Types of Pain

Neck

Neck pain (or cervicalgia) is a common problem, with two-thirds of the population having neck pain at some point in their lives. Neck pain, although felt in the neck, can be caused by numerous other spinal problems. Neck pain may arise due to muscular tightness in both the neck and upper back or to pinching of the nerves emanating from the cervical vertebrae. Joint disruption in the neck creates pain, as does joint disruption in the upper back. The head is supported by the lower neck and upper back, the areas that commonly cause neck pain. The top three joints in the neck allow for most movement of the neck and head. The lower joints in the neck and those of the upper back create a supportive structure for the head to sit on. If this support system is affected adversely, then the muscles in the area will tighten, leading to neck pain.

Headache

Over 200 types of headache exist, and the causes range from being harmless to life-threatening. The description of the headache, together with findings on neurological examination, determines the need for any further investigations and the most appropriate treatment. The most common types of headache are the “primary headache disorders” such as tension-type headache and migraine. They have typical features; migraine, for example, tends to be pulsating in character, affecting one side of the head. It is also associated with nausea, disabling in severity, and usually lasts between three hours and three days. Rarer primary headache disorders are trigeminal neuralgia (a shooting face pain), cluster headache (severe pains that occur together in bouts), and hemicrania continua (a continuous headache on one side of the head).

Back

Pain felt in the back usually originates from the muscles, nerves, bones, joints, or other structures in the spine. The pain can often be divided into neck pain, upper back pain, lower back pain, or tailbone pain. It may have a sudden onset or can be a chronic pain; it can be constant or intermittent, stay in one place, or radiate to other areas. It may be a dull ache or a sharp, piercing, or burning sensation. The pain may radiate into the arm and hand, into the upper back, or into the lower back, (and might radiate into the leg or foot), and may include symptoms other than pain, such as weakness, numbness or tingling. Back pain is one of humanity’s most frequent complaints. In the U.S., acute lower back pain (also called lumbago) is the fifth most common reason for physician visits. About nine out of ten adults experience back pain at some point in their life, and five out of ten working adults have back pain every year. The spine is a complex interconnecting network of nerves, joints, muscles, tendons, and ligaments, and all are capable of producing pain. Large nerves that originate in the spine and go to the legs and arms can cause pain to radiate to the extremities.

Hip

The most common causes of hip pain are arthritis, bursitis, muscle strain, and nerve irritation. Arthritis happens because the hip is a “ball and socket” joint formed by the pelvic bone and the end of the femur bone. Both bones are covered with a smooth layer of protective cartilage; loss of this cartilage from wear and tear, inflammation, or injury causes arthritis. The hip joint and the large muscles that cover it are lubricated by five large bursa sacs and the fluid contained in the hip joint. Each sac produces lubricating fluid and functions to reduce pressure and friction around the joint. These bursa sacs can become irritated from injury, excessive pressure, and overuse. Inflammation of a bursa is called bursitis. Three major muscle groups help to move the hip through a wide range of movements. Overuse and irritation of these muscles can lead to muscle strain. Nerve irritation occurs when the major nerves controlling lower leg function cross the hip. Irritation of these nerves can cause pain through the hip and/or down the leg. Injury to the sciatic nerve frequently causes pain along the outer thigh or down the back of the leg. This is discussed separately.

Post-Surgery

Post-surgical pain is a complex response to tissue trauma during surgery that stimulates hypersensitivity of the central nervous system. The result is pain in areas not directly affected by the surgical procedure. Post-operative pain may be experienced by an inpatient or outpatient. It can be felt after any surgical procedure, whether it is minor dental surgery or a triple-bypass heart operation. Post-operative pain increases the possibility of post-surgical complications, raises the cost of medical care and, most importantly, interferes with recovery and return to the normal activities of daily living. Management of post-surgical pain is a basic patient right. When pain is controlled or removed, a patient is better able to participate in activities such as walking or eating, which hastens recovery. Patients will also sleep better, which aids the healing process.

Sciatica

Sciatica is a set of symptoms, including pain that may be caused by general compression and/or irritation of one of five spinal nerve roots that give rise to each sciatic nerve, or by compression or irritation of the left, right, or both sciatic nerves. The pain is felt in the lower back, buttocks, and/or various parts of the leg and foot. In addition to pain, which is sometimes severe, numbness, muscular weakness, pins and needles or tingling, and difficulty in moving or controlling the leg may occur. Typically, the symptoms are only felt on one side of the body. Although sciatica is a relatively common form of low back pain and leg pain, the true meaning of the term is often misunderstood. Sciatica is a set of symptoms rather than a diagnosis for what is irritating the root of the nerve, causing the pain. This point is important because treatment for sciatica or sciatic symptoms will often be different, depending upon the underlying cause of the symptoms.

SI Joint

The sacroiliac joint or SI joint is the joint in the bony pelvis between the sacrum and the ilium of the pelvis. These are joined together by strong ligaments. In humans, the sacrum supports the spine and is supported in turn by an ilium on each side. The joint is a strong, weight-bearing synovial joint with irregular elevations and depressions that produce interlocking of the two bones. The ligaments of the sacroiliac joint become loose during pregnancy due to the hormone relaxing; this loosening allows widening of the pelvic joints during the birthing process, especially the related symphysis pubis. The long SI ligaments may be palpated in thin persons for pain and compared from one side of the body to the other. Sacroiliac joint dysfunction is tested in many different ways, although the reliability of most individual tests has been shown to be low. Combining tests will often improve their reliability.

Musculoskeletal

Because many other body systems, including the vascular, nervous, and integumentary systems, are interrelated, disorders of one of these systems may also affect the musculoskeletal system and complicate the diagnosis of the disorder’s origin. Diseases of the musculoskeletal system mostly encompass functional disorders or motion discrepancies; the level of impairment depends specifically on the problem and its severity. Articular diseases (of/or pertaining to the joints) are the most common. Some diseases and disorders may adversely affect the function and overall effectiveness of the system. Disorders of muscles from another body system can cause irregularities such as impairment of ocular motion and control, respiratory dysfunction, or bladder malfunction. Complete paralysis, paresis, or ataxia may be caused by primary muscular dysfunctions of infectious or toxic origin; however, the primary disorder is usually related to the nervous system, with the muscular system acting as the effector organ capable of responding to a stimulus, especially a nerve impulse.

Degenerative Disc Disease

Degeneration of the intervertebral disc, often called “degenerative disc disease” (DDD) of the spine, is a condition that can be painful and can greatly affect the quality of one’s life. While disc degeneration is a normal part of aging and is not a problem for most people, a degenerated disc can cause severe, chronic pain for certain individuals. With symptomatic degenerative disc disease, chronic low back pain sometimes radiates to the hips, buttocks, or thighs while walking; sporadic tingling or weakness through the knees may also be evident. Similar pain may be felt or may increase while sitting, bending, lifting, or twisting. Chronic neck pain can also occur in the upper spine, with pain radiating to the shoulders, arms, and hands.

Post-Trauma

Post-traumatic pain is pain that occurs after a traumatic injury such as that sustained in an accident. Persistent chronic pain after a traumatic injury is not uncommon. Initial phases of treatment are focused on repair of fractures, closure of soft tissue defects, and/or immobilization. Pain that does not resolve is many times inappropriately classified as “RSD” (reflex sympathetic dystrophy) or a newer term CRPS I (chronic regional pain syndrome). Most patients with chronic pain after trauma, excluding spine trauma, have causalgia or CRPS II. These conditions indicate that the pain is from a nerve injury, which could be either a direct injury to the nerve or nerve compression from the contraction of the surrounding traumatized tissues. No trauma is too small to cause a chronic pain syndrome. There are nerves all over the body, any of which can be injured by various types of trauma. Comprehensive evaluation allows the pain specialist to determine what can be done to relieve the patient suffering from post-traumatic pain.

Degenerative Joint Disease

Osteoarthritis (OA), also known as degenerative arthritis or degenerative joint disease, is a group of mechanical abnormalities involving degradation of joints, including articular cartilage and subchondral bone. Symptoms may include joint pain, tenderness, stiffness, locking, and sometimes an effusion. A variety of causes hereditary, developmental, metabolic, or mechanical may initiate processes leading to loss of cartilage. When bone surfaces become less well protected by cartilage, bone may be exposed and damaged. As a result of decreased movement secondary to pain, regional muscles may atrophy, and ligaments may become more lax. Treatment generally involves a combination of exercise, lifestyle modification, and analgesics. If pain becomes debilitating, joint replacement surgery may be done to improve the quality of life. OA is the most common form of arthritis and the leading cause of chronic disability in the United States.

Spinal Stenosis

Spinal stenosis refers to the narrowing of the spinal canal anywhere along its axis. Although the disorder often results from acquired degenerative changes (spondylosis), spinal stenosis may also be congenital in nature. In some cases, the patient has acquired degenerative changes that augment a congenitally narrow canal. The canal components that contribute to acquired stenosis include the facets (hypertrophy, arthropathy), ligamentum flavum (hypertrophy), posterior longitudinal ligament (OPLL), vertebral body (bone spurs), the intervertebral disc, and the epidural fat. Congenital stenosis may predispose an individual with mild degenerative changes to become symptomatic earlier in life.

Neuralgia / Neuropathy

Neuralgia is pain in one or more nerves , which occurs without stimulation of pain receptor cells. Neuralgia pain is produced by a change in neurological structure or function rather than by the excitation of pain receptors that causes nociceptive pain. Neuralgia falls into two categories: central neuralgia and peripheral neuralgia. This unusual pain is thought to be linked to three possible mechanisms: ion gate malfunctions in which the nerve becomes mechanically sensitive and creates an ectopic signal, cross signals between large and small fibers, and malfunction due to damage in the central processor.

Complex Regional Pain Syndrome

Complex Regional Pain Syndrome (CRPS) is a chronic progressive disease characterized by severe pain, swelling, and changes in the skin. Though treatment is often unsatisfactory, early multimodal therapy can cause dramatic improvement or remission of the syndrome in some patients. The International Association for the Study of Pain has proposed dividing CRPS into two types based on the presence of nerve lesion following the injury. Type I, formerly known as reflex sympathetic dystrophy (RSD), Sudeck’s atrophy, reflex neurovascular dystrophy (RND), or algoneurodystrophy, does not have demonstrable nerve lesions. Type II, formerly known as causalgia, has evidence of obvious nerve damage. The cause of this syndrome is currently unknown. Precipitating factors include injury and surgery, although documented cases have shown no demonstrable injury to the original site.

Fibromyalgia

Fibromyalgia pain, meaning muscle and connective tissue pain, is a medical disorder characterized by chronic widespread pain and allodynia, a heightened and painful response to pressure. Fibromyalgia symptoms are not restricted to pain, leading to the use of the alternative term fibromyalgia syndrome for the condition. Other symptoms include debilitating fatigue, sleep disturbance, and joint stiffness. Some patients may also report difficulty with swallowing, bowel and bladder abnormalities, numbness and tingling, and cognitive dysfunction. Fibromyalgia is frequently combid with psychiatric conditions such as depression and anxiety and stress-related disorders such as posttraumatic stress disorder. Not all people with fibromyalgia experience all associated symptoms. Fibromyalgia is estimated to affect 2–4% of the population, with a female to male incidence ratio of approximately 9:1. Evidence from research conducted in the last three decades has revealed abnormalities within the central nervous system affecting brain regions that may be linked both to clinical symptoms and research phenomena. These studies show a correlation, but not causation. Some research suggests that alterations in the central nervous system might be the result of childhood stress, or prolonged or severe stress. Historically, fibromyalgia has been considered either a musculoskeletal disease or neuropsychiatric condition. Although fibromyalgia has no cure yet, some treatments demonstrated by controlled clinical trials have been effective in reducing symptoms, including medications, behavioral interventions, patient education, and exercise. The most recent approach of a diagnosis of fibromyalgia involves pain index and a measure of key symptoms and severity.

Cancer

Cancer pain can almost always be relieved or lessened. Many medicines and methods can be used to control cancer pain. The patients should expect his health care team to work with him to keep him as comfortable as possible. If the patient is in pain and the doctor has nothing more to offer, he should ask to see a pain specialist or have his doctor consult with a pain specialist. Controlling cancer pain is part of cancer treatment. The doctor wants and needs to hear about what works for pain and what does not. Keeping pain from starting and keeping it from getting worse are the best ways to control it. Pain is best relieved when treated early. Some people refer to this as “staying on top of the pain.” The patient should not try to hold off as long as possible between doses because the pain may get worse. Then it may take longer or a larger dose of medicine may be needed to give relief. The patient has a right to ask for pain relief. Talking about pain is not a sign of weakness. Not everyone feels pain in the same way. The patient should not “tough it out” or be “brave” if experiencing more pain than other people with the same kind of cancer. In fact, as soon the pain begins, the patient should speak up. Remember, it is easier to control pain right when it begins rather than to wait until it becomes severe.