Differential Diagnosis for Pain Aggravated by Heat and Massage and Alleviated by Cold and TENS

• Single Most Likely Diagnosis
  • Complex Regional Pain Syndrome (CRPS): This condition is characterized by pain that is disproportionate to the initial injury, and it is often aggravated by heat, massage, and other stimuli. Cold and TENS (Transcutaneous Electrical Nerve Stimulation) can provide relief, making CRPS a strong candidate for the described symptoms.
• Other Likely Diagnoses
  • Fibromyalgia: While fibromyalgia pain can be widespread and not necessarily localized like CRPS, some patients may experience relief with cold therapy and TENS. However, the response to heat and massage can be variable.
  • Peripheral Neuropathy: Certain types of peripheral neuropathy can cause pain that is worsened by heat and improved by cold. TENS can also be beneficial for neuropathic pain.
• Do Not Miss Diagnoses
  • Deep Vein Thrombosis (DVT): Although DVT typically presents with swelling, redness, and warmth of the affected limb, in some cases, the pain can be exacerbated by heat and relieved by cold. It's crucial to consider DVT due to its potential for severe complications, such as pulmonary embolism.
  • Cellulitis or Abscess: Infections can cause pain that is worsened by heat and massage due to increased blood flow and potential for spreading the infection. Cold compresses might provide temporary relief, but these conditions require urgent medical attention.
• Rare Diagnoses
  • Erythromelalgia: A rare disorder characterized by burning pain, heat, and redness in the hands and feet. It is typically relieved by cold and can be exacerbated by heat, making it a rare but possible diagnosis for the described symptoms.
  • Reflex Sympathetic Dystrophy (RSD): Now more commonly referred to as CRPS, RSD is an outdated term for what is essentially the same condition. However, some literature may still use this term, and it's worth noting for completeness.