One of the core values of our philosophy at Carolinas Pain Center is that patient empowerment comes from understanding experiences, developing critical perspectives on each issue, and then planning a methodical approach to take action. An important part of understanding any experience with pain and developing a critical perspective is to learn more about chronic pain—its various types and causes. To that end we’ve put together a collection of useful information about some of the most common causes of pain that we treat on a daily basis.
What is Chronic Pain?
Acute pain is a normal sensation triggered in the nervous system to alert you to possible injury and the need to take care of yourself. Chronic pain is different. Chronic pain persists. Pain signals keep firing in the nervous system for weeks, months, even years. Chronic pain can be initiated by single event such as sprained back or there may be an ongoing cause of pain like arthritis, cancer or ear infection.
The most common type of headache is a tension headache. Tension headaches are due to tight muscles in your shoulders, neck, scalp and jaw. They are often related to stress, depression, anxiety, lock of sleep, missed meals or use of alcohol. Other common types of headaches include migraines, cluster headaches and sinus headaches. Most people can feel much better by making lifestyle changes, learning ways to relax and taking pain relievers. A migraine headache can cause intense throbbing or pulsing in one area of the head and is commonly accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Migraine attacks can cause significant pain for hours to days and be so severe that all you can think about is finding a dark, quiet place to lie down.
Not everyone with cancer experiences cancer pain, but one of out three people undergoing cancer treatment does. If you have advanced cancer, your chance of experiencing cancer pain is even higher. Cancer pain occurs in many ways. Your pain may be dull, aching or sharp. It could be constant, intermittent, mild, moderate or severe. It can result from the cancer itself or from cancer growing into or destroying tissue near the cancer itself. As a tumor grows, it may put pressure on nerves, bones or organs, causing pain. Most acute (short-term) pain is caused by treatment or diagnostic procedures, though radiotherapy and chemotherapy may produce painful conditions that persist long after treatment has ended. Cancer pain can diminish the quality of life by adversely affecting mood, sleep, social relations and activities of daily living.
Arthritis is a complex family of musculoskeletal disorders consisting of more than 100 different diseases or conditions that destroy joints, bones, muscles, cartilage and other connective tissues, negatively effecting physical movement.
The three most common diseases that make up arthritis are osteoarthritis, rheumatoid arthritis and juvenile arthritis.
- Osteoarthritis (OA) is the most common form of arthritis. It is a progressive degenerative joint disease characterized by the breakdown of joint cartilage. It is associated with risk factors, such as obesity, history of joint injury and age. Cartilage is the part of the joint that cushions the ends of the bones and allows easy movement of joints. The breakdown of this cartilage causes the bones to rub against each other, causing stiffness, pain and loss of movement in the joint. For example, you can see this breakdown in the 4 phases of knee pain.
- Rheumatoid Arthritis (RA) is a systemic disease characterized by the inflammation of the membranes lining the joint. Rheumatoid arthritis is not only a form of inflammatory arthritis but also an autoimmune disease. The immune system normally protects our health by attacking foreign cells such as viruses and bacteria. Here it attacks the body’s own tissues, specifically the thin membrane that lines the joints. As a result, fluid builds up in the joints, causing pain and inflammation throughout the body. This causes not only pain but also stiffness, warmth, swelling and sometimes severe joint damage.
- Juvenile Arthritis (JA) is a term used to describe the autoimmune and inflammatory conditions that can develop in children ages 16 and younger. It can involve the eyes, skin and gastrointestinal tract as well.
Another type of chronic pain. Nerve pain is caused by pressure on nerves or the spinal cord, or by damage to nerves. It is also called neuropathic pain. People often describe nerve pain as burning, shooting, tingling, or as a feeling of something crawling under their skin. It can sometimes be more difficult to treat than other types of pain.
Diabetic Peripheral Neuropathy
Diabetic Peripheral Neuropathy is a form of chronic pain where nerve damage in the hands and/or feet. It is one of the most common complications that can occur if you have diabetes. High blood sugar can injure nerve fibers throughout your body, but diabetic neuropathy most often damages nerves in your legs and feet. Depending on the affected nerves, symptoms can range from pain and numbness in the extremities to problems with the digestive system, urinary tract, blood vessels and heart. For some people, these symptoms are mild. For others, diabetic neuropathy can be painful, disabling and even fatal.
Fibromyalgia is a medically unexplained syndrome characterized by chronic widespread pain and a heightened and painful response to pressure. Difficulty with swallowing, bowel and bladder abnormalities, numbness, tingling and cognitive dysfunction are common symptoms. Symptoms of fibromyalgia can vary in intensity. Fatigue, sleep disturbances, cognitive difficulties, and joint stiffness are the most prevalent symptoms reported. Additional common symptoms may include depression, anxiety, migraines, tension headaches, pelvic pain, irritable or overactive bladder, irritable bowel syndrome (IBS), temporo-mandibular joint disease (TMJD), and gastrointestinal reflux disease (GERD). There is no cure for fibromyalgia. Multi-disciplinary approaches for relief of symptoms are recommended including medications, cognitive behavioral therapies, and gentle exercise.
Complex regional pain syndrome
Complex regional pain syndrome (CRPS) is a type of chronic pain condition most often affecting one of the limbs (arms, legs, hands, or feet). It usually occurs after an injury or trauma to that limb, and is believed to be caused by damage to the peripheral and central nervous systems. CRPS is characterized by prolonged or excessive pain and changes in skin color, temperature, and swelling in the affected area. These symptoms vary in severity and duration. Most cases are mild and individuals recover gradually with time. In more severe cases, individuals may not recover and may have long-term disability. The pain may feel like a burning, “pins and needles” sensation, or as if someone is squeezing the affected limb. The pain may spread to include the entire arm or leg, even though the precipitating injury might have been only to a finger or toe. Pain can sometimes even travel to the opposite extremity. There is often increased sensitivity in the affected area, such that even light touch or contact is painful. Other common features of CRPS include changes in skin texture, nail and hair growth patterns, abnormal sweating pattern, stiffness in affected joints, decreased ability to move the affected body part, fixed abnormal posture, and tremors in or jerking of the affected limb.
Dorsal Column Spinal Cord Stimulation
Dorsal Column Spinal cord stimulation (DCS) is a technique used in the management of certain chronic pain syndromes such as failed-back surgery syndrome (FBSS), complex regional pain syndrome (CRPS) and diabetic peripheral neuropathy. It can also be used for refractory angina pectoris and peripheral vascular disease. A device placed under your skin is used to send a mild electric current to your spinal cord. A small wire carries the current from a pulse generator to the nerve fibers of the spinal cord. When turned on, the stimulation feels like a mild tingling in the area where pain is felt. Stimulation does not eliminate the source of pain. Your pain is reduced because the electrical current interrupts the pain signal from reaching your brain. The amount of pain relief varies for each person. Some patients may find the tingling sensation unpleasant. For these reasons a trial stimulation is performed before the device is permanently implanted. Stimulation does not work for everyone. If unsuccessful, the implant can be safely removed.
Kyphoplasty is a minimally invasive procedure for patients immobilized by the painful vertebrae compression fracture. Vertebral body fractures lead to the collapse or compression of a vertebra, causing the spine to shorten and curve. This can result in pain and a kyphotic (hunched-over) deformity. Osteoporosis is the main cause of vertebral compression fractures. Another cause is a pathologic fracture related to spinal. Kyphoplasty is performed under mild sedation anesthesia. Using flouroscopic guidance, two small incisions are made and a probe is placed into the vertebral space where the fracture is located. A specially designed balloon is inserted, inflated with contrast medium until they expand to the desired height and removed. The spaces created by the balloons are then filled with cement, binding the fracture. The cement hardens quickly, providing strength and stability to the vertebra, restoring height and relieving pain.
Addiction is a primary, chronic, neurobiologic disease, with genetic, psychosocial, and environmental factors influencing its development and manifestations. Fear of addiction is one of the factors that limits opioid prescribing. Addiction is the traditional term used to identify the irresistible craving for, loss of control over use of, compulsive use of, and continued use despite harm of certain types of drugs. Drugs capable of producing addiction do so by interacting with the biochemistry of the brain in such a way that the drug begins to seem essential—one feels a “need” for it as one does for food and water.