Hovhannes M. Manvelyan

 

Chronic pain syndrome (CPS) is one of most common medical problems that present a major challenge to health-care providers because of its complex natural history, unclear etiology, and poor response to therapy. CPS is a poorly defined condition. Both duration and location parameters in chronic pain are used arbitrarily. Certain and internationally wide accepted criteria for the diagnosis of CPS yet are missing. CPS itself is a constellation of different syndromes that usually do not respond to the traditional medical approach, and needs multidisciplinary management. Most widespread CPS condition, Fibromyalgia, is associated with many somatic symptoms, including fatigue, gastrointestinal complaints, and headaches, as well as sleep disturbance, anxiety, and depression, making the differential diagnosis sometimes difficult. Clinical investigations in those patients usually reveal real comorbidities in the spine as herniated intervertebral discs, spinal stenosis, and presence of brain structural abnormalities, including arterial pathology, cysts or lesions. Those very often are considering as the main reason for the pain and patients undergo unnecessary and unsuccessful procedures, including surgeries, local treatments, blockades, physiotherapies, and further rehabilitation. The role of proper skilled and experienced medical professionals in the case with handling of CPS patient is extremely important to get the right diagnosis and effective treatment. To our knowledge, each patient with widespread long-lasting pain must be examined and evaluated for CPS, including additional anamnestic questioning on other painful localizations, mandatory tender point checking, questioning on depression and mood swings, and lab diagnostics must also include thyroid profile, vitamin D deficiency, Epstein Bar Virus detection, etc. Each patient needs professional counseling to learn the complications of his problem, possible solutions and proper understanding of the important role of his own active participation in effective treatment. Treatment, besides pain management, must include mandatory physical activities, management of possible endocrine problems and substitution of vitamin deficiencies, and in some cases, antidepressants too.