Internal Medicine

0521779407-17 CUNY1086/Karliner 0 521 77940 7 June 4, 2007 21:18

1124 Paget Disease Pain Syndromes

■Calcitonin:

➣Side effects: occasional abdominal cramps (SQ), rhinorrhea,

nasal irritation

➣Contraindications: none

follow-up

■Alkaline phosphatase q 4–6 wks

■Monitor pain

■Bone scan at end of treatment or when disease activity in doubt

■Audiogram repeated periodically if skull involved

complications and prognosis

■Degenerative joint disease adjacent to involved bone

■Deafness from temporal bone impinging on 8th cranial nerve or

direct involvement of middle ear ossicles

■Spinal stenosis

■Other foraminal occlusion less common

■Fracture at involved weight-bearing sites

■Osteogenic sarcoma rare but lethal

■High-output cardiac failure uncommon; improves with successful

therapy of Paget disease

PAIN SYNDROMES

MICHAEL J. AMINOFF, MD, DSc

history & physical

■Acute or chronic pain: document onset, character, distribution, pro-

gression, duration, severity

■Sharp, short-duration, stabbing pain, sometimes on background of

constant burning pain, suggests neuropathic pain that may radiate

in nerve or root territory

■Associated symptoms

➣Local or systemic disease may suggest pain felt at one site is

referred from another (eg, chest/arm pain from cardiac ischemia)

➣Limb pain may be accompanied by swelling, discoloration, tem-

perature change, disuse (reflex sympathetic dystrophy or com-

plex regional pain syndrome type 1 after seemingly minor injury

or CRPS 2 after severe nerve injury)

➣Preceding rash suggests shingles or postherpetic neuralgia

■Past medical history may suggest cause of pain