An Overview of Pain and Pain Management

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An Overview of Pain and Pain Management 2016-11-17T10:03:44+00:00

Pain by Definition

Pain by definition is an unpleasant sensation that occurs in varying degrees of severity and is the consequence of disease, injury or emotional disorder.

Nociceptive pain is pain that is detected by sensory nerves called nociceptors, which are located throughout soft tissues (muscles, skin, internal organs). There are two types of nociceptive pain, somatic pain and visceral pain.

Somatic pain:

A type of pain that comes from the skin and deep tissues. For example, both a papercut and soreness in the muscles after exercise are somatic pain. Nociceptors send signals to the brain as they detect tissue has been compromised. Most somatic pain can be easily treated with over-the-counter medications (NSAIDs such as Tylenol ®, Advil ®, etc.), and pain fades when the injury heals. However, should pain persist, it may become chronic pain.

Visceral pain:

Pain that originates from the internal organs. Like somatic pain, visceral pain is detected by nociceptors. While somatic pain is often sharp and the source is easily identifiable, visceral pain is normally dull and vague, and it can be a challenge to exactly pinpoint the location and cause.

Bone pain:

While less common than joint and muscle pain, bone pain is often obvious, as with a fracture. Bone pain can also be from the less obvious, such as osteoporosis, cancer in the bones, sickle cell anemia, leukemia, or infection in the bones. Whatever the cause, bone pain is often serious, and should be evaluated by a medical professional as soon as possible.

Muscular pain:

Is fairly common, and usually occurs from overuse, tension or exercise. When muscle pain has occurred from one of the aforementioned situations, it generally begins during or quickly after the activity and is easy to pinpoint the cause of the pain. Infections, such as the flu and disorders that affect tissues in the body such as lupis, can also cause muscle pain. A chronic muscle pain disorder is fibromyalgia, a chronic pain condition that causes pain in the muscles and surrounding tissues within the body.

Neuropathic pain:

Is pain that is due to nerve damage and is complex and painful. Nerve function is affected both at the site of the initial injury, as well as surrounding areas. While extremely difficult to identify the source of pain, neuropathic pain is caused by back, leg and hip problems, facial nerve problems, fibromyalgia, spine surgery, and multiple sclerosis, among other causes. The pain is often burning or tingling in nature, and can cause numbness.

Psychogenic pain:

Is largely mental, rather than physical. Mental or emotional problems, rather than disease or trauma, often cause, increase or prolong pain. Stomach pain, headache, and back pain are often listed as psychogenic pains. Those with psychogenic pain often report pain that is not associated with their symptoms.

Acute pain and chronic pain are two very different and distinct types of pain. Acute pain is related to injury, is temporary, and resolves in the expected healing period. Chronic pain lasts longer than three months, or longer than the expected healing process.

Pain Management

Pain management is a fairly new specialty that is not only innovative, but quickly gaining respect and validity within the medical community. A specialty that has been in existence since the late 1990’s, interventional pain management requires that a physician not only be an anesthesiologist, but also board certified in pain management – ensuring that pain physicians are well equipped to treat specific pain conditions.

Interventional pain management utilizes a multidisciplinary approach including pharmacologic measures, minimally invasive procedures, alternative therapies and cutting-edge technology.

Pharmacologic

Medications often used in pain management include non-steroidal anti-inflammatory drugs (NSAIDs), opioids, muscle relaxants and membrane stabilizing medications. Examples of these are:

NSAIDs: include ibuprofen (Advil ®, Motrin ®), aspirin (Bayer ®), naproxen (Aleve ®).
Opioids: include Vicodin ®, Percodan ® and Percocet ® as short-term treatment of severe pain. Although, as these are short-acting medications, they are not indicated for long-term treatment.
Muscle relaxants: include Valium ®, Flexeril ®, Soma ®
Membrane Stabilizing Medications: Neurontin ®, Topamax ®, Klonopin ®

Minimally invasive procedures

There are many minimally invasive interventional procedures and the procedure used on each patient varies depending on the source, severity and causation of their pain.

Epidural Steroid Injections: These injections are often used to treat pain known as “radicular pain” or pain that radiates from the spine and progresses down an irritated spinal nerve. Common conditions that may be treated with epidural steroid injections (ESI) are degenerative disc disease, herniated discs, spondylysis, sciatica, and spinal stenosis among other conditions.

Medial Branch Blocks: Often used for arthritis-caused neck and back pain, medial branch blocks (MBB) reduce inflammation in the facet joints of the spine. If the medial branch block is to be successful, a patient will notice rapid pain relief, and should be able to return to their daily activities with notably less, if any, pain. Medial branch blocks may also be used as a diagnostic procedure to determine whether or not pain is originating from the joint – if pain is alleviated with a medial branch block, it is safe to assume that pain is coming from the joint itself.

Radiofrequency Ablation: Should a patient experience significant pain relief from the medial branch block, radiofrequency ablation (RFA) may be a viable option for more permanent pain relief. Utilizing a device that delivers controlled heat and disrupts the pain signal, radiofrequency ablation essentially interrupts the communication of pain signals to the brain.

Percutaneous Discectomy: Using the Stryker branded Dekompressor, percutaneous discectomy is a procedure that is an effective treatment for neck and/or back pain that is caused by herniated discs. A herniated or bulging disc extends beyond the usual boundaries and irritates the nerves closest to it. A percutaneous discectomy removes the irritation by extracting the bulging material, which effectively causes pain relief.

Spinal Cord Stimulator: Known by pain physicians as a “pacemaker for pain,” a spinal cord stimulator (SCS) is quickly becoming more popular for the treatment of many chronic back pain conditions. By delivering low-level electrical impulses, spinal cord stimulation works by blocking pain signals to the brain and replacing pain with “parathesia” or a tingling or buzzing sensation. Many patients report the tingling or buzzing to be a pleasant sensation, and infinitely preferable to the pain they had previously felt.

Vertebroplasty: A minimally invasive procedure, vertebroplasty has been shown to effectively eliminate pain caused by vertebral compression fractures. Caused by trauma or osteoporosis, spinal compression fractures are painful and debilitating. A vertebroplasty reduces pain by an injection of medical grade acrylic cement into the fracture, creating an internal cast which stabilizes and strengthens the previously fractured vertebra.

Alternative Therapies

Pain physicians will often recommend alternative therapies in conjunction with other treatments. These alternative therapies include but are not limited to chiropractic care, acupuncture, massage therapy, physical therapy, aquatherapy and biofeedback.

Chiropractic Care: A chiropractor works toward providing their patient with restoring the body to its natural form and regaining function. In light of this goal, a chiropractor provides non-invasive, non-pharmacological therapies that have been shown to help many who suffer from chronic pain conditions.

Acupuncture: An alternative treatment that originated in China over 2,000 years ago, acupuncture is becoming a widely accepted alternative treatment for those who suffer from chronic pain. Using finely gauged, sterile, one-time-use needles, acupuncture is thought to release endorphins, the body’s natural pain reliever. By placing needles strategic to the patient’s specific pain condition, acupuncture has shown ever increasing results in contributing to a chronic pain patient’s journey toward pain relief.

Biofeedback: By teaching a patient to control their body’s physiological response, biofeedback uses self-control to deal with stressors on the body. Studies have shown that those with conditions such as migraines, anxiety, insomnia, and some chronic pain disorders benefit greatly from the techniques learned in biofeedback sessions. Patients gain a sense of control as they learn to regulate their response to daily stress and changes.

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