Pain Management - Causes

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What are other causes of pain?

Other causes of pain include:

  • headaches,
  • facial pain,
  • peripheral nerve pain,
  • coccydynia,
  • compression fractures,
  • post-herpetic neuralgia,
  • myofasciitis,
  • torticollis,
  • piriformis syndrome,
  • plantar fasciitis,
  • lateral epicondylitis, and
  • cancer pain .

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

Headaches are a major source of discomfort and lost productivity in the workplace. Many effective treatments exist for persisting headaches, including medication, biofeedback, injections and implants, depending upon the precise type of headache. Botox also provides a useful means of effectively and safely treating headaches.

Atypical facial pain can be debilitating. Often times it can be treated by injections into local nerve tissue (such as the sphenopalatine ganglion).

Trigeminal neuralgia, also called tic douloureux, is a condition that most commonly causes very intense intermittent shooting pain in the face.

Peripheral nerve pain

Peripheral nerve pain, or neuropathy, can be debilitating. It can respond well to simple treatments such a trigger point injections with anesthetic medicines and cryoablation (an office based procedure which involves freezing the nerves). Examples of peripheral nerve pain include intercostal neuralgia, ilioinguinal neuroma, hypogastric neuroma, lateral femoral cutaneous nerve entrapment, interdigital neuroma and related nerve entrapments.

Coccydynia

Coccydynia is simply pain in the region on the tailbone, or coccyx. It can result from trauma or arise without apparent cause. The initial treatment is conservative, with oral pain relief medicines (analgesics). Oftentimes, the pain originates in the portion of the nervous system that we have no control of (involuntary or autonomic nervous system) and can respond to either a local anesthetic injection of the head of a nerve called Ganglion Impar, which is located below the coccyx or by medically destroying (ablating) the Ganglion Impar, usually using radiofrequency.

Compression fractures

Compression fractures of the bony building blocks (vertebral bodies) are common in the elderly as a result of osteoporosis, or loss of calcium in the bone. With less calcium, the bone becomes weak and can break. Like any fracture, compression fractures hurt. Like any fracture, they are treated by stabilization, in this case, by injecting cement into the bone in a procedure known as a vertebroplasty or kyphoplasty. Vertebroplasty is an effective way to treat the pain of compression fractures. Kyphoplasty uses a balloon to restore height to the compressed vertebral body.

Post-herpetic neuralgia

Post herpetic neuralgia (PHN) is a painful condition occurring after a bout of shingles. When we are young, we are almost all exposed to chickenpox, caused by the Herpes Zoster virus. Our immune system controls the virus, but it lives in a dormant state in the spinal cord. When we age, or become ill or stressed, the virus can reactivate and attack the infected nerve and adjacent skin. However, in this second attack, the body usually recognizes the Herpes Zoster virus and contains the pain to a localized area, along the course of one nerve. A patient may have the characteristic blisters, which normally heal. Sometimes, however, the Herpes Zoster virus damages the nerve, causing ongoing nerve pain that persists after the skin blisters from the shingles have healed.

The ideal way to treat the post herpetic neuralgia is to treat it before it sets in. Medications, such as acyclovir (Zovirax), steroids and injections such as sympathetic injections can help prevent the onset of PHN. After the pain is present, injections, local anesthetics, medications [duloxetine (Cymbalta), amitriptyline, (Elavil, Endep)] and pain medications or topical patches can be useful.

Myofasciitis and Torticollis

Myofasciitis (pain in the muscles, whether in the neck or back) often responds to conservative physical therapy treatments (for example, massage and exercise). If the pain persists, trigger point injections can be used. If the trigger point injections provide temporary relief, sometimes Botox injections can help. Botox, which is botulinum toxin, can relax the muscles for six or more months, with long-term relief of pain. It provides a safe, effective treatment for what can otherwise be a difficult, ongoing problem.

Torticollis is spasm of the muscles in the neck, forcing the sufferer to hold his or her neck tilted or rotated to the side. Botox is approved for treatment of this problem.

Piriformis Syndrome

The piriformis muscle goes from the hip to sacrum (tailbone). It is important in that the sciatic nerve passes through it. Piriformis syndrome is a spasm of the piriformis muscle. When the muscle goes into spasm, it can squeeze the sciatic nerve, causing pain going down the leg. Piriformis syndrome will usually respond to physical therapy. When pain persists, local anesthetic and/or steroid injection can help. If the pain persists, injecting Botox or Myobloc, which are both botulinum toxins, into the muscle can provide effective, safe treatment.

Plantar fasciitis and lateral epicondylitis

Plantar fasciitis (heel pain) and lateral epicondylitis (tennis elbow) are two common pain problems. Treatment starts with conservative options, such as rest, non-steroidal anti-inflammatory medications, steroid injections, over-the counter pain medications, physical therapy and, for heel pain, shoe inserts.

If the pain lasts for more than six months, Extracorporeal Shockwave Treatment is an effective, FDA approved treatment. Extracorporeal shockwave treatment is not recommended for pregnant women, children, anyone with a pacemaker, anyone on anti-coagulant therapy or anyone with a history of bleeding problems.

Cancer pain

Cancer pain can arise from many different causes, including the cancer itself, compression of a nerve or other body part, fractures or treatment of the cancer. There are many techniques to assist with treating the various pains from cancer, including medications and injections. In particular, medical destruction of nerve tissue (ablative therapies) and the use of pumps surgically placed into the body to deliver pain medication into the subarachnoid space can be used. Pain pumps deliver medication that is targeted to pain receptors on the spinal cord. The advantage to the cancer patient is chronic pain control with decreased side effects.

Return to Pain Management

See what others are saying

Comment from: Midgedoll, 45-54 Female (Patient) Published: October 18

I acquired my back pain 6 years ago, and it has been a painful and trying time. On vacation to visit relatives, I got hit on my back. I arrived back home and about 3 weeks later I woke in excruciating back pain and went to the emergency room about 3 times over the next few weeks. Years of chiropractic treatment, physiotherapy, massage and medication still haven't relieved the pain much. I feel like I am resigned to spend the rest of my life in pain.

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Comment from: ShanaF, 35-44 Female (Patient) Published: March 18

I accidentally shot myself in the thigh with a 22 revolver. The bullet traveled down below my knee cap. The pain was and still is unreal. I have been to five different hospitals in agony, crying and screaming due to the pain. The doctors told me that I have "Reflex Sympathetic Dystrophy. I take gabapentin three times a day. That controls the unbearable pain. But I still burn bad. I cannot move my foot. It is very swollen. I have been on crutches for six months now. I have sharp pains that appear out of nowhere. It feels as if scorpions are stinging my blood veins. Sometimes, it feels as if my bones have broke through the skin. I can feel them grinding. I also feel sharp pains in my toenails! That is crazy, huh? It feels as if there is a knife poking the toenails. My leg burns all down the calf. I have never felt this much pain. The doctors have started physical therapy. I have a boot on my leg to keep my foot straight. It has not helped. I am supposed to start spinal shots in a couple of weeks. I pray my way through the pain. I sometimes cry uncontrollably. My friends feel so bad when it happens and I am with them. They see the agony I am in and they want to help. They can't. I don't know? I pray they figure something out. I can't spend time with my 1-year-old granddaughter like I want. I cannot do things with my children. I want to walk again.

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