PAIN MANAGEMENT

Terms & Definitions

Axial Pain: Axial pain, also called mechanical pain, is the most common cause of back pain and may present in a number of different ways (sharp or dull, constant or comes and goes, etc). It is confined to the back or neck and does not travel into an arm or leg. A muscle strain is a common cause of axial pain.

 

Bursitis: Bursitis simply means inflammation of a bursa. It is often, although not always, associated with pain. A bursa is a small sac filled with a small amount of fluid that is found between certain muscles, muscles and tendons, tendons and bone, etc. Its function is to act as a medium to prevent friction between tissues. It helps muscles, tendons, etc. to slide over each other. There are many bursas in the body - particularly in the areas of the shoulders, the elbows, the hips, the knees and the Achilles tendon areas. Inflammation of a bursa sac causes pain.

 

Cancer-Related Pain: Cancer can cause pain in a variety of different ways. If a tumor grows directly into a structure with nerves, this will lead to a sensation of pain. Cancer can invade bones, organs, or even press on nerves. The best way to reduce this type of pain is to treat the cancer directly, by shrinking it or removing it. Until that happens, though, patients will often need pain medications to help them function with their pain.

If cancer presses on a nerve, this can cause a feeling of pain in the area that the nerve came from. Patients can then experience what is called "referred pain". For instance, if a tumor in someone's pelvis presses on a nerve that is traveling up from their foot, they can experience foot pain even though there isn't any cancer in their foot.

Cancer can sometimes block the path of an organ that needs material to flow through it. If cancer obstructs the path of digested food in the gut, then people can experience pain. If a tumor keeps someone from being able to pass urine out of their bladder, this can cause pain. The best way to manage this pain is to remove the tumor, or sometimes (if it is not possible to remove it), your doctors can open up a pathway by "stenting" it open with various devices.

 

Coccyxdynia: Tailbone pain

 

Complex Regional Pain Syndrome Type I and II/Causalgia/ Reflex Sympathetic Dystrophy: Causalgia is also known as complex regional pain syndrome (CRPS) or reflex sympathetic dystrophy which is a chronic pain condition. The key symptom of CRPS is continuous, intense pain out of proportion to the severity of the injury, which gets worse rather than better over time. CRPS most often affects one of the arms, legs, hands, or feet. Often the pain spreads to include the entire arm or leg.

Typical features include dramatic changes in the color and temperature of the skin over the affected limb or body part, accompanied by intense burning pain, skin sensitivity, sweating, and swelling. Doctors aren't sure what causes CRPS. In some cases the sympathetic nervous system plays an important role in sustaining the pain. Another theory is that CRPS is caused by a triggering of the immune response, which leads to the characteristic inflammatory symptoms of redness, warmth, and swelling in the affected area.

 

Myelopathy: A disorder in which the tissue of the spinal cord is diseased or damaged.

 

Myofascial Pain: Myofascial Pain Syndrome (MPS) is a painful musculoskeletal condition, a common cause of musculoskeletal pain. MPS is characterized by the development of Myofascial trigger points that are locally tender when active, and refer pain through specific patterns to other areas of the body. A trigger point or sensitive, painful area in the muscle or the junction of the muscle and fascia develops due to any number of causes. Trigger points are usually associated with a taut band, a ropey thickening of the muscle tissue. Typically a trigger point, when pressed upon, will cause the pain to be felt elsewhere. This is what is considered "referred pain."

 

Nerve Impingement or Radiculopathy: Another word for the nerve root is the "radicular nerve". When a disc herniates or prolapses (pushes out of the vertebra), the disc presses on the radicular nerve which causes pain. The pain often travels down the leg or arm, and this is referred to as a radiculopathy. Sciatica is another name for a radiculopathy in the low back.

 

Neuritis: Pain or tingling from damaged or inflamed peripheral nerves (nerves not located in the brain or spiral cord).

 

Neuropathic/Somatic/Visceral Pain: Neuropathic pain or "Neuralgia" (from the Greek neuro, meaning nerves, and pathy, meaning abnormality) pain that occurs due to injury or disease of the nerve tissue itself. This injury or disease can disrupt the ability of the sensory nerves to transmit correct information to the brain.The brain interprets painful stimuli even though there is no obvious physiologic cause for the pain. Neuropathic pain is often described as shooting, stabbing, burning, or searing.

 

Neuropathy: Neuropathy, strictly speaking, is any disease that affects the nervous system. The most common form is peripheral neuropathy which mainly affects the feet and legs.

 

Piriformis Syndrome: Piriformis syndrome is a condition in which the piriformis muscle irritates the sciatic nerve, causing pain in the buttocks and referring pain along the course of the sciatic nerve. This referred pain, called "sciatica", often goes down the back of the thigh and/or into the lower back. Patients generally complain of pain deep in the buttocks, which is made worse by sitting, climbing stairs, or performing squats.

 

Post Laminectomy Syndrome: About one in three patients who have had a surgical procedure on their spine will experience pain and discomfort, sometimes debilitating, long after the surgery is completed. Post laminectomy syndrome is characterized by pain that occurs or persists after back surgery.

 

Radicular Pain: Radicular pain is often described as deep, radiating through the extremity (arm or leg), and can be accompanied by numbness and tingling or weakness. This type of pain is caused by compression, inflammation and/or injury to a spinal nerve root. Another term for lumbar radicular pain is sciatica and can be caused by such conditions as a herniated disc or spinal stenosis.

 

Referred Pain: Referred pain is often characterized as dull, achy and tends to move around and vary in intensity. For example, pain may radiate from the lower back into the groin, pelvis, buttock and upper thigh. Injury to any of the interconnecting sensory nerves of the lower back can cause this type of pain.

 

Sciatica: Sciatica is a referred pain that runs along the sciatic nerve, a large nerve extending from the lower back and down the back of each leg. Sciatica is a common kind of back pain. Sciatica can be very painful but it rarely causes permanent nerve damage. Most sciatica pain syndromes result from inflammation and will usually get better within a few weeks.

 

Somatic Pain: Pain that originates from ligaments, tendons, bones, blood vessels. The pain is poorly localized and lasts longer than cutaneous pain. Examples: sprained ankle, broken bones.

 

Visceral Pain: Visceral pain originates from body organs. The pain is usually more aching and of a longer duration than somatic pain. Visceral pain is extremely difficult to pinpoint, and several injuries to visceral tissue will exhibit "referred" pain, where the sensation is identified in an area completely unrelated to the site of injury. Myocardial ischemia (the loss of blood flow to a part of the heart muscle tissue) is possibly the best known example of referred pain-- the painful sensation can occur in the upper chest as a restricted feeling, or as an ache in the left shoulder, arm or hand.