Patient Resources

What Causes Pain?

In the simplest case, something dangerous — heat from the stove, the cut of a knife, electricity from an outlet, an object colliding with your toe — damages or threatens to damage tissue in your body.

Pain receptors, called nocioceptors, send signals to your brain via your spinal column telling you of the danger so you can take measures to protect yourself or prevent further injury. This type of pain, called nocioceptive pain, is the most common. It is experienced with muscle or bone injuries, surgery, or pressure from an infection or condition like cancer. It can be experienced as sharp, dull or aching, in a large or small area, and generally goes away as the damage to your body heals.

Nocioceptive pain can last for months or years when damaged tissues cannot heal, and chronic inflammation may be involved. Arthritis, some kinds of neck and back pain, osteoporosis pain, some kinds of cancer pain, and many other types of chronic pain are nocioceptive.

Another type of pain is caused by injured nerves, or other changes in the nervous system, and is called neuropathic pain. The disturbed nervous system sends pain signals to the brain even when there is no other ongoing tissue damage. Neuropathic pain is often experienced as tingling, aching, or burning and can last for months or years. One example of this type of pain is phantom limb pain, when a person who has had an arm or leg removed still experiences pain as if it were coming from the missing limb. Other types of neuropathic pain include trigeminal neuralgia, peripheral neuropathy, postherpetic neuralgia, and complex regional pain syndrome (CRPS).

Some patients have chronic pain, and doctors cannot pinpoint the source. Often, it is best to refer to this pain as idiopathic — which means that the cause is unknown.

All types of pain are subjective and can be measured and reported only by the person experiencing it. All types of pain are real and can be treated. Many factors influence the experience of pain, including the mechanisms in the body that are sustaining the pain, the meaning of the pain, and psychological factors, such as individual coping styles and emotional support.


Can Pain Be Treated?

Yes. Pain can be treated safely and effectively. There are many types of treatments for pain, including medication and non-drug treatments. It is important to treat pain. Unrelieved pain brings unnecessary suffering. Living with pain uses up a lot of energy that can be better used to fight illness or maintain activities of daily living. Pain may cause patients to:

  • Feel weak because of disruptions in activity, appetite, and sleep
  • Give up hope
  • Reject treatment programs
  • Feel helpless, anxious, and depressed
  • Think about suicide
  • Stop enjoying normal activities, such as work, recreation, and relations with others

If you are in pain, don’t give up! Working with your doctor and other professionals, you can manage your pain. Sometimes pain relief can be obtained right away. In other situations, it takes time for treatment to be tailored to fit the individual and his/her unique condition.


How Can Pain Be Treated?

Pain treatment needs to be tailored to the individual. What works for one person may not work for the next. Pain can be treated through the use of:

DRUG THERAPIES

Acetaminophen and non steroidal anti-inflammatory drugs (NSAIDs), such as aspirin, ibuprofen, naproxen, and others; opioids (also called narcotics); so-called adjuvant analgesics, which are drugs that are used primarily to treat conditions other than pain but can relieve some painful conditions. Adjuvant drugs include antidepressants, anticonvulsants, local anesthetics, and others.

REHABILITATION THERAPIES

Physical therapy, occupational therapy, treatments such as heat, cold, ultrasound, and others.

PSYCHOLOGICAL THERAPIES

Cognitive approaches, such as relaxation training, distraction techniques, hypnosis, biofeedback, and other behavioral approaches; other types of psychotherapy.

ANESTHETIC THERAPIES

Nerve blocks, drug infusion into the spine, spinal cord stimulation.

NEUROSTIMULATORY PROCEDURES

Transcutaneous electrical nerve stimulation (TENS), acupuncture, invasive stimulatory therapies (spinal cord and brain).

SURGICAL APPROACHES

ALTERNATIVE OR COMPLEMENTARY APPROACHES


Treatment Plans for the Elderly

The elderly are more likely to experience pain than the general population and are often under treated for pain due to myths about their pain sensitivity, pain tolerance, and ability to benefit from opioid drugs.

If you are an older person experiencing pain, you should take the following factors into account:

  • You may experience more than one source of pain;
  • You may have several medical problems and be taking a number of medications at once, and this may increase the risk of analgesic drugs;
  • You run a higher-than-average risk of side effects from all drugs, including analgesics like non-steroidal anti-inflammatory drugs. It is important to report the over-the-counter pain medications you take to your health care team;
  • Having chronic medical problems and an increased risk of side effects does not mean than your pain cannot, or should not, be aggressively treated. You may be a candidate for any of the many pain-relieving therapies that exist.

What should I expect after the injection?  Are there any side effects?

Side effects vary from patient to patient.  The most common side effects, however, are slight numbness in the legs and headaches.  If these symptoms don’t subside within 2 days after the injection, contact the doctor.


Should I continue taking my medications in preparation for the injection and after the injection?

Most medications are fine to take while under the treatment of injections.  However, any blood thinners must be stopped at least 7 days prior to the injection and the patient must get a blood test before the injection to make sure that his/her blood consistency is right for the injection.


Treatment Plans for Children

PAIN MANAGEMENT FOR CHILDREN SHOULD

  • Be tailored to the child’s level of development, including his/her verbal skills, ability to separate from parents, and understanding of medical procedures;
  • Take advantage of the child’s personality and draw on his/her emotional and physical resources wherever possible;
  • Respond to issues the child’s pain is causing in the family.

Treatment Plans for Substance Abusers

For those with no history of substance dependence, there is a very low risk of developing addiction — with its hallmark loss of control, compulsive drug use, and continued use despite harm. For those who do have a history of substance abuse, pain management can be more difficult. Doctors may have a greater tendency to under treat, and patients may not be able to benefit from the treatments offered if they are actively abusing, particularly if the level of abuse is consistent with addiction. In some cases:

  • The doctor may want to work in collaboration with a psychiatrist or substance abuse specialist.
  • The doctor may want to avoid drugs that can be abused or very closely monitor those prescribed. It may be best to develop a contract or agreement between treating physician and patient, defining limits and acceptable behaviors.
  • The doctor may strongly encourage non-drug therapies to complement any drugs that are prescribed.

FAQs republished courtesy of www.stoppain.org


Is there any preparation for the injection?

No preparation is required unless the patient is on blood thinners, in which case they must cease taking the blood thinners and have a blood test done.


Can I drive home after the injection?  Can I go back to work after the injection?

Most patients have no trouble driving home and getting back to work after the injection.  However, because patients react very differently, on the first visit we request that the patient have a ride afterwards or that they call a taxi.  In all likelihood, you will be fine to go back to work after the injection.


How long is the injection procedure?

The procedure takes only minutes.  However, if it is your first injection, it may take longer while Dr. Dombrowski learns about you and your condition.


After a series of 3 injections, how long do I have to wait before having another series?

6 months – 1 year


What if the injections offered in the office do not work?  Is there an alternative to these injections?

There are a number of alternatives.  One alternative is a spinal cord stimulator which sends pulses to the site of pain.  Instead of feeling the pain, the patient will feel a slight vibration.

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