Pain Management (cont.)
What are the basic types of pain?
There are many sources of pain. One way of dividing these sources of pain is
to divide them into two groups, nociceptive pain and neuropathic pain. How pain
is treated depends in large part upon what type of pain it is.
Nociceptive pain
The body's nervous system is working properly. There is a
source of pain, such as a cut, a broken bone or a problem with the spine. The
body's system of telling the brain that there is an injury starts working. This information is
passed on to the brain and one becomes aware that they are hurting.
Neuropathic pain
The body's nervous system is not working properly. There is no obvious source
of pain, but the body nonetheless tells the brain that injury is present.
What are types of nociceptive pain?
Most back, leg, and arm pain is nociceptive pain. Nociceptive pain can be
divided into two parts, radicular or somatic.
Radicular pain: Radicular pain
is pain that stems from irritation of the nerve roots, for example, from a disc
herniation. It goes down the leg in the
distribution of the nerve that exits from the nerve root at the spinal cord.
Associated with radicular pain is radiculopathy, which is weakness, numbness,
tingling or loss of reflexes in the distribution of the nerve.
Somatic pain: Somatic pain is pain limited to the back or thighs. The problem
that doctors and patients face with
back pain, is that
after a patient goes to the doctor and has an appropriate history taken, a
physical exam performed, and appropriate imaging studies (for example, X-rays,
MRIs or CT scans), the doctor can only make an exact diagnosis a minority of the
time. Research has shown that most back pain that does not go away after
conservative treatment usually comes from one of three structures in the back:
the facet joints, the discs, or the sacroiliac joint. The facet joints are small joints in the back of the spine
that provide stability and limit how far you can bend back or twist. The discs
are the "shock absorbers" that are located between each of the bony building
blocks (vertebrae) of the spine. The sacroiliac joint is a joint at the buttock
area that serves in normal walking and helps to transfer weight from the upper
body onto the legs.
Fluoroscopically (x-ray) guided injections can help to determine where pain
is coming from. Once the pain has been accurately diagnosed, it can be optimally
treated.
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