Pain Management Miramar [Part 2] will cover the different types of pain patients may experience. As well as the risk factors that contribute to chronic pain and lifestyle changes and suggestions to deal with chronic pain.
As you know, pain management starts with the health practitioner evaluating the patient’s pain complaint(s) to develop a care plan. The practitioner assesses the location to determine what type of pain the patient presents with. Understanding the type of pain is essential because the treatment protocol will be developed based on the patient’s complaint and the physical examination.
Furthermore, once the pain source is determined then, the patient and practitioner can discuss a plan on how to diminish and control the pain symptoms. Pain management does not promise to get rid of all the pain but to reduce it so the patient can return to their activities of daily living. In addition, pain reduction will improve the patient’s quality of life.
So, I have been talking about types of pain, but which are the most common types of pain? The most common types are Nociceptive, Neuropathic, Radicular, Acute, and Chronic.
First, what is Nociceptive pain?
Let me start by talking about what a nociceptor is. A nociceptor (“pain receptor”) is a sensor at the end of pain nerve fibers. They are known to exist in muscles, joints, and skin. These sensors are essential to avoid injury. When a nociceptor senses tissue damage from excess pressure, extreme heat/cold, cutting/tearing forces, etc., it signals the spinal cord and brain. So, nociceptors respond to specific temperature ranges and mechanical stimuli.
Therefore, once the nociceptors sense and respond to a damaged body part, the patient experiences nociceptive pain. Patients often describe nociceptive pain as a sharp, achy, or throbbing pain. For example, you may feel nociceptive pain if you hit your elbow, stub your toe, twist your ankle, fall and scrape up your knee, or burn yourself.
Second, what is Neuropathic pain?
Neuropathic pain happens when there is damage to the nerves or other parts of the nervous system. Often the cause of Neuropathic pain is unknown. It usually stems from disease processes that alter the nerve’s function, causing the nerves to misfire. Patients often describe it as shooting, stabbing, burning, or tingling pain.
Neuropathic pain is one of the most common types of chronic pain. However, it may also come and go (intermittent). Sometimes it can be so severe that it makes performing daily tasks difficult. Furthermore, because the pain can interfere with normal movement, it can also lead to mobility issues.
Some known causes of Neuropathic pain are due to:
- Spine surgery
- Amputations ( phantom limb pain, where the nerves continue to fire even though the limb is missing telling the brain something is wrong)
- Diabetes
- Multiple sclerosis
- Shingles
- HIV
- Facial nerve problems like Bell’s Palsy
- Trauma
- Cancer
Third, what is Radicular pain?
Radicular pain happens when something in the body pushes or pulls on the nerve structure. Therefore, the spinal nerve gets compressed and/or inflamed. Patients with radicular pain may experience tingling, numbness, and muscle weakness.
The most common example of radicular pain is sciatic nerve pain (sciatica) coming from the lumbar region in the spine. The pain starts in the low back. However, the pain may spread along the nerve track and go down the back of the leg. Radiculopathy is when the pain radiates from the back and into the leg. Patients usually complain that this pain is steady and feels deep in the lower extremity. Prolonged sitting, standing, walking, and other activities can worsen sciatic pain.
So, you may wonder, what is the difference between Radicular and Neuropathic pain?
Radicular pain is an injury to the nerve from a physical pressure such as pulling or compression. Neuropathic pain can be caused by a systemic health problem(s) that alter the functioning of the nerve. Or even the misfiring of nerve fiber from an old injury that no longer exists (phantom limb pain).
Now, let’s talk about Acute and Chronic pain. What is Acute Pain?
Acute pain is usually caused by tissue damage such as burns, cuts, broken bones, surgery, or a temporary illness. It comes on suddenly and is often described as sharp. Acute pain is short in duration. It usually lasts from days to three months (sometimes six months). Acute pain typically subsides after the illness subsides, or the injury heals. However, there are times that acute pain may evolve into chronic pain if the injury doesn’t heal correctly or if the pain signals malfunction.
So, what is Chronic pain?
Chronic pain lingers long after the area has recovered from the injury, sometimes without apparent cause. Chronic pain can last 6 months or longer and sometimes for a lifetime. It tends to get worse the longer it is present.
Chronic pain is often due to a health condition, like arthritis, fibromyalgia, or a spine condition. Chronic pain negatively affects these patients’ psychological health and functional abilities. Often patients with chronic pain experience muscle tension, decreased mobility, decreased energy, changes in appetite, depression, anger, anxiety, and fear of re-injury. These things affect one’s ability to perform daily activities, work duties and enjoy leisure activities.
So, how does pain management work for all these types of pain?
Usually, pain management for acute pain is often managed by medication or with modalities, such as cold packs, electrical stimulators, etc. There are different pain medications, such as anti-inflammatories, muscle relaxants, and opioids. One concern is that all of these medications have side effects. Another concern is chronic addiction. Prolonged use of many pain meds can also cause liver damage, addiction/overdose, possible mood changes, confusion, and respiratory issues.
As the pain becomes longer and more persistent, other healthcare practitioners (such as surgeons, physical therapists, acupuncturists, etc.) become part of the pain management program. The team’s goal is to decrease pain and improve the patient’s function using different therapies.
So what are the risk factors that can increase the risk of having chronic pain?
Obesity. Increased body weight puts undue stress on a person’s joints and cardiovascular systems. It is said that 1 lb. of body fat places 10 lbs. per square inch on the lumbar spine and 5 lbs. per square inch on the hips and knees. This is a considerable risk factor for people who suffer from arthritis.
Previous injuries/ surgeries. People with prior injuries and surgeries are at higher risk of chronic pain in the future. The brain sometimes is hyperactive with the inflammatory response due to trauma. Therefore, the body continues to think that it is injured.
Age. Older adults are at a higher risk of experiencing chronic pain due to arthritis, neuropathy, and deteriorating health issues.
Smoking. Smoking has been shown to delay or prevent healing.
Tobacco impairs the delivery of oxygen-rich blood to your bones and tissues. Decreasing blood and nutrient flow can cause degeneration, particularly in discs of the spine, which already have more limited blood flow. Healthcare practitioners also link smoking with fatigue. Fatigue and slower healing are factors that make painful conditions more prominent.
So, what lifestyle changes can help with chronic pain and be part of the pain management program?
Reduce stress levels. Stress leads to increased muscle tension and cortisol levels. Acupuncture, relaxation therapy, mediation, mindfulness, etc., can help reduce stress.
Get more exercise. Exercise helps maintain an appropriate weight, decrease stress hormones, stabilize joints, and improve active range of motion.
Have a healthy diet. Eating healthy foods can improve your overall immune system. Also, avoiding foods with a high glycemic index, such as processed foods, can help reduce inflammation.
Get adequate sleep. When you sleep, this is the time your body helps heal itself. Poor sleep often instigates weight gain, increases cortisol level, irritability/stress, blood pressure, etc.
What complementary medicine practices/ therapies are used to help with chronic pain?
Acupuncture. This form of Alternative Medicine has been shown to be able to help change the pain pathways. Furthermore, increase blood flow and decrease muscle tension to help reduce a patient’s pain levels.
Cognitive Behavioral Therapy. Counseling helps patients deal with the pain differently and give the patient coping strategies to deal with the pain.
Physical therapy. Physical therapy focuses on strengthening, stretching, and providing stability to the structure involved. For example, specific exercises after having a knee replacement. Also, core strengthening exercises for back pain and education to avoid movements that may worsen the pain.
Occupational therapy. Occupational therapy teaches people how to perform everyday tasks using proper body mechanics to decrease stress on their bodies. Other techniques include joint protection techniques, ergonomics, work simplification, and energy conservation techniques. These techniques improve the person’s ability to complete everyday tasks.
To summarize this Pain Management Miramar [Part 2] blog post, the root cause of the pain is essential to develop a care plan. A physical examination and the patient’s complaints will help the practitioner determine the type of pain that needs to be addressed. Furthermore, lifestyle changes and conventional and alternative treatments can help the patients decrease their pain and improve their quality of life.
