What is Pain?
Pain is an unpleasant sensation. Pain can be sharp or dull, burning or numbing, minor or major, acute or chronic. It can be a minor inconvenience or completely disabling. Both the area of the injury and how the brain deals with signals from the area of pain affect the sensation.
Generally, medications try either to stop the transmission of pain from the site of injury or to affect the brain directly. The effects of pain medication are different for different people. Also, the tolerance of pain varies greatly from one person to another.
What is Chronic Pain?
Chronic pain persists despite the fact that an injury has healed. Pain signals remain active in the nervous system for weeks, months, or years. Physical effects include tense muscles, limited mobility, a lack of energy, and changes in appetite. Emotional effects include depression, anger, anxiety, and fear of re-injury. Such a fear may hinder a person’s ability to return to normal work or leisure activities. Common chronic pain complaints include:
- Lower Back pain
- Cancer pain
- Arthritis pain
- Psychogenic pain (pain not due to past disease or injury or any visible sign of damage inside)
- Neurogenic pain (pain resulting from damage to nerves)
Chronic pain may have originated with an initial trauma/injury or infection, or there may be an ongoing cause of pain. However, some people suffer chronic pain in the absence of any past injury or evidence of body damage. Learn more: Conquering Chronic Pain
What is Acute Pain?
Acute pain begins suddenly and is usually sharp in quality. It serves as a warning of disease or a threat to the body. Acute pain may be caused by many events or circumstances, including:
- Broken Bones
- Dental Work
- Burns or cuts
- Labor or childbirth
Acute pain may be mild and last just a moment, or it may be severe and last for weeks or months. In most cases, acute pain does not last longer than six months and it disappears when the underlying cause of pain has been treated or has healed. Unrelieved acute pain, however, may lead to chronic pain.
Which Type of Doctor Should I see for my Pain?
Many different types of doctors treat back pain, from family physicians to doctors who specialize in disorders of the nerves and musculoskeletal system. In most cases, it is best to see your primary care physician first. In many cases, he or she can treat the problem. In other cases, your doctor may refer you to a pain management center.
A pain management center is a setting where you receive treatment and learn ways to manage chronic pain. Treatment is usually provided by a team of doctors who work together to address all the possible causes of your chronic pain. (WebMD)
Interventional pain management doctors are equipped with non-surgical treatments that go well beyond pain medications. Our website aims to help you learn about more about what interventional pain physicians can do to treat pain and rectify some of the misconceptions of pain management.
When Should I see a Doctor for my Pain?
In most acute cases back pain usually goes away with or without treatment. In cases where pain persists, however, you should consider visiting a pain specialist at the earliest opportunity. For persistent pain the sooner it is treated the less likely you are to have long-term issues such as nerve damage.
However, a trip to the doctor is advisable if you have numbness or tingling, if your pain is severe and doesn’t improve with over the counter medications and rest, or if you have pain after a fall or an injury.
It is important to see your doctor if you have pain along with any of the following problems:
- trouble urinating,
- pain, or numbness in your legs,
- fever, or unintentional weight loss
Such symptoms could signal a serious problem that requires treatment soon. (WebMD)
Who is a Pain Management Specialist?
Pain management specialists are concerned about a patient’s ability to function and their quality of life. When pain is chronic or complicated by other medical conditions, a patient may need to see a pain specialist.
A pain management specialist is often a physiatrist, rehabilitation physician or an anesthesiologist with sub-specialty training in pain management. These physicians develop treatment plans to relieve, reduce, or manage pain and help patients return to everyday activities quickly without surgery or heavy reliance on medication. To make sure all the patient’s needs are met, the physician may coordinate care through an interdisciplinary team of health professionals.
At Newbridge Spine and Pain Center our pain management specialists are most concerned with the patient’s overall quality of life. To that end, they treat the whole patient, not just one part of the body.
What Causes Back Pain?
The following conditions may result in back pain:
Strains, Sprains and Spasms: The most common cause of back pain is an injury to a muscle (strain) or a ligament (sprain). Strains and sprains can occur for many reasons, including improper lifting, excess body weight and poor posture. Strains and sprains can also develop from hauling around a heavy handbag or sleeping at an awkward angle. As a pivot point for turning at the waist, the lower back is especially vulnerable to muscle strains. Sometimes a strain or sprain causes immediate back pain. In other cases, soreness and stiffness come later. An injured muscle may also “knot up.” This muscle spasm is your body’s way of immobilizing the affected area to prevent further damage.
Osteoarthritis: As people age, the disks that act as cushions between the vertebrae become flatter and less flexible. Without the cushioning that these disks normally provide, the joints (facets) between vertebrae press tightly against each other. This can cause back pain and stiffness. Your body may try to compensate for these changes by building new bone (spurs) to support the area where loading pressure is increased. Because osteoarthritis usually develops over many years of physical activity, it’s known as “wear-and-tear” arthritis. Obesity and injury to a joint are other risk factors for osteoarthritis.
Herniated Disk: Normal wear and tear over time can cause one of the disks in your spine to rupture (herniate). Exceptional strain or traumatic injury can have the same effect. Many people describe this as a “slipped” disk. Back pain results when the herniated disk pinches one of the nerves that come out of the spinal cord. If the sciatic nerve is affected, you may develop sciatica – a sharp, shooting pain in the lower back, buttocks and leg.
Osteoporosis: As you age, the amount of calcium in your bones decreases. This lowers the density or mass of your bones, making them porous and brittle — a condition known as osteoporosis. What does osteoporosis have to do with back pain? Plenty. If you have osteoporosis, daily lifting and other routine activities can cause low back pain by fracturing the front part of the weakened bones. These are known as compression fractures. A fall can have the same effect.
Fibromyalgia: Fibromyalgia is a chronic condition characterized by fatigue and widespread pain in the muscles, ligaments and tendons — including the lower back. The diagnosis of fibromyalgia usually includes a history of at least three months of widespread muscle pain accompanied by pain and tenderness in at least 11 of the 18 “tender points” in your body
How is Pain Diagnosed?
Before a physician can treat a patient’s pain, he or she must understand the cause of the pain. In some pain cases the cause may be obvious, such as a spinal fracture. In cases of chronic pain, the cause(s) may be elusive and make diagnosis difficult. The physician relies on the patient’s medical history, physical and neurological examinations. Additional diagnostic tools may help to support or rule out a suspected diagnosis. [Source: SpineUniverse]
How is Pain Treated?
Here are some of the available treatments being used to successfully treat pain patients.
Pain Medication Your pain medicine doctor may conclude that a combination of medication and treatments may be right for you. Your therapy plan will be tailored to your specific needs and circumstances.
Injection Treatments Local anesthetics, with or without cortisone-like medicines, can be injected around nerve roots and into muscles or joints. These medicines reduce swelling, irritation, muscle spasms and abnormal nerve activity that can cause pain.
Nerve Blocks Often a group of nerves, called a plexus or ganglion, that causes pain to a specific organ or body region can be blocked with local anesthetics. If the nerve block is successful, another solution that numbs the nerves can then be injected.
Physical and Aquatic Therapy The physiatrist or physical therapist may suggest an exercise program tailored for you that will increase your daily functioning and decrease your pain. Other treatments may include whirlpool therapy, ultrasound and deep-muscle massage.
Electrical Stimulation Transcutaneous electrical nerve stimulation (TENS) is the most common form of electrical stimulation used in pain management. It is not painful and does not require needles or medicine. TENS consists of a small, battery-operated device that can diminish pain by stimulating nerve fibers through the skin.
Spinal Cord Stimulation Spinal cord stimulation (SCS) is a procedure that uses an electrical current to treat chronic pain. A small pulse generator, implanted in the back, sends electrical pulses to the spinal cord. These pulses interfere with the nerve impulses that make you feel pain. When in use, the spinal cord stimulator creates a tingling feeling, rather than the pain you have felt in the past. Learn more: Spinal Cord Stimulation
Acupuncture This ancient Chinese practice uses very thin needles at very specific points on the skin to treat disease and pain.
Psychological Support Many patients who are in pain feel the emotional effects of suffering along with the physical aspects of pain. Support and counseling from a psychiatrist or psychologist, combined with a comprehensive pain treatment program, may be needed to help you manage your condition.
Surgery When necessary, surgical treatment may be recommended. In rare instances when severe pain has not responded to other treatments and procedures, surgery on certain nerves can be done to give the patient some relief and allow them to resume near-normal activities. Usually all other avenues of treatment are tried before surgery is considered. [Source: ASAHQ]
What is Degenerative Disk Disease?
Degenerative disc disease is not really a disease but a term used to describe the normal changes in your spinal discs as you age. Spinal discs are soft, compressible discs that separate the interlocking bones (vertebrae) that make up the spine. The discs act as shock absorbers for the spine, allowing it to flex, bend, and twist.
Degenerative disc disease can take place throughout the spine, but it most often occurs in the discs in the lower back (lumbar region) and the neck (cervical region). [Source: WebMD]
What is an Intrathecal Pump Implant?
An Intrathecal Pump Implant is designed to interrupt transmission of pain signals from the spinal cord to the brain. If the neuropathic pain signals do not reach the brain, then the patient does not actually feel the pain. Spinal pumps (or pain pump) delivers pain medication (typically morphine) directly to the intrathecal space around the spinal cord via an implanted pump. The pump is implanted during a surgical procedure, and medication in the pump is added periodically (e.g. monthly) by injecting medication through the skin into the pump reservoir.
Spinal pumps may be used to manage chronic pain from osteoporosis or axial somatic pain (nociceptive pain), and sometimes may by used to manage pain from failed back surgery syndrome (although the efficacy for this use is unclear). Spinal pumps are also used to treat painful spasticity as is seen in multiple sclerosis.
Often multiple medications are put into the pump to treat certain specific situations. That is, morphine to treat the nociceptive pain and local anesthetics (such as bipuvicaine) to treat a neuropathic pain component. [Source: Spine-Health.com]
What is Myofascial Pain Syndrome?
Myofascial Pain syndrome is a chronic form of muscle pain. The pain of myofascial pain syndrome centers around sensitive points in your muscles called trigger points. The trigger points in your muscles can be painful when touched. And the pain can spread throughout the affected muscle. [Source: MayoClinic] Learn more: What is Myofascial Pain Syndrome?
What is Spinal Cord Stimulation?
Spinal cord stimulation uses low voltage stimulation of the spinal nerves to block the feeling of pain. It helps you to better manage your pain and potentially decrease the amount of pain medication. It may be an option if you have long-term (chronic) leg or arm pain, and have not found relief through traditional methods. A small battery-powered generator implanted in the body transmits an electrical current to your spinal cord. The result is a tingling sensation instead of pain. By interrupting pain signals, the procedure has shown success in returning some people to a more active lifestyle. [Source: Mayfieldclinic] Learn more: Spinal Cord Stimulation
What is Spinal Stenosis?
Spinal stenosis is a condition due to narrowing of the spinal canal that can cause spinal cord or nerve pinching which leads to persistent pain in the buttocks, limping, lack of feeling in the lower extremities, and decreased physical activity. [Source: TheACPA]
What is a Herniated disk?
The disks in your spine, called intervertebral disks, are thin, oblong structures that serve as cushions between the bones of your back (vertebrae). Each disk is made of a soft gel core surrounded by a tough, fibrous outer shell. This structure allows the disk to be firm enough to maintain the space between the vertebrae, but soft enough to compress when the spine flexes during bending, leaning and turning sideways.
In some people, mostly middle-aged adults, a disk’s tough outer shell develops an area of weakness or a small tear. When this happens, part of the disk’s soft inner core can bulge out of its normal position (herniate), producing a condition called a herniated disk. If the herniated disk presses on nerves in the nearby spina canal, this can cause variety of nerve-related symptoms, including pain, numbness and muscle weakness.
In most cases, a herniated disk (with or without sciatica) will respond to conservative treatment. This may include limited bed rest (generally no more than a day or two) warm baths, heating pads and medications, such as aspirin or other nonsteroidal anti-inflammatory drugs (NSAIDs) or muscle relaxants. When/if these more conservative measures don’t work, epidural steroid injections may be helpful. [Source: HealthCentral]
What is Sciatica?
Sciatica describes persistent pain felt along the sciatic nerve, which runs from the lower back, down through the buttock and into the lower leg. This is the longest nerve in the body. Pain results when this nerve is irritated by inflammation, pressure on the nerve from arthritis growths or a displaced (herniated) disk in the lower spine.
What is Piriformis Syndrome?
Piriformis syndrome is a rare neuromuscular disorder that occurs when the piriformis muscle compresses or irritates the sciatic nerve-the largest nerve in the body. The piriformis muscle is a narrow muscle located in the buttocks. Compression of the sciatic nerve causes pain-frequently described as tingling or numbness-in the buttocks and along the nerve, often down to the leg. The pain may worsen as a result of sitting for a long period of time, climbing stairs, walking, or running.
Treatment Generally, treatment for the disorder begins with stretching exercises and massage. Antiinflammatory drugs may be prescribed. Cessation of running, bicycling, or similar activities may be advised. A corticosteroid injection near where the piriformis muscle and the sciatic nerve meet may provide temporary relief. In some cases, surgery is recommended.
Prognosis The prognosis for most individuals with piriformis syndrome is good. Once symptoms of the disorder are addressed, individuals can usually resume their normal activities. In some cases, exercise regimens may need to be modified in order to reduce the likelihood of recurrence or worsening. [Source: NIDS.NIH.gov ]
What is Neuropathic Pain?
Neuropathic pain is a type of pain that can result from injury to nerves, either in the peripheral or central nervous system. Neuropathic pain can occur in any part of the body and is frequently described as a hot, burning sensation, which can be devastating to the affected individual. It can result from diseases that affect nerves (such as diabetes) or from trauma, or, because chemotherapy drugs can affect nerves, it can be a consequence of cancer treatment.
Among the many neuropathic pain conditions are diabetic neuropathy (which results from nerve damage secondary to vascular problems that occur with diabetes); reflex sympathetic dystrophy syndrome, which can follow injury; phantom limb and post-amputation pain, which can result from the surgical removal of a limb; postherpetic neuralgia, which can occur after an outbreak of shingles; and central pain syndrome, which can result from trauma to the brain or spinal cord.
Where can I get more info?
American Chronic Pain Association (ACPA)h
Provides self-help coping skills and peer support to people with chronic pain. Sponsors local support groups throughout the U.S. and provides assistance in starting and maintaining support groups.
American Pain Foundation
Independent non-profit information, education, and advocacy organization serving people with pain. Works to improve the quality of life for people with pain by raising public awareness, providing practical information, promoting research, and advocating the removal of barriers and increased access to effective pain management.
Mayday Fund [For Pain Research]
The Mayday Pain Project works to increase awareness and to provide objective information concerning the treatment of pain.
National Foundation for the Treatment of Pain
Not-for-profit organization dedicated to providing support for patients who are suffering from intractable pain, their families, friends and the physicians who treat them. Offers a patient forum, advocacy programs, information, support resources, and direct medical intervention.
National Pain Foundation
A non-profit organization that provides education and support resources for people in chronic pain, their families, and physicians.