Medical Council of Canada

Medical expert

Generalized Pain Disorders - 67-1-2-1

Rationale

Complaints of non-articular generalized pain are common, often chronic and can be difficult to manage.

Causal Conditions

(list not exhaustive)
  1. Fibromyalgia / Chronic fatigue syndrome
  2. Polymyalgia rheumatica (PMR)
  3. Mental health disorders (e.g., depression, somatic symptom disorders)

Key Objectives

Given a patient with a generalized pain disorder, the candidate will differentiate articular from non-articular pain, diagnose the cause, severity, and complications, and will initiate an appropriate management plan.

Enabling Objectives

Given a patient with generalized pain disorder, the candidate will

  1. list and interpret critical clinical findings, including
    1. findings on history and physical examination which
      1. differentiate fibromyalgia from other generalized pain syndromes and specific articular disease;
      2. suggest other pain syndromes which may be associated with serious complications;
        1. PMR and temporal arteritis;
        2. Depression and suicide;
  2. list and interpret appropriate investigations (e.g., erythrocyte sedimentation rate, temporal artery biopsy), including
    1. recognizing that many generalized pain disorders are associated with normal investigations;
  3. construct an effective initial management plan appropriate for the working diagnosis, including
    1. when appropriate, take a multidisciplinary approach (e.g., physiotherapy, psychosocial support);
    2. determine if the patient requires specialized care.
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