Functional pain syndromes

Athena Mavromati, MD, Anesthesiologist, 02 Mar 2012

Functional pain syndromes are the conditions where the patient complains of pain and other functional disorders that are not accompanied by a corresponding lesion. Depending on the location of the main complaints enters the corresponding diagnosis. Thus, we have the irritable bowel syndrome, chronic back pain, temporomandibular joint dysfunction, tinnitus syndrome, migraine, atypical facial pain, pelvic floor dysfunction, urethral syndrome, neurogenic bladder, interstitial cystitis, chronic prostatitis, atypical chest pain, angina pectoris, and idiopathic arthritis. When the pain is diffused then the diagnosis of fibromyalgia is made. In all the above cases, an organic disorder cannot be found and the diagnosis is performed by exclusion. These syndromes share many common characteristics, coexist with each other, coexist with chronic fatigue syndrome, lack of concentration, sleep disorders, emotional disturbances, anxiety, panic attacks, depression, post traumatic stress disorder.

The traditional approach for the treatment of these syndromes which comes from the respective medical specialties that address the patient according to the main symptom, does not solve the problem. These patients are subjected to extensive clinical and laboratory tests and treatments that lack rational basis and thus fail, which further aggravate the already existing problem. Eventually, and quite often, they end up being treated with suspicion by doctors and their environment or even considered psychiatry incidents.

Yet today there is much evidence that these disorders are not associated with damage to the respective organ but with neurophysiological and anatomical changes in the nervous system. Also, perinatal and environmental factors, stress early in life of a person or an adult, and lifestyle can trigger the appearance of the syndrome in people who have the genetic predisposition.

The treatment of pain syndromes based on the aforementioned reasoning includes medication, cognitive-behavioral therapy, and alternative methods. The medications used are antidepressants, anticonvulsants, anxiolytics, and opioids. These drugs interfere with the creation, reproduction and transfer of pain in the body. Their role is to balance the neurophysiological disturbances involved in the creation of pain. The cognitive-behavioral therapy significantly helps sufferers to cope with the everyday problems, to recognize and to better control the aggravating factors of their condition resulting in pain reduction and increased quality of life. Alternative treatments can help focusing on natural self-healing mechanism of the organism, the close monitoring of the patient and the patient-physician relationship. The complex nature of pain needs multimodal addressing and an all-aspect consideration of the individual. This includes the peripheral systems and also environmental and genetic factors. This includes not only the peripheral organs and anatomical entities of our body, but also the functional neural systems environmental and genetic factors as well.