MUSCULOSKELETAL PAIN SYNDROMES
Joint pain is a presenting feature of many conditions outside the scope of this textbook. Where pain is associated with synovitis and progressive articular cartilage destruction, there is a clear requirement that treatment of the disease process is a key part of the management of pain and the reduction of disability. Pain is to a large extent nociceptive, with the additional factor that chronic nociceptive states induce a permanent state of hyperexcitability of the central nervous system, and chronically painful conditions cause secondary changes in mental well-being and function. The specific management of conditions in which inflammation is part of the disease process will not be discussed here. The reader is referred to rheumatology textbooks for details of the management of rheumatoid arthritis, ankylosing spondylitis, polymyalgia rheumatica and gout. It is worth noting, however, that the disease process of rheumatoid arthritis can be affected by the central nervous system. Thus, rheumatoid arthritis is not observed in joints of a limb affected by a stroke. Palindromic arthritis, a type of rheumatoid arthritis with flitting joint pains and inflammation, has been claimed to respond to block of the sympathetic system.