Background
Epidemiology
Etiology and pathogenesis
Trauma
Psychological factors
Abnormal neurologic findings
Inflammatory and immune abnormalities
Genetics
Clinical findings
Pain – amplification of the pain
Autonomic findings
Trophic changes
Motor disturbances
Diagnosis
Diagnosis | Distinguishing charateristics |
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Fibromyalgia | Diffuse chronic musculoskeletal pain with multiple predictable tender points |
Hypermobilty | Common, younger age (preschool to elmentary school age), pain more sever towards the end of the day, usually associated with specific activities, evidence of hypermobility in physcal examination |
Myofascial pain | Pain arises from sustained contraction of a muscle, especially in the head, jaw, and upper back. Presence of a trigger point (tender point) and reproduction of the pain by maneuvers which place stress upon proximal structures or nerve roots. |
Unrecognized local pathology (fracture, strain, sprain) | Trauma/strain to the affected limb, pain worsens with physical activity and excersice, positive findings in plain radiographs. |
Arthritis | Inflamation of one or more joints, pain is constant, localized to the affected joint.positive physical findings. |
Spondyloarthropathy | Lumbar spinal pain associated with arthritis, imaging or other evidence of arthritis affecting the sacroiliac joints and the lumbar vertebral column, response to nonsteroidal anti-inflammatory medications. |
Leukemia | Child appears sick, presence of anorexia and lethargia, fever is common, nucturnal pain and bone pain. Abnormal blood count, relative thrombocytopenia, and elevated erythrocytes sedimentation rate. |
Spinal cord tumors | Slow progression of pain, pain quality – low and steady intesity, abnormal neurologic examination, pathologic MRI. |
Chronic recurrent multifocal osteomyelitis | Chronic, noninfectious inflammation in the metaphyses close to the physes of multiple bones. Bony tenderness over the affected sites. Presence of lytic lesions on plain radiographs. Lesions appear on bone scan. Pain usually responds to nonsteroidal anti-inflammatory drugs or corticosteroids. |
Raynaud’s disease | Cold or emotional stress causes vasospasms which enduces discoloration of the fingers, toes, and occasionally other areas. Episodes are short lived, pain, numbness, or tingling can be experienced with the episode. Pain can be reproduced with a cold challenge. Digital tip ulcers might occur. |
Farby disease | Deficiency of ceramide trihexoside α-galactosidase, X-linked recessive inheritance. Episodic excruciating burning pain in the hands and feet. Symptomes usuall begin in adolescence. Presence of bluish maculopapular hyperkeratotic lesions around the perineum, elevated erythrocytes sedimentation rate. |
Erythromelalgia | Rare disorder characterized by burning pain, warmth, and redness of the extremities. Can be familial or secondary to myeloproliferative disorders. Pain alleviated by cold exposure. |
Pernio | Episodic inflammatory skin condition presenting after exposure to cold as pruritic and/or painful erythematous-to-violaceous acral lesions, recures with cold exposure. |
Chronic compartment syndrome | Usually occurs in athletes, repetitive loading or exertional activities cause exercise-induced pain that is relieved by rest. Onset of symptoms typically occurs at a specific exercise distance or time interval or intensity level, symptoms tend to subside with rest and are minimal during normal daily activities. |
Peripheral mononeuropathy | More common among adults. Occurs following an injury or infection. Can cause severe burning pain in the distribution of the involved peripheral nerve. Findings in a physical examination are limited to the area supplied by the injured nerve. |
Progressive diaphyseal dysplasia | Begins in adolescence. Causes severe leg pain, fatigue, headaches, weight loss, weakness, abnormal waddling gait. Diagnosis confirmed via plain radiographs which demonstrate cortical thickening and sclerosis of the diaphysis of the long bones. |
Idiopathic juvenile osteoporosis | Uncommon, typically occurs just before the onset of puberty, pain in the lower back, hips, and feet, often accompanied by difficulty walking, fractures of the lower extremities can occur. Plain radiographs demonstrate low bone density, fractures of weight-bearing bones, and collapsed or misshapen vertebrae. Bone scans can demonstrate microfractures. |
Thyroid disease | Hyperthyroidism/hypothyroidism can cause widespread musculoskeletal pain. History and physical examination reveals signs and symptomes of thyroid disease. Abnormal thyroid function tests. |
Vitamin D deficiency | Uncommon in developed countries. Causes limb pain. Low levels of vitamin D in laboratory tests. |
CRPS I | CRPS II |
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1) The presence of an initiating noxious event, or a cause of immobilization. 2) Continuing pain, allodynia, or hyperalgesia with which the pain is disproportionate to any inciting event. 3) Evidence at some time of edema, changes in skin blood flow, or abnormal sudomotor activity in the region of the pain. 4) This diagnosis is excluded by the existence of conditions that would otherwise account for the degree of pain and dysfunction. | 1) The presence of continuing pain, allodynia, or hyperalgesia after a nerve injury, not necessarily limited to the distribution of the injured nerve. 2) Evidence at some time of edema, changes in skin blood flow, or abnormal sudomotor activity in the region of the pain. 3) This diagnosis is excluded by the existence of conditions that would otherwise account for the degree of pain and dysfunction. |
Note: Criteria 2–4 must be satisfied. | Note: All three criteria must be satisfied. |
All the following criteria must be met: |
1) Continuing pain, which is disproportionate to any inciting event. 2) Must report at least one symptom in three of the four following categories: • Sensory: Reports of hyperesthesia and/or allodynia. • Vasomotor: Reports of temperature asymmetry and/or skin color changes and/or skin color asymmetry. • Sudomotor/Edema: Reports of edema and/or sweating changes and/or sweating asymmetry. • Motor/Trophic: Reports of decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair, nail, skin). 3) Must display at least one sign at time of evaluation in two or more of the following categories: • Sensory: Evidence of hyperalgesia (to pinprick) and/or allodynia (to light touch and/or temperature sensation and/or deep somatic pressure and/or joint movement). • Vasomotor: Evidence of temperature asymmetry (>1 °C) and/or skin color changes and/or asymmetry. • Sudomotor/Edema: Evidence of edema and/or sweating changes and/or sweating asymmetry. • Motor/Trophic: Evidence of decreased range of motion and/or motor dysfunction (weakness, tremor, dystonia) and/or trophic changes (hair, nail, skin). 4) There is no other diagnosis that better explains the signs and symptoms. |