Pain management: evaluation & treatment

For any part of our anatomy to be in pain, it must be: an area susceptible to injury exposed to pain-causing stimuli and connected to a nerve supply. Through the intricate network in the nervous system, pain tells our brain that there is injury. Sometimes the cause of this injury is obvious to plain sight, sometimes it is not. Either way, pain is the tool that allows us to detect that something, somewhere, is wrong. In congruence with this, and once the pained area has been identified, determining the true root cause of pain best serves the goal to manage it.

There are two basic types of pain: When the nervous system is working properly, NOCICEPTIVE PAIN is experienced when there is an obvious/visible injury to the body. There are two categories under nociceptive pain and these are the radicular and somatic, where radicular pain stems from irritation of the nerve roots. Pain shoots through the nerves from the spinal cord to the body part making this feel weak, numb, or tingly.

Somatic pain is pain limited to the back or thighs. Despite a complete battery of tests to determine the cause of back pain, diagnoses are most often vague. Research shows that most long-lasting back pain issues comes either from: the facet joints, which are the joints in the back of the spine; the discs, which are between the vertebrae; and/or the sacroiliac joint which is in the buttocks area. There are many different types of nociceptive pain:

1. Headaches and facial pain including atypical facial pain and trigeminal neuralgia.

2. Peripheral nerve pain, or neuropathy and similar nerve entrapments

3. Coccydynia is pain in the region on the tailbone, or coccyx.

4. Compression fractures of the vertebrae especially in the elderly due to lack of calcium.

5. Post-Herpetic Neuralgia (PHN) as an effect of the virus that remains in a dormant state in our spinal cord after contracting chickenpox.

6. Myofasciitis (back/neck muscle pain) and Torticollis (neck spasms)

7. Piriformis syndrome is a spasm of the piriformis muscle causing it to squeeze on the sciatic nerve.

8. Plantar fasciitis (heel pain) and lateral epicondylitis (tennis elbow)

9. Cancer pain which can arise from the cancer itself, compression of a nerve or other body part, fractures or treatment of the cancer.

In some cases though, the nervous system is NOT working properly. Here, NEUROPATHIC PAIN is experienced when there is no obvious source of pain but the body nonetheless tells the brain that an injury is present.

Whatever the case may be it is of vital importance that the cause of pain be determined in order to appropriately select its best treatment. No matter how big or small any pain may be at any time, pain is the most natural way by which our bodies communicate to us that there is a persisting problem that needs to be addressed, sometimes more immediately than others. Significant or not, pain should always be treated as pain greatly affects an individual’s everyday life.