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Acute
Pain
One common type of pain is acute pain, currently defined as
pain lasting less than 3 to 6 months, or pain that is
directly related to tissue damage. This is the kind of pain
that is experienced from a paper cut or needle prick. Other
examples of acute pain include:
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Touching a hot stove
or iron. This pain will cause a fast, immediate, intense
pain with an almost simultaneous withdrawal of the body
part that is being burned. More of an aching pain might
be experience a few seconds after the initial pain and
withdrawal.
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Smashing one’s finger
with a hammer. This pain is similar to that of touching
a hot stove in that there is immediate pain, withdrawal
and then “slower” aching pain.
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Labor pains. The pain
during childbirth is acute and the cause is certainly
identifiable.
The longer pain goes on
the more susceptible it is to other influences and
developing into a chronic pain problem. These influences
include such things as the ongoing pain signal input to the
nervous system even without tissue damage, lack of exercise
(physical deconditioning), a person’s thoughts about the
pain, as well as emotional states such as depression and
anxiety.
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Chronic
Pain
There are at least two different types of chronic pain
problems - chronic pain due to an identifiable pain
generator (e.g. an injury), and chronic pain with no
identifiable pain generator (e.g. the injury has healed).
Chronic pain due to an identifiable pain generator
This type of chronic pain is due to a clearly identifiable
cause. Certain structural spine conditions (for example,
degenerative disc disease, spinal stenosis and
spondylolisthesis) can cause ongoing pain until successfully
treated. These conditions are due to a diagnosable
anatomical problem.
If the pain caused by these types of conditions has not
subsided after a few weeks or months of conservative (nonoperative)
treatments, then spine surgery may usually be considered as
a treatment option.
Chronic pain with no identifiable pain generator
This type of pain
continues beyond the point of tissue healing and there is no
clearly identifiable pain generator that explains the pain.
It is often termed “chronic benign pain”.
It appears that pain can set up a pathway in the nervous
system and, in some cases, this becomes the problem in and
of itself. In chronic pain the nervous system may be sending
a pain signal even though there is no ongoing tissue damage.
The nervous system itself misfires and creates the pain. In
such cases, the pain is the disease rather than a symptom of
an injury.
The term “chronic pain” is generally used to describe pain
that lasts more than three to six months, or beyond the
point of tissue healing. Chronic pain is usually less
directly related to identifiable tissue damage and
structural problems. Examples of chronic pain are: chronic
back pain without a clearly determined cause, failed back
surgery syndrome (continued pain after the surgery has
completed healed), and fibromyalgia.
Chronic pain is influenced by many factors, such as ongoing
pain signal input to the nervous system even without tissue
damage, physical deconditioning due to lack of exercise, a
person’s thoughts about the pain, as well as emotional
states such as depression and anxiety. Chronic pain is much
less well understood than acute pain.
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Neuropathic Pain
Neuropathic pain has only been investigated relatively
recently. In most types of neuropathic pain, all signs of
the original injury are usually gone and the pain that one
feels is unrelated to an observable injury or condition.
With this type of pain, certain nerves continue to send pain
messages to the brain even though there is no ongoing tissue
damage.
Neuropathic pain (also called nerve pain or neuropathy) is
very different from pain caused by an underlying injury.
While it is not completely understood, it is thought that
injury to the sensory or motor nerves in the peripheral
nervous system can potentially cause neuropathy. Neuropathic
pain could be placed in the chronic pain category but it has
a different feel then chronic pain of a musculoskeletal
nature.
Neuropathic pain feels different than musculoskeletal pain
and is often described with the following terms: severe,
sharp, lancinating, lightning-like, stabbing, burning, cold,
and/or ongoing numbness, tingling or weakness. It may be
felt traveling along the nerve path from the spine down to
the arms/hands or legs/feet. It’s important to understand
neuropathic pain because it has very different treatment
options from other types of back pain. For example, opioids
(such as morphine) and NSAIDs (such as ibuprofen, COX-2
inhibitors) are usually not effective in relieving
neuropathic pain. Treatments for neuropathic pain include
certain medications, nerve “block” injections, and a variety
of interventions generally used for chronic pain.
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Axial Pain
This pain can run the gamut from a very sharp to a dull
ache. It may occur all the time, or it may come and go. It
also varies in intensity from very mild to extremely severe.
One patient may report that his/ her lower back is only sore
when having been seated for a long time, or after working in
the garden. Another patient may report severe, debilitating
pain and need assistance to walk or stand, or even to get up
from a sitting position. While one patient is perfectly
straight, the other is bent over and locked in a crooked
posture. The one thing that is common in these conditions is
that the pain is restricted to the lower back area.
This most common type of problem, mechanical back pain,
is completely non-specific with regards to the injured
structure or structures. Generally, the pain gets worse with
certain activities or positions. It is usually relieved by
rest or changing positions. Note, extended bed rest may
aggravate this type of problem.
This condition responds extremely well to conservative
care. At times, spinal manipulation alone is the “miracle”
affording immediate relief. More often, the injury involves
more than just a misalignment of a vertebrae or of your
pelvis. nerves, muscles, tendons, ligaments and skin can all
have an influence on the degree of discomfort. And each of
these may need to be addressed to attain relief.
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Referred Pain
This type of low back pain can vary widely with regards
to severity and quality. It tends to be achy, dull and
migratory (moves around). It tends to come and go and often
varies in intensity. It can result from the identical injury
or problem that causes simple axial back pain and is often
no more serious.
Area of Pain Distribution
Referred pain is usually felt in the low
back area and tends to radiate into the groin, buttock and
upper thigh. The pain often moves around, and rarely
radiates below the knee. This type of low back pain is not
as common as axial low back pain or
radicular pain (sciatica).
Referred pain is analogous to the pain that radiates down
the left arm during a heart attack. It is the result of the
extensive network of interconnecting sensory nerves that
supply many of the tissues of the low back, pelvis and
thigh.
An injury to any of these structures can cause pain to
radiate – or be “referred” - to any of the other structures.
It is important to understand that this type of pain is not
due to “pinched nerves”.
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Radicular Pain
The last type of back pain is known as radicular pain. In
this case, the pain is described as deep and usually
constant. It follows the nerve down the leg and is often
accompanied by numbness or tingling and muscle weakness.
The most common example of this type of problem is the
sciatic pain that radiates along that sciatic nerve – down
the back of the thigh and calf into the foot. This type of
pain is caused by injury to a spinal nerve. Some of the
possible causes of this are a disc protrusion or bulge,
arthritic changes or a narrowing of the opening through
which the nerve exits.
While a few of these cases will require surgery, most
respond to conservative care. Here the care will consist of
multiple therapies, all designed to reduce inflammation,
balance your posture, strengthen supporting structures,
attain normal motion and improve the health of the nerve
that is involved.
In all types of back pain, your health habits play an
important role. For example, there are certain foods that
are high in the fats that cause more inflammation. Limiting
intake of these animal fats and increasing your intake of
the good fats that reduce inflammation may play an important
role in your healing. Smoking is another health concern.
Statistically, smokers are slow healers with respect to back
pain.
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