I read a good article on Regional Pain Syndrome and Complex Regional Pain Syndrome this week form the June edition of Medicine Today (Australia). It was written by Professor Geoffery Littlejohn. Some of the points I gleaned from the article was that:
1 there was central or peripheral sensitisation involved in the ongoing perpetuation of pain in the presence or absence of the original injury.
Comment: This also describes the mechanism for neuropathic pain. Is Regional Pain Syndrome similar to neuropathic pain?
2 Emotional distress and medicolegal complications enhances central sensitisation and makes this problem difficult to treat.
Comment: most people with chronic pain have a range of psychosocial risk factors (yellow flags), Chronic pain also causes emotional distress often leading to depression. The initial injury may also cause symptoms of Post Traumatic Stress.
3 Strong evidence base for the treatment of this condition is lacking due to the lack of good studies partially due to the fact that most patients have emotional distress and medico-legal complications of varying degrees and the making high quality clinical studies difficult to perform.
Comment: Painful conditions are always hard to study as the perception of pain is so subjective and dependent on all the other aspects of the patent’s life. Despite the various pain scores available, the ultimate result of any treatment should be Zero pain.
4 The presence of Myofascial trigger points as a feature of this condition.
Comment: It is very refreshing to read an article by a specialist and professor that has included Musculoskeletal dysfunction and trigger points as a feature of a painful condition. In time, I hope to prove that Myofascial trigger points are the major factor in the perpetuation and exacerbation of chronic pain especially in Regional pain syndrome, neuropathic pain or fibromyalgia.