Paroxysmal Extreme Pain Disorder

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Paroxysmal Extreme Pain Disorder (PEPD) is a rare neurological condition characterized by sudden, severe, stabbing pain attacks accompanied by sweating, flushing, tachycardia, and hypertension. These attacks can be debilitating and significantly impact the quality of life for individuals affected by this disorder. In this article, we will delve into the details of PEPD, its symptoms, causes, and potential treatment options.

Symptoms of Paroxysmal Extreme Pain Disorder

The hallmark symptom of PEPD is the occurrence of paroxysmal attacks of extreme pain. These attacks typically last for a few minutes to several hours and can be triggered by various factors such as stress, physical exertion, or even simple touch. The pain is often described as sharp, shooting, or electric shock-like, and it can affect any part of the body.

Alongside the excruciating pain, individuals with PEPD may experience accompanying symptoms including:

  • Sweating
  • Flushing
  • Tachycardia (rapid heart rate)
  • Hypertension (high blood pressure)

These additional symptoms further contribute to the distress and discomfort experienced during an attack.

Causes and Diagnosis

The exact cause of PEPD is still not fully understood. However, it is believed to be a genetic disorder, with mutations in the SCN9A gene being associated with the condition. This gene is responsible for encoding a sodium channel involved in transmitting pain signals.

Diagnosing PEPD can be challenging due to its rarity and the similarity of symptoms to other pain disorders. A thorough medical history, physical examination, and genetic testing are often necessary to reach a definitive diagnosis. It is crucial to rule out other potential causes of the symptoms before confirming PEPD.

Treatment Options

Managing PEPD involves a multidisciplinary approach aimed at alleviating pain, reducing the frequency and severity of attacks, and improving overall quality of life. While there is no known cure for PEPD, several treatment options can help individuals cope with the condition:


Various medications can be prescribed to manage the pain associated with PEPD. These may include:

  • Nonsteroidal anti-inflammatory drugs (NSAIDs)
  • Anticonvulsants
  • Tricyclic antidepressants
  • Opioids (in severe cases)

It is important to work closely with a healthcare professional to find the most effective medication and dosage for each individual.

Lifestyle Modifications

Adopting certain lifestyle changes can also help in managing PEPD:

  • Avoiding triggers: Identifying and avoiding triggers that can precipitate an attack, such as stress or specific physical activities, can be beneficial.
  • Stress management: Engaging in stress-reducing activities like meditation, yoga, or deep breathing exercises can help minimize the frequency and intensity of attacks.
  • Physical therapy: Working with a physical therapist can aid in improving overall physical function and reducing pain.

Supportive Therapies

Complementary therapies can provide additional support in managing PEPD:

  • Acupuncture: This ancient practice involves the insertion of thin needles into specific points on the body to alleviate pain and promote relaxation.
  • Transcutaneous electrical nerve stimulation (TENS): TENS units deliver low-voltage electrical currents to the affected area, providing pain relief.
  • Psychological support: Seeking therapy or counseling can help individuals cope with the emotional and psychological impact of living with a chronic pain disorder.

Living with Paroxysmal Extreme Pain Disorder

Living with PEPD can be challenging, but with the right support and management strategies, individuals can lead fulfilling lives. Here are some tips for coping with PEPD:

  • Build a support network: Surround yourself with understanding family members, friends, or support groups who can provide emotional support and empathy.
  • Educate yourself: Learn as much as you can about PEPD to better understand your condition and advocate for your needs.
  • Practice self-care: Prioritize self-care activities that promote relaxation and well-being, such as engaging in hobbies, taking warm baths, or practicing mindfulness.
  • Communicate with healthcare professionals: Regularly communicate with your healthcare team to ensure your treatment plan is optimized and to address any concerns or changes in symptoms.

Remember, each individual’s experience with PEPD is unique, and finding the right combination of treatments may require some trial and error. Patience and perseverance are key in managing this condition.


Paroxysmal Extreme Pain Disorder is a rare neurological condition characterized by sudden, severe, stabbing pain attacks accompanied by sweating, flushing, tachycardia, and hypertension. While there is no known cure for PEPD, various treatment options can help manage the symptoms and improve quality of life. By working closely with healthcare professionals, adopting lifestyle modifications, and seeking supportive therapies, individuals with PEPD can find relief and lead fulfilling lives despite the challenges posed by this disorder.

Haroon Rashid, MD
Rate author
Urgent Care Center of Arlington, VA
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