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Regional pain syndrome: clinical characteristics, mechanisms and management

Nature Clinical Practice Rheumatology volume 3, pages 504–511 (2007)Cite this article

Abstract

Regional soft-tissue complaints are commonplace, and they usually relate to a disease process, such as strain, inflammation or degeneration of a muscle, tendon or related muscle–tendon unit. The clinical features and investigations of the causative processes of these complaints are characteristic, and outcomes to treatments are usually predictable and satisfactory. Regional pain syndromes are different: these syndromes present with regional pain and tenderness, and other sensory symptoms unaccounted for by a simple musculoskeletal mechanistic explanation. Approved classification criteria for regional pain syndromes are lacking, and these syndromes are poorly understood and frequently misdiagnosed. Regional pain syndromes often occur after injury and overlap extensively with other musculoskeletal pain syndromes, in terms of clinical signs and symptoms. The clinician and patient are often confused about the nature of the problem and routine treatments directed to putative tissue damage will fail. Review of the epidemiology of regional pain syndromes combined with knowledge of other similar pain syndromes has enabled an evolving understanding of the condition. The musculoskeletal and central nervous systems both contribute to regional pain syndromes, through spine-related pain mechanisms and central sensitization, respectively. The patient's emotional state, particularly the effect on pain modulation, links these two systems.

Key Points

  • Regional pain syndrome is characterized by regional pain and tenderness, which has a non-neuroanatomic distribution, with the symptomatic area involving the spine

  • Regional pain syndrome shares clinical features with both fibromyalgia syndrome and complex regional pain syndrome

  • Epidemiologic studies implicate a more significant role for psychosocial factors than ergonomic factors in these syndromes

  • Central sensitization and spine-associated pain mechanisms are probably major contributors to the syndrome

  • Regional pain syndrome is managed using similar approaches to those used for fibromyalgia syndrome, which address sensitization through education, neuroactive drugs, exercise and psychological techniques

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Figure 1: Common regions involved in regional pain syndromes include upper and lower quadrants, low neck and back and the interscapular region

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Authors and Affiliations

  1. G Littlejohn is the Director of Rheumatology at the Monash Medical Center and Associate Professor of Medicine at Monash University in Melbourne, Victoria, Australia.,

    Geoffrey Littlejohn

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  1. Geoffrey Littlejohn
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Correspondence to Geoffrey Littlejohn.

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The author declares no competing financial interests.

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Littlejohn, G. Regional pain syndrome: clinical characteristics, mechanisms and management. Nat Rev Rheumatol 3, 504–511 (2007). https://doi.org/10.1038/ncprheum0598

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