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Oxford University Hospitals NHS Foundation Trust
OxPARC

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Pain syndromes

Pain syndromes overlap in clinical features and share the same treatments. We have grouped them together in treatment categories:

Musculoskeletal imbalance syndromes

Includes:

  • Hypermobility
  • Knee pain syndromes (Patello-femoral syndrome; Chondromalacia Patellae)
  • Adolescent onset growing pain

The focus of treatment is principally physiotherapy led exercise to correct imbalances of muscles, tendons and accommodate asymmetric bone growth.

Growing pains

There are two forms of growing pains. Both often resolve on their own with time.

Benign nocturnal limb pain of childhood

Growing pains often occur at night, waking a child from sleep and sometimes making them cry. The shins are usually affected.

The best treatment is to reassure the child and rub their legs. This stimulates other nerve fibres to soothe the pain.

Adolescent onset growing pain

Leg and joint pain during or after growth spurts is common. During growth spurts the tendons may tighten up.

Pain typically occurs in the evening or after prolonged or increased activity. Regular stretching of the hamstrings, quadriceps or calves (see physiotherapy) will gradually ease this discomfit.

We advise continued participation in sporting activity. The best forms of exercise for limb pains include swimming and cycling which have additional benefits on the heart and lung.

Localised idiopathic pain / complex regional pain syndrome

These are complex disorders with altered or heightened sensations. Changes in the colour of the affected limb, skin temperature and swelling may occur. Loss of hair overlying the affected area occurs late.

Physiotherapy guided exercise and rehabilitation is the principle form of treatment. Several different treatment strategies are used to maximise a patient's response. This includes

  • Desensitisation of the skin
  • Goal oriented physical activity
  • A paced increase in everyday activity

See treatment of chronic pain for more information.

Localised pain syndromes include:

  • Reflex Sympathetic Dystrophy
  • Sudeck's Atrophy
  • Neurovascular Dystrophy
  • Algodystrophy
  • Post-traumatic Vasospasm
  • Causalgia
  • Shoulder-hand Dystrophy

Diffuse idiopathic pain

Pain occurs at several sites around the body and commonly includes back ache. Each pain is distinct and may occur at separate times. Intermittent headache or abdominal pain may also occur and may be the only pain for many years before musculoskeletal pain occurs. There may be periods when pain is absent or relatively mild.

The pain notably affects everyday activities and long periods of schooling may be lost. Most patients complain of reduced social contact and a marked loss in quality of life. Sleep problems may occur.

A comprehensive rehabilitation programme is essential. A multidisciplinary (physiotherapy, occupational therapy and psychology) assessment is often undertaken to tailor treatment to the specific needs of the patient.

See treatment of chronic pain for information on how each team member contributes to pain management.

Diffuse pain syndromes include:

  • Fibromyalgia
  • Myofibrositis myofascial syndrome
  • Fibromyositis
  • Nonarticular rheumatism
  • Fibrositis
  • Musculorheumatism
  • Idiopathic myalgias
  • Interstitial myofibrositis
  • Nodular rheumatism
  • Rheumatic pain modulation disorder
  • Rheumatic myalgia
  • Soft tissue rheumatism
  • Muscular rheumatism