Diagnosing Intractable Pain Syndrome

What is intractable pain syndrome?

Intractable pain is considered a constant and severe form of chronic pain that is difficult to manage or treat. Intractable pain syndrome (IPS) occurs when chronic pain progresses to intractable pain. IPS results in the dysfunction of multiple bodily systems, such as immunologic, neurologic and cardiovascular.

Intractable pain syndrome occurs when an underlying pain condition or injury causes the body to send excessive signals or impulses to the central nervous system (CNS). This results in inflammation and tissue loss in the body.

Diagnosing intractable pain syndrome

An IPS diagnosis is typically preceded by a primary chronic pain diagnosis. Diagnosing intractable pain syndrome may involve the trial and error of treatment to ease chronic pain symptoms. These treatment plans may include the following:

• NSAIDs
• Mild opioids
• Muscle relaxants
• Anti-seizure medications
• Corticosteroid injections
• Surgery
• Physical therapy
• Physical activity
• Psychological interventions

Criteria of an IPS diagnosis

It is generally recommended that a diagnosis of IPS only be given if certain criteria are met. This includes the following:

• An underlying disease or injury in pain is present.
• Pain is constant and debilitating.
• Hyperarousal of the cardiovascular system exists along with elevated blood pressure, heart rate, or other vasomotor dysfunctions, such as cold hands or feet, hyperactive reflexes, or mydriasis.
• Lab tests indicate the presence of abnormal hormone, glucose, or inflammatory levels.

Intractable pain syndrome vs. chronic pain

Differentiating between IPS and standard chronic pain is often difficult. Key identifiers for IPS that rarely present with standard chronic pain include, but are not limited to, the following:

• Constant pain
• Depression or hopelessness
• Malnutrition
• Endocrine abnormalities
• Around-the-clock treatment
• Elevated blood pressure or pulse
• Extreme elevation of inflammatory markers
• Elevated temperature and breathing rate
• Insomnia
• Restriction of life activities
• Decreased capability for activities of daily living

Additional sources: Tennant Foundation’s Intractable Pain Syndrome Research and Education Project and MedCentral