Pain Types and Classifications
1.Acute Pain and Chronic Pain
2.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.
3.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.
4.Psychogenic Pain (stress)
5.Mixed
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.
Low-Back Pain (LBP)
Headache Pain
Pain Treatment in Palliative Care
Cancer-Related Pain
Fibromyalgia Pain
Shingles/PHN (Postherpetic Neuralgia)
Pain Treatment in Pediatrics
Spinal stenosis
Vertebral Compression Fractures
Cervical and lumbar facet joint disease
Sciatica/Radiculopathy ("pinched nerve")
Sacroiliac joint disease
Failed back surgery pain (FBSS) / Post-Laminectomy Neuropathic Pain
Neuropathic (Nerve) pain
Head pain / Occipital neuralgia (Scalp/head pain)
Hip pain
Intercostal neuralgia (Rib pain)
Peripheral neuropathy (Diabetic nerve pain)
Complex regional pain syndrome (Reflex Sympathetic Dystrophy - RSD)
Herniated discs and degenerative disc disease (discogenic pain)
Neck pain
Shoulder and knee arthritic pain (osteoparthritis)
Myofascial (Muscular) pain
Post surgical pain
Cancer pain (pancreatic, colorectal, lung, breast, bone)
Pain from peripheral vascular disease
Anginal pain (chest pains)
Post-herpetic neuralgia (shingles pain)
Nerve entrapment syndromes
Spastisticy related syndromes/ pain
Spinal Cord Injury (central pain)
Pelvic pain
Thoracic outlet syndrome
Other Sections Are in Development
* Introduction to pain management
* How is pain treatment guided?
* What are the basic types of pain?
* Nociceptive pain
* Neuropathic pain
* What are other causes of pain
* Pain Management Glossary
* Pain Management Index
* Find a local Pain Management Physician in your town
What are the basic types of pain?
There are many sources of pain. One way of dividing these sources of pain is to divide them into two groups, nociceptive pain and neuropathic pain. How pain is treated depends in large part upon what type of pain it is.
Nociceptive pain
The body's nervous system is working properly. There is a source of pain, such as a cut, a broken bone or a problem with the spine. The body's system of telling the brain that there is an injury starts working. This information is passed on to the brain and one becomes aware that they are hurting.
Neuropathic pain
The body's nervous system is not working properly. There is no obvious source of pain, but the body nonetheless tells the brain that injury is present.
What are types of nociceptive pain?
Most back, leg, and arm pain is nociceptive pain. Nociceptive pain can be divided into two parts, radicular or somatic.
Radicular pain: Radicular pain is pain that stems from irritation of the nerve roots, for example, from a disc herniation. It goes down the leg in the distribution of the nerve that exits from the nerve root at the spinal cord. Associated with radicular pain is radiculopathy, which is weakness, numbness, tingling or loss of reflexes in the distribution of the nerve.
Somatic pain: Somatic pain is pain limited to the back or thighs. The problem that doctors and patients face with back pain, is that after a patient goes to the doctor and has an appropriate history taken, a physical exam performed, and appropriate imaging studies (for example, X-rays, MRIs or CT scans), the doctor can only make an exact diagnosis a minority of the time. Research has shown that most back pain that does not go away after conservative treatment usually comes from one of three structures in the back: the facet joints, the discs, or the sacroiliac joint. The facet joints are small joints in the back of the spine that provide stability and limit how far you can bend back or twist. The discs are the "shock absorbers" that are located between each of the bony building blocks (vertebrae) of the spine. The sacroiliac joint is a joint at the buttock area that serves in normal walking and helps to transfer weight from the upper body onto the legs.
Fluoroscopically (x-ray) guided injections can help to determine where pain is coming from. Once the pain has been accurately diagnosed, it can be optimally treated.
What are types of neuropathic pain?
Neuropathic pain includes:
* Complex regional pain syndrome (CRPS), also called reflex sympathetic dystrophy;
* Sympathetically maintained pain;
* Fibromyalgia;
* Interstitial cystitis; and
* Irritable bowel syndrome.
Treatment of neuropathic pain
The various neuropathic pains can be difficult to treat. However, with careful diagnosis and often a combination of methods of treatments, there is an excellent chance of improving the pain and return of function.
Medications are a mainstay of treatment of neuropathic pain. In general, they work by influencing how pain information is handled by the body. Much pain information is filtered out by the central nervous system, usually at the level of the spinal cord, so that you never need to deal with that information. For example, if you are sitting in a chair, your peripheral nerves would correctly send the response to the pressure between your body and the chair to your nervous system. But, because that information serves no usual purpose, it is filtered out in the spinal cord. Many medications to treat neuropathic pain operate on this filtering process. Amongst the types of medications are antidepressants, influencing the amount of serotonin or norepinephrine and antiseizure medications, influencing the amount of various neurotransmitters, such as GABA and glycine.
One of the most powerful tools in treating neuropathic pain is the spinal cord stimulator, which delivers tiny amounts of electrical energy directly onto the spine. The effect of this stimulation of the spinal cord is to allow the spinal cord to function normally even during a painful condition. It works by interrupting inappropriate pain information being sent up to the brain.
What are other causes of pain?
Other causes of pain include:
* headaches,
* facial pain,
* peripheral nerve pain,
* coccydynia,
* compression fractures ,
* post-herpetic neuralgia,
* myofasciitis,
* torticollis,
* piriformis syndrome,
* plantar fasciitis,
* lateral epicondylitis, and
* cancer pain .
Headaches and facial pain, including atypical facial pain and trigeminal neuralgia.
Headaches are a major source of discomfort and lost productivity in the workplace. Many effective treatments exist for persisting headaches, including medication, biofeedback, injections and implants, depending upon the precise type of headache. Botox also provides a useful means of effectively and safely treating headaches.
Atypical facial pain can be debilitating. Often times it can be treated by injections into local nerve tissue (such as the sphenopalatine ganglion).
Trigeminal neuralgia, also called tic douloureux, is a condition that most commonly causes very intense intermittent shooting pain in the face.
Peripheral nerve pain
Peripheral nerve pain, or neuropathy, can be debilitating. It can respond well to simple treatments such a trigger point injections with anesthetic medicines and cryoablation (an office based procedure which involves freezing the nerves). Examples of peripheral nerve pain include intercostal neuralgia, ilioinguinal neuroma, hypogastric neuroma, lateral femoral cutaneous nerve entrapment, interdigital neuroma and related nerve entrapments.
Coccydynia
Coccydynia is simply pain in the region on the tailbone, or coccyx. It can result from trauma or arise without apparent cause. The initial treatment is conservative, with oral pain relief medicines (analgesics). Oftentimes, the pain originates in the portion of the nervous system that we have no control of (involuntary or autonomic nervous system) and can respond to either a local anesthetic injection of the head of a nerve called Ganglion Impar, which is located by the coccyx or by medically destroying (ablating) the Ganglion Impar, usually using radiofrequency.
Compression fractures
Compression fractures of the bony building blocks (vertebral bodies) are common in the elderly as a result of osteoporosis, or loss of calcium in the bone. With less calcium, the bone becomes weak and can break. Like any fracture, compression fractures hurt. Like any fracture, they are treated by stabilization, in this case, by injecting cement into the bone in a procedure known as a vertebroplasty. Vertebroplasty is an effective way to treat the pain of compression fractures.
Post-herpetic neuralgia
Post herpetic neuralgia (PHN) is a painful condition occurring after a bout of shingles. When we are young, we are almost all exposed to chickenpox, caused by the Herpes Zoster virus. Our immune system controls the virus, but it lives in a dormant state in the spinal cord. When we age, or become ill or stressed, the virus can reactivate and attack the nerve infected and adjacent skin. However, in this second attack, the body usually recognizes the Herpes Zoster virus and contains the pain to a localized area, along the course of one nerve. A patient may have the characteristic blisters, which normally heal. Sometimes, however, the Herpes Zoster virus damages the nerve, causing ongoing nerve pain that persists after the skin blisters from the shingles have healed.
The ideal way to treat the post herpetic neuralgia is to treat it before it sets in. Medications, such as acyclovir (Zovirax), steroids and injections such as sympathetic injections can help prevent the onset of PHN. After the pain is present, injections, local anesthetics, medications [duloxetine (Cymbalta) , amitriptyline, (Elavil, Endep)] and pain medications or topical patches can be useful.
Myofasciitis and Torticollis
Myofasciitis (pain in the muscles, whether in the neck or back) often responds to conservative physical therapy treatments (for example, massage and exercise). If the pain persists, trigger point injections can be used. If the trigger point injections provide temporary relief, sometimes Botox injections can help. Botox, which is botulinum toxin, can relax the muscles for six or more months, with long-term relief of pain. It provides a safe, effective treatment for what can otherwise be a difficult, ongoing problem.
Torticollis is spasm of the muscles in the neck, forcing the sufferer to hold his or her neck tilted or rotated to the side. Botox is approved for treatment of this problem.
Piriformis Syndrome
The piriformis muscle goes from the hip to sacrum (tailbone). It is important in that the sciatic nerve passes through it. Piriformis syndrome is a spasm of the piriformis muscle. When the muscle goes into spasm, it can squeeze the sciatic nerve, causing pain going down the leg. Piriformis syndrome will usually respond to physical therapy. When pain persists, local anesthetic and/or steroid injection can help. If the pain persists, injecting Botox or Myobloc, which are both botulinum toxins, into the muscle can provide effective, safe treatment.
Plantar fasciitis and Lateral epicondylitis
Plantar fasciitis (heel pain) and lateral epicondylitis (tennis elbow) are two common pain problems. Treatment starts with conservative options, such as rest, non-steroidal anti-inflammatory medications, steroid injections, over-the counter pain medications, physical therapy and, for heel pain, shoe inserts.
If the pain lasts for more than six months, Extracorporeal Shockwave Treatment is an effective, FDA approved treatment. Extracorporeal shockwave treatment is not recommended for pregnant women, children, anyone with a pacemaker, anyone on anti-coagulant therapy or anyone with a history of bleeding problems.
Cancer pain
Cancer pain can arise from many different causes, including the cancer itself, compression of a nerve or other body part, fractures or treatment of the cancer. There are many techniques to assist with treating the various pains from cancer, including medications and injections. In particular, medical destruction of nerve tissue (ablative therapies) and the use of pumps surgically placed into the body to deliver pain medication into the subarachnoid space can be used. Pain pumps deliver medication that is targeted to pain receptors on the spinal cord. The advantage to the cancer patient is chronic pain control with decreased side effects.