Neurologic Pain Syndromes

Access our high-yield videos for free at BoardsMD.com.

1
Neurologic Pain Syndromes

2
Complex regional pain syndrome (reflex sympathetic dystrophy, causalgia)
Fibromyalgia
Phantom limb syndrome
Thalamic pain syndrome
Trigeminal neuralgia
Herpes zoster (+ophthalmicus)

Wikicommons – Cu

3
 Complex Regional Pain Syndrome
Presentation: “Reflex Sympathetic Dystrophy” OR “Causalgia” (nerve)
• Pain, swelling, ↓ROM starting in a distal extremity
• Sympathetic Dysfunction => changes in nail/hair growth, skin
temperature

Pathophysiology: Trauma => Abnormal nerve regeneration

• Release of inflammatory mediators (e.g. IL-1, Substance P)

Wikicommons - Curtishand

4
 Complex Regional Pain Syndrome
Dx: Clinical
• +/- Bone scan

Mgmt: Physical therapy

• NSAIDs
• Gabapentin, Amitriptyline
• Calcitonin
• Corticosteroids
• Topical Lidocaine/Capsaicin

Wikicommons - Curtishand

5
 DDx
• Compartment syndrome
• DVT
• Cellulitis/Osteomyelitis
• Vascular claudication

Wikicommons - Curtishand

6
 Fibromyalgia
Presentation: Woman age 30-50 w/ muscle pain, but NO inflammation
• “Fibro fog”

Pathophysiology: Abnormal pain processing

• Depression/Anxiety
• Irritable Bowel Syndrome
• Interstitial Cystitis

https://blausen.com/

7
 Fibromyalgia
Dx: Tender points
• Normal Labs (e.g. ESR, CRP, CBC, CK)

Mgmt: TCAs, SSRIs, SNRIs, Gabapentin

• Physical Therapy/Structured exercise program

Wikicommons – Sav vas

8
 Trigeminal Neuralgia
Presentation: Sudden-onset, severe facial pain in V2 or V3 distribution
• Duration: < 1 minute
• Trigger Zone (If bilateral => Multiple Sclerosis)

Pathophysiology: Irritation of CN V root

Dx: Clinical

Mgmt: Carbamazepine
• 2 nd-line: Valproate, Gabapentin
• Surgery

https://blausen.com/

9
 Phantom Limb Syndrome
Presentation: Burning or shock-like pain in amputated extremity

Pathophysiology: Abnormal nerve reorganization

Dx: Clinical

Mgmt: Gabapentin, Amitriptyline

• Mirror therapy

https://blausen.com/

10
 Post-Stroke Pain Syndrome
Presentation: Paresthesias following a lacunar stroke
• Over weeks to months => Allodynia, Dysesthesia
• Pain may worsen in response to noises or stress

Pathophysiology: Contralateral thalamic lesion

Dx: Exam => Pain out of proportion

Mgmt: Opiates, Amitriptyline, Gabapentin

Wikicommons - NASA

11
 Varicella Zoster
Presentation:

Wikicommons - Curtishand

12
 Varicella
Presentation: Pregnant mother has fever, malaise, lymphadenopathy
• Newborn is normal, or has:
• Dermatomal lesions/scarring
• Microcephaly
• Cataracts
• Limb hypoplasia

Etiology: Transplacental transmission (risk ↑ 1 st trimester)

Wikicommons – Blausen.com

13
 Varicella
Dx: IgM and IgG antibodies
• U/S => Symmetric IUGR

Mgmt: If mother exposed or has active disease

 Varicella zoster immune globulin (VZIG)
 Do NOT give her the live vaccine

For infant => Acyclovir

Wikicommons – Blausen.com

14