Specific Types Of Chronic Pain
Specific Types Of Chronic Pain
Marc Darrow (Physical Medicine and Rehabilitation, Joint Rehabilitation Sports Medical Center, Inc. ) gives expert video advice on: What are some specific types of chronic pain?; What is "somatic pain"?; How is somatic pain treated? and more...
What are some specific types of chronic pain?
Well, we have several types of chronic pain that we can describe. One is visceral pain, which has to do with the inner organ systems. Another is somatic pain, which has to do more with the musculoskeletal system in the body. So, we're dealing with tendons, ligaments, capsules around the joint, things of that nature. Another can be what we call neuropathic pain. That has to do more with the nervous system and how it can become unregulated, creating a continuing pain cycle, even when there's no noxious stimulus that would normally cause pain present at that time.
What is "somatic pain"?
Somatic pain is pain that deals really with the body as a whole; maybe the muscular, skeletal system would be another term for it. We're dealing with the joints of the body. We're dealing with the tendons that move the joints. We're dealing with ligaments that hold the bones together and the collagen that wraps around the joints; things of that nature. We're dealing with the collagen, the bones, and the muscles.
How is somatic pain treated?
Due to the fact that somatic pain deals with so many different types of pain, there's no easy way to describe how to treat somatic pain unless we know which specific form of it we're dealing with. If it's a joint pain, we might be dealing with an injection into the joint. We might be dealing with using a cortisone injection which is a steroid injection to dis-inflame the joint. We might be using a trigger point of a local anaesthetic into the area around a joint. We might be using prolotherapy that actually grows more collagen, or cartilage, inside of a joint. If it's a tendon, the same type of things can be used. There can be acupuncture that can be used. For somatic pain, it can be great to use physical therapy, which is either active; moving the body, strengthening, doing more range of motion, or doing passive modalities; things like ultrasound, electrical stimulation, things of that nature.
What is "visceral pain"?
Visceral pain is pain that comes from the organs inside the body, the viscera of the body. It can be just about anything you can conceive of that goes on inside the body. Things like cancer cause visceral pain. Cancers grow and become space occupying lesions that put pressure on the organs and they can also metastasise. Cancers can metastasise outside of the organ systems through the blood and to other areas, or by just pushing through the body, and we can end up having things like bone pain coming from visceral pain. We can have abdominal pain from the GI system; from the stomach, let's say, and you could have disastrous abdominal pain due to things like spasms in the stomach. They can be very non-specific things that are very difficult to treat.
What is "bone pain"?
Bone pain is very bad pain. Unfortunately it is typically a pain that comes from a cancer that's metastasized the bones. When the cancer gets in the bone, which can be locally, it can be what we call a primary tumor of bone, where it starts in the bone. It starts to expand within the bone and that's extremely painful. And cancer can also actually start to eat the bone away. It's "lytic" in nature, meaning the cells of the cancer will chew up the bone, and cause extreme pain from that.
What is "osteoporosis"?
Osteoporosis is a disease of bone. It's a disease of actually losing bone. Osteoporosis takes place from not building up enough bone when we were young. Bone mass will often peak out at around the age of 27 or 28, and then start to diminish after that period. The reason for the bone growth is because our hormones are high in our youth, and then as we hit our thirties and later, the hormones (things like testosterone, oestrogen, and progesterone) start to diminish in the body, and we start to actually lose bone.
What is "osteomyelitis"?
Osteomyelitis is really a combination of a few words. One is “osteo” which means bone and “itis” which means inflammation. The term strictly though refers to more of a infection in the bone. Now in the bone we have what are called diversing canals which are little caverns through the bones and we have trabeculli which are little openings in the bones and when bacteria gets into these and infect the bone it's very difficult to get rid of them. We often have to use IV antibiotics. Often times with osteomyelitis a person will lose the infection at least in terms of the white count in the blood going down so it looks like the infection is gone and then maybe five years later it will reappear. It's just very difficult to remove infection from bone.
What is "arthritis"?
Arthritis is a word that comes from a couple of words. One is "arthro," meaning "joint", and the other is "itis," meaning "inflammation." Arthritis, meaning "inflammation of a joint," refers to the destruction of the joint, which can be from an erosive type of arthritis like rheumatoid arthritis, psoriatic arthritis, and things of that nature. Or, it can be like osteoarthritis, which is just a breakdown of the joint. Osteoarthritis can be the cartilage being worn out, or it can be from an injury that affects the cartilage or the joint and creates instability in that joint.
How can bone pain be treated?
Bone pain is often treated with anti-inflammatory medication, which seems very simple because we don't think of anti-inflammatories as one of the big guns in medicine. Many years ago, people that had bone pain were often treated with narcotics and other things of that nature, which were called the big guns of analgesics. Since then there have been studies that have shown that anti-inflammatories often do an even better job of reducing the inflammation of whatever it is that's causing the bone pain.
What are "muscle spasms"?
Muscle spasms are actually involuntary contractions of muscles. What doctors often will do, is they will treat the muscle spasm, whereas in my practice I'll treat more of what we call the emphasis of where the muscle will attach to bone. The reason for that is I find that if we get to the actual emphasis of the muscle attachment and we treat that, the muscle spasm will go away. Now, if someone has an acute muscle spasm, it may be a good idea to use a muscle relaxant for them, or they may want to get a trigger point injection or a tender point injection into the area where there is a spasm. This can often just reduce it, and it can often eliminate the muscle spasm in a minute or so.
How are muscle spasms treated?
If a doctor can actually feel a muscle spasm (what we call palpation, by touching) we can inject into the area. We can use a dry needle, like an acupuncture needle, and just stimulate the area, which often will reduce the muscle spasm. We can inject fluid into the area where there is muscle spasm. We can use a local anaesthetic. We can actually use saline; that will help. Sometimes I will pepper saline around an entire muscle area, and that will reduce the spasm. We can inject into the area of muscle spasm with a steroid injection, which is an anti-inflammatory with a little local anaesthetic mixed in with it. You can use electrostimulation to help get rid of the muscle spasm, to get rid of the pain. You can also use cold therapy for the pain, and sometimes you can use heat therapy for it. Chiropractic treatment works very well for muscle spasm. There is just an endless array of tools that can be used in medicine for muscle spasms.
What is "peripheral neuropathy"?
Peripheral neuropathy is a syndrome in which there is an actual injury of some sort to the peripheral nervous system. The peripheral nervous system refers to the nerves that are outside of the central nervous system (which is comprised of the spinal cord and the brain). The nerves in the peripheral nervous system are those that are coming down the arms into the hands, down the legs into the feet, or are wrapped around from the spine into different nerve route distributions.
What are some causes of peripheral neuropathy or nerve pain?
The highest incidence we find of peripheral neuropathy is from diabetes and alcohol abuse. There are also other reasons. HIV often has a peripheral neuropathy that comes with it, and another cause of peripheral neuropathy may just be a nutritional deficiency, for example a deficiency of B12.
What is "sciatica"?
Sciatica is a syndrome of inflammation of a nerve. When we have a compression or an irritation of a nerve root in the lumbar sacrum spine, which is the lower spine, then where those nerves come out of the vertebrae, there may be an impingement in this plexus (complex of nerves). By impinging on a nerve in the back, a person can feel pain or numbness, or what we call a paraesthesia, which is an unusual sensation all the way and down the back of the leg, the side of the leg, and down into the foot.
What are the symptoms of nerve pain?
Nerve pain can be experienced in many different ways. It can be an aching pain, a dull pain, a sharp lancinating pain, or it can be a tingling pain. Nerve pain can be experienced in just so many ways. Nerve pain can also be experienced as just a numbness.
How is nerve pain treated?
Nerve pain is treated in many different ways like all pain is. When we can't get to the source of what is creating nerve pain, we often will use anti-seizure medication and anti-depressant medication, which you would think doesn't apply to what that medication was made for. They'll be used for off-label purposes that they weren't generally manufactured for.
What is "circulatory pain"?
The term for circulatory pain is usually claudication, which means that there is ischemia at a certain area of the body. Ischemia just means a lack of oxygen. Oxygen is what gives us the ability to create energy in an area of the body. In a claudication area, or an area where there's ischemia, the circulation is not good because there may be atherosclerosis, or hardening of the arteries, or blockage to an area which we call peripheral vascular disease. We'll find that often in the case of someone who's walking and their legs start aching. That's what we call peripheral vascular disease claudication pain.
What causes poor circulation?
There are many reasons for poor circulation. One can be Vasculitis, meaning inflammation of the blood vessels to the area. There is also a syndrome called Raynaud's syndrome, where the blood vessels in the fingers when it's cold, spasm and none of blood gets through to the area and thus the oxygen can't get to that area. Poor circulation can also be from a block of the blood vessels, from a mobilization or just use.
What causes circulatory pain?
Circulatory pain is usually caused by a lack of oxygen to tissue. When there is circulatory pain, there's usually a blockage or a diminishment of blood going through to an area. When we have poor circulation to an area, we'll often feel pain because not enough blood is getting to that area, and therefore not enough oxygen is getting to the area.