Sources of pain: Nerve Pain, Muscle Pain, and More
Nerve Pain, Muscle Pain, and More
It’s safe to say most of us are not big fans of pain. Nevertheless, it is one of the body’s most important communication tools. Imagine, for instance, what would happen if you felt nothing when you put your hand on a hot stove. Pain is one way the body tells you something’s wrong and needs attention.
But pain — whether it comes from a bee sting, a broken bone, or a long-term illness — is also an unpleasant sensory and emotional experience. It has multiple causes, and people respond to it in multiple and individual ways. The pain that you push your way through might be incapacitating to someone else.
Even though the experience of pain varies from one person to the next, it is possible to categorize the different types of pain. Here’s an overview of the different types of pain and what distinguishes them from one another.
Acute Pain and Chronic Pain
There are several ways to categorize pain. One is to separate it into acute pain and chronic pain. Acute pain typically comes on suddenly and has a limited duration. It’s frequently caused by damage to tissue such as bone, muscle, or organs, and the onset is often accompanied by anxiety or emotional distress.
Chronic pain lasts longer than acute pain and is generally somewhat resistant to medical treatment. It’s usually associated with a long-term illness, such as osteoarthritis. In some cases, such as with fibromyalgia, it’s one of the defining characteristic of the disease. Chronic pain can be the result of damaged tissue, but very often is attributable to nerve damage.
Both acute and chronic pain can be debilitating, and both can affect and be affected by a person’s state of mind. But the nature of chronic pain — the fact that it’s ongoing and in some cases seems almost constant — makes the person who has it more susceptible to psychological consequences such as depression and anxiety. At the same time, psychological distress can amplify the pain.
About 70% of people with chronic pain treated with pain medication experience episodes of what’s called breakthrough pain. Breakthrough pain refers to flares of pain that occur even when pain medication is being used regularly. Sometimes it can be spontaneous or set off by a seemingly insignificant event such as rolling over in bed. And sometimes it may be the result of pain medication wearing off before it’s time for the next dose.
Other Ways Pain Is Classified
Pain is most often classified by the kind of damage that causes it. The two main categories are pain caused by tissue damage, also called nociceptive pain, and pain caused by nerve damage, also called neuropathic pain. A third category is psychogenic pain, which is pain that is affected by psychological factors. Psychogenic pain most often has a physical origin either in tissue damage or nerve damage, but the pain caused by that damage is increased or prolonged by such factors as fear, depression, stress, or anxiety. In some cases, pain originates from a psychological condition.
Pain is also classified by the type of tissue that’s involved or by the part of the body that’s affected. For example, pain may be referred to as muscular pain or joint pain. Or a doctor may ask you about chest pain or back pain.
Certain types of pain are referred to as syndromes. For instance, myofascial pain syndrome refers to pain that is set off by trigger points located in the body’s muscles. Fibromyalgia is an example.
Pain Caused by Tissue Damage
Most pain comes from tissue damage. The pain stems from an injury to the body’s tissues. The injury can be to bone, soft tissue, or organs. The injury to body tissue can come from a disease such as cancer. Or it can come from physical injury such as a cut or a broken bone.
The pain you experience may be an ache, a sharp stabbing, or a throbbing. It could come and go, or it could be constant. You may feel the pain worsen when you move or laugh. Sometimes, breathing deeply can intensify it.
Pain from tissue damage can be acute. For example, sports injuries like a sprained ankle or turf toe are often the result of damage to soft tissue. Or it can be chronic, such as arthritis or chronic headaches. And certain medical treatments, such as radiation for cancer, can also cause tissue damage that results in pain.
Pain Caused by Nerve Damage
Nerves function like electric cables transmitting signals, including pain signals, to and from the brain. Damage to nerves can interfere with the way those signals are transmitted and cause pain signals that are abnormal. For instance, you may feel a burning sensation even though no heat is being applied to the area that burns.
Nerves can be damaged by diseases such as diabetes, or they can be damaged by trauma. Certain chemotherapy drugs may cause nerve damage. Nerves can also be damaged as a result of stroke or an HIV infection, among other causes. The pain that comes from nerve damage could be the result of damage to the central nervous system (CNS), which includes the brain and spinal cord. Or it could result from damage to peripheral nerves, those nerves in the rest of the body that send signals to the CNS.
The pain caused by nerve damage, neuropathic pain, is often described as burning or prickling. Some people describe it as an electrical shock. Others describe it as pins and needles or as a stabbing sensation. Some people with nerve damage are often hypersensitive to temperature and to touch. Just a light touch, such as the touch of a bed sheet, can set off the pain.
Much neuropathic pain is chronic. Examples of pain caused by damaged nerves include:
Central pain syndrome. This syndrome is marked by chronic pain that stems from damage to the central nervous system. The damage can be caused by stroke, MS, tumors, and several other conditions. The pain, which is typically constant and may be severe, can affect a large part of the body or be confined to smaller areas such as the hands or feet. The pain often can be made worse by movement, touch, emotions, and temperature changes.
Complex regional pain syndrome. This is a chronic pain syndrome that can follow a serious injury. It’s described as persistent burning. Certain abnormalities such as abnormal sweating, changes in skin color, or swelling may be noticed in the area of the pain.
Diabetic peripheral neuropathic pain. This pain comes from nerve damage in the feet, legs, hands, or arms caused by diabetes. Individuals with diabetic neuropathy experience various kinds of pain including burning, stabbing, and tingling.
Shingles and postherpetic neuralgia.Shingles is a localized infection caused by the same virus that causes chickenpox. The rash and associated pain, which can be debilitating, occurs on one side of the body along the path of a nerve. Postherpetic neuralgia is a common complication in which the pain from shingles lasts more than a month.
Trigeminal neuralgia. This condition causes pain as a result of inflammation of a facial nerve. The pain is described as intense and lightning like, and it can occur in the lips, scalp, forehead, eye, nose, gums, cheek, and chin on one side of the face. The pain can be set off by touching a trigger area or by slight motion.
Types of Pain | Acute, Chronic, Radicular & More | Beaumont
Medically speaking, pain is an uncomfortable sensation that usually signals an injury or illness. Generally speaking, pain is the body’s way of telling you something isn’t right. This is the purpose of pain. It is meant to make you uncomfortable so if you are injured or sick, you will know you need to do something (or stop doing something).
When you do something that hurts your body, your brain normally triggers the pain response. If you touch something hot, the pain you feel is your body’s way of telling you that you should stop touching the hot item and should take action to cool the skin. If you walk on an injured ankle and it hurts, that’s also your body telling you to stop.
The perception of pain varies from person to person. One person might have a broken bone and not even realize it, while another might feel significant pain from that same injury. That’s because pain is mediated by nerve fibers in your body, and these nerve fibers have the job of sending pain signals to the brain (which happens very quickly). Once they find their way to the brain, the brain acts to make you aware of the pain. Because every person’s body is different, their nerve fibers and their brain can react differently to the same stimuli. That helps explain why pain perception and pain tolerance can differ so much from one person to another.
Types of pain
We hear this question all the time: “What are the different types of pain?”
This is both a simple and a complicated answer. There are five common types of pain, but some pain can fit into more than one category, which is where the complication comes in.
The five most common types of pain are:
- Acute pain
- Chronic pain
- Neuropathic pain
- Nociceptive pain
- Radicular pain
Acute pain means the pain is short in duration (relatively speaking), lasting from minutes to about three months (sometimes up to six months). Acute pain also tends to be related to a soft-tissue injury or a temporary illness, so it typically subsides after the injury heals or the illness subsides. Acute pain from an injury may evolve into chronic pain if the injury doesn’t heal correctly or if the pain signals malfunction.
Chronic pain is longer in duration. It can be constant or intermittent. For example, headaches can be considered chronic pain when they continue over many months or years – even if the pain isn’t always present. Chronic pain is often due to a health condition, like arthritis, fibromyalgia, or a spine condition.
Neuropathic pain is due to damage to the nerves or other parts of the nervous system. It is often described as shooting, stabbing, or burning pain, or it feels like pins and needles. It can also affect sensitivity to touch and can make someone have difficulty feeling hot or cold sensations. Neuropathic pain is a common type of chronic pain. It may be intermittent (meaning it comes and goes), and it can be so severe that it makes performing everyday tasks difficult. Because the pain can interfere with normal movement, it can also lead to mobility issues.
Nociceptive pain is a type of pain caused by damage to body tissue. People often describe it as being a sharp, achy, or throbbing pain. It’s often caused by an external injury. For example, if you hit your elbow, stub your toe, twist your ankle, or fall and scrape up your knee, you may feel nociceptive pain. This type of pain is often experienced in the joints, muscles, skin, tendons, and bones. It can be both acute and chronic.
Radicular pain is a very specific type of pain can occur when the spinal nerve gets compressed or inflamed. It radiates from the back and hip into the leg(s) by way of the spine and spinal nerve root. People who have radicular pain may experience tingling, numbness, and muscle weakness. Pain that radiates from the back and into the leg is called radiculopathy. It’s commonly known as sciatica because the pain is due to the sciatic nerve being affected. This type of pain is often steady, and people can feel it deep in the leg. Walking, sitting, and some other activities can make sciatica worse. It is one of the most common forms of radicular pain.
How do I know if my pain is normal or if I should see a doctor?
Most pain is a normal response to injury or illness and doesn’t require a trip to the doctor. But how will you know if your pain is a sign of something serious? If you fall asleep in an awkward position and you wake up with neck or back pain, that’s most likely normal. If you get a minor (first degree) burn, the associated pain is normal and probably doesn’t require doctor’s attention. If stub your toe or bump your knee, short-term pain is normal.
As a rule, if your pain only lasts for the amount of time you’d expect it to and you know the cause, it’s probably normal. But if your pain is severe, lasts longer than you think it should for the injury or illness, or you don’t know what’s causing it, you may want to call your doctor.
Here are some examples of both normal pain and the type of pain that requires medical attention.
Some causes of normal pain
- A skinned elbow or knee
- A minor burn
- A pulled or strained muscle
- A tension headache
- Post-surgical pain at the incision site
- A broken bone
- A minor ankle sprain
- Muscle, tendon, skin, or bone injury
- Labor and delivery
Sometimes normal pain still requires a visit to the doctor or even the emergency room. If you have a serious injury, regardless of your pain severity or tolerance, you should see a doctor. If you have other symptoms besides pain, such as significant bleeding, joint or bone malformation, swelling, or difficulty performing normal, everyday tasks, seek medical attention. When in doubt, call your doctor. It’s always better to err on the site of caution than to take the chance that your injury or illness will get worse.
Some causes of pain that may require medical attention
- A herniated disc in the neck or back
- Chronic migraine headaches
- A compressed or pinched nerve
- Chronic fatigue syndrome
- Heart attack
Pain Management at Beaumont
At the Beaumont Centers for Pain Management and other locations, Beaumont uses the latest technology and pain management procedures to help patients with all forms of pain. We provide treatment from a multi-disciplinary perspective, individually tailoring care to meet each patient’s pain management needs. Using the latest technology, we can offer interventions to reduce pain severity, improve quality of life, and increase physical functioning. Pain treatment at Beaumont is available through many different specialists in multiple disciplines.
Make an appointment at Beaumont
If you’re experiencing any type of pain, we can help. Call the Beaumont Physician Referral service today us today at 800-633-7377 to make an appointment and for assistance determining what Beaumont physician or clinic is the best choice for your pain management situation.
What it is and how to treat it
Pain is an unpleasant sensation and emotional experience that links to tissue damage. It allows the body to react and prevent further tissue damage.
People feel pain when a signal travels through nerve fibers to the brain for interpretation. The experience of pain is different for every person, and there are various ways to feel and describe pain. This variation can, in some cases, make it challenging to define and treat pain.
Pain can be short- or long-term and stay in one place or spread around the body.
In this article, we look at the different causes and types of pain, different ways to diagnose it, and how to manage the sensation.
People feel pain when specific nerves called nociceptors detect tissue damage and transmit information about the damage along the spinal cord to the brain.
For example, touching a hot surface will send a message through a reflex arc in the spinal cord and cause an immediate contraction of the muscles. This contraction will pull the hand away from the hot surface, limiting further damage.
This reflex occurs so fast that the message has not even reached the brain. However, the pain message does continue to the brain. Once it arrives, it will cause an individual to feel an unpleasant sensation — pain.
The brain’s interpretation of these signals and the efficiency of the communication channel between the nociceptors and the brain dictate how an individual experiences pain.
The brain may also release feel-good chemicals, such as dopamine, to try to counter the unpleasant effects of pain.
In 2011, researchers estimated that pain costs the United States between $560 billion and $635 billion each year in treatment costs, lost wages, and missed days of work.
Pain can be either acute or chronic.
This type of pain is generally intense and short-lived. It is how the body alerts a person to an injury or localized tissue damage. Treating the underlying injury usually resolves acute pain.
Acute pain triggers the body’s fight-or-flight mechanism, often resulting in faster heartbeats and breathing rates.
There are different types of acute pain:
- Somatic pain: A person feels this superficial pain on the skin or the soft tissues just below the skin.
- Visceral pain: This pain originates in the internal organs and the linings of cavities in the body.
- Referred pain: A person feels referred pain at a location other than the source of tissue damage. For example, people often experience shoulder pain during a heart attack.
This type of pain lasts far longer than acute pain, and there is often no cure. Chronic pain can be mild or severe. It can also be either continuous, such as in arthritis, or intermittent, as with migraines. Intermittent pain occurs on repeated occasions but stops in between flares.
The fight-or-flight reactions eventually stop in people with chronic pain as the sympathetic nervous system that triggers these reactions adapts to the pain stimulus.
If enough cases of acute pain occur, they can create a buildup of electrical signals in the central nervous system (CNS) that overstimulate the nerve fibers.
This effect is known as “windup,” with this term comparing the buildup of electrical signals to a windup toy. Winding a toy with more intensity leads to the toy running faster for longer. Chronic pain works in the same way, which is why a person may feel pain long after the event that first caused it.
There are other, more specialized ways of describing pain.
- Neuropathic pain: This pain occurs following injury to the peripheral nerves that connect the brain and spinal cord to the rest of the body. It can feel like electric shocks or cause tenderness, numbness, tingling, or discomfort.
- Phantom pain: Phantom pain occurs after the amputation of a limb and refers to painful sensations that feel as though they are coming from the missing limb.
- Central pain: This type of pain often occurs due to infarction, abscesses, tumors, degeneration, or bleeding in the brain and spinal cord. Central pain is ongoing, and it can range from mild to extremely painful. People with central pain report burning, aching, and pressing sensations.
Knowing how to describe pain can help a doctor provide a more specific diagnosis.
An individual’s subjective description of the pain will help the doctor make a diagnosis. There is no objective scale for identifying the type of pain, so the doctor will take a pain history.
They will ask the individual to describe:
- the character of all pains, such as burning, stinging, or stabbing
- the site, quality, and radiation of pain, meaning where a person feels the pain, what it feels like, and how far it seems to have spread
- which factors aggravate and relieve the pain
- the times at which pain occurs throughout the day
- its effect on the person’s daily function and mood
- the person’s understanding of their pain
Several systems can identify and grade pain. However, the most important factor in getting an accurate diagnosis is for the individual and the doctor to communicate as clearly as possible.
Some of the pain measures that doctors use are:
- Numerical rating scales: These measure pain on a scale of 0–10, where 0 means no pain at all, and 10 represents the worst pain imaginable. It is useful for gauging how pain levels change in response to treatment or a deteriorating condition.
- Verbal descriptor scale: This scale may help a doctor measure pain levels in children with cognitive impairments, older adults, autistic people, and those with dyslexia. Instead of using numbers, the doctor asks different descriptive questions to narrow down the type of pain.
- Faces scale: The doctor shows the person in pain a range of expressive faces, ranging from distressed to happy. Doctors mainly use this scale with children. The method has also shown effective responses in autistic people.
- Brief pain inventory: This more detailed written questionnaire can help doctors gauge the effect of a person’s pain on their mood, activity, sleep patterns, and interpersonal relationships. It also charts the timeline of the pain to detect any patterns.
- McGill Pain Questionnaire (MPQ): The MPQ encourages people to choose words from 20 word groups to get an in-depth understanding of how the pain feels. Group 6, for example, is “tugging, pulling, wrenching,” while group 9 is “dull, sore, hurting, aching, heavy.”
Other indicators of pain
When people with cognitive impairments cannot accurately describe their pain, there can still be clear indicators. These include:
- moaning and groaning
- resistance to care
- reduced social interactions
- increased wandering
- not eating
- sleeping problems
The doctor will either treat the underlying problem, if it is treatable, or prescribe pain-relieving treatment to manage the pain.
There is a prevalent myth that Black people feel pain differently from white people. Because of this, Black Americans often receive insufficient treatment for pain, compared with their white counterparts.
Racial bias in pain assessment and management is well-documented.
For instance, a 2016 study revealed that half of white medical students and residents believed that Black people have thicker skin or less sensitive nerve endings than white people.
The research also showed that these misconceptions affected the medical personnel’s pain assessments and treatment recommendations. This indicates that healthcare professionals with these beliefs may not treat Black people’s pain appropriately.
Eradicating racist stereotypes and biases are crucial steps toward addressing systemic inequities in healthcare.
Read more about systemic racism in healthcare and health inequities here.
Doctors will treat different types of pain in different ways. A treatment that is effective against one type of pain may not relieve another.
Acute pain treatment
Treating acute pain often involves taking medication.
Often, this type of pain results from an underlying health issue, and treating it may relieve the pain without the need for pain management. For example, if a bacterial infection is causing a sore throat, antibiotics can treat the infection, easing the soreness as a result.
Acetaminophen is a type of analgesic, or pain reliever. It is an active ingredient in hundreds of medications, including over-the-counter and prescription drugs.
Often known by the brand name Tylenol, acetaminophen can relieve pain and a fever. Combined with other ingredients, it can help treat allergy symptoms, coughs, flu symptoms, and colds.
Doctors often prescribe drugs that contain acetaminophen and other ingredients to treat moderate to severe pain.
When taken in higher doses, however, acetaminophen can cause serious liver damage. People should never exceed the recommended dosage.
Nonsteroidal anti-inflammatory drugs (NSAIDs)
NSAIDs are another type of analgesic. They can reduce pain and help a person regain daily function. They are available over the counter or on prescription at a range of strengths. NSAIDs are suitable for minor acute pains, such as headaches, light sprains, and backaches.
NSAIDs can relieve localized inflammation and pain that is due to swelling. These drugs may have side effects relating to the digestive system, including bleeding. Therefore, a doctor will monitor a person taking a high dosage.
It is always important to read the packaging to find out what is in an analgesic before using it and to check the maximum dosage. People should never exceed the recommended dosage.
Doctors prescribe these drugs for the most extreme acute pains, such as those that result from surgery, burns, cancer, and bone fractures. Opioids are highly addictive, cause withdrawal symptoms, and lose effectiveness over time. They require a prescription.
In situations involving severe trauma and pain, the doctor will carefully manage and administer the dosage, gradually reducing the amount to minimize withdrawal symptoms.
People should discuss all medication options carefully with a doctor and disclose any health conditions and current medications. Opioids may significantly affect the progression of several chronic diseases, including:
- chronic obstructive pulmonary disease (COPD)
- kidney disease
- liver problems
- previous drug use disorder
Opioids can cause dangerous side effects in people with certain chronic diseases. For instance, they can cause respiratory depression, which can exacerbate the symptoms of COPD.
Chronic pain treatment
A range of nondrug therapies can help relieve pain. These alternatives to medication may be more suitable for people experiencing chronic pain.
These therapies include:
- Acupuncture: Inserting very fine needles at specific pressure points may reduce pain.
- Nerve blocks: These injections can numb a group of nerves that act as a source of pain for a specific limb or body part.
- Psychotherapy: This can help with the emotional side of ongoing pain. Chronic pain often reduces the enjoyment of everyday activities and makes working difficult. Also, studies have found that chronic pain can lead to depression and that depression intensifies chronic pain. A psychotherapist can help a person implement changes to minimize the intensity of pain and build coping skills.
- Transcutaneous electrical nerve stimulation (TENS): TENS aims to stimulate the brain’s opioid and pain gate systems and thus provide relief.
- Surgery: Various surgeries on the nerves, brain, and spine are possible for treating chronic pain. These include rhizotomy, decompression, and electrical deep brain and spinal cord stimulation procedures.
- Biofeedback: Through this mind-body technique, a person can learn to control their organs and automatic processes, such as their heart rate, with their thoughts more effectively. Virtual reality may now play a role in the use of biofeedback in pain management, according to 2019 research.
- Relaxation therapies: These include a wide range of controlled relaxation techniques and exercises, mostly in the realm of alternative and complementary medicine. A person can try hypnosis, yoga, meditation, massage therapy, distraction techniques, tai chi, or a combination of these practices.
- Physical manipulation: A physiotherapist or chiropractor can sometimes help relieve pain by manipulating the tension from a person’s back.
- Heat and cold: Using hot and cold packs can help. People can alternate these or select them according to the type of injury or pain. Some topical medications have a warming effect when a person applies them to the affected area.
- Rest: If pain occurs due to an injury or overworking a part of the body, rest may be the best option.
With adequate pain management, it is possible to maintain daily activities, social engagement, and an active quality of life.
Discover how yoga can help people who have fibromyalgia.
4 Most Common Types of Chronic Pain
Chronic pain is commonly defined as any pain that lasts more than 12 weeks. Whereas acute pain is the normal sensation which alerts us to an injury or illness, chronic pain is one that persists, often for months or even longer.
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Chronic pain is estimated to affect 20% of U.S. adults. It can be caused by a musculoskeletal injury (involving the bones, muscles, or joints), nervous system dysfunction, chronic diseases, and autoimmune disorders.
Chronic Back Pain
According to research from the University of North Carolina at Chapel Hill, no less than 84% of adults in the U.S. will experience chronic back pain at some point in their life.
Often occurring in the lower back, the pain may be caused by an injury or develop progressively due to arthritis, osteoporosis, or normal wear and tear.
Common causes of chronic back pain include:
- Slipped or bulging discs, typically caused by twisting or lifting injuries
- Spinal stenosis involving the narrowing of the spinal canal and compression of nerves
- Compression fractures, commonly associated with osteoporosis
- Soft-tissue damage caused by strain or trauma to back muscles, ligaments, or tendons
- Spinal fractures
- Structural deformities such as scoliosis (the abnormal sideways curvature of the spine) or lordosis (the excessive inward curvature of the lower back)
Back pain has become an epidemic in the United States, and it is a leading cause of disability and lost productivity in the workplace today.
According to research, 50% of the adult population will report headaches during the course of a year, while more than 90% will report a lifetime history of headaches.
A chronic headache is one that occurs for at least 15 days per month for no less than three consecutive months. The most common types of chronic headaches are:
Chronic Joint Pain
Joint pain, typically caused by injury, infection, or advancing age, is one of the leading types of chronic pain among American adults.
According to a report from the U.S. Bone and Joint Initiative, arthritis is the most common cause, affecting over 51 million Americans (or roughly one of every two adults).
Some of the more common types of chronic joint pain are:
- Osteoarthritis, common in the elderly and usually affecting the larger joints
- Rheumatoid arthritis, an autoimmune disorder which causes swelling of the joint spaces
- Repetitive motion injury, common in athletes and people who do repetitive physical activities
- Bursitis, caused by swelling of the fluid-filled sacs that cushion the joints
- Tendinitis, caused by the inflammation of joint tendons
Chronic Nerve Pain
Chronic nerve (neuropathic) pain affects one of every 10 Americans, according to a study from the Mayo Clinic School of Medicine. This commonly happens when the nerves are either compressed, damaged, or exposed to drugs that strip their protective exterior coating (called the myelin sheath).
Some of the more common examples of chronic neuropathic pain are:
- Sciatica, typically caused by nerve compression that triggers a shooting pain down the leg
- Diabetic neuropathy, often occurring in the hands or feet
- Carpal tunnel syndrome, commonly associated with repetitive motion
- Postherpetic neuralgia, a type of chronic pain that persists after a shingles outbreak
- Trigeminal neuralgia, caused by injury to the trigeminal nerve of the face
Causes of Lower Back Pain
Most commonly, mechanical issues and soft-tissue injuries are the cause of low back pain. These injuries can include damage to the intervertebral discs, compression of nerve roots, and improper movement of the spinal joints.
Lower Back Strain Video
Lower back sprains caused by damage to the muscles and ligaments are the most common sources of back pain. Watch: Lower Back Strain Video
The single most common cause of lower back pain is a torn or pulled muscle and/or ligament.
Muscle Strain and Ligament Sprain
A low back sprain or strain can happen suddenly, or can develop slowly over time from repetitive movements.
- Strains occur when a muscle is stretched too far and tears, damaging the muscle itself.
- Sprains happen when over-stretching and tearing affects ligaments, which connect the bones together.
For practical purposes, it does not matter whether the muscle or ligament is damaged, as the symptoms and treatment are the same.
See Pulled Back Muscle Treatment
Common causes of sprain and strain include:
- Lifting a heavy object, or twisting the spine while lifting
- Sudden movements that place too much stress on the low back, such as a fall
- Poor posture over time
- Sports injuries, especially in sports that involve twisting or large forces of impact
While sprains and strains do not sound serious and do not typically cause long-lasting pain, the acute pain can be quite severe.
Causes of Chronic Lower Back Pain
Pain is considered chronic once it lasts for more than three months and exceeds the body’s natural healing process. Chronic pain in the low back often involves a disc problem, a joint problem, and/or an irritated nerve root. Common causes include:
Lumbar herniated disc. The jelly-like center of a lumbar disc can break through the tough outer layer and irritate a nearby nerve root. The herniated portion of the disc is full of proteins that cause inflammation when they reach a nerve root, and inflammation, as well as nerve compression, cause nerve root pain. The disc wall is also richly supplied by nerve fibers, and a tear through the wall can cause severe pain.
Degenerative disc disease. At birth, intervertebral discs are full of water and at their healthiest. As people age over time, discs lose hydration and wear down. As the disc loses hydration, it cannot resist forces as well, and transfers force to the disc wall that may develop tears and cause pain or weakening that can lead to a herniation. The disc can also collapse and contribute to stenosis.
See Lumbar Degenerative Disc Disease (DDD)
Facet joint dysfunction. There are two facet joints behind each disc at each motion segment in the lumbar spine. These joints have cartilage between the bones and are surrounded by a capsular ligament, which is richly innervated by nerves. These joints can be painful by themselves, or in conjunction with disc pain.
Sacroiliac joint dysfunction. The sacroiliac joint connects the sacrum at the bottom of the spine to each side of the pelvis. It is a strong, low-motion joint that primarily absorbs shock and tension between the upper body and the lower body. The sacroiliac joint can become painful if it becomes inflamed (sacroiliitis) or if there is too much or too little motion of the joint.
See Sacroiliac Joint Dysfunction (SI Joint Pain)
Spinal stenosis. This condition causes pain through narrowing of the spinal canal where the nerve roots are located. The narrowing can be central, forminal, or both, and can be at a single level or multiple levels in the lower back.
See Lumbar Spinal Stenosis
Spondylolisthesis. This condition occurs when one vertebra slips over the adjacent one. There are 5 types of spondylolisthesis but the most common are secondary to a defect or fracture of the pars (between the facet joints) or mechanical instability of the facet joints (degenerative). The pain can be caused by instability (back) or compression of the nerves (leg).
Osteoarthritis. This condition results from wear and tear of the disc and facet joints. It causes pain, inflammation, instability, and stenosis to a variable degree, and can occur at a single level or multiple levels of the lower spine. Spinal osteoarthritis is associated with aging and is slowly progressive. It is also referred to as spondylosis or degenerative joint disease.
Deformity. Curvature of the spine can include scoliosis or kyphosis. The deformity may be associated with lower back pain if it leads to the breakdown of the discs, facet joints, sacroiliac joints or stenosis.
Trauma. Acute fractures or dislocations of the spine can lead to pain. Lower back pain that develops after a trauma, such as a motor vehicle accident or a fall, should be medically evaluated.
Compression fracture. A fracture that occurs in the cylindrical vertebra, in which the bone essentially caves in on itself, can cause sudden pain. This type of fracture is most common due to weak bones, such as from osteoporosis, and is more common in older people.
It is important to note that the presence of one or more of these conditions does not necessarily mean that is the cause of pain. For example, osteoarthritis or degenerative disc disease could appear on an imaging study but the person may not report pain.
View Slideshow: 8 Common Causes of Lower Back Pain
In This Article:
Less Common Causes of Low Back Pain
While considerably less common, low back pain may also be caused by:
Infection. Also called osteomyelitis, a spinal infection is rare but can cause severe pain and is life threatening if untreated. It can be caused by surgical procedures, injections, or spread through the blood stream. Patients with a compromised immune system are more susceptible to developing an infection in the spine.
Tumor. Most spinal tumors start in another part of the body and metastasize to the spine. The most common tumors that spread to the spine start from cancer in the breast, prostate, kidney, thyroid, or lung. Any new symptoms of back pain in a patient with a known diagnosis of cancer should be evaluated for possible spinal metastasis.
Autoimmune disease. Back pain is a possible symptom associated with autoimmune conditions, such as ankylosing spondylitis, rheumatoid arthritis, lupus, crohn’s disease, fibromyalgia, and others.
This list includes the more common causes of back pain, but there are many more. Finding the optimal treatment for low back pain usually depends on obtaining a correct clinical diagnosis that identifies the underlying cause of the patient’s symptoms.
Understanding different types of pain | Health Management and Education
Neuropathic pain: Pain that develops as a result of damage to the peripheral nervous system (Neuropathy means nerve disease or damage). Peripheral nerves send sensory information from the body back to the brain and spinal cord, such as a message that the feet are cold. Peripheral nerves also carry signals from the brain and spinal cord to the muscles to generate movement. Damage to the peripheral nervous system interferes with these vital connections. Symptoms can range from numbness or tingling, to pricking sensations (paresthesia), or muscle weakness. Areas of the body may become abnormally sensitive leading to an intense or distorted experience of touch. Severe symptoms may include burning pain (especially at night), muscle wasting, paralysis, or organ or gland dysfunction.
Examples of Neuropathic pain include:
- Diabetic neuropathy
- Sciatic pain
- Pain from shingles infection
- Trigeminal nerve pain
Musculoskeletal pain: Pain that affects the bones, muscles, ligaments, tendons, and nerves. It can be acute or chronic. Musculoskeletal pain can be focused in one area, or widespread. Musculoskeletal pain is often caused by imflammation (swelling) of joints or muscles as a result of injury, such as car accidents or falls. Musculoskeletal pain can also be caused by overuse. Pain from overuse affects 33% of adults. Lower back pain from overuse is the most common work-related diagnosis in Western society. Poor posture or prolonged immobilization can also cause musculoskeletal pain.
Examples of musculoskeletal pain include:
- Rheumatoid arthritis
- Back/neck pain
- Chronic pelvic pain
Cancer Pain: Cancer itself and the side effects of cancer treatment can sometimes cause pain. Patients with cancer may experience acute pain, chronic pain, neuropathic pain, or musculoskeletal pain- or any combinations of those types of pain. Cancer pain can be complex and your oncologist and/or a pain management specialist will help you navigate pain control.
Low Back Pain Fact Sheet
If you have had lower back pain, you are not alone. Back pain is one of most common reasons people see a doctor or miss days at work. Even school-age children can have back pain.
Back pain can range in intensity from a dull, constant ache to a sudden, sharp or shooting pain. It can begin suddenly as a result of an accident or by lifting something heavy, or it can develop over time as we age. Getting too little exercise followed by a strenuous workout also can cause back pain.
There are two types of back pain:
- Acute, or short-term back pain lasts a few days to a few weeks. Most low back pain is acute. It tends to resolve on its own within a few days with self-care and there is no residual loss of function. In some cases a few months are required for the symptoms to disappear.
- Chronic back pain is defined as pain that continues for 12 weeks or longer, even after an initial injury or underlying cause of acute low back pain has been treated. About 20 percent of people affected by acute low back pain develop chronic low back pain with persistent symptoms at one year. Even if pain persists, it does not always mean there is a medically serious underlying cause or one that can be easily identified and treated. In some cases, treatment successfully relieves chronic low back pain, but in other cases pain continues despite medical and surgical treatment.
What structures make up the back?
The lower back—where most back pain occurs—includes the five vertebrae (referred to as L1-L5) in the lumbar region, which supports much of the weight of the upper body. The spaces between the vertebrae are maintained by round, rubbery pads called intervertebral discs that act like shock absorbers throughout the spinal column to cushion the bones as the body moves. Bands of tissue known as ligaments hold the vertebrae in place, and tendons attach the muscles to the spinal column. Thirty-one pairs of nerves are rooted to the spinal cord and they control body movements and transmit signals from the body to the brain.
Other regions of vertebrate are cervical (in the neck), thoracic (upper back), and sacral and coccygeal (below the lumbar area) segments.
What can cause lower back pain?
Most acute low back pain is mechanical in nature, meaning that there is a disruption in the way the components of the back (the spine, muscle, intervertebral discs, and nerves) fit together and move. Some examples of mechanical causes of low back pain include:
- Skeletal irregularities such as scoliosis (a curvature of the spine), lordosis (an abnormally exaggerated arch in the lower back), kyphosis (excessive outward arch of the spine), and other congenital anomalies of the spine.
- Spina bifida which involves the incomplete development of the spinal cord and/or its protective covering and can cause problems involving malformation of vertebrae and abnormal sensations and even paralysis.
- Sprains (overstretched or torn ligaments), strains (tears in tendons or muscle), and spasms (sudden contraction of a muscle or group of muscles)
- Traumatic Injury such as from playing sports, car accidents, or a fall that can injure tendons, ligaments, or muscle causing the pain, as well as compress the spine and cause discs to rupture or herniate.
- Intervertebral disc degeneration which occurs when the usually rubbery discs wear down as a normal process of aging and lose their cushioning ability.
- Spondylosis the general degeneration of the spine associated with normal wear and tear that occurs in the joints, discs, and bones of the spine as people get older.
- Arthritis or other inflammatory disease in the spine, including osteoarthritis and rheumatoid arthritis as well as spondylitis, an inflammation of the vertebrae.
Nerve and spinal cord problems
- Spinal nerve compression, inflammation and/or injury
- Sciatica (also called radiculopathy), caused by something pressing on the sciatic nerve that travels through the buttocks and extends down the back of the leg. People with sciatica may feel shock-like or burning low back pain combined with pain through the buttocks and down one leg.
- Spinal stenosis, the narrowing of the spinal column that puts pressure on the spinal cord and nerves
- Spondylolisthesis, which happens when a vertebra of the lower spine slips out of place, pinching the nerves exiting the spinal column
- Herniated or ruptured discs can occur when the intervertebral discs become compressed and bulge outward
- Infections involving the vertebrae, a condition called osteomyelitis; the intervertebral discs, called discitis; or the sacroiliac joints connecting the lower spine to the pelvis, called sacroiliitis
- Cauda equina syndrome occurs when a ruptured disc pushes into the spinal canal and presses on the bundle of lumbar and sacral nerve roots. Permanent neurological damage may result if this syndrome is left untreated.
- Osteoporosis (a progressive decrease in bone density and strength that can lead to painful fractures of the vertebrae)
- Kidney stones can cause sharp pain in the lower back, usually on one side
- Endometriosis (the buildup of uterine tissue in places outside the uterus)
- Fibromyalgia (a chronic pain syndrome involving widespread muscle pain and fatigue)
- Tumors that press on or destroy the bony spine or spinal cord and nerves or outside the spine elsewhere in the back
- Pregnancy (back symptoms almost always completely go away after giving birth)
What are the risk factors for developing low back pain?
Anyone can have back pain. Factors that can increase the risk for low back pain include:
Age: The first attack of low back pain typically occurs between the ages of 30 and 50, and back pain becomes more common with advancing age. Loss of bone strength from osteoporosis can lead to fractures, and at the same time, muscle elasticity and tone decrease. The intervertebral discs begin to lose fluid and flexibility with age, which decreases their ability to cushion the vertebrae. The risk of spinal stenosis also increases with age.
Fitness level: Back pain is more common among people who are not physically fit. Weak back and abdominal muscles may not properly support the spine. “Weekend warriors”—people who go out and exercise a lot after being inactive all week—are more likely to suffer painful back injuries than people who make moderate physical activity a daily habit. Studies show that low-impact aerobic exercise can help maintain the integrity of intervertebral discs.
Weight gain: Being overweight, obese, or quickly gaining significant amounts of weight can put stress on the back and lead to low back pain.
Genetics: Some causes of back pain, such as ankylosing spondylitis (a form of arthritis that involves fusion of the spinal joints leading to some immobility of the spine), have a genetic component.
Job-related factors: Having a job that requires heavy lifting, pushing, or pulling, particularly when it involves twisting or vibrating the spine, can lead to injury and back pain. Working at a desk all day can contribute to pain, especially from poor posture or sitting in a chair with not enough back support.
Mental health: Anxiety and depression can influence how closely one focuses on their pain as well as their perception of its severity. Pain that becomes chronic also can contribute to the development of such psychological factors. Stress can affect the body in numerous ways, including causing muscle tension.
Smoking: It can restrict blood flow and oxygen to the discs, causing them to degenerate faster.
Backpack overload in children: A backpack overloaded with schoolbooks and supplies can strain the back and cause muscle fatigue.
Psychological factors: Mood and depression, stress, and psychological well-being also can influence the likelihood of experiencing back pain.
How is low back pain diagnosed?
A complete medical history and physical exam can usually identify any serious conditions that may be causing the pain. Neurologic tests can help determine the cause of pain and appropriate treatment. Imaging tests are not needed in most cases but may be ordered to rule out specific causes of pain, including tumors and spinal stenosis. Occasionally the cause of chronic lower back pain is difficult to determine even after a thorough examination.
Blood tests are not routinely used to diagnose the cause of back pain but might be ordered to look for signs of inflammation, infection, cancer, and/or arthritis.
Bone scans can detect and monitor an infection, fracture, or bone disorder. A small amount of radioactive material is injected into the bloodstream and collects in the bones, particularly in areas with some abnormality. Scanner-generated images can identify specific areas of irregular bone metabolism or abnormal blood flow, as well as to measure levels of joint disease.
Discography involves injecting a contrast dye into a spinal disc thought to be causing low back pain. The fluid’s pressure in the disc will reproduce the person’s symptoms if the disc is the cause. The dye helps to show the damaged areas on CT scans taken following the injection.
Electrodiagnostics can identify problems related to the nerves in the back and legs. The procedures include:
- electromyography (EMG) assesses the electrical activity in a muscle and can detect if muscle weakness results from a problem with the nerves that control the muscles. Very fine needles are inserted in muscles to measure electrical activity transmitted from the brain or spinal cord to a particular area of the body.
- evoked potential studies involve two sets of electrodes—one set to stimulate a sensory nerve, and the other placed on the scalp to record the speed of nerve signal transmissions to the brain.
- nerve conduction studies (NCS) also use two sets of electrodes to stimulate the nerve that runs to a particular muscle and record the nerve’s electrical signals to detect any nerve damage.
Diagnostic imaging tests allow specialists to see into the body without having to perform exploratory surgery. Imaging includes:
- Computerized tomography (CT) can show soft tissue structures that cannot be seen on conventional x-rays, such as disc rupture, spinal stenosis, or tumors.
- Magnetic resonance imaging (MRI) creates a computer-generated image of bony structures and soft tissues such as muscles, ligaments, tendons, and blood vessels. An MRI may be ordered if a problem such as infection, tumor, inflammation, disc herniation or rupture, or pressure on a nerve is suspected
- X-ray imaging can show broken bones or an injured or misaligned vertebra.
Myelograms enhance the diagnostic imaging of x-rays and CT scans. In this procedure, a contrast dye is injected into the spinal canal, allowing spinal cord and nerve compression caused by herniated discs or fractures to be seen on an x-ray or CT scans.
How is back pain treated?
Acute back pain usually gets better on its own. Acute back pain is usually treated with:
- Medications designed to relieve pain and/or inflammation
- analgesics such as acetaminophen and aspirin
- non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen may be sold over the counter; some NSAIDS are prescribed by a physician
- muscle relaxants are prescription drugs that are used on a short-term basis to relax tight muscles
- topical pain relief such as creams, gels, patches, or sprays applied to the skin stimulate the nerves in the skin to provide feelings of warmth or cold in order to dull the sensation of pain. Common topical medications include capsaicin and lidocaine.
- Heat and/or ice may help ease pain, reduce inflammation, and improve mobility for some people
- Gentle stretching (not vigorous exercise) upon advice by your healthcare professional
Exercising, bed rest, and surgery are typically not recommended for acute back pain.
Chronic back pain is most often treated with a stepped care approach, moving from simple low-cost treatments to more aggressive approaches. Specific treatments may depend on the identified cause of the back pain.
Step 1 Early treatments
Medications may include:
- Analgesics and NSAIDS
- Opioid drugs prescribed by a physician (opioids should be used only for a short period of time and under a physician’s supervision, as opioids can be addictive, aggravate depression, and have other side effects)
- Anticonvulsants—prescribed drugs primarily used to treat seizures—may be useful in treating people with sciatica
- Antidepressants such as tricyclics and serotonin, and norepinephrine reuptake inhibitors have been commonly prescribed for chronic low back pain (prescribed by a physician)
- Hot or cold packs
- Resuming normal activities as soon as possible may ease pain; bed rest is not recommended
- Exercises that strengthen core or abdominal muscles may help to speed recovery from chronic low back pain. Always check first with a physician before starting an exercise program and to get a list of helpful exercises.
Step 2 Complementary and alternative techniques include:
- Acupuncture is moderately effective for chronic low back pain. It involves inserting thin needles into precise points throughout the body and stimulating them (by twisting or passing a low-voltage electrical current through them), which may cause the body to release naturally occurring painkilling chemicals such as endorphins, serotonin, and acetylcholine.
- Behavioral approaches include:
- Biofeedback involves attaching electrodes to the skin and using an electromyography machine that allows people to become aware of and control their breathing, muscle tension, heart rate, and skin temperature; people regulate their response to pain by using relaxation techniques
- Cognitive therapy involves using relaxation and coping techniques to ease back pain
- Transcutaneous electrical nerve stimulation (TENS) involves wearing a battery-powered device which places electrodes on the skin over the painful area that generate electrical impulses designed to block or modify the perception of pain
- Physical therapy programs to strengthen core muscle groups that support the low back, improve mobility and flexibility, and promote proper positioning and posture are often used in combination with other interventions
- Spinal manipulation and spinal mobilization are approaches in which doctors of chiropractic care use their hands to mobilize, adjust, massage, or stimulate the spine and the surrounding tissues. Manipulation involves a rapid movement over which the individual has no control; mobilization involves slower adjustment movements. The techniques may provide small to moderate short-term benefits in people with chronic low back pain but neither technique is appropriate when a person has an underlying medical cause for the back pain such as osteoporosis, spinal cord compression, or arthritis.
Spinal injections include:
Trigger point injections can relax knotted muscles (trigger points) that may contribute to back pain. An injection or series of injections of a local anesthetic and often a corticosteroid drug into the trigger point(s) can lessen or relieve pain.
Epidural steroid injections into the lumbar area of the back are given to treat low back pain and sciatica associated with inflammation. Pain relief associated with the injections tends to be temporary and the injections are not advised for long-term use.
Radiofrequency ablation involves inserting a fine needle into the area causing the pain through which an electrode is passed and heated to destroy nerve fibers that carry pain signals to the brain. Also called a rhizotomy, the procedure can relieve pain for several months.
- Traction involves the use of weights and pulleys to apply constant or intermittent force to gradually “pull” the skeletal structure into better alignment. Some people experience pain relief while in traction but the back pain tends to return once the traction is released.
Step 3 More advanced care options
When other therapies fail, surgery may be considered to relieve pain caused by worsening nerve damage, serious musculoskeletal injuries, or nerve compression. Specific surgeries are selected for specific conditions/indications. However, surgery is not always successful. It may be months following surgery before the person is fully healed and there may be permanent loss of flexibility. Surgical options include:
- Vertebroplasty and kyphoplasty for fractured vertebra are minimally invasive treatments to repair compression fractures of the vertebrae caused by osteoporosis. Vertebroplasty uses three-dimensional imaging to assist in guiding a fine needle through the skin into the vertebral body, the largest part of the vertebrae. A glue-like bone cement is then injected into the vertebral body space, which quickly hardens to stabilize and strengthen the bone and provide pain relief. In kyphoplasty, prior to injecting the bone cement, a special balloon is inserted and gently inflated to restore height to the vertebral structure and reduce spinal deformity.
- Spinal laminectomy (also known as spinal decompression) is done when a narrowing of the spinal canal causes pain, numbness, or weakness. During the procedure, the lamina or bony walls of the vertebrae are removed, along with any bone spurs, to relieve pressure on the nerves.
- Discectomy and microdiscectomy involve removing a herniated disc through an incision in the back (microdiscectomy uses a much smaller incision in the back and allows for a more rapid recovery). Laminectomy and discectomy are frequently performed together and the combination is one of the more common ways to remove pressure on a nerve root from a herniated disc or bone spur.
- Foraminotomy is an operation that “cleans out” or enlarges the bony hole (foramen) where a nerve root exits the spinal canal. Bulging discs or joints thickened with age can narrow the space where the spinal nerve exits and press on the nerve. Small pieces of bone over the nerve are removed through a small slit, allowing the surgeon to cut away the blockage and relieve pressure on the nerve.
- Nucleoplasty, also called plasma disc decompression (PDD), is a type of laser surgery that uses radiofrequency energy to treat people with low back pain associated with mildly herniated discs. Under x-ray guidance, a needle is inserted into the disc. A plasma laser device is then inserted into the needle and the tip is heated to 40-70 degrees Celsius, creating a field that vaporizes the tissue in the disc, reducing its size and relieving pressure on the nerves.
- Radiofrequency denervation uses electrical impulses to interrupt nerve conduction (including pain signaling). Using x-ray guidance, a needle is inserted into a target area of nerves and the region is heated, which destroys part of the target nerves and offers temporary pain relief.
- Spinal fusion is used to strengthen the spine and prevent painful movements in people with degenerative disc disease or spondylolisthesis (following laminectomy). The spinal disc between two or more vertebrae is removed and the adjacent vertebrae are “fused” by bone grafts and/or metal devices secured by screws. Spinal fusion may result in some loss of flexibility in the spine and requires a long recovery period to allow the bone grafts to grow and fuse the vertebrae together. Spinal fusion has been associated with an acceleration of disc degeneration at adjacent levels of the spine.
- Artificial disc replacement is an alternative to spinal fusion for treating severely damaged discs. The procedure involves removing the disc and replacing it with a synthetic disc that helps restore height and movement between the vertebrae.
- Interspinous spacers are small devices that are inserted into the spine to keep the spinal canal open and avoid pinching the nerves. It is used to treat people with spinal stenosis.
Implanted nerve stimulators
- Spinal cord stimulation uses low-voltage electrical impulses from a small implanted device that is connected to a wire that runs along the spinal cord. The impulses are designed to block pain signals that are normally sent to the brain.
- Dorsal root ganglion stimulation also involves electrical signals sent along a wire connected to a small device that is implanted into the lower back. It specifically targets the nerve fibers that transmit pain signals. The impulses are designed to replace pain signals with a less painful numbing or tingling sensation.
- Peripheral nerve stimulation also uses a small implanted device and an electrode to generate and send electrical pulses that create a tingling sensation to provide pain relief.
Rehabilitation teams use a mix of healthcare professionals from different specialties and disciplines to develop programs of care that help people live with chronic pain. The programs are designed to help the individual reduce pain and reliance on opioid pain medicines. Programs last usually two to three weeks and can be done on an in-patient or out-patient basis.
Can back pain be prevented?
Recurring back pain resulting from improper body mechanics may be prevented by avoiding movements that jolt or strain the back, maintaining correct posture, and lifting objects properly. Many work-related injuries are caused or aggravated by stressors such as heavy lifting, contact stress (repeated or constant contact between soft body tissue and a hard or sharp object), vibration, repetitive motion, and awkward posture.
Recommendations for keeping one’s back healthy
- Exercise regularly to keep muscles strong and flexible. Consult a physician for a list of low-impact, age-appropriate exercises that are specifically targeted to strengthening lower back and abdominal muscles.
- Maintain a healthy weight and eat a nutritious diet with sufficient daily intake of calcium, phosphorus, and vitamin D to promote new bone growth.
- Use ergonomically designed furniture and equipment at home and at work. Make sure work surfaces are at a comfortable height.
- Switch sitting positions often and periodically walk around the office or gently stretch muscles to relieve tension. A pillow or rolled-up towel placed behind the small of the back can provide some lumbar support. Put your feet on a low stool or a stack of books when sitting for a long time.
- Wear comfortable, low-heeled shoes.
- Sleeping on one’s side with the knees drawn up in a fetal position can help open up the joints in the spine and relieve pressure by reducing the curvature of the spine. Always sleep on a firm surface.
- Don’t try to lift objects that are too heavy. Lift from the knees, pull the stomach muscles in, and keep the head down and in line with a straight back. When lifting, keep objects close to the body. Do not twist when lifting.
- Quit smoking. Smoking reduces blood flow to the lower spine, which can contribute to spinal disc degeneration. Smoking also increases the risk of osteoporosis and impedes healing. Coughing due to heavy smoking also may cause back pain.
What research is being done?
The mission of the National Institute of Neurological Disorders and Stroke (NINDS) is to seek fundamental knowledge of the brain and nervous system and to use that knowledge to reduce the burden of neurological disease. NINDS is a component of the National Institutes of Health (NIH), the leading supporter of biomedical research in the world.
As a primary supporter of research on pain and pain mechanisms, NINDS is a member of the NIH Pain Consortium, which was established to promote collaboration among the many NIH Institutes and Centers with research programs and activities addressing pain. On an even broader scale, NIH participates in the Interagency Pain Research Coordinating Committee, a federal advisory committee that coordinates research across other U.S. Department of Health and Human Services agencies as well as the Departments of Defense and Veterans Affairs.
The NIH HEAL (Helping to End Addiction Long-term) Initiative, launched in April 2018, is a trans-NIH effort (which NINDS co-leads) that aims to prevent opioid addiction and provide more non-drug treatment options for chronic pain. Back pain is one of the most common pain conditions worldwide and is a major contributor to the prescribing and use of opioids in America. The treatment of low back pain is a specific area of focus of the Initiative. The Back Pain Consortium established through HEAL will conduct studies to better understand the mechanisms of common pain conditions such as chronic low back pain, develop improved diagnostic and treatment tools, and identify, prioritize, and test therapies that reduce the need for opioid use for millions of Americans. For more about the HEAL Initiative, see https://www.nih.gov/heal-initiative.
NINDS-funded studies are contributing to a better understanding of why some people with acute low back pain recover fully while others go on to develop chronic low back pain. Brain imaging studies suggest that people with chronic low back pain have changes in the structure and function of certain brain regions. Other research seeks to determine the role of brain circuits important for emotional and motivational learning, and memory in this transition, in order to identify new preventive interventions. Furthermore, several studies are being conducted to identify and characterize bidirectional neural circuits that communicate between the spinal cord to brain, which are aimed at discovering and validating new interventional targets for low back pain.
Different studies are looking at the response to placebos in individuals with acute and chronic back pain. For example, one study is designed to examine brain properties for placebo response and critically assess the neurobiology of placebo pain relief for individuals with chronic pain. Another study is assessing ibuprofen plus acetaminophen compared to ibuprofen plus placebo in treating acute low back pain.
In addition to NINDS, other NIH Institutes— including the National Institute on Arthritis and Musculoskeletal and Skin Diseases, the National Institute on Drug Abuse, and the National Center on Complementary and Integrative Health—fund research on low back pain. More information on NIH efforts on back pain research and on other disorders can be found using NIH RePORTER (http://projectreporter.nih.gov), a searchable database of current and past research projects supported by NIH and other federal agencies. RePORTER also includes links to publications and patents citing support from these projects.
Where can I get more information?
For more information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, contact the Institute’s Brain Resources and Information Network (BRAIN) at:
P.O. Box 5801
Bethesda, MD 20824
Information also is available from the following organizations:
American Academy of Family Physicians
11400 Tomahawk Creek Parkway
Leawood, KS 66211-2680
913-906-6000 or 800-274-2237
American Academy of Orthopaedic Surgeons
9400 West Higgins Road
Rosemont, IL 60018
American Academy of Physical Medicine & Rehabilitation
9700 West Bryn Mawr Avenue
Rosemont, IL 60018
American Association of Neurological Surgeons
5550 Meadowbrook Drive
Rolling Meadows, IL 60008-3852
847-378-0500 or 888-566-2267
American Chronic Pain Association (ACPA)
P.O. Box 850
Rocklin, CA 95677-0850
National Institute of Arthritis and Musculoskeletal and Skin Diseases Information Clearinghouse
1 AMS Circle
Bethesda, MD 20892-3675
301-495-4484 or 877-226-4267; 301-565-2966 (TTY)
“Back Pain Fact Sheet”, NINDS, Publication date March 2020.
NIH Publication No. 20-NS-5161
Back to Back Pain Information Page
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90,000 causes and treatment methods
We are all afraid of pain. It disturbs, brings discomfort, incapacitates, and sometimes causes unbearable suffering. But the doctors of antiquity called pain “the chain dog of the body.” After all, it is she who signals that urgent help is needed. But what if the “dog” fell off the chain?
Our expert is a neurologist, associate professor of the Department of Nervous Diseases of the Faculty of Medicine of the First Moscow State Medical University.I. M. Sechenova, Ph.D. Natalia Vakhnina.
Pain is an important defense mechanism. It is not for nothing that people who have been deprived of pain from birth, as a rule, do not live up to 3 years. But if the pain is ignored for a long time or treated incorrectly, it will become chronic. In this case, it ceases to be useful, and it will already be very difficult to get rid of it. In addition, every 2-3 patient with chronic pain develops depression or anxiety disorders.
Many-sided and mysterious
In time, the pain is transient (does not last very long), acute (may bother until the sore spot heals, but not more than 1.5 months) and chronic (lasts more than 3 months).Neurologists measure its strength on a special scale (from 0 to 10). This indicator is subjective and depends only on the patient’s feelings.
But finding a place where it hurts is not always easy, because pain is both local and radiating (for example, with angina pectoris, it can be given under the scapula or in the arm, and in diseases of the pelvic organs – in the back). And it can also be reflected – in this case, that part of the skin that is innervated from the same part of the spinal cord as the internal organ hurts – the true source of pathology.In addition, pain can vary in appearance. It can be nociceptive, neuropathic, and psychogenic.
What are you worried about?
Nociceptive pain – the most frequent (up to 80% of cases)
Reasons. The most common are inflammation, mechanical injury or burns (thermal and chemical). Back pain, hangover headaches, or abdominal cramps during menstruation also fall into this category.Such pain is caused by irritation of peripheral pain receptors located in almost all organs and tissues.
Complaints . Patients describe this pain with the words “squeezing”, “aching”, “throbbing”, “cutting”.
How to treat? The main thing is to exclude dangerous pain associated with damage to internal organs. If no serious cause is suspected, it is necessary to take a non-steroidal anti-inflammatory drug or analgesic.But too much medication is dangerous. Drinking pain relievers for headaches more than 3 times a week can cause a drug-induced headache. This is much more difficult to cope with.
Neuropathic pain (up to 8% of cases)
Reasons . Nerve trauma or chronic diseases (diabetes mellitus, alcoholism, trigeminal neuralgia, shingles and others). Phantom pain after limb amputation can also be attributed to neuropathic pain.This pain is caused by damage to the nervous system, which increases the activation of pain pathways.
Complaints . On “burning”, “cutting”, “stabbing”, “shooting” pain. This increases the sensitivity to pain stimuli, which doctors call hyperesthesia. In this case, a person may react sharply even to body contact with sheets or soft clothes. Symptoms may worsen with rest (keeping you awake) but diminish with physical activity.But everything can happen and vice versa.
How to treat? Anticonvulsants (gabapentin, thebantine, pregabalin), antidepressants (amitriptyline, duloxetine), B vitamins.
Reasons. Severe stress and mental disorders. Depression, anxiety, neurasthenia, schizophrenia and others. In this case, there is no neurological or somatic cause, but the pain is nevertheless present.
Complaints . They differ in a huge variety. The pains described can be pretentious, unlike anything. Patients use unusual metaphors to describe their pain (“as if worms are crawling under the skin”, “as if someone is fingering their brains,” etc.)
How to treat? Antidepressants (amitriptyline, duloxetine), tranquilizers, antipsychotics. From non-drug methods – psychotherapy.
It happens to everyone
Nonspecific – musculoskeletal pain (SMP) accounts for about a third of all acute and chronic pain syndromes.
Reason. Osteochondrosis. And among the triggers – stress, hypothermia, high loads, or, conversely, physical inactivity.
Complaints . For pain in the lumbar and sacral spine, buttock, neck and area above the shoulders. Half of the patients have pain in several areas at once. But pain in the lower back (LBP) is in the 1st place (it is present in 80% of people), and in the cervical spine (cervicalgia) – in the 4th (2 out of 3 people have experienced it at least once, and 30 50% of adults experience it every year).
How to treat? Taking non-steroidal anti-inflammatory drugs (NSAIDs) in topical forms or in tablets and muscle relaxants (drugs that relieve muscle spasms that increase pain). Often, NSAIDs alone can be dispensed with.
Among the 200 drugs in this group, drugs containing diclofenac and other active substances stand out. Diclofenac with prolonged or frequent use, especially in people with gastrointestinal problems, can cause complications (ulcers and perforation of the stomach, internal bleeding), as well as increase blood pressure, increase edema.More preferred are preparations based on aceclofenac (aertal, aceclagin, alenthal).
With insufficient effectiveness of NSAIDs, muscle relaxants are required (mydocalm, calmyrex, sirdalud). They are applied in a course (1-2 weeks). With severe pain, treatment begins with injections, then switches to pills.
Hurry cannot be slowed down
Patients with pain have two extreme approaches: immediately run to the doctor or ignore it for a long time.The second reaction is, of course, more dangerous.
According to doctors, it is necessary to act like this: if somewhere the illness is not very severe and the reason is obvious and harmless, it is enough to take an analgesic or non-steroidal anti-inflammatory drug and, if after 1-2 days it does not feel better, go to the doctor (therapist or neurologist).
An exception is acute pain in the abdomen or chest. With such symptoms, you must immediately call an ambulance, as this can be a symptom of a very dangerous disease (appendicitis, heart attack, ruptured aneurysm, etc.).It is especially dangerous to take analgesics for abdominal pain. After all, this way you can “blur” the picture of the disease and hold out until the development of fatal complications, such as peritonitis or perforation of the ulcer.
There is no need to immediately bring any research results to a neurologist. Indeed, each of them has its own indications, and the doctor himself will prescribe what is needed: X-ray, MRI, CT or other studies. However, in 90% of cases, none of this is needed. It is often enough for an experienced doctor to examine and interview the patient, finding out the localization, irradiation, duration, intensity and nature of the pain in order to determine the cause of the pain and prescribe treatment.
Sometimes a neurologist has to send a patient for an additional examination or consultation with other specialists (psychiatrist, surgeon, rheumatologist, gynecologist, oncologist, etc.). This happens infrequently – dangerous causes of pain occur no more than 5% of cases. Nevertheless, it happens, and a good neurologist knows what to look for.
For example, it is atypical when an elderly person or a patient with a history of cancer complains of severe back pain that has arisen for no apparent reason – in this case, it is better to play it safe and send him for CT or MRI to rule out cancer or its recurrence.It is also necessary to exclude osteoporosis, which is treated by endocrinologists. By the way, the doctor will certainly ask a question about constantly taken medications: after all, for example, corticosteroids lead to the development of osteoporosis.
In young people under 20 years of age, severe musculoskeletal pain that arose without injury is also rare – in this case, a consultation with a rheumatologist will not hurt. The presence of a sharp weight loss, fever and other alarming symptoms also cannot be ignored.It is also suspicious when the back pain does not subside at rest (which is uncharacteristic for an ordinary “lumbago”).
The sensation of pain is very subjective. There are factors that enhance this experience or, conversely, decrease it. The more pain is felt, the higher the risk of it becoming chronic. The pain is aggravated by:
– physical inactivity;
– fear, anxiety;
– distrust of the doctor;
– social isolation;
– passive position.
Arguments and Facts
90,000 Why is pain so difficult to measure and relieve?
- John Walsh
- BBC Future
Photo author, Getty Images
Surprisingly, it is sometimes difficult for us to explain exactly how we feel when we are hurt.This is why doctors are developing new ways to assess and treat severe pain, which is covered by the columnist BBC Future .
One night in May, my wife woke up, sat up in bed and said: “I have a terrible pain here.” She felt her stomach and grimaced in pain.
“I think I have something serious,” she complained. Even before I really woke up, I noticed that it was two o’clock in the morning. I asked her to describe the pain. “It’s like something is constantly biting into me,” she replied.
An hour later, she got worse. “Now it hurts even more,” she said, just awful. “Can you call the doctor?”
Fortunately, the family doctor answered the call at three o’clock in the morning, listened to her story about the symptoms and concluded: “Perhaps it is appendicitis. Did you have it removed?” It turned out not.
“Appendicitis cannot be ruled out,” he said, “but if it was serious, you would be much more in pain. Go to the hospital in the morning, and now drink paracetamol and try to sleep.”
In less than half an hour, everything repeated.She woke up a third time, but the pain was already so excruciating and unbearable that she just screamed like a witch who is being burned at the stake.
There was no point in comforting her and playing for time. I called a taxi, quickly pulled on my clothes, put on a robe, and we hurried to St. Mary’s Hospital. The clock was almost 4 am.
A nurse in the emergency room poked a needle in my wife’s wrist and asked, “Does it hurt? How about? How about?” and concluded: “Impressive. You have a very high pain threshold.”
The cause of the pain was pancreatitis.
She was prescribed a course of antibiotics and a month later had an operation to remove her gallbladder.
“This is a minimally invasive surgery,” the surgeon said nonchalantly, “so you will bounce back very quickly. Some patients feel so good after surgery that they take the bus home.”
However, his optimism was premature. My adorable wife, with her surprisingly high pain threshold, had to stay in the hospital overnight, and the next day she returned home pumped up with painkillers.When their effect passed, she was simply twisted in pain.
Photo author, Getty Images
In the hand are some of the densest accumulations of nerves in the human body
During the recovery period after surgery, looking at how she crooked, gritted her teeth and only occasionally allowed herself to scream, Until a long course of ibuprofen and codeine helped her overcome the pain, I asked myself various questions.
The most important of them sounded like this: “Can any of the doctors confidently talk about pain?” Both the family doctor and the surgeon made comments and assumptions that seemed overly cautious, generalized, incompetent and even potentially dangerous to me.
I also wondered if there were any terms that could help the doctor understand what kind of pain his patient is experiencing.
I remembered how my father, who worked as a general practitioner in a public clinic in south London in the 1960s, talked about the colorful descriptions of pain symptoms he had heard: “as if someone attacked me with a stapler”, “as if I have rabbits running down my spine, “” as if someone had opened a cocktail umbrella in my penis … “
Few of these descriptions, he said, matched the symptoms listed in medical textbooks.So what should he have done? Guesses and prescribes aspirin for everyone?
I wanted to know how pain is understood in the medical environment, what words they call what cannot be seen and measured simply by listening to the patient’s subjective opinion, and what can only be cured with the help of opium derivatives that were used in the Middle Ages.
In many countries of the world, the main clinical method for the study of pain is the McGill Pain Questionnaire, created in the 1970s by two scientists from McGill University – Dr. Ronald Melzak and Dr. Warren Thorgerson.It is still one of the most widely used pain measurement tools.
Melzak began to write down the words that patients used to describe pain and divided them into three groups: sensory (including “heat”, “pressure”, “pulsation” or “heartbeat”), affective (associated with emotions, including “exhausting”, “sickening”, “debilitating” or “frightening”) and, finally, evaluative (related to the experience, from “annoying” and “annoying” to “terrible”, “unbearable” and “excruciating”) …
Unfortunately, all these words sounded like the Duchess was complaining about a ball that did not live up to her expectations. Nevertheless, it was this Melzak pain matrix that formed the basis of the McGill Pain Questionnaire.
A list of epithets describing pain is read out loud to the patient, and he says whether each word is suitable for what he is experiencing. If so, then he needs to determine how strong this sensation is.
The doctors then check the boxes and calculate the result, which can be expressed either in numbers or as a percentage, and then use it to see if the treatment has given the desired result.
Photo Credit, Getty Images
For women with childbirth experience, any other pain often appears to be relatively mild
A more recent option is the Pain Quality Scale developed by the National Pain Control Initiative.
Patients are asked on a scale of 1 to 10 to rate how “strong” or “sharp”, “hot”, “dull”, “cold”, “sensitive”, “muffled”, “ticklish”, etc. are asked. their pain has been for the last week.
The problem with this approach was the inaccuracy of the scale from 1 to 10, where 10 is “the most painful sensation you can imagine.” How can a patient imagine the worst pain and assign a serial number to his own pain?
The average British middle class who has never been involved in hostilities is unlikely to imagine anything worse than a toothache or an injury sustained while playing tennis, while women who have given birth can only rate any pain as 3 or four.
A friend of mine who specializes in World War I drew my attention to Stuart Cloit’s memoir, The Victorian Son (1972), in which the author recounts his time in a field hospital.
He marvels at the strength of spirit of the wounded soldiers: “I heard the guys crying from weakness on their beds, but they never asked for anything but water or a cigarette. The only exception was a man with a pierced arm. I think this is the most painful the wound is possible, because when the muscles of the arm contract, the tendons stretch the flesh like a rack. “
Stephen McMeigon of the London Pain Consortium, founded in 2002 to conduct international pain research, is skeptical about pain quantification questionnaires.
“There are a lot of problems when trying to measure pain,” he says. “It seems to me that the fascination with numbers is an oversimplification. Pain is not one-dimensional. It is characterized not only by intensity, but also by many other factors – how dangerous it is, how emotionally difficult it is. how it affects your ability to focus. “
“I think that the urge to measure pain is primarily inherent in regulatory bodies – they think that it is necessary in order to understand how effective a particular drug is,” he adds.
Pain can be acute or chronic. Acute pain is a temporary or isolated sensation of discomfort that usually needs to be treated with medication. Chronic pain does not go away with time and becomes an unpleasant companion for the person with whom he has to put up.
Patients with chronic pain develop drug resistance and therefore need to consider other treatments.
“I would say that 55 to 60 percent of our patients suffer from lower back pain,” says Adnan Al-Qaysi, who heads the Pain and Neuromodulation Center at London’s Gays and St Thomas Hospital, Europe’s largest the activity is devoted to the study and elimination of pain.
“The reason for this is simple: we do not pay attention to the needs of our body, how we sit, stand, walk, and so on.We sit for hours at the computer, thereby heavily loading the small joints in the lower back, “he explains.
Photo author, Science Photo Library
According to Al-Qaysi’s calculations, the number of cases of chronic low back pain has increased significantly over the past 15-20 years, and “losses due to lost working days are estimated at 6-7 billion pounds.”
In addition, the clinic treats severe chronic headaches and injuries resulting from accidents affecting the nervous system.
Are they still using the McGill Pain Questionnaire? “Unfortunately, yes, – says Al-Qaysi. – This is a subjective method of measurement. But pain can increase due to a quarrel at home or problems at work, so we try to find out what lifestyle a person leads, how he sleeps, how he walks and it is worth what his appetite is. It’s not only the patient’s condition, but also in his environment. “
The difficulty is to turn this information into scientific data. “We are working with Raymond Lee, Chair of the Department of Biomechanics at South Bank University, to see if the degree of pain-related impairment in a patient’s health can be objectively measured,” he says.
“They are trying to develop a tool, something like an accelerometer, that will give an accurate idea of how actively a person can move and tell the cause of the pain based on how he sits or stands.We really want to find a new way to assess pain, and not just ask people how bad their pain is, “explains Al-Qaysi.
The clinic also has patients with symptoms that are much worse than back pain. Al-Qaysi says of one patient – let’s call him Carter – who suffered from ilio-inguinal neuralgia, a terrible condition causing severe burning and stabbing pain in the groin.The pain was unbearable: when he came to us, he took four or five types of drugs, including very high dosage opiates, anticonvulsants, opioid patches, plus paracetamol and ibuprofen. His life turned upside down, he risked losing his job, “- this is how the condition of the patient Al-Qaysi describes.
This case was one of Al-Qaysi’s greatest successes.
Since 2010, Gays and St. could not be cured in other clinics, a four-week course of treatment in a hospital.
Patients leave their familiar environment and are examined by doctors of various specialties, including psychologists, physiotherapists, and health and safety specialists. They then collectively develop a program to educate the patient about pain management strategies.
Many of these strategies involve neuromodulation. This term is very common in pain management circles.
In simple terms, neuromodulation is a distraction of the brain from the constant processing of pain signals from the peripheral nervous system.Sometimes clever technologies are used for this using electric current.
Photo Credit, Science Photo Library
Exposing the nerve endings of the spinal cord with a weak electrical current using an implantable device can help relieve chronic pain
“We were the first center in the world to use spinal cord stimulation technology, – says Al-Qaysi proudly, “We send weak electrical shocks to the spinal cord by inserting a conductor into the epidural space.The voltage reaches only one or two volts, so the patient only feels a slight tingling sensation in the area that was hurting him before. “
” The patient feels nothing but pain relief. This is a non-invasive method – we usually let patients go home the same day, “he adds.
When Carter, the guy with the groin pain, was not affected by other treatments, Al Qaisi decided to try his own method.
“We gave him what we call lumbar node stimulation,” says Al-Qaysi.- It overexcites the spinal cord and sends impulses to it and to the brain. Ten days later, according to the patient’s own assessment, the pain had decreased by 70%. “
” I received a very pleasant email from him saying that I had changed his life, that there was no more pain, but he was returning to normal life. He said that he managed to keep his job and marriage, and he wants to go back to sports. This is an incredible result, and it is impossible to achieve it by other methods, “says Al-Qaysi.
According to Irene Tracy, head of the Department of Clinical Neurobiology. Nuffield at Oxford University, the most recent advance in pain assessment is the understanding that chronic pain is a distinct entity.
“We always thought that chronic pain is the same acute pain, only lasting for a very long time,” she explains. “If this is true, then you just have to eliminate the cause of acute pain, and chronic pain will also pass. This turned out to be far from the truth.” …
“We now view chronic pain as a shift to another location, with different mechanisms, including changes in gene expression, chemical production, neurophysiology, and neuronal function. We now look at chronic pain in a whole new way. This is a new word in areas of pain management, ”says Tracy.
Tracey was dubbed “the queen of pain” by journalists. Despite this nickname, in life she looks absolutely not intimidating: this is an energetic, friendly woman of fifty with burning eyes and incredibly fast speech.
She speaks about pain competently. She can easily determine “severe pain”, which, according to the McGill pain questionnaire, will pull 10 points: “I have three children, and now my 10 points are very different from 10 points before childbirth. In my understanding, this scale has undergone significant changes.”
But how does she explain what severe pain is to those who have never given birth? “I say:“ Imagine that your hand is sharply clamped by the door of the car – this is 10. ”
According to her, a breakthrough has recently been made in understanding the relationship between the brain and pain.Neuroimaging helps connect subjective pain with objective perception.
“It fills the gap between what you see and what you are told. Thanks to her, we can explain why the patient is in pain, even though the source of the pain is not visible either on the X-ray or anywhere else. We help to discover the truth. and prove that the person is really in pain, although no one believes him. ”
Nevertheless, it is impossible to simply “see” how the pain glows and pulsates on the screen.
“Using brain imaging, we have learned a lot about the neural networks of the brain and how they function,” she says. “However, it is not a means of measuring pain. It is a tool that gives us a startling picture of the anatomy, physiology and neurochemistry of the body and can tell us about the causes pain and ways to eliminate it “.
According to her, access to the human brain can be obtained using fairly simple mechanical methods – such as the Al-Qaysi conductor to stimulate the spinal cord.
“There are now devices that attach to the head and manipulate different parts of the brain. They can be worn like bathing caps. They are portable and ethically acceptable devices for brain stimulation. They are easy to use, and clinical studies have proven to be effective for elimination of the consequences of strokes and for rehabilitation “.
Photo Credit, Science Photo Library
Burning pain after a herpes zoster infection can be unbearable
Scientists at the Human Pain Research Laboratory at Stanford University, California, study individual pain responses to guide treatment more targeted.
The center was founded in 1995 by a man with a speaking surname Martin Angst (the word angst in English means “fear”, “anxiety”, “anxiety” – bbcrussian ) from the Department of Anesthesiology.
His early research focused on finding reliable methods for quantifying pain. Then Angst, together with an assistant with an equally speaking surname Martha Tingle (the word tingle in English means “tingling”, “tingling”, “burning” – bbcrussian ), he began to study the pharmacology of opiates, for example, how quickly a person develops addiction to medications.
Several types of pain have been studied in the laboratory, including migraine, fibromyalgia, and facial pain, but the largest of these has been devoted to back pain.
The US National Institutes of Health has awarded a $ 10 million grant to study alternative drug-free treatments for low back pain.
These include mental practices, acupuncture, cognitive behavioral therapy, and neuronal feedback. Perhaps to some, this set of methods will seem purely Californian, but the laboratory takes them very seriously and involves a lot of patients in research in order to create an extensive database.
A distinctive feature of the assessment process is that the psychological state of patients is also measured: according to a certain scale, the level of depression, anxiety, anger, physical functioning, behavior in pain, and the impact of pain on their lives are determined. Doctors plan to use this information to develop individual treatment methods.
The Human Pain Research Laboratory is headed by Sean Mackey, Professor of Anesthesiology, Perioperative Pain Medicine and Neurobiology at Stanford University.
“It so happens that a person, trying to get rid of pain, commits suicide,” he says. to drill his skull to get rid of it, “he says.
When asked about his biggest successes, he talks about simple solutions. “At the very beginning of my career, I focused on the obvious side of pain – that is, the areas where it occurred.I have resorted to medical interventions, and some patients get better and others do not. So I started listening to their fears and anxieties and working with them, and eventually I started to concentrate on the brain, “says Mackey.
” One day a girl came to me with a terrible burning sensation in her hand. The hand was constantly swollen. Any touch of her felt unbearable, “he says.
Mackie noticed that she had a scar on her arm from an operation to treat carpal tunnel syndrome.Assuming that this was the problem, he injected Botox, a muscle relaxant, at the site of the scar.
“A week later, she came to me, hugged me tightly and said: for the first time in two years, I was able to pick up my daughter. I could not do this since she was born.” The swelling was gone. I concluded that it was not just a part of the body and not just a brain. The point is both.
How surprising to find that, after centuries of opiate pain management, the brain can compete with morphine.
Emotional sources of pain in various parts of the body
Cause of pain
We often suffer from various pains and, without really thinking about the cause of their occurrence, we take a pain reliever to get rid of unpleasant sensations. We often explain neck pain by an uncomfortable position during sleep, back pain – by sedentary work, leg pain – by uncomfortable shoes or long walking, headache – by a change of weather.
However, in many cases, the true cause of pain can be emotions in which we are not aware.
Emotions as a source of pain: the opinion of a psychologist
According to the psychologist Susan Beibel, a person’s emotions can influence the severity of chronic pain and even cause them. Undoubtedly, physical injuries and various diseases are leading in the list of sources of pain. However, emotional problems, according to the psychologist, can also be a direct cause of pain.
First of all, it is necessary to exclude the physical sources of pain, seeking help from qualified specialists, and only after that start looking for the emotional causes of pain.Here is a list of pain sensations that may not be associated with, say, muscle strain, injury or illness, namely:
- pain in the head, neck, shoulders;
- Pain in the upper and lower back;
- pain in elbows and arms;
- Pain in the hips, knees, legs, ankles and feet.
Emotional sources of pain in the head, neck and shoulders
The headache may be related to the primary needs of the body. Migraines and other types of headaches can signal a lack of water, food, lack or excess of a substance in the body.However, the leading source of head pain is stress. Relax, relax and rethink your life priorities.
A feeling of guilt can be manifested by a pain in the neck, which you cannot get rid of in any way. If you cannot forgive yourself or a loved one in any way, try directed meditation to get rid of this feeling.
Every day the burden of problems falls on our shoulders, literally and figuratively. This invisible weight puts pressure on your shoulders, causing pain.Learn to abstract yourself from problems, especially from those that you cannot solve.
Emotional sources of pain in the upper and lower back
It is the upper back that begins to disturb people who do not feel emotional support from loved ones. The feeling of lack of love, the need for attention and care are possible sources of pain in this area. It may be time to strengthen bonds with loved ones or find a loved one. Get out into the light and interact with those around you.
If your lower back hurts, it may mean that you are not sure about your financial stability. Try to solve your financial problems by saving money and planning your budget carefully.
Emotional sources of pain in the elbows and arms
Pain in the upper arms and elbows may indicate a lack of flexibility. Experiences associated with changes in life can be a source of pain in these parts of the body. Try not to resist the change, but to embrace it. Remember, most changes are for the better.
Lack of companionship can lead to pain in the hands, including the palms. Try spending time actively with coworkers or meeting old friends to ease this pain and make up for the lack of communication.
Emotional sources of pain in the hips, knees, legs, ankles and feet
Hip pain can be a sign of fear and unwillingness to move forward. A reluctance to make an important decision can also be a possible source of hip pain.Remember that all difficulties and obstacles exist only in our head. And by facing your fears face to face, you can get rid of them and improve your life.
Knee pain is a common concern for people who like to have everything go according to their requirements. Complete ignorance of the needs and feelings of others, unwillingness to yield to others and the need to always be right often cause pain in the knees. Consider this: it might be time to learn to give in.
The shins may hurt as a result of tension, stress or jealousy.Learn to relieve stress and trust your partner.
Pain in the ankles may indicate a lack of pleasure in life. Treat yourself to interesting events.
Depression can cause pain in the feet. Come up with a new hobby, hobby, get a pet, chat with friends more often.
Only a doctor can accurately determine the source of physical pain, therefore it is better to consult a specialist if any alarming symptoms occur.Having a positive attitude, being in a good mood, dealing with stress, and connecting with loved ones are great ways to increase the effectiveness of any treatment and avoid emotional sources of pain.
Based on materials from samoraskrytie.ru
Back pain: causes, treatment, orthotics
Causes of back pain and risk groups
Back pain is one of the most common complaints of diseases of people of working age, elderly and senile age.The human spine bears almost the entire weight of a person. It consists of 33-34 vertebrae, which are connected by intervertebral discs. Thanks to this connection, the vertebrae can move relative to each other. The sacrum and tailbone are special parts of the spine. The sacrum is formed by five fused vertebrae, and the coccyx is a rudimentary part of the spine that does not perform a supporting function.
Pain can develop in any one or all three parts of the spine.Most often, pain occurs in the cervical, thoracic and lumbar spine. Pain can be caused by diseases and injuries of the discs (protrusion of the disc, herniated disc) and intervertebral joints (arthrosis of the facet joints), or other conditions.
The number of people with back pain has increased dramatically in recent years and decades, making it the most common complaint in the world.
Types of back pain
Acute back pain lasts up to six weeks.If it lasts up to 12 weeks, it is called subacute. Pain that persists after 12 weeks is called chronic pain.
Depending on the definition of certain causes of pain, there are
- nonspecific back pain
- specific back pain
Specific back pain
Specific back pain
If the exact cause of the pain is known, it is referred to as specific back pain.
Examples of specific pain are trauma, lesions of the intervertebral disc, inflammation of the intervertebral joints (arthrosis of the facet joints).
Nonspecific back pain
Nonspecific back pain
In some cases, back pain is classified as nonspecific, since it is not possible to accurately determine its cause.
Nonspecific back pain can occur with poor posture or lack of physical activity.
Symptoms and complaints
Almost everyone has experienced either “lumbago” or mild back pain. “Back again!” – a very common phrase, because the back is under significant stress every day. Hours spent sitting in the office, slouching in front of the computer, lifting and carrying heavy objects, or working in the garden in a position: minor back pain is an integral part of everyday life.
Back pain must be taken seriously. The reason for contacting a doctor should be situations when the pain does not go away for several days, when certain movements intensify the pain or when the pain radiates to the limb (s), and especially when there is a feeling of numbness .
Shooting pains in the lower extremities are characteristic of compression of the spinal cord or its roots (for example, herniated disc). The pain inherent in arthritic changes in the intervertebral joints is usually dull and local.The nature and intensity of pain can vary greatly from person to person. Only a doctor can, on the basis of complaints and symptoms, prescribe the necessary examination and treatment appropriate to the situation. Depending on the situation, the doctor may prescribe physiotherapy, therapeutic exercises, or schedule surgery. With conservative treatment and during the period of postoperative rehabilitation, it is very important to regularly do therapeutic exercises, because they train muscles, stabilize the spine and reduce pain.
Most common causes of back pain
The spine or vertebral column is a complex structure consisting of vertebrae, intervertebral discs and ligaments 1 . Pain occurs when the interaction of these structures is disturbed. Typical reasons are:
Stress causes back pain
Predominantly sedentary work and lack of physical activity in daily life lead to chronic tension of the back muscles and pain in the spine in the absence of any disease.
Did you know that emotional stress at work and in your personal life also leads to muscle tension? For more information on the relationship between psychological stress and back pain, see this brochure.
The intervertebral discs act as biological shock absorbers and separate the vertebral bodies from each other. With a decrease in the elasticity of the disc, it begins to bulge into the lumen of the spinal canal (the so-called prolapse), and its height decreases.The latter negatively affects the work of the intervertebral joints, because their biomechanics is disrupted.
If the protruding part of the intervertebral disc presses on the sensitive nerve fibers, then various sensory disturbances may occur in the innervation zone of the compressed nerve: pain, tingling, numbness, creeping, etc. If the motor nerve fibers responsible for the work of the muscles are compressed, then the function of the innervated muscle is disrupted, up to paralysis.
Posture disorders and heavy lifting can lead to disruption of the anatomical relationships of the structures of the spine.In some cases, this leads to the so-called block of intervertebral joints, usually accompanied by severe pain. When the intervertebral joints are blocked, the back muscles are in a state of painful spasm. Thus, pain occurs not only in the blocked joint, but in the muscles. This dramatically reduces the physical activity of patients up to the inability to walk. When blocking intervertebral joints, effective stabilization of the spine with medi braces helps to eliminate muscle spasm, localize pain and increase motor activity.
As we age, our spine gradually changes its structure, which is described by the general term “degenerative changes”. In this case, the word “degenerative” refers to irreversible changes as a result of aging. Despite the irreversibility of the process, the use of orthoses helps to relieve and improve the patient’s condition.
Degenerative changes in the intervertebral disc imply a violation of its elasticity, a decrease in height and bulging into the lumen of the spinal canal.A decrease in disc height causes increased stress on the intervertebral (facet) joints.
The position of the spine, including the lumbar spine, is stabilized by the work of the muscles. The back muscles, the abdominal muscles and the muscles of the lateral abdominal wall are involved in maintaining posture. Muscle work makes the load on the intervertebral discs more even and prevents excessive stretching of the tendon-ligamentous apparatus.Any pain syndromes negatively affect the functioning of muscles, which can lead to local hypertonicity or, conversely, local weakness. As a result, the stabilization of the spine is impaired. This, in turn, provokes an increase in the hypertonicity of some muscles, i.e. a vicious pathological circle is formed.
Therapeutic gymnastics helps to break the pathological circle, allowing to restore the symmetry of the tone of the muscles of the trunk.
The cause of back pain can be localized not only in the trunk.For example, abnormal gait biomechanics can also cause back pain. First of all, this is due to the loss of the cushioning function of the foot in case of certain deformations. Another reason may be the difference in the length of the limbs, exceeding the norm.
Good news: In many cases, back pain goes away after a few weeks. Nonspecific pain is successfully treated with the help of mobilization techniques (manual therapy) and medication.With such pain, exercise therapy exercises are very effective.
Each of us can reduce the strain on the back and prevent pain.
Exercises useful for the back.
There are strength training exercises that you can easily integrate into your daily routine. This complex was developed in conjunction with a specialist in physiotherapy exercises.
Try it! And your back will thank you.
- Regular exercise : Three 45-minute sessions per week will help improve well-being, activate the immune system and help maintain muscle tone.Optimal back sports are swimming and walking.
- Balanced nutrition : Proper nutrition prevents excess weight, which is an additional burden on the back.
- Lift Weights Correctly : When lifting weights, squat down and lift the load by extending your legs, not your back muscles.
- Carry weights correctly : Carry heavy objects as close to your body as possible.Don’t carry heavy things in one hand.
- Be physically active : Sedentary workers should take every opportunity to increase their physical activity, such as walking up stairs better, getting up more often during the day, walking while talking on the phone, and taking walks during their lunch break.
Back pain often occurs in the workplace. Prolonged sitting in the wrong position can lead to chronic muscle fatigue and subsequent pain. Also, back pain is often provoked by work associated with frequent bending and lifting.
Download the medi brochure to learn more about ways to keep your back healthy at work and in your daily activities.
Back pain treatment
There are many treatments for back pain.First of all, the attending physician chooses between conservative and surgical treatment. The latter is used when conservative treatment is ineffective and in a number of other cases.
View our Orthopedic Products for Back Pain brochure.
Physiotherapy and massage
Physiotherapy and massage
Complexes of remedial gymnastics and special exercises for the back should be performed under the supervision of a doctor or physiotherapy instructor until you have mastered the technique of performing each exercise. Such sets of exercises are developed to train the strength of the musculature of the trunk.The doctor chooses the exercises that best suit the patient. Massage and physical therapy may be prescribed to reduce the intensity of pain.
Drug therapy is prescribed to reduce pain and inflammation in the acute period. Taking pain relievers helps to eliminate the uncomfortable protective position that the patient takes to relieve pain.Medication should be taken only as directed by a doctor.
Strong trunk muscles protect the spine from adverse stress, reduce the likelihood of spasm and pain. To prevent back pain, you should regularly do exercises to train your back muscles. Swimming or walking is also helpful.
The set of exercises combines strength training and stretching exercises, and is designed for 20 minutes.The optimal frequency of exercise is 2-3 times a week. Important: consult your healthcare professional before exercising.
Orthopedic products for the spine
Medical braces and braces for the spine are designed to treat pain and muscle spasms.Modern bandages and corsets effectively fight pain and increase physical activity. Depending on the diagnosis, devices with greater or lesser potential are used to stabilize the lumbar spine.
Lumbar braces and corsets with higher height and more rigid stabilizing elements better stabilize and support the spine in the desired position. The ability to move without pain and participate in social life eliminates the seeming bulkiness of even the most rigid corsets.
Stylish orthosis – practical guide
Can a spine orthosis be fashionable and stylish? You can get the answer by reading our brochure.Learn how to take care of your health and dress appropriately at the same time.
Treatment can be trendy!
Download the brochure!
medi products for effective back support
Bandages and corsets medi
The medi company manufactures a large number of orthopedic devices for the treatment of a wide variety of diseases.Hundreds of thousands of people around the world note the high efficacy of medi products, including those intended for the treatment of back pain. At the same time, patients point to the high comfort and durability of the products. Thanks to their special design, all medi lumbar braces are easy to put on. Additional comfort in the sitting position is also provided by a design solution – a special pattern in the area of the groin folds.
Stabilization of the lumbar spine with medi orthopedic products is not accompanied by muscle weakening, much less atrophy.As already mentioned, the ability to move without pain increases the physical activity of patients. In addition, orthopedic support is aimed at eliminating excessive and / or painful mobility, and not at immobilization, which is the reason for the functional inactivity of the muscles and their weakening.
Find out more about medi orthopedic products for the spine.
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1 Klein, Dr Christoph (2014): Orthopedics for patients.Understanding medicine. Remagen: Published Michels-Klein, p. 277.
Diagnostics and treatment
Types, causes and treatment of back pain.
90,000 What Pains in the Heart Are Saying | Causes of pain in the heart area
Not all pains in the left side of the chest are caused by cardiac pathologies. The causes of such symptoms can be diseases of the respiratory system, digestion, muscles, nervous and endocrine systems.How to understand the nature of pain in the region of the heart and start the correct treatment?
What is the cause of the pain?
It is important to determine what kind of problem in your body is causing discomfort.
- If pain appears during physical exertion, changes with movement, change of position, deep breath, then most likely it is thoracic sciatica, or otherwise intercostal neuralgia;
- Short-term or intermittent aching pain in the region of the heart is a common complaint with neuroses;
- Pressing or stitching pains accompanied by shortness of breath are associated with disturbances in the functioning of the intestines;
- And if painful sensations directly depend on periods of fasting and taking any food, then the reason lies in gastrointestinal diseases.
How to find the source of pain?
When pain in the heart area occurs, it is important to correctly determine its true cause, excluding, if possible, cardiac diseases. This requires a thorough examination by a cardiologist, surgeon and neurologist. Mandatory diagnostic methods are:
- Holter examination,
- computed tomography and MRI of the spine.
According to the results of examinations, specialists will be able to say how painful sensations in the heart region are associated with the most important organ of the human body. If the cardiologist and neurologist do not find any serious violations in the work of the heart muscle and the condition of the spine, then you will have to look for the cause of the pain in an endocrinologist or gastroenterologist. Often, pressing chest pains are caused by stomach cramps.
What to do at the time of an attack?
Acute pressing pain in the left side of the body may occur suddenly.The main thing is not to panic. What to do during an attack:
- take the most comfortable position, sitting or reclining,
- provide air flow and loosen clothing,
- take nitroglycerin tablet,
- call an ambulance.
Only professional doctors are able to help you get rid of pain with minimal losses for the general physical condition of the body.
90,000 Back pain in children and adolescents | Sergeev A.V., Ekusheva E.V.
The article is devoted to the diagnosis and treatment of back pain in children and adolescents
The most common causes of back pain in children are benign musculoskeletal pain and injury. Despite the high prevalence of musculoskeletal pain (about 50%), specific causes of pain syndromes can often be identified: infectious spinal pathology, inflammatory spondyloarthropathies, osteoid osteoma, Scheuermann-Mau thoracic hyperkyphosis, spodilolysis and spondylolisthesis .In practice, it is important to train doctors of various specialties (pediatricians, orthopedists, neurologists) in examining children with complaints of back pain and using evidence-based effective algorithms for diagnosis and treatment.
Contrary to the popular belief that “children rarely have back pain”, back pain is observed in children quite often, especially in adolescence [1, 2]. The incidence of back pain increases linearly with age and pubertal development of children .In most cases, the causes of back pain are musculoskeletal disorders; at initial manifestations, the pain syndrome is mild, regresses on its own, and most parents and children do not seek medical help. As a result of the largest epidemiological cross-sectional study, more than 5,000 children and young adults were interviewed. It was found that at the age of 12, 7% of children experienced back pain at least once. The overall incidence of back pain increased to 50% by the age of 18 in the female population and by the age of 20 in the male population .On every certain day, 1% of children aged 12 years complain of back pain, 5% – at 15 years old, and every 10th – at 20 years old . Interesting data were obtained when analyzing the factors associated with back pain in the pediatric population. At school age, the risk of developing back pain is higher in girls, in children who watch TV for a long time, spend a lot of time at the computer, and also have affective (anxiety) disorders and a family history of back pain. Professional sports are also significantly associated with back pain.At the same time, moderate sports activity, mainly aerobic, is a factor in the prevention of various pain syndromes, for example, neck and back pain, tension headache, migraine .
Data on the frequency and structure of specific causes of back pain are scarce and highly dependent on the analyzed population. One prospective study analyzed the data of 73 children who visited a specialized clinic with chronic back pain that lasted more than 3 months.Patients after surgery were not included in the study. In 60 children (82%), the main cause of pain was musculoskeletal disorders, and only 13 patients (18%) had certain diseases that were sources of pain syndrome: spondylolysis with / without spondylolisthesis (9), Scheuermann-Mau disease (2 ), osteoid osteoma (1), extrusion of the intervertebral disc . According to a retrospective analysis of data from 116 adolescents who received treatment in an orthopedic clinic, in 63 people (55%), back pain was associated with musculoskeletal causes with / without scoliosis.Scheuermann-Mau disease was detected in 23 cases (20%), spondylolysis / spondylolisthesis – in 18 patients (16%), other causes, including 2 extrusions of intervertebral discs – in 12 patients (10%) . We also analyzed the structure of back pain in children admitted to the emergency department with this complaint. In 25% of cases, the cause of pain was acute trauma, in 24% of cases – muscular-tonic syndrome. In 13% of patients (quite often), back pain was a manifestation of a crisis in sickle cell anemia.In 13% of cases, the pain syndrome had an unclear ethology, in 5% of cases it was caused by an infection of the urinary system, in 4% – by an acute viral infection . In more than 90% of cases, back pain continues in children for less than 4 weeks. There are interesting data from longitudinal studies of the course of back pain in children: one group of children (n = 225) with complaints of back pain was examined at the age of 9, 13 and 15 years. In 7% of cases, pain was noted at each age .
Causes of back pain in children
Benign musculoskeletal pain and trauma are the most common causes of back pain in children.
Sources of musculoskeletal pain in most cases are muscles, ligaments, joints (facet and sacroiliac), intervertebral discs and bone structures of the spine.
The most common source of back pain in children and adolescents is muscle tonic, myofascial syndrome (MFS) . This syndrome can develop both against the background of orthopedic pathology (pronounced scoliosis, kyphoscoliosis, asymmetry of the pelvis, leg length), and against the background of muscle strain and injuries.More often, muscle pain is localized in the region of the paravertebral muscles, trapezius muscles with irradiation to the zones of reflected pain from myofascial points with intensification during twisting and extension.
Several factors have been identified that are associated with muscular back pain in children and adolescents:
Wearing a heavy backpack. According to the recommendations of the American Association of Pediatricians, the weight of the backpack should be no more than 10–20% of the child’s body weight .
Use of soft mattresses (associated with pain and morning stiffness in the back) .
Intense sports / training technique disorders (incorrect riding position, incorrect running shoes, etc.) .
Psychosocial distress, anxiety / depression .
In most cases, muscle pain in the back regresses spontaneously; in case of unexpressed pain syndrome, it is preferable to use non-drug methods of therapy (exercise therapy, massage).
With bone sources of pain, as a rule, pain is localized along the central axis of the spine with intensification during extension and rotation, which, however, is not a specific symptom.As noted, bone causes of back pain in children are rare. Among them, the most common are spondylolysis, spondylolisthesis, scoliosis, Scheuermann-Mau juvenile kyphosis, less often juvenile osteoporosis, congenital absence of a vertebral pedicle, vertebral apophysis fracture or Limbus vertebra (displaced vertebral apophysis), stress injuries of the SIJ during
Spondylolysis and spondylolisthesis. Spondylolysis is a congenital or acquired one / two-sided defect (nonunion / damage) in the area of the vertebral arch in the inter-articular region.In most cases, spondylolysis occurs at the lower lumbar level, mainly L 5 . In case of bilateral damage (or congenital nonunion), the vertebral body can move forward (spondylolisthesis) . Risk factors for the development of spondylolysis and spondylolisthesis are certain sports with a combination of frequently repeated flexion / extension and hyperextension in the lumbar spine (for example, gymnastics and dancing, figure skating, weightlifting, volleyball, football, tennis).Usually, the clinical manifestations of spondylolysis are observed in adolescence in the presence of provoking factors. For spondylolysis of character, acute shooting (piercing) pain in the lumbar spine with an increase in hyperextension and a decrease at rest. Examination of the patient may reveal increased muscle tension (with an emphasis on the side of the pathology) in the paravertebral muscles with an increase in extension and / or lateral tilt, as well as soreness during passive lifting of a straight leg and bending forward.In addition, it may be useful to conduct a hyperextension test on one leg, when the patient stands on one leg and bends (deflection) backward with possible ispilateral increase in pain syndrome, while this test is not specific for spondylolysis .
In the process of rapid growth in adolescence in the presence of predisposing factors, spondylolysis can be complicated by spondylolisthesis, which is clinically associated with persistent pain syndrome.
Scoliosis – lateral curvature of the spine with an angle (Cobb angle) of deviation of more than 10 °. As a rule, scoliosis is combined with various types of spinal rotation. Scoliosis can be idiopathic or develop as a result of various pathological processes (congenital malformations, muscle spasms, infections, tumors). The idiopathic variant of scoliosis occurs in most cases – 80–85%. The prevalence of scoliosis in the adolescent population is about 3% .In patients with scoliosis, musculoskeletal pain syndrome is significantly more frequent. However, in connection with overdiagnosis of scoliosis, a comprehensive approach to identifying the causes of back pain with an overall assessment of biomechanical, orthopedic and neurological manifestations should be made. A deviation of less than 10 ° (Cobb angle) is considered within the acceptable physiological asymmetry.
Scheuermann’s disease – Mau. Juvenile kyphosis is defined as an anterior wedge-shaped deformity (compression) of 5 ° or more in at least 3 adjacent vertebrae and is usually detected by radiography .The exact etiology of Scheuermann-Mau disease remains unknown. A variant of genetic predisposition is being considered, which is confirmed by research data among twins . Prolonged bed rest (for various reasons) and conditions accompanied by transient osteoporosis are most often noted as possible risk factors . It was also noted that adolescents with this pathology are slightly taller than their peers and have a shortened sternum size, which can lead to a predisposition to compression damage to the anterior part of the vertebrae.At the same time, there is no convincing data showing the relationship between sports (including weightlifting) and the development of Scheuermann-Mau disease.
The incidence of juvenile kyphosis is estimated in the range of 4–8%, the disease is more common in boys . The clinical manifestations of Scheuermann’s disease are nonspecific: usually there are subacute pains in the thoracic and, less often, lumbar regions, without connection with trauma, with an increase with physical exertion and a decrease after rest.Juvenile kyphosis can be combined with spondylolysis and, less often, with pronounced changes, with myelopathy [22, 23].
In Scheuermann’s disease, there is a rigid (rigid) kyphosis with the formation of a relatively acute angle, which does not smooth out when bending forward, extending and in the prone position. Also, on examination, compensatory lumbar hyperlordosis and hamstring syndrome can be detected. However, these manifestations do not serve as obligate signs of juvenile kyphosis, the “gold standard” of diagnosis is the analysis of radiographic images.
As a rule, conservative treatment is carried out with an emphasis on non-drug methods of therapy (therapeutic gymnastics, massage), limitation of possible provocateurs of musculoskeletal pain (ergonomics of the student’s workplace), in case of acute pain syndrome, it is possible to use analgesics (paracetamol, ibuprofen). With kyphosis more than 60 °, persistent pain syndrome, additional orthopedic disorders (spondylolysis, spondylolisthesis) or neurological complications (myelopathy), surgical orthopedic treatment is possible .
Discogenic pain syndromes. Despite the fact that pain syndromes associated with damage to intervertebral discs are less common in adolescence than in adults, about 10% of persistent back pain in adolescents is associated with discogenic pathology . Risk factors for extrusion of intervertebral discs are acute trauma, juvenile kyphosis, family history, obesity, physical inactivity. Practicing some sports is reliably associated with an increased risk of disc herniation – weightlifting, artistic gymnastics, figure skating and sports with an increased risk of injury (alpine skiing, rugby, boxing, hockey, etc.)) .
The clinical manifestations of discogenic pathology in adolescents are similar to those in adults. Distinguish between a variant of axial discogenic pain and radicular pain syndrome with the possible development of a clinic of radiculopathy or myelopathy. With discogenic pain, forward bending can often be limited with increased pain.
Diagnosis of the cause of back pain in children and adolescents
The initial examination of a child with back pain should be aimed at excluding the specific causes of the pain syndrome with the further determination of the optimal tactics of therapy and prevention.The main non-specific and specific causes of back pain in children are presented in Table 1.
Anamnesis analysis, orthopedic and neurological examinations in most cases allow to identify the source of pain and make the correct diagnosis, and form a therapy plan. For musculoskeletal pain, as a rule, additional examinations are not required. Additional examinations (laboratory diagnostics and imaging) are required if there are signs of a specific etiology of pain syndrome, the so-called “danger signals” or “red flags” (Table.2).
The diagnostic algorithm for back pain in childhood is shown in Figure 1.
Basic approaches to the treatment of back pain in children and adolescents
The basis for the treatment and prevention of musculoskeletal back pain is non-drug therapy. Among the methods, individual exercise therapy classes with training in motor control, maintaining daily activity, identifying and correcting factors contributing to musculoskeletal pain show the greatest efficiency .In addition, it is possible to use massage, however, the data of clinical studies on the effectiveness of massage, acupuncture and physiotherapy are rather contradictory and do not show convincing positive results . Taking into account the peculiarities of musculoskeletal pain in children and adolescents (Scheuermann-Mau disease, idiopathic scoliosis, spondylolysis, spodilolisthesis), when the pain syndrome persists, it is recommended to use a multidisciplinary approach with examination by an orthopedist, exercise therapy doctor and a neurologist.
Pharmacological treatment of back pain in pediatric patients is used as shortly as possible. The main goal of therapy is the rapid, effective and safe relief of acute pain syndrome, contributing to the normalization of the daily activities of children, preventing or reducing the risk of relapse and chronicity of pain. The optimal approach is to use drugs with high efficacy and a low spectrum of adverse reactions.
The “gold standard” and the most widely used drugs in pediatric practice for the relief of acute back pain and as part of the complex therapy of chronic pain syndrome are drugs from the group of non-steroidal anti-inflammatory drugs (NSAIDs), among which ibuprofen is most often used in children, like an analgesic acetaminophen.
Recurrent back pain in children is common; in adolescence, their prevalence is almost comparable to that in adults. In most cases, pain is caused by benign musculoskeletal pain or minor trauma. In order to identify specific causes of back pain, it is recommended to use a system of “danger signals” / “red flags” for screening, if necessary – laboratory diagnostics (CBC, C-reactive protein, etc.) and imaging methods (X-ray, computed tomography or Magnetic resonance imaging). Pain persistence for more than 4 weeks.is an indication for re-analysis of the history of the disease and examination of the patient in order to exclude specific causes of pain. The basis for the treatment and prevention of musculoskeletal pain is the use of various methods of exercise therapy with training in motor control, maintaining daily activity, as well as correcting the risk factors existing in a particular patient. In case of acute pain syndrome, the use of NSAIDs is possible in a short course.
Pain at the base of the skull – causes of occurrence, in what diseases it occurs, diagnosis and methods of treatment
The information in this section cannot be used for self-diagnosis and self-medication.In case of pain or other exacerbation of the disease, only the attending physician should prescribe diagnostic tests. For a diagnosis and correct treatment, you should contact your doctor.
Pain at the base of the skull: causes of occurrence, in what diseases it occurs, diagnosis and methods of treatment.
Pain at the base of the skull (cervicocranialgia vertebrogenic) is a pain syndrome localized in the cervico-occipital region, which can spread to the frontotemporal region and the eye region from the homolateral side.It has been proven that the structures of the upper cervical spine can be a source of pain. Typically, this is the level of the C1, C2, and C3 vertebrae, which includes joints, discs, ligaments, and muscles. The lower cervical vertebrae usually play an indirect role in the formation of the clinical symptoms of pain.
Pathological diseases of the cervical spine, which are accompanied by intense or aching pain, experts call the “painful neck” syndrome.
The International Society for the Study of Headache Revision 3 (ICGB-3) recommended considering cervicogenic headache as secondary, arising from changes in the cervical spine, including bone structures, intervertebral discs, and soft tissue structures, the pathology of which is often accompanied by pain in neck. 70% of patients with pain in the cervical spine simultaneously experience headache, but only 18% of cases are considered a consequence of neck pain.
Functional disorders in the spinal motion segments of the cervical spine, in particular, disorders in the structures of its upper cervical spine, play a significant role in the genesis of headaches in childhood and adolescence.
Varieties of pain at the base of the skull
Cervicogenic pain is evidenced by such differential signs as one-sided headache spreading from the occiput back to front, and evidence of the involvement of the cervical spine in it.A pain attack can be triggered by pressure on trigger points in the cervical / occipital region or by holding the neck uncomfortable. It is important that in some cases such pain has migraine features – a number of patients feel photo- and phonophobia, lacrimation, nausea, vomiting, which can sometimes be regarded as a manifestation of migraine.
Pain at the base of the skull is characterized by limited range of motion in the cervical spine, soreness of the cervical muscles, changes in muscle tone, or a reaction to passive or active stretching.Usually, pain is combined with a functional block at the upper cervical level.
Injuries to the upper cervical spine from tumors, fractures, infections, and rheumatoid arthritis can cause headaches that are clinically similar to cervicocranialgia. However, a feature of cervicogenic headache is that it is provoked by movements in the cervical spine, and after performing certain warm-up movements in the neck, it can be stopped.Most often, such complaints are not associated with a serious pathology, and the patient recovers completely.
Possible causes of pain at the base of the skull
Pain at the base of the skull is based on functional and organic changes in various anatomical structures of the cervical spine: joints, ligaments, fascia, muscles, nerves. The leading role is given to degenerative-dystrophic changes in the spine. In this case, there are only a few indications of the role of functional disorders.
One of the main reasons for the appearance of neck pain is prolonged stay in an unchanged position. Other causes of the disease include:
- osteochondrosis spondyloarthrosis, spondylosis, uncovertebral arthrosis; other changes in the spine;
- neck injuries, trauma;
- herniated disc;
- spondyloarthritis, rheumatoid arthritis.
A common cause of cervicogenic pain is inferior oblique muscle syndrome.A spasmodic muscle can squeeze the neurovascular bundle passing under it (a segment of the vertebral artery with a periarterial sympathetic plexus, occipital nerves) – for this condition, the development of paresthesias in the scalp is typical, sometimes pain occurs when combing. It has been noticed that stimulation of the cervical structures causes pain, and anesthesia reduces it.
Recently, doctors are increasingly talking about the “text neck” syndrome, which is formed in people who spend a lot of time reading texts from electronic devices (gadgets).
The head of an adult weighs about 5 kg – this is the weight of the neck in its normal position. When reading from gadget screens, the head, as a rule, is tilted: when it is tilted by only 15 °, the load on the spine increases to 12 kg, and when tilted at 60 °, up to 27 kg. As a result, the posture changes, the intervertebral discs of the cervical spine suffer, the muscles spasm, and pain occurs at the base of the skull.
The main manifestations of pain at the base of the skull include:
- frequent contraction of the occipital muscles, convulsions;
- Painful sensations when turning the head;
- noise in the head, sleep disturbance;
- pain in the cervical spine, radiating to the head;
- Constant tension in the neck, occiput.
The presence of three or four signs should make the patient think about seeking medical help.
Which doctor should I contact if there is pain at the base of the skull
To establish the cause of the headache, consult
general practitioner, general practitioner or
a neurologist. The doctor will prescribe the necessary examination, establish the cause of the disease and prescribe treatment.
Diagnostics and examinations for pain at the base of the skull
The following diagnostic criteria are used for making a diagnosis:
- The causal relationship of headache with pathology of the cervical region is based on at least one of the following signs:
- Clinical signs suggest that the source of the pain is in the neck;
- Pain stops after diagnostic blockade of neck structures or nerve formations (with an adequate comparison with placebo).
- Headache resolves within 3 months after successful treatment of the disorder or injury causing the pain syndrome.