regional pain syndrome type 2 replaces the diagnosis of causalgia and is defined by the same symptoms and signs, albeit with a background of major nerve injury. It is still believed that the sympathetic nervous system is involved in this disease, although it is a subject of ongoing debate.

Pelvic Pain Syndrome
  • The name chronic pelvic pain syndrome is used to define a series of processes that affect the pelvis, genital area, perineum - proctalgia and chronic vulvodynia - whose aetiology is unknown but which are usually associated with an initial event - prostatitis, cystitis, endometriosis etc. - and often course with the involvement of the pelvic musculature and/or genito-femoral or pudendal nerve entrapments.
    In the opinion of many researchers, central sensitisation mechanisms could account for the persistence of these symptoms, even in the absence of an observable anatomical anomaly.
Fibromyalgia
What is it?

Fibromyalgia is a general pain syndrome of unknown cause. This muscle pain is almost invariably compound by fatigue, sleep disorders, anxiety and depression.

Fibromyalgia pain points.

Diagnostic criteria

The diagnostic criteria used are those of the American College of Rheumatology (2010), and are as follows:

A patient may be diagnosed with fibromyalgia if they fulfil the following conditions:

  1. Widespread Pain Index of 7 or > and Symptom Severity Score > 5 or WPI between 3 and 6 and SSS > 9
  2. The symptoms have been present at a similar level over the last 3 months
  3. The patient has no other pathology that explains the pain
Score

WPI: Write down the number of areas where the patient has had pain (max. 19)

Areas: Left shoulder girdle, right shoulder girdle, leg left, right leg, left arm, right arm, left jaw, right jaw, left forearm, right forearm, chest (thorax), abdomen, left hip (buttock/trochanter), right hip (buttock/trochanter), neck (nape and front), upper back, lower back, left thigh and right thigh

SS Score:

  • Fatigue
  • Waking unrefreshed
  • Cognitive symptoms

0 = No problem , 1 = mild 2 = moderate 3 = severe

Somatic symptoms

* Muscle pain, irritable bowel syndrome, fatigue/tiredness, thinking or remembering problems, muscle weakness, headache, pain/cramps in abdomen, numbness/tingling, dizziness, insomnia, depression, constipation, pain in upper abdomen, nausea, nervousness, chest pain, blurred vision, diarrhoea, dry mouth, itching, wheezing, Raynaud's, hives/welts, ringing in ears, vomiting, heartburn, oral ulcers, loss/change in taste, dry eyes, seizures, shortness of breath, loss of appetite, rash, sun sensitivity, hearing difficulties, easy bruising, hair loss, frequent urination, painful urination, bladder spasms

0 = 0 symptoms, 1 < 10 symptoms, 2 < 25 symptoms 3 > 25 symptoms

The SS Score is the sum of the previous 4, fatigue, sleep, cognitive symptoms and somatic symptoms, and its maximum value is 12.

Further information: www.fibromialgia-cat.org

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