What is Pain Management?

  • Pain management can be simple or complex, depending on the cause of the pain.
  • Customized on a per patient basis
  • Includes therapeutic and diagnostic procedures

An example of pain that is typically less complex would be nerve root irritation from a herniated disc with pain radiating down the leg. This condition can often be alleviated with an epidural steroid.

What are the basic types of pain?

There are many sources of pain. One way of dividing these sources of pain is to divide them into two groups, nociceptive pain and neuropathic pain. How pain is treated depends in large part upon what type of pain it is.

Examples of nociceptive pain are a cut or a broken bone. Tissue damage or injury initiates signals that are transferred through peripheral nerves to the brain via the spinal cord. Pain signals are modulated throughout the pathways. This is how we become aware that something is hurting.

Neuropathic pain

Neuropathic pain is pain caused by damage or disease that affects the nervous system. Sometimes there is no obvious source of pain, and this pain can occur spontaneously. Classic examples of this pain are shingles and diabetic peripheral neuropathy. It is pain that can occur after nerves are cut or after a stroke.

What are types of Neuropathic pain?

Neuropathic pain includes:

  • Complex regional pain syndrome (CRPS), also called reflex sympathetic dystrophy;
  • Sympathetically maintained pain;
  • Fibromyalgia;
  • Interstitial cystitis; and
  • Irritable bowel syndrome

Treatment of Neuropathic pain

The various neuropathic pains can be difficult to treat. However, with careful diagnosis and often a combination of methods of treatments, there is an excellent chance of improving the pain and return of function

Medications are a mainstay of treatment of neuropathic pain. In general, they work by influencing how pain information is handled by the body. Most pain information is filtered out by the central nervous system, usually at the level of the spinal cord. For example, if you are sitting in a chair, your peripheral nerves send the response to the pressure between your body and the chair to your nervous system.

However, because that information serves no usual purpose, it is filtered out in the spinal cord. Many medications to treat neuropathic pain operate on this filtering process. The types injection and physical therapy. Sometimes, however, the pain does not go away. This can require a wide variety of skills and techniques to treat the pain. These skills and techniques include:

  • Interventional procedures
  • Medication management
  • Physical therapy or chiropractic therapy
  • Psychological counseling and support
  • Acupuncture and other alternative therapies; and
  • Referral to other medical specialists

All of these skills and services are necessary because pain can involve many aspects of a person’s daily life.

How is pain treatment guided?

The treatment of pain is guided by the history of the pain, its intensity, duration, aggravating and relieving conditions, and structures involved in causing the pain. In order for a structure to cause pain, it must have a nerve supply, be susceptible to injury, and stimulation of the structure should cause pain. The concept behind most interventional procedures for treating pain is that there is a specific structure in the body with nerves of sensation that is generating the pain. Pain management has a role in identifying the precise source of the problem and isolating the optimal treatment.

Fluoroscopy is an X-ray guided viewing method. Fluoroscopy is often used to assist the doctor in precisely locating the injection so that the medication reaches the appropriate spot and only the appropriate spot. Ultrasound is also used to identify structures and guide injections.

What are types of nociceptive pain?

Most back, leg, and arm pain is nociceptive pain. Nociceptive pain can be divided into two parts, radicular or somatic.

Radicular pain: Radicular pain is pain that stems from irritation of the nerve roots, for example, from a disc herniation. It goes down the leg or arm in the distribution of the nerve that exits from the nerve root at the spinal cord. Associated with radicular pain is radiculopathy, which is weakness, numbness, tingling or loss of reflexes in the distribution of the nerve.

Somatic pain: Somatic pain is pain limited to the back or thighs. The problem that doctors and patients face with back pain, is that after a patient goes to the doctor and has an appropriate history taken, a physical exam performed, and appropriate imaging studies (for example, X-rays, MRIs or CT scans), the doctor can only make an exact diagnosis a minority of the time. The cause of most back pain is not identified and is classifies as idiopathic. Three structures in the back which frequently cause back pain are the facet joints, the discs, and the sacroiliac joint. The facet joints are small joints in the back of the spine that provide stability and limit how far you can bend back or twist. The discs are the “shock absorbers” that are located between each of the bony building blocks (vertebrae) of the spine. The sacroiliac joint is a joint at the buttock area that serves in normal walking and helps to transfer weight from the upper body onto the legs.

Fluoroscopically (x-ray) guided injections can help to determine from where pain is coming. Once the pain has been accurately diagnosed, it can be optimally treated.

What are other causes of pain?

Other causes of pain include:

  • headaches,
  • facial pain,
  • peripheral nerve pain,
  • coccydynia,
  • compression fractures,
  • post-herpetic neuralgia,
  • myofasciitis,
  • torticollis,
  • piriformis syndrome,
  • plantar fasciitis,
  • lateral epicondylitis, and
  • cancer pain.

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