Body Pain Syndrome: Causes and Management

Pain is an undesirable sensation in the body which is triggered by our brain. Pain experienced by each individual varies in frequency and severity. Complaints regarding body pain are very common, especially in women aged above 50 years. Many of them are habituated to taking pain killers and other modes of treatment.
However, it is vital for the doctor to have a systematic approach to the common problems as they could indicate underlying serious issues like muscular skeletal pain. Instead of prescribing painkillers, if the doctors have a systematic approach, it can prevent adverse effects of pain killers such as acidity, renal failure, hypertension, etc.

What are the causes of body pain?:

The causes of persistent body pain include the following:

• Lack of sleep
• Excessive working hours
• Hypothyroidism
• Systemic Lupus Erythematosus (SLE)
• Hyperuricemia
• Arthritis of Joints
• Drugs (Statins)
• Muscle spasm
• Hyponatremia
• Entrapment of nerves
• Complex regional pain syndrome
• Myofascial pain syndrome
• Fibromyalgia
• Polymyalgia rheumatica
• Chronic pelvic pain syndrome
• Somatic symptom disorder
• What are the common pain syndromes?

There are a few conditions due to which, the body pain lasts long after the causes are gone. Such pain is called chronic pain and the conditions are termed as pain syndrome. The common pain syndromes are:

1. Fibromyalgia:

Fibromyalgia (FM) is a common cause of chronic widespread musculoskeletal pain, often accompanied by fatigue, cognitive disturbance, and psychiatric symptoms. The aetiology (cause) of the syndrome is unknown. Despite symptoms of soft tissue pain affecting the muscles ligaments and tendons, there is no evidence of tissue inflammation.Fibromyalgia is a common cause of widespread musculoskeletal pain in women ageing between 20- 55 years. Typically the patient complains of generalised pain as they suffer from viral fever. It is associated with fatigue especially when waking up from sleep. Even with 8-10 hours of sleep, they tend to feel fatigued. They experience cognitive disturbances, due to which they are unable to perform the tasks which require rapid thought changes.It may be associated with depression, anxiety and headache. To diagnose fibromyalgia, a detailed study of clinical history is conducted by excluding other causes and side effects.

2. Myofascial pain syndrome:

It is not a widespread pain condition like Fibromyalgia. In myofascial pain syndrome, the pressure on sensitive points in your muscles (trigger points) causes pain. Sensory symptoms and muscle contraction away from the trigger point is called the trigger zone. These trigger points are present within the muscles. Specifically, in the pelvis, these trigger points can get stimulated at various points. Hence patients experience back pain associated with urogenital symptoms with negative urine culture reports and normal ultrasound abdomen reports from various doctors and clinics. That is also called chronic pelvic pain syndrome.

3. Polymyalgia Rheumatica:

It is not widespread and it is not localised pain condition. There are no trigger and tender points. In this condition shoulder girdle (neck muscles, shoulder muscles) and hip girdle (Pelvic muscles and thigh muscles) are involved. In this condition, the patient not only experiences the aching sensation of the muscles but also stiffness that lasts more than 30 minutes in the early morning or after an inactive period. These pains and stiffness respond very well to the treatment and as early as within 5 days of steroid therapy.

4. Complex regional pain syndrome:

After a fracture or soft tissue trauma, within 4-6 weeks of time and degree of trauma, the patient gets regional pain associated with skin and sensory abnormalities This is sometimes seen even without an identifiable trigger. Previously it was called “Reflex Sympathetic Dystrophy”.

5. Lumbar spinal stenosis:

It is a condition, in which, the spinal canal compresses creating pressure on spinal nerves. Due to this, the patient may get pain in the lower back that sometimes extends to the buttock and sometimes below the knee joint. The volume of the lumbar canal (the abdominal segment of the torso) decreases with the backward extension of the body. Hence these patients complain about increased back pain while walking down. Sometimes this condition causes aching sensation and numbness.

6. Thoracic outlet syndrome:

Due to the compression of the vascular component in the thorax (the part between the neck and the abdomen), the patient may get the pain that lasts over a week. The pain radiates from shoulder to head. Most often it is caused by sagging of shoulder girdle resulting from ageing, obesity and pendulous breast (when nipple and breasts are below the breast crease line on the chest).

7. Arthritis:

The inflammation of the joints is called arthritis. This condition is of two types – osteoarthritis and inflammatory arthritis. Arthritis occurs due to connective tissue disorders. Osteoarthritis is due to the ageing process, it usually increases when the patient is doing activities and decreases during the resting period. Inflammatory arthritis has severe swelling and pain, especially during early morning at least more than 1 hour. This is called early morning stiffness. Osteoarthritis occurs only in the aged population but inflammatory arthritis occurs at any age.

8. Brucellosis:

A case of chronic fatigue syndrome is defined by the presence of four or more of the following symptoms that persist or recur during 6 or more consecutive months of illness and that do not predate the fatigue:

• Self-reported impairment in short-term memory or concentration.
• Sore throat
• Tender cervical or axillary nodes
• Muscle pain
• Multi-joint pain without redness or swelling
• Headaches of a new pattern or severity
• Unrefreshing sleep
• Post-exertional malaise lasting greater than or equal to 24 hrs.

How can body pain be managed?

Body pain can be managed by bringing about a lifestyle change. Inculcating a well-balanced diet, weight management, including low-impact physical activities, like walking or swimming, help prevent body pain.
Along with the lifestyle changes, following approaches also help in reducing or eliminating body pain.

1. Eliminate aggravating factors:

As seen above, a number of factors cause body pain, tackling the causes can reduce body pain.
For example for lack of sleep:

• Restrict excessive daily work at home
• Maintain good sitting posture
• Exclude stress conditions
• Exclude any drugs causing muscle pain, ex: Lipid-lowering drugs
• Maintain a minimum of 8 hours of sleep per day.

2. Eliminate systemic diseases:

Conditions like hypothyroidism, hyperuricemia, SLE (Systemic Lupus Erythematosus) and occult cancers cause pain, especially during the night. A persistent lower back pain that does not get relieved with rest is seen in prostate, lung and breast metastasis. In such cases, the doctors should explain the illness to the patient which may, in turn, relieve anxiety related pains. Doctors should explain pain relief strategies, for example walking, basic stretching exercises, etc.

3. Thermotherapy (Heat therapy) or Cryotherapy (Cold therapy):

Sometimes, even doctors also get confused about whether to apply heat or cold modalities for musculoskeletal disorders. But there is a differentiation between cold and heat modality.

• When to apply hot packs or hot water bottles?

Whenever there is a muscle spasm associated with pain, hot packs are suggested so that an analgesic effect is created on free nerve endings.

• When should we apply ice packs?

If there is any inflammation-associated pain without a muscle spasm, one should apply ice packs. With cold packs, the blood supply decreases leading to a decreased local metabolism which reduces the swelling and pain.

Conclusion:

As most of these diseases don’t have a specific diagnostic test and the overlapping symptoms among these diseases make diagnosis very tough. Hence, proper questioning of the patient, counselling of patient and proper treatment by the doctor is the only way to get diagnosed and get rid of symptoms.