Successful Treatment of Multifactorial Chronic Daily Headaches at an Interdisciplinary Chronic Pain Program: A Case Study.

Chronic daily headaches (CDHs) are common, disabling, and difficult to treat. We report a case of a patient with a complex medical history experiencing multifactorial CDH referred for and eventually enrolled in an interdisciplinary chronic pain program. Focusing on enhancing the patient's function while minimizing the use of medications and invasive procedures, this comprehensive rehabilitation intervention consists of diverse treatment approaches, including cognitive-behavioral therapy, physical and occupational therapy, and medical interventions. Despite the patient's challenges with implementation of strategies learned in the program, positive results were seen, including decreased symptomatology, decreased opioid use, and attainment of employment. Although time-intensive, interdisciplinary chronic pain programs may result in a greater likelihood for sustained functional improvements and prevention of disability for patients with CDH, even in the most complex. LEVEL OF EVIDENCE: IV.

A mediastinal mass presenting with unilateral periscapular and arm pain.

We describe a case of a patient with mediastinal lymphoma who presented with arm and scapular pain, which is an atypical referral pattern for pain originating from the mediastinum. We use this case as a platform to discuss mediastinal pain referral patterns and the importance of maintaining a broad differential diagnosis of arm and scapular pain, especially when symptoms atypical of pure neuromusculoskeletal structural disease are present.