Pain Conditions

What is Cirrhosis-related Pain?

• Cirrhosis is scarring of the liver.
• Between 40-79% of people with cirrhosis have pain.
• Pain and fatigue from cirrhosis can make it hard to perform daily life activities.

Symptoms of Cirrhosis-related Pain

• Muscle cramps
• Bloating
• Pressure in the belly

What causes Cirrhosis-related Pain?

• Scar tissue causes pain.
• Pressure from ascites (fluid in the belly).
• Tissue and nerve damage.
• Muscle weakness.

Diagnosis of Cirrhosis-Related Pain

• Cirrhosis is diagnosed using imaging (MRI, CT).
• A biopsy (taking a sample of the liver tissue) can give more information about cirrhosis.
• Exam- talk to your liver doctor about pain you have.

Who Treats Cirrhosis-related Pain?

• Hepatologists (liver doctor)- doctors who are also gastroenterologists and have extra training on caring for the liver.
• Palliative care: doctors who specialize in managing pain and symptoms related to pain.
• Psychologists - healthcare providers that use mind and behavior skills to improve quality of life.
• Physical therapists- use exercise and stretching to improve strength and reduce pain
• Occupational therapists- teach ways to save energy and improve quality of life

Treatment of Cirrhosis-related Pain

Self-care

• Ask your doctor about over the counter medicines and supplements before use.
• Pickle juice – a sip of kosher or dill pickle juice (a splash at the back of the throat) can stop a muscle cramp.
  • No more than a sip should be used.
• Relaxation
• Meditation
• It is important to get enough sleep.
• Exercise – strengthening exercises, tai chi can be helpful.
• Healthy eating- eating a diet low in salt can reduce bloating.
• Energy conservation during activities – prevents people from getting so tired that it hurts.
• Practicing gratitude – changes how we experience pain.
• Social support – feeling loved and supported changes how pain is experienced.

Professional Care

• Psychologists use a process called cognitive restructuring that is helpful.
• This helps to change how pain is experienced to make it less overwhelming.
  • Acupuncture – using needles to change how pain is experienced.
• Medications can be used:
  • Acetaminophen (Tylenol):
• Tylenol is the safest pain medication as long as no more than 2000mg (2 grams) is taken in 24 hours.
• Overdose can cause liver failure.
• An extra-strength pill has between 500-650 mg of acetaminophen.
• The bottle tells how many mg each pill has, so it’s important to look at the bottle you’re using.
  • Lidocaine patches can be helpful for some pain with small / specific areas.
    • Capsaicin cream is helpful for people with nerve pain.
      • This is something that can be bought without a prescription at your local pharmacy.
      • Opioid medicines increase the risk of hepatic encephalopathy (especially if constipation develops) and should be used cautiously- talk to your doctor.
      • Non-steroidal anti-inflammatories (NSAIDs) should be used cautiously or not at all (especially if you have fluid in the belly).
        • Ask your doctor about what medicines are best for you and if topical non-steroidal anti-inflammatories (which are safer) are best.

Resources

Cirrhosis: A Patient's Guide

A Guide to Liver Cirrhosis for Patients and Care Providers

Cirrhosis in adults: Etiologies, clinical manifestations, and diagnosis - UpToDate

Videos | PainGuide

What is Cancer-Related Pain?

• About half of people with cancer have pain.
• Pain can be:
  • From the cancer itself- felt where the cancer is located.
  • From treatment – side effects from surgery or radiation.
  • Felt right before, during, or after treatment (acute), over a long period of time (chronic), or both.
  • Pain can get in the way of daily activities, relationships, and work.

Symptoms

• Pain from a tumor: Tumors can cause pain. You can also have pain where the cancer used to be even after it has been taken out. This is called “phantom pain.”
• Musculoskeletal pain: Pain in the bones, muscles, and joints can be from the cancer itself or from the medicine used to treat the cancer.
• Nerve pain: Nerves can be damaged by cancer or cancer treatments. Sometimes nerve damage is permanent.
• Mouth and skin pain: Chemotherapy and radiation therapy can cause painful mouth sores and skin rashes.
• Other symptoms: Many people with cancer-related pain also have fatigue, sleep difficulties, anxiety, or depression.

What Causes Cancer-Related Pain?

• There are different causes of pain from cancer:
  • Directly: Cancer can put pressure on nerves, bones or soft tissue.
  • Indirectly: Swelling, fractures (broken bones), blockages in organs, cancer treatments (chemotherapy, radiation, surgery).

Diagnosis of Cancer-Related Pain

• Imaging: X-rays, CT scans, bone scans, and PET scans are used to look for blockages or broken bones.
• Symptoms: Doctors can diagnose some conditions, like peripheral neuropathy and lymphedema without extra imaging.

Who treats Cancer-Related Pain?

Cancer-related pain is usually treated by primary care doctors (family practice, internists) and cancer doctors (oncologists, surgeons). Working with a healthcare team is the best way to approach cancer-related pain. The team can include:

• Oncologists – doctor specializing in cancer treatment.
• Surgical oncologists- doctors who do surgery for cancer.
• Palliative care providers- healthcare providers who specialize in managing pain and symptoms related to pain.
• Physical and occupational therapists- healthcare team members who help maintain mobility and independence with self-care. Some specialize in lymphedema.
• Integrative health practitioners- healthcare team members who teach behavioral approaches to promote healing.

Treatment of Cancer-Related Pain

There are many ways to treat and manage cancer pain. We describe them below. You can follow the link to learn more details about each treatment and management strategy.

Self-care

• Use support system – talk to your friends, family, and other cancer survivors about your experiences.
  • Healthy eating- Eating nutritious meals helps to fuel our bodies.
  • Get plenty of rest- This includes taking breaks when we need it and getting enough sleep.
  • Energy conservation- It is important to pace ourselves to avoid flares.
  • Relaxation – relaxation and stretching can help prevent pain from muscle tightness.

Professional Care

• Over the counter medications: There are medications available without a prescription, but it is important to talk to your healthcare provider before using any new medicine or supplement.
  • Prescription medications: Healthcare providers can prescribe medicine to help manage symptoms.
  • Procedures: Nerve blocks are sometimes helpful to block pain signals.
  • Integrative treatment: Massage, relaxation exercises, or psychotherapy can reduce how pain impacts your daily life.

Additional Resources

• American Society of Clinical Oncology/Cancer.Net
• American Cancer Society
• National Cancer Institute
• Livestrong
• National Lymphedema Network

What is CRPS?

• Also called Reflex Sympathetic Dystrophy (RSD).

• CRPS is a rare disease caused by the body responding too intensely to injury.

• Symptoms include intense pain.

  • There may be swelling or changes in skin color at site of injury.
  • Other symptoms include neurological and muscle dysfunction.
  • Issues with skin, nails, hair, bone, and immune system may occur.

• Usually happens after an injury or traumatic event, like a sprain, fracture, or surgery.

• CRPS is more common in women but can happen to anyone.

• It can be disabling, but treatment options are available.

Symptoms of CRPS

Symptoms can come and go but include the following symptoms:

• Pain that is deep, aching, cold, burning.
• Sensitive to touch.
• Pain starts in an arm or leg.
• Pain continues after what should be a normal healing time.
• Pain (moderate-to-severe) associated with something that should not cause pain, like the touch of clothing or a shower.
• Swelling.
• Changes in skin color.
• Skin temperature that is warmer or colder than other areas of the body.
• Limited movement or weakness.

Diagnosis

• The healthcare provider can make a diagnosis if following the new standard diagnostic criteria.

• During the exam, the healthcare provider will assess:

  • Skin color, temperature, and texture.
  • Mobility of affected arm or leg.
  • Swelling.

• Some patients spend months or years to get a diagnosis.

• Early diagnosis helps promote best outcomes.

• See references for website link to list of doctors experienced with CRPS.

Who Treats CRPS?

Pain from CRPS is usually treated by specialists. Working with a healthcare team is the best way to approach to treating pain from CRPS. The team can include:

• Physiatrist – doctor that specializes in rehabilitation.
• Pain specialist – doctor that specializes in ways to treat pain.
• Psychologist- healthcare providers that use mind and behavior skills to improve quality of life.
• Physical and/or occupational therapists- provide exercises and activities to improve function.

Treatment

Treatment usually includes:

• Medications.
• Physical therapy, occupational therapy, and behavioral therapy.
• Social support.
• Sometimes nerve blocks or other procedures are needed.
• Treatments like biofeedback or mirror box therapy may help
• Medications
• Treatment Goal: Reduce pain and improve function

Resources The Reflex Sympathetic Dystrophy Syndrome Association of America

What is Geriatric Pain?

• Pain is common as people age.

• People with chronic pain may limit their activity, which can lead to weakness.

  • Weakness can increase risk of falls.
  • Fear of falling can lead to less activity and cause more weakness, which increases the risk of falls.

• Older adults have a higher risk of side effects from over the counter and prescription medications.

  • Talk to your healthcare provider about medications and supplements.

Symptoms

• Muscle and joint pain — especially in the back, knees, and hips.

  • Osteoarthritis is the most common pain condition in older adults. It causes stiffness and pain.

• Nerve pain: Nerves can be damaged from certain health conditions such as diabetes, shingles, or stroke.

  • This damage can cause a feeling of tingling, prickling, or burning.

• Sleep problems, anxiety, and depression.

What Causes Geriatric Pain?

• Musculoskeletal conditions- pain from arthritis, fractures, less muscle, or wear and tear on joints.
• Nerve Damage – can be caused from diabetes, vitamin B12 deficiency, or shingles.
• Chronic disease- diseases like congestive heart failure, kidney disease, chronic obstructive pulmonary disease can cause pain in late stages.

Diagnosis of Geriatric Pain

• Geriatric pain is diagnosed by:

  • Getting information about your symptoms and health history.
  • Doing a physical exam.
  • Imaging.
  • Lab tests.

• A team approach is important to establish goals of care.

Who treats Geriatric Pain?

• Primary care providers (family practice doctor, internist).
• Geriatricians – physicians who specialize in the care of older adults.
• Physical and occupational therapists – provide exercises and activities to improve function.
• Social workers –provide community resources and support.
• Palliative care providers – healthcare providers who specialize in managing pain and symptoms related to pain.
• Integrative health practitioners - specialists who use mindfulness and other positive behavioral approaches to improve pain symptoms, promote healing, and improve functional status and overall well-being.

Treatment of Geriatric Pain

Self-care

• Staying active can improve symptoms.
• Muscle strengthening can reduce stress on joints.
• Eating a healthy diet fuels our bodies.
• Get enough sleep and take breaks before causing a painful flare.
• Avoid being in the same position for too long.

Professional Care

• Physical/occupational therapists can give exercises and activities to improve function and reduce pain.
• Discuss over the counter and prescription medications that may help improve symptoms with your healthcare provider.

Additional Resources

American Chronic Pain Association

Arthritis Foundation

U.S. National Library of Medicine

National Institute on Aging Go4Life program (Exercise for older adults)

What is Multiple Sclerosis (MS)?

• MS is an autoimmune condition (the body attacks itself).

  • Occurs in the brain, spinal cord, and optic nerves.
  • Causes damage to nerve cells and the insulation around nerve cells.
  • The damage interrupts normal messaging between the brain, spinal cord, and optic nerves.

• About 1 million people in the U.S. have MS.

There are different subtypes of MS:

• Clinically Isolated Syndrome (CIS)

  • CIS does not technically meet criteria for an MS diagnosis but is the first episode when someone experiences symptoms of MS.

• Relapsing Remitting MS (RRMS).

  • This is the most common type of MS.
  • Periods of worsened symptoms (“exacerbations”) are followed by periods of complete or partial recovery (“remission”).

• Secondary Progressive MS (SPMS).

  • SPMS first happens after a RRMS course.
  • Eventually symptoms become progressively worse over time.

• Primary Progressive MS (PPMS)

  • Skips the initial phase of RRMS.
  • Symptoms progress over time.

How is MS diagnosed?

• Images from the brain and spinal cord are used to diagnose MS.

  • The diagnosis is usually made by a neurologist (someone who specializes in the brain and spinal cord).

• The images show spots on the brain and spinal cord that are caused by damage to the myelin and/or nerve cells.

How many people have MS?

• About 1 million adults in the United States have MS.
• More people have it now, but it is not understood if this is driven by a growing population or more cases of MS.

Common MS Symptoms

Not everyone experiences MS in the same way, but there are some common symptoms:

• Numbness and tingling in the face, body, and extremities is often one of the first symptoms of MS.

• Motor symptoms, like problems walking and using fingers

• Fatigue is one of the most common symptoms of MS.

  • About 80% of people with MS have fatigue.

• Muscle spasticity and muscle weakness- can be anywhere in the body but is usually worse in the legs.

  • Spasticity (feelings of stiffness of spasms) can cause pain and fatigue.
  • Muscle weakness is also often experienced along with physical fatigue.

• Many people with MS have Pain

  • 55% of people with MS have pain.
  • Facial pain (trigeminal neuralgia), electric type pain down the spine pain (Lhermitte’s sign), and painful pressure around the torso (“MS hug”)

• Depression

  • About 50% of people with MS have depression.

• Cognitive problems- Common symptoms are memory loss, attention, and word finding problems.

  • Problems with organization, multi-tasking, and decision-making may get worse over time.
  • Some people need to stop working or driving because of cognitive issues.

• Visual problems may occur from damage to the optic nerve.

  • Vision changes can be mild (blurred vision) or severe (blindness).
  • Eye pain can happen with the vision changes.

• Bladder and bowel problems

  • About 80% of people with MS have bladder problems.
  • Constipation is common in MS.

Who Treats MS?

• There is no cure for MS, but treatments focus on slowing the progression of the disease and managing symptoms.
• The treatment team usually includes a neurologist, but can also include other healthcare professionals:
  • Primary care- family doctor or internist who works with your neurologist.
  • PT/OT/Speech therapy- rehabilitation can maximize independence with mobility, self-care, and swallowing.
  • Vocational Therapist – specialists who help with employment modifications or alternative employment.
  • Behavioral Health – Intervention to address emotional symptoms and interpersonal dynamics related to MS symptoms.

Treatment of Multiple Sclerosis

Self-care

• Exercise and movement can help reduce muscle tightness.
• Healthy eating can improve outcomes.
• Energy conservation can help save energy for the most important tasks.

Professional Care

• Medication is used to manage symptoms, like feeling anxious or depressed.
  • Fatigue, pain, and sleep disorders can also be managed with medications.
  • Rehabilitation can help improve function and manage symptoms.
    • Physical therapists work with mobility, balance, pain, and muscle tightness.
    • Occupational therapists can help with hand and finger function and self-care activities like bathing, dressing, and toileting, and fall prevention.
    • Speech therapists can help when someone has trouble swallowing, speaking, or with cognition.
    • Physical medicine doctors can guide treatment to improve functioning.
    • Vocational therapists help people with MS maintain employment or find new employment.
    • Behavioral therapists can work with emotional struggles, relationship issues, and to find ways to cope with pain and fatigue.

Additional Resources

National Multiple Sclerosis Society

MS Society of Canada

My MS Toolkit

What is Osteoarthritis (OA)?

• OA is also known as degenerative joint disease.

• It is the most common type of arthritis.

• About 10% of men and 13% of women in the U.S. have OA.

  • OA is more common in older adults.
  • Being overweight puts more stress on joints and increases risk of OA.

• Joint cartilage becomes damaged over time.

  • Cartilage protects bone from rubbing on bone.
  • Missing cartilage causes stiffness and pain.

Symptoms

• People may feel achiness in their joints after exercise.
• The achiness can progress to joint stiffness and more severe pain.
• OA is most common in certain parts of the body:
  • Hands
  • Neck
  • Back/spine
  • Knees/hips

What Causes OA?

• Not everyone gets OA as they age.
• Wear and tear over time causes damage to cartilage.
• OA can be made worse by:
  • Being overweight.
  • Repetitive joint stress.
  • Prior injury to area.

Diagnosis of OA

• Your provider will get information about your medical history and do a physical exam to make a diagnosis.
• X-rays and MRIs- images of the painful area will help with diagnosis.

Who treats OA?

• Treatment is usually led by one healthcare provider, and that may be a primary care doctor (family doctor, gerontologist, internist) or a orthopedic doctor.
• Other members of the healthcare team may be involved:
  • Orthopedic doctor- healthcare provider who specializes in treating bones.
  • Nurse educators- nurses that teach patients on medical conditions and treatment options.
  • Physical/occupational therapists- provide exercises to reduce pain and protect joints.
  • Dieticians- provide education on healthy diets and weight management.
  • Massage therapists- help reduce muscle tightness through massage.

Treatment of OA

Self-care

• Maintain a healthy weight to reduce stress on the joints.
• Exercise- having strong muscles reduces stress on the joints.
• Stop smoking if you currently smoke- this helps reduce swelling.
• Get enough sleep.

Professional Care

• Medications to reduce swelling- always talk to your healthcare provider about over the counter medicines and supplements.
• Massage helps with muscle tightness.
• Injections can reduce the pain and swelling.
• Surgery – there are several surgical options to treat pain from OA.

Additional Resources

American College of Rheumatology National Institute of Arthritis and Musculoskeletal and Skin Diseases, (NIH) Arthritis Foundation Chronic Pain Research Alliance Chronic Pain and Fatigue Research Center (CPFRC)

What is Rheumatoid Arthritis (RA)?

• RA is a chronic inflammatory disease.
• About 1% of U.S. adults have RA.
• Men and women both get RA but it is more common in women.

Symptoms

• Common symptoms are joint pain, swelling, and stiffness.
• The most common locations for pain are the hands, feet, and wrists.
• Symptoms can get better and worse, changing over time, and even go away sometimes.
• Fatigue and muscle weakness are other common symptoms.

What Causes RA?

• Genetic and environmental factors cause the immune system activate.

  • The body is exposed to a substance, called an antigen, which triggers an immune response.
  • The immune response causes immune cells to enter the joint space, which causes breakdown in the cartilage and bone.

• Environmental factors, like cigarette smoke are risk factors.

Diagnosis of RA

• Your healthcare provider will use your symptoms and medical history to help with a diagnosis.
• A physical exam is needed to look for joint swelling and tenderness.
• Blood tests are used to test for certain blood markers.
• Imaging- X-rays can show swelling in the joints and help the healthcare provider make a diagnosis.

Who Treats RA?

• There are many healthcare professionals that treat RA:
  • Rheumatologist- a healthcare provider who specializes in arthritis and autoimmune conditions.
  • Orthopedic physician- specialize in bones and joints.
  • Podiatrist- specialize in feet and ankles.
  • Physical and occupational therapists- provide exercises to protect joints and improve function.
  • Psychologists- healthcare providers that use mind and behavior skills to improve quality of life.
  • Dietician- provides education on healthy diets and weight management.

Treatment of RA

Self-care

• Gentle exercise- ask your healthcare provider for home exercises that can reduce stiffness.
• Avoid repetitive movements with your joints.
• Use good positioning and body mechanics during activities.
• Get enough rest and sleep.
• Wear splints/braces as recommended by your healthcare team.
• Social support – joint a group for people with RA to get helpful support and suggestions.
• Using energy conservation strategies can help prevent too much fatigue.

Professional Care

• Medications to treat symptoms- talk to your healthcare provider about prescription and over the counter medicines and supplements.
• Medications to reduce severity of RA- there are medications that treat flares.
• Physical/occupational therapy- provide exercises and activities to improve function- may recommend use of splints.

Additional Resources

American College of Rheumatology National Institute of Arthritis and Musculoskeletal and Skin Diseases, (NIH) Arthritis Foundation Chronic Pain Research Alliance Chronic Pain and Fatigue Research Center (CPFRC)

What is Sickle Cell Disease?

• Sickle Cell Disease (SCD) is a genetic blood disorder.
• Pain is the most common symptom of sick cell disease.
• SCD is caused by moon-shaped red blood cells that clot blood vessels.
• Dehydration and cold weather can trigger a crisis.

Symptoms of SCD Pain

• Pain is the most common symptom of SCD.
  • Pain can be felt in the arms, legs, shoulders, back or chest.
  • It may feel sharp, stabbing, or throbbing.
  • Pain can be daily, lasting for months.
  • Fatigue, anxiety, and depression can be experienced with pain.

What Causes Pain in SCD?

• Pain is caused from damage to the body tissues over time.
• Reduced blood supply to bones and joints leads to pain.

Diagnosis of SCD

• SCD is diagnosed using a blood test.

Who treats Sickle Cell Disease-Related Pain?

• Hematologist- doctors who specialize in blood disorders treat SCD-related pain.
• Palliative care- healthcare providers who specialize in managing pain and symptoms related to pain can also help treat the symptoms.
• Psychologists- healthcare providers that use mind and behavior skills to improve quality of life can help with coping skills.

Treatment of SCD-Related Pain

Self-care

• It is important that someone seeks medical care as needed if they have SCD.

Professional Care

• A personalized treatment approach works best.
• Blood transfusions are one form of treatment.
• Medication can help manage the disease.
  • Talk to your healthcare provider about over the counter medicines and supplements.

What is Fibromyalgia?

• Fibromyalgia is a chronic condition that can cause problems with sleep, memory, mood, and fatigue.
• 10-20 million people in the U.S. have Fibromyalgia.
• Men and women can both get fibromyalgia but it affects women more than men.
• Fibromyalgia tends to run in families.
• There is no known cure, but there are options for managing symptoms.

Symptoms

• Pain and tenderness are the most common symptoms.

  • The location and severity of the pain can change.
  • Stiffness when waking up, sitting or standing in one place, or in response to weather changes are also common.

• Fatigue is common.

  • Fibromyalgia can cause mental or physical fatigue.

• Many people with fibromyalgia have sleep problems.

  • Some people with fibromyalgia struggle to fall asleep or stay asleep.
  • Some people can sleep but still feel exhausted when they wake up.

• Cognitive problems – “fibro fog” is used to describe mental cloudiness from fibromyalgia.

  • Poor concentration is common.
  • Some people have trouble finding words.
  • Depression and anxiety can happen with fibromyalgia.

• Overactive senses

  • Sounds, smells, light, touch, and tastes can feel very intense.

• Dry eyes or mouth are common.

• Overlapping pain conditions:

  • People with Fibromyalgia are more likely to have other chronic pain conditions.

What Causes FM?

• There is no known trigger in about half of all cases.
• About half of people with FM had an injury that triggered symptoms.

Diagnosis of FM

• There is no specific test currently available to diagnose fibromyalgia.
• It is diagnosed after ruling out other possible diagnoses.
• The diagnosis is based on medical exam that includes:
  • Where the pain is located.
  • How long pain lasts.
  • Other symptoms like fatigue, sleep issues, or memory issues are considered.

Who treats FM?

• Rheumatologists are doctors who specialize in arthritis and autoimmune conditions.
• Physical and occupational therapists- provide exercises to protect joints, save energy, and improve function.
• Psychologists- healthcare providers that use mind and behavior skills to improve quality of life.
• Dieticians- provide education on foods as fuel to meet the body’s needs.
• Acupuncturists- use needles to promote healing.

Treatment of FM

Self-care

• Regular exercise helps with blood flow and muscle tightness.
• Use good positioning and body mechanics during activities to prevent strains.
• Get adequate rest.
• Eating a healthy diet is good to prevent extra inflammation and weight on the joints.
• Practicing energy conservation can save energy for important things.

Professional Care

• Medications are available to treat symptoms- talk to your healthcare provider about prescription and over the counter medications and supplements.

Chronic Overlapping Pain Conditions (COPCs)

People who have FM may also have one or more of these other COPCs:

• Irritable Bowel Syndrome
• low back pain
• urinary chronic pelvic pain syndrome
• Temporomandibular Joint Disorder
• Migraine and tension headache
• Endometriosis
• Vulvodynia (VVD)
• Chronic fatigue syndrome (also called myalgic encephalopathy)

Additional Resources

American College of Rheumatology National Institute of Arthritis and Musculoskeletal and Skin Diseases, (NIH) National Fibromyalgia Association (NFA) National Fibromyalgia Partnership, Inc. Chronic Pain Research Alliance Chronic Pain and Fatigue Research Center (CPFRC) Dr. Daniel Clauw provides a mechanistic review of FM and its treatment. Overview of non-pharmacological interventions for FM Using the Internet to deliver pain interventions.

What is Low Back Pain?

• Almost 80% of adults have low back pain during their life.
• Low back pain can be caused from an injury or over time due to age.
• Low back pain that continues past three months is called chronic low back pain.

Symptoms

• Pain in lower back or buttocks is the primary symptom.

  • The pain may be aching, shooting, or stabbing.

• Other signs and symptoms may include:

  • Difficulty standing up straight.
  • Tingling, numbness, and weakness.

• People with low back pain are more likely to have one or more of these conditions:

  • Fibromyalgia
  • Irritable Bowel Syndrome
  • Temporomandibular Joint Disorder (TMD)
  • Migraine Headache
  • Tension Type Headache
  • Urologic Chronic Pelvic Pain Syndrome (e.g., Interstitial Cystitis)
  • Endometriosis
  • Vulvodynia
  • Chronic Fatigue Syndrome

What Causes CLBP?

• Most CLBP is caused by mechanical problems.

  • Trauma from car accidents or sports can cause damage that leads to pain.
  • Sprains and strains – overstretching or tearing of ligaments or tendons.
  • Disc degeneration- cushion between vertebral bones wears down and results in pain.
  • Herniated or ruptured discs- injury or age can cause fluid to leak out of the discs that provide cushion between the vertebral bones.
  • Radiculopathy- pain, numbness, or tingling is caused by narrowing of the bone around the spinal cord or from herniated discs.
  • Spondylolisthesis- pinched nerves from vertebral bones being unstable can cause pain.
  • Spinal stenosis- narrowing of the spinal column that puts pressure on the spinal cord and nerves. This can cause pain or numbness.
  • Scoliosis- people who have a curve in the wrong place of the spine can have pain in middle age.

• Other conditions that cause CLBP

  • Infections
  • Tumors
  • Osteoarthritis, rheumatoid arthritis
  • Osteoporosis- can cause fractures of vertebra

Risk Factors for CLBP

• Risk of CLBP increases with age.
• Exercise and fitness help protect against CLBP.
• Obesity is a risk factor for CLBP.

Diagnosis of CLBP

• Medical history - to diagnose low back pain, your healthcare provider will ask you about:

  • Where you feel the pain.
  • How severe the pain is and what it feels like (ache, burn, shooting).

• Physical Exam- a physical exam will help your healthcare provider determine how to treat the pain using:

  • Range of motion – where and how movement is limited helps with diagnosis and treatment.
  • Location and type of pain.

Who treats CLBP?

• Several types of healthcare providers treat chronic low back pain:
  • Pain medicine specialists- doctors who have extra training how to treat spinal pain using medicines, exercise, or procedures.
  • Spine surgeons- doctors who do surgery on the spine.
  • Physical/occupational therapists- provide exercises to reduce pain and protect joints
  • Psychologists- healthcare providers that use mind and behavior skills to improve quality of life
  • Dietician – teach about diet and ways to maintain a healthy weight
  • Acupuncturist - use needles to change how pain is experienced

Treatment of CLBP

Self-care

• Applying heat or cold to painful area can help with muscle spasms and swelling.
• Stretches can be used to prevent muscle tightness.
• Strengthening- ask your healthcare provider for exercises that stabilize the spine.
• Weight loss – losing excess weight reduces burden on spine.
• Practice good body mechanics- do not sit or stand for more than 15-20 minutes at a time.
• Wear comfortable, supportive shoes.
• Quit smoking- smoking causes inflammation and reduces blood supply, which can make pain worse.

Professional Care

Non-surgical treatments are available to help manage pain related to low back pain.

• Physical therapy- strengthens muscles that support the back.
• Biofeedback- electrodes are attached to the skin and helps increase awareness of breathing, muscle tension, and heart rate.
• Injections – medicine can be injected into or around the painful area to reduce pain.
• TENS unit- uses electrodes to help block pain signals.
• Acupuncture - use needles to change how pain is experienced.
• Medications- talk to your provider about prescription and over the counter medicines and supplements.

Surgery

• Surgery is only used when other treatments do not work.
• It can be helpful, but does not always make pain go away.

Chronic Overlapping Pain Conditions (COPCs)

People who have chronic low back pain may also have one or more of other COPCs listed below:

• Fibromyalgia
• Irritable Bowel Syndrome
• Urinary chronic pelvic pain syndrome
• Temporomandibular Joint Disorder
• Migraine and tension headache
• Endometriosis
• Vulvodynia (VVD)
• Chronic fatigue syndrome (also called myalgic encephalopathy)

Additional Resources

American Society of Anesthesiology (ASA)

American Society of Regional Anesthesia and Pain Medicine (ASRA)

National Institute of Arthritis, Musculoskeletal, and Skin Diseases (NIAMS – NIH)

National Institute of Neurologic Disorders and Stroke (NINDS – NIH)

National Institute of Complimentary and Integrative Health (NCCIH – NIH)

Chronic Pain Research Alliance

Chronic Pain and Fatigue Research Center (CPFRC)

What is Irritable Bowel Syndrome (IBS)?

• IBS is problem with how the bowels work.

  • IBS causes chronic abdominal pain and changes in stool form or consistency.

• Between 10-15% of people in the U.S. have IBS.

• IBS is underdiagnosed- although between 10-15% of people in the U.S. have IBS, only about 7% have been diagnosed.

• Most people have symptoms that come and go.

• It is not "in your head."

Symptoms

The most common symptoms of IBS is abdominal pain and discomfort. The pain can get better or worse after pooping.

• Other symptoms include:

  • bloating- feeling of belly fullness.
  • gas.
  • pain.
  • diarrhea or constipation.
  • urgency- needing to get to the restroom fast.
  • fatigue- IBS can make people feel tired.
  • sleep problems- difficulty falling asleep or staying asleep.
  • anxiety or depression.

• Chronic Overlapping Pain Conditions (COPC)- people with IBS are more likely to have one ore more of the following conditions:

  • Fibromyalgia
  • Low back pain
  • Temporomandibular disorder
  • Urinary chronic pelvic pain syndrome
  • Migraine and tension headaches
  • Endometriosis
  • Vulvodynia
  • Myalgic Encephalopathy/ Chronic Fatigue Syndrome

What Causes IBS?

• The cause of IBS is not fully understood.
• It seems to be a problem with how the bowels work.
• There are some risk factors for IBS, like:
  • Family history
  • Prior gastrointestinal (GI) infection
  • Stressful life events

Diagnosis of IBS

• To diagnoses IBS, your healthcare provider may ask about:
  • Belly discomfort and bloating.
  • Bleeding.
  • Shape, color, or consistency of poop.
  • How often you poop.

Who treats IBS?

• Gastroenterologists- doctors who specialize in GI conditions.
• Dieticians- provide education on diets that help manage IBS symptoms.
• Integrative health practitioners- use mindfulness to improve IBS symptoms.

Treatment of IBS

Self-care

• Keep a food diary to see what foods trigger symptoms.
• Reduce stress as much as possible.
• Avoid sugar substitutes.
• Drink plenty of water and get enough fiber.

Professional Care

• Talk to your healthcare provider about over the counter medicines or supplements.
• Your healthcare provider can prescribe medicines to help with symptoms.

Chronic Overlapping Pain Conditions (COPCs)

People who have IBS may also have one or more of other COPCs listed below:

• Fibromyalgia
• Low back pain
• Urinary chronic pelvic pain syndrome
• Temporomandibular Joint Disorder
• Migraine and tension headache
• Endometriosis
• Vulvodynia (VVD)
• Chronic fatigue syndrome (also called myalgic encephalopathy)

Additional Resources

American Gastroenterological Association American College of Gastroenterology National Institute of Diabetes and Digestive and Kidney Diseases International Foundation for Functional Gastrointestinal Disorders Rome Foundation American Neurogastroenterology and Motility Society

What are Migraines?

• A migraine is more than just a really bad headache.

• Migraines can have several symptoms, including:

  • pain on one side of the head.
  • nausea and vomiting.
  • dizziness.
  • vision changes.
  • tingling and numbness in arms, legs, or face.
  • sensitivity to sound, light, smell, and touch.

• It is a genetic neurologic disease.

• About 39 million people in the U.S. have migraines.

• Men and women both can have migraines but they are more common in women.

What causes Migraines?

• The cause of migraines is unclear.
• Scientists now believe that migraines are caused by a problem with nerve pathways and brain chemicals.
• Migraines can be triggered by many different things.
  • Foods- alcohol, caffeine, chocolates, artificial sweeteners, and MSG (found in processed and some Asian foods).
  • Lifestyle- eye strain, not getting enough sleep, dehydration, smoking, tight muscles.
  • Infection- viral or bacterial infections can trigger symptoms.
  • Environment- weather changes, allergens, bright or flickering lights, high altitudes, strong odors, and tobacco smoke can cause migraines.
  • Hormone changes- regular hormonal changes and those from birth control pills or hormone replacement therapy.

Types of Migraines:

Some people have an aura before getting a migraine.

• Aura are changes that happen before head pain starts.
• The symptoms can be a warning sign for a headache.
• They can last a few minutes or up to an hour.
• Symptoms of aura: seeing flashing lights, numbness, or dizziness.
• Migraine without aura:
  • no warning is given.
  • pulsing or throbbing pain, usually on one side of the head.
  • nausea and vomiting.
  • sensitivity to light and sound.
  • Physical activity makes the pain worse.
• Migraine with aura:
  • The aura warns of a an oncoming headache.
  • About 25% of people with migraines have aura.
• Migraine without head pain:
  • This is also called a Silent or Acephalgic Migraine.
  • People with this type of migraine feel weakness on one side of the body.
  • Other common symptoms: visual aura, loss of sensation on one side of the body, feeling of “pins and needles.”
  • The migraine may be felt without severe head pain.
• Retinal migraine:
  • People with this type of migraine temporarily lose vision in one eye.
  • It is most common in women during childbearing years.
  • Blindness from this type of migraine can last from a minute to months.
• Chronic migraine:
  • When a migraine lasts for more than 15 days a month.
  • Symptoms and their severity can vary a lot on any given day.

What are the Phases of Migraine?

Prodromal Phase:

• Occurs hours or 1–2 days before the onset of head pain
• Symptoms may include:
  • Fatigue
  • Nausea
  • Blurred vision
  • Difficulty concentrating
  • Neck stiffness
  • Sensitivity to light and/or sound
  • Excessive yawning
  • Paleness

Aura Phase (not always present):

• Symptoms last a few minutes to one hour.
• Symptoms vary and may include:

  • Visual:

    • Occurs in over 90% of patients with migraine with aura
    • Zig zag lines or lights
    • Spots of flickering light
    • Blurred vision

  • Body sensations:

    • Pins and needles
    • Numbness, often in the hands and face

  • Cognitive, speech, language:

    • Often, people feel like they are not thinking clearly
    • Less frequently, people describe difficulty with written and spoken words
      • This may be difficulty in understanding what others are saying, putting words together, and/or processing written words
      • Some people may have slurred or garbled speech

  • Vertigo (a feeling of being off balance and dizziness)

  • Tinnitus (ringing or buzzing in the ear)

Headache Phase:

• Typically, throbbing pain on one side of the head. However, people can have pain on both sides of the head and without throbbing.
• Other common symptoms include nausea, vomiting, and sensitivity to light and sound.
• Without treatment, the headache may continue for up to 72 hours.

Postdromal Phase:

• Postdromal symptoms may occur after the headache and last for up to 48 hours.
• Also called the “migraine hangover”.
• There is less understanding of the Postdromal Phase.
• Symptoms may include:
  • Fatigue
  • Elated mood
  • Depressed mood
  • Achiness
  • Mental fogginess
  • Acute pain after coughing and sudden movements

Diagnosis:

• Migraine is diagnosed by taking a careful assessment of the symptoms, reviewing family history, conducting medical tests, and eliminating other possible causes of the headache.
• Testing may include imaging from CT or MRI.
• Use of a headache diary can be a helpful tool for diagnosis and to better understand the frequency and severity of attacks, triggers, and responses to treatments.

Who treats Migraines?

• Migraines are often treated by primary care or family medicine physicians and neurologists.
• Mental health providers trained in pain and headache treatments are often included in treatment.
• There can be a focus on techniques for managing pain, increasing quality of life, improving lifestyle behaviors that trigger or worsen symptoms, and decreasing stress.

Treatment of Migraines:

Although there is no current cure for migraines, there are treatments that help with preventing and managing symptoms.

There is ongoing research on new migraine treatments (see American Migraine Foundation for more information).

• Short-term medications, such as triptans (e.g. sumatriptan, almotriptan) are used at the onset of migraine to try to stop a migraine once it has started or to decrease the symptoms.

  • They are not used to prevent migraine.
  • They are generally not useful for other types of pain, unless it is associated with migraine headache.

• Preventative medication focuses on reducing migraine frequency and severity. Several types of medications are approved to prevent migraines, and they work in different ways:

  • Anticonvulsants, also used to prevent seizures, such as valproic acid (e.g. Depakote) or topiramate (e.g. Topamax)
  • Botulinum toxin (Botox): periodic injections into the face and scalp.
  • Beta-blockers, which relax blood vessels, such as propranolol (e.g. Inderal) or metoprolol (e.g. Lopressor)
  • Calcium-channel blockers, which reduce the constriction of blood vessels, such as verapamil (e.g. Verelan) or diltiazem (e.g. Cardizem)

• Opioids are not recommended as a treatment for migraine.

  • There is not evidence that they are helpful.
  • Opioids have serious side effects.
  • There is a potential for dependence, and possible overdose death.

• It is important to use medications only as directed and not overuse medicine as this might lead to overuse (medication rebound) headaches and unwanted side effects.

• Non-medication preventative treatments include:

  • Trigger avoidance
  • Cognitive behavioral therapy
  • Biofeedback
  • Mindfulness-based therapy
  • Relaxation techniques
  • Behavioral therapy
  • Anti-inflammatory diet

• There are many new treatments currently being studied for migraines.

  • Cefaly is a new non-drug and non-invasive treatment for migraines.
  • Cefaly is a device that is temporarily placed on the forehead and sends micro-impulses to the trigeminal nerve to relieve pain and prevent future migraines.

Additional Resources

American Migraine Foundation

What Type of Headache Do I Have? The Science of Migraine – How to Deal With Postdrome What to Know About the New Anti CGRP Migraine Treatment Options Integrative and Complementary Migraine Treatments](https://americanmigrainefoundation.org/resource-library/integrative-complementary-migraine-treatments/) Headache Classification Committee of the International Headache Society (HIS). 2013. The international classification of headache disorders, (beta version). Cephalalgia. 33:629–808. DOI: 10.1177/0333102413485658 International Headache Society

What is TMD?

• Temporomandibular Joint Disorder is also called TMJ.
• 35 million people in the U.S. have TMD.
• It is more common in women.
• There are two temporomandibular joints on each side of the head.
  • Each joint connects the jawbone and the skull.
  • This joint moves back and forth, up and down, and side to side.
• People may have pain if there is an injury, but can also have pain with no obvious cause.

Symptoms of TMD

• Pain is felt at the jaw.
• Jaw clicking or popping is common.
• Jaw locking can happen.
• Ear pain/earaches.
• Headaches.
• Stiff or sore jaw muscles.
• Face or neck pain.
• A change in how your teeth fit together may be noticed by you or your dentist.

What Causes TMD?

• Injury to the jaw can cause TMD.
• Other causes include:
  • teeth grinding.
  • stress/anxiety.
  • arthritis.
  • excessive gum chewing.
• Sometimes the cause is not clear.

Diagnosis of TMD

• There is no test to diagnose TMD.
• Exam- the doctor will look for these things during a medical exam:
  • Swelling or irritation around jaw and muscles
  • Clicking sound
  • Jaw movement
  • Images- x-ray, MRI

Who Treats TMD?

• Primary care provider – family doctor, internist.
• Dentist
• Oral maxillofacial specialist – doctors and dentists who specialize in the teeth and jaw.
• Otolaryngologists- doctors who specialize in the ear, nose, and throat.
• Physical and occupational therapists- provide exercises to protect the jaw.
• Psychologists and social workers – healthcare providers that use mind and behavior skills to improve quality of life.
• Dieticians- teach about foods as fuel to meet the body’s needs.
• Acupuncturists- use needles to change how pain is experienced.

Treatment of TMD

Self-care

• Applying heat or cold to the jaw can reduce muscle pain.
• Avoid chewing gum because it can make the jaw tired.
• Avoid nail biting.
• Practice relaxation.
• Limit stress.
• Perform exercises or stretches for TMD.

Professional Care

• Talk to your healthcare provider about over the counter medicines or supplements.
• Prescribed medicines can help.
• Cognitive behavioral therapy.
• Massage.
• Acupuncture.
• Injections.
• Dental splints.
• Surgery.

Chronic Overlapping Pain Conditions (COPCs)

People who have TMD may also have one or more of other COPCs listed below:

• Fibromyalgia
• Low back pain
• Urinary chronic pelvic pain syndrome
• Irritable bowel syndrome (IBS)
• Migraine and tension headache
• Endometriosis
• Vulvodynia (VVD)
• Chronic fatigue syndrome (also called myalgic encephalopathy)

Additional Resources

The TMJ Association Canadian Dental Association American Dental Association National Institute of Dental and Craniofacial Research (NIDCR – NIH) Chronic Pain Research Alliance Chronic Pain and Fatigue Research Center (CPFRC)

What is Interstitial Cystitis / Bladder Pain Syndrome? (IC/CBPS)

• About 10 million people in the U.S. have interstitial IC/CBPS.
• It is more common in women.
• Many people are diagnosed years after symptoms begin.
• Most people with IC/CBPS do not have a clear cause of pain.
• Symptoms are similar to chronic prostatitis/chronic pelvic pain syndrome (CP/CPPS) in men.

Common Symptoms

• Bladder pain or pressure:

  • Pain can be sharp.
  • Can also feel like pressure or discomfort.

• Frequent urination:

  • Urinating helps relieve pressure but not for long.
  • Some people with IC urinate more than 20 times a day.

• Symptom Flares

  • Symptoms can get better and then get worse again (“flares”).
  • Spicey foods, sex, and riding a bike can cause a flare.
  • Sometimes there is no known cause for flares.

• Muscle pain is felt in the pelvis or vaginal area.

• Depression and anxiety are common for people with chronic pain.

What Causes IC/BPS?

• The cause is not yet understood.
• Genetics, infections, hormonal issues, trauma (physical or psychological), repetitive injuries, stress are associated with IC/BPS.

Diagnosis of IC/BPS

• First step is to rule out other causes of pain.
• There are no lab tests or imaging to diagnose IC/BPS.
• Exam- your doctor will make a diagnosis based on symptoms after other causes have been ruled out.

Who Treats IC/BPS?

• Primary care physician (family doctor, internist).
• Gynecologist- doctor who specializes in women’s health.
• Urologist- doctor who specializes in urinary system (bladder, kidneys).
• Anesthesiologist – doctor specializing in treating pain.
• Physical therapists- healthcare providers that use exercises to alleviate pain.
• Psychologist – healthcare providers that use mind and behavior skills to improve quality of life.

Treatment of IC/BPS

Self-care

• It is important to get enough rest and sleep.
• Stop smoking if you smoke.
• Talk to your healthcare provider about any over the counter medicine or supplements that you take.
• Use energy conservation during activities.

Professional Care

• Medicine to treat IC/BPS- talk to your doctor about medicines.
• Liquid medication into the bladder:
  • can help with symptom flares.
  • Medicine is put into the bladder once a week for six weeks.

Chronic Overlapping Pain Conditions (COPCs)

People who have IC/CBPS may also have one or more of other COPCs listed below:

• Fibromyalgia
• Low back pain
• Temporomandibular joint dysfunction
• Irritable bowel syndrome (IBS)
• Migraine and tension headache
• Endometriosis
• Vulvodynia (VVD)
• Chronic fatigue syndrome (also called myalgic encephalopathy)

What is endometriosis?

• About 5-15% of women in the U.S. have endometriosis.
• Caused from tissue in the uterus getting outside the uterus.
• Symptoms usually begin after the first menstrual period and go away after menopause.
• Some people do not have symptoms.
• Some people have severe symptoms.

Symptoms:

• Pelvic pain
  • Usually worse around time of menstrual period.
• Some activities may be painful:
  • Sex
  • Bowel movements
  • Urination
• Infertility- difficulty getting pregnant.
• Ovarian cysts
• Bloating – feeling of belly fullness.
• Fatigue
• Sleep problems – difficulty falling asleep or staying asleep.
• Anxiety and depression

What Causes Endometriosis?

• No exact cause is understood.
• Risk factors:
  • Family history
  • Starting period at early age
  • Having periods that last only a couple days
  • Heavy periods that last longer than 7 days
  • Low body mass

Diagnosis of Endometriosis

• Surgery can be used to see pelvic organs using small incisions with tiny camera.
• Your doctor will diagnosis endometriosis based on symptoms and medical history.
• Imaging (ultrasound or MRI) can be used for endometriosis that is not deep.

Who treats Endometriosis?

• Gynecologists- doctors who specialize in women’s health, can use surgery to treat endometriosis.
• Urologist or surgeon- surgically removes.
• Pelvic health physical or occupational therapists- healthcare professionals who specialize in pelvic pain.
• Psychologists- healthcare providers that use mind and behavior skills to improve quality of life.
• Integrative health practitioners – use relaxation to promote healing.

Treatment of Endometriosis

Self-care

• Get enough rest.
• Exercise.
• Healthy eating.
• Talk to your doctor about over the counter medicine and supplements.
• Social support.
• Using energy conservation during activities.

Professional Care

• Medicine to change hormone levels can be used.

• Pelvic floor therapy- exercises to strengthen pelvic muscles.

  • These are done with physical or occupational therapists.

• Surgery- can be done after medication has not helped symptoms.

  • Conservative surgery- takes out the tissue and leaves the uterus.

    • Minimally invasive

  • Radical surgery- removes the uterus and the tissue.

Chronic Overlapping Pain Conditions (COPCs)

People who have endometriosis may also have one or more of other COPCs listed below:

• Fibromyalgia
• Low back pain
• Temporomandibular joint dysfunction
• Irritable bowel syndrome (IBS)
• Migraine and tension headache
• Interstitial Cystitis / Bladder Pain Syndrome
• Vulvodynia (VVD)
• Chronic fatigue syndrome (also called myalgic encephalopathy)

ADDITIONAL RESOURCES

International Pelvic Pain Society American College of Obstetricians and Gynecologists, Patient Education FAQs American Society for Reproductive Medicine, Patient Resources Royal College of Obstetricians and Gynaecologists Academy of Pelvic Health Physical Therapy, Section on Women’s Health

What is Vulvodynia?

• Pain at the opening of the vagina lasting more than 3 months.
• About 16% of women in the U.S. have vulvodynia.
• May be triggered by touch (sex, tampon insertion, etc.).
• May not be triggered by anything.

Symptoms

• Pain at the opening of the vagina.

  • Burning, irritation, stinging, throbbing, itching, feeling of rawness

• Symptoms can come and go.

• Depression and anxiety.

• Not interested in sex.

  • This can be from less lubrication, difficulty reaching orgasm, and less enjoyment during sex.

What Causes Vulvodynia?

• There is no known cause.
• There are risk factors for vulvodynia:
  • Genetics
  • Childhood trauma

Diagnosis of Vulvodynia

• Several types of doctors can diagnose vulvodynia – primary care doctor, gynecologist, neurologist, dermatologist.
• Medical exam
  • Your doctor will ask questions about your symptoms and medical history.
  • A physical pelvic exam rules out other conditions and helps diagnose vulvodynia.
  • "Cotton-swab test" – a cotton swab is touched to vagina to see if it causes pain.

Who Treats Vulvodynia?

• Doctor- primary care doctor, gynecologist, dermatologist, neurologist.
• Physical therapist- provides exercises to make sex more comfortable and enjoyable.
• Sex therapist- helps to work through sexual issues.

Treatment of Vulvodynia

Self-care

• Talk to your healthcare provider about over the counter medicines and supplements.
• Topical medications- lidocaine.
• Social support.

Professional Care

• Medicine – some medications are helpful with reducing pain.
• Botox- medicine is injected to stop muscle spasms.
• Acupuncture- use needles to promote healing.
• Physical therapy- uses exercises and TENS units to reduce pain.
• Surgery- removes skin around the vagina.

Chronic Overlapping Pain Conditions (COPCs)

People who have vulvodynia may also have one or more of other COPCs listed below:

• Fibromyalgia

• Low back pain

• Temporomandibular joint dysfunction

• Irritable bowel syndrome (IBS)

• Migraine and tension headache

• Interstitial Cystitis / Bladder Pain Syndrome

• endometriosis

• Chronic fatigue syndrome (also called myalgic encephalopathy)

ADDITIONAL RESOURCES

National Vulvodynia Association (NVA) Organization of patient advocates, physicians and PhDs involved with vulvodynia care and research, and interested others. The NVA provides information about vulvodynia, funding for pilot studies regarding all aspects of the disorder, and provider information to patients. International Society of the Study of Vulvovaginal Diseases (ISSVD) Organization composed of physicians and PhDs (researchers and clinicians) who have a strong interest in diseases of the vulva.

What is ME/CFS?

• Myalgic Encephalopathy is also called Chronic Fatigue Syndrome.
• More than 1 million people in the U.S. have ME/CFS.
• It is more common in women than men.
• About 1 in 4 people with ME/CFS become too sick to leave their house.
• The body can not use fats and sugars to create fuel like it should.
• Causes extreme fatigue that lasts at least 6 months.

Symptoms

• Feeling so tired that it makes you feel sick.
• Symptoms get worse with physical or mental activity.
• Stress makes symptoms worse.
• Sleep issues- not feeling rested after waking up, or not sleeping through the night.
• Easily confused.
• May feel sick after standing up.
• Feeling dizzy.
• Cold hands and feet.
• Sensitivity to cold and heat.
• Feeling feverish.
• Generalized pain:
  • Headaches.
  • Muscle and joint aches.
• Tingling/numbness in feet or hands.
• Belly pain.
• Bloating – belly fullness.

What causes ME/CFS?

• The cause is not fully understood.
• Likely related to the immune system.

Diagnosis of ME/CFS

• Exam- your doctor will ask you about symptoms.

• Physical exam- your doctor will look for these signs:

  • Pale skin color with cool blotchy skin.
  • Redness in the throat near the tonsils.
  • Tender lymph nodes.
  • Unstable balance.

• Medical Tests

  • Orthostatic testing- measure blood pressure and heart rate in standing compared to sitting or lying down.
  • Cardiopulmonary Exercise Tests- measure oxygen and carbon dioxide after riding a stationary bike.
  • Lab tests- blood tests help to make a diagnosis but are not diagnostic without other signs and symptoms.
  • Neurocognitive testing- tests of concentration and thinking.

Who Treats ME/CFS?

• Doctor- ME/CFS can be diagnosed by any of the following: primary care (family practice, internist), neurology, immunology, endocrinology, cardiology, rheumatology, gastroenterology, pain specialists, physiatrists.
• Physical/occupational therapists- help improve endurance and save energy.
• Dieticians- teach about foods as fuel to meet the body’s needs.

Treatment of ME/CFS

Self-care

• Talk to your doctor about over the counter medicines and supplements.
• Practicing energy conservation during activities.
• Getting enough rest.
• Limiting stress as much as possible.
• Social support.

Professional Care

• Your doctor can prescribe medicine to help manage symptoms.

Chronic Overlapping Pain Conditions (COPCs)

People who have ME/CFS may also have one or more of other COPCs listed below:

• Fibromyalgia
• Low back pain
• Temporomandibular joint dysfunction
• Irritable bowel syndrome (IBS)
• Migraine and tension headache
• Interstitial Cystitis / Bladder Pain Syndrome
• Endometriosis
• Vulvodynia