Generalized pain disorders

Rationale

Nonarticular generalized pain is common and often chronic, and it can be difficult to manage.

Causal Conditions

(list not exhaustive)

1. Fibromyalgia/chronic fatigue syndrome
2. Myofascial pain syndrome
3. Hypermobility syndrome
4. Complex regional pain syndromes
5. Somatoform disorders

Key Objectives

Given a patient with a generalized pain disorder, the candidate will differentiate articular from nonarticular pain; diagnose the cause, severity, and complications; and 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 those based on
   1. a history and physical examination that
      1. exclude systemic disease (physical examination with normal findings is key), and
      2. suggest other pain syndromes that may be associated with serious complications, including
         1. major depressive disorder
         2. bone metastases
         3. multiple myeloma;
2. list and interpret appropriate investigations (e.g., complete blood count, basic serum biochemistry, thyroid function tests, C-reactive protein, urinalysis), including
   1. recognizing that chronic nonorganic pain syndromes are associated with investigations that have normal findings; and
3. construct an effective initial management plan appropriate for the working diagnosis, including
   1. taking a multidisciplinary approach (e.g., physiotherapy, psychosocial support) when appropriate, and
   2. determining if the patient is open to relaxation techniques (e.g., meditation, cognitive behaviour therapy, exercise programs, dietary counselling).
   3. demonstrate appropriate prescribing of analgesics, antidepressants and other agents to safely manage pain