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KEY POINTS

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KEY POINTS

  1. Most common pain syndromes involve peripheral and central processes. Treatment should target both, in an interdisciplinary, biopsychosocial fashion.

  2. Low back pain and neck pain are among the leading causes of disability worldwide. Accurate diagnosis and early, interdisciplinary treatment are critical for successful care.

  3. Headache disorders rarely represent sinister intracranial pathology. The International Headache Society Guidelines can aid in the diagnosis of various headache disorders.

  4. Treatment of many headache disorders entails preventive and abortive strategies. Sound preventive measures are important to optimize outcomes.

  5. More than half of all cluster headache sufferers report suicidal ideation. Inquiring about suicidal ideation, contracting patients for safety, and referring them for mental healthcare is very important.

  6. Giant cell arteritis should be promptly diagnosed and treated to prevent blindness.

  7. Myofascial pain syndrome can occur primarily, or secondarily to another condition. The pathognomonic feature is the myofascial trigger point.

  8. Peripheral nerve injury can result in mild to intractable pain due to compression, stretch injury, or transection. Lesion localization may lead to directed treatment with targeted nerve blocks, surgical release, and other measures.

  9. Phantom sensation occurs in almost all amputees. Its incidence peaks approximately 1 month after amputation.

  10. New American College of Rheumatology diagnostic criteria for fibromyalgia no longer require performance of a tender point count. It now includes somatic symptoms, in addition to widespread pain index symptom severity.

  11. The main goals of the treatment for complex regional pain syndrome are analgesia, physical rehabilitation, functional recovery of the affected limb, and return to work.

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INTRODUCTION TO COMMON PAIN SYNDROMES

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In clinical practice, it is common to encounter patients with a variety of pain syndromes. Mechanistically, many common pain syndromes involve peripheral and central mechanisms, which are explained in detail in other chapters. Treatment often entails an interdisciplinary, biopsychosocial approach. This chapter will provide a concise, updated review of common pain conditions and their management.

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BACK AND NECK PAIN

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Low back pain is one of the most common symptoms that prompts patients to seek medical care and is the leading cause of disability both in the United States and worldwide.1,2 The one-year prevalence of low back pain globally is estimated to be about 38%, with age-related prevalence increasing until the 60-65-year age group.3 The cost burden associated with low back and neck pain is extremely high. In 2013, an estimated $87.6 billion was spent treating back and neck pain.4

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Neck pain is the sixth leading cause of disability in the United States and the fourth most common globally.2,5 The estimated one-year prevalence is approximately 25% overall and found to be higher in women, high-income countries, and urban areas.6

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Pain emanating from the back or neck can be attributed to degeneration and/or inflammation of the neuraxial structures, including the bony spine and its articulations (facet joints, sacroiliac joints), intervertebral disks, ligaments, ...

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