Types of Pain and Chronic Pain Syndromes
By Kamau Kokayi, MD
In the holistic view of a human being, components of mind, body, and spirit are the primary influences in the life and well-being of the person, as contained in the concept that the whole is greater than the sum of its parts. Pain is not always easily categorized because it often derives from more than one component or system in the patient. The following descriptive types of pain and chronic pain syndromes provide a loose categorization, but contain overlap between injury to muscle, connective tissue, nerve damage due to disease or injury, as well as influences due to neuroendocrine system changes, mood or outlook. This is the complex nature of pain.
Musculoskeletal pain can derive from incidences of disease, injury, or surgery. Low back, thoracic, neck, and coccyx pain are common forms of musculoskeletal pain, as are conditions affecting the knee. Pain associated with repetitive stress injuries often involves nerve stimulation or damage, while systemic pain syndromes are not easily classified and may result from or involve multiple influences in the mind-body-spirit system: muscles, joints, nerves, hormones, mood, outlook, and tolerance of extrinsic stressors.
Low back pain may result from direct trauma, as in compression injuries, congenital defects, or improper lifting and strains. Disc or ligament injuries are common sources of low back pain exacerbated by age, lack of physical activity, or poorly executed physical exertion. Discs stiffen and lose flexibility with age, and can rupture or bulge from between vertebrae, or suffer from degenerative disease such as arthritis, or from viral or other infection. Obesity, smoking, and poor posture and sleeping positions can all exacerbate low back pain.
Knee pain can result from injuries to the connective tissues sheathing the knee and aiding the articulation of the joint. A torn meniscus or ligament, such as the anterior cruciate ligament (ACL), often results in a difficult-to-heal, painful outcome. Healing of some of these connective tissue injuries is aided by acupuncture and nutritional supplement therapy, or by minimally invasive surgery in more extreme injuries.
Patellofemoral pain syndrome is a pain disorder that can affect the knee, typically worsening during activity, such as descending steps or hills, but interestingly, it can also be triggered by prolonged sitting. Both knees can be involved, or one knee. Although a definitive cause has not been arrived at, hip movements, foot posture (whether the sufferer is flat-footed or high-arched), overuse, and overloading of the knee, particularly in runners, may all contribute to the condition.
Carpal tunnel syndrome (CTS) affects the median nerve guide in the hands, and is a common repetitive stress injury. Inflammation of this nerve sheath impinges on the nerves serving the thumb, index finger, middle finger, and half of the ring finger, causing tingling, numbness, weakness, and pain. If these symptoms are present in each of these fingers but not the little finger, it is likely due to CTS. Nerves serving the little finger follow a separate path from the carpal tunnel.
Thoracic and neck pain can result from compression injuries involving nerves at the base of the neck, or of the subclavian artery or vein, inflammation, viral infection, or conditions such as transverse myelitis, an inflammatory condition affecting the myelin sheath on both sides of the spinal cord.
Systemic pain syndromes frequently present more complicated conditions requiring holistic, multifaceted therapies to treat the whole person. Fibromyalgia is one such syndrome (FMS), the symptoms of which include chronic widespread pain, fatigue, depression, and anxiety as a result of the pain. In population studies FMS is prevalent in 1% to 5% of people, the majority of whom are women.
Complex regional pain syndrome (CRPS) frequently follows trauma or injury that has itself healed but in which the pain syndrome continues, intensifies, and defies treatment. Burning, out-of-proportion pain relative to the initial injury, skin sensitivity and allodynia, muscle spasm, or edema (swelling) are all potential symptoms. CRPS I generally follows illness or injury. CRPS II presents similar symptoms but occurs after a specific nerve injury.
Myofascial pain syndrome (MPS) is a condition characterized by chronic muscle pain. Centered around trigger or sensitive points in the muscle, pain can radiate throughout the muscle when trigger points are touched. Symptoms are generally specific to muscle pain, stiffness, and stiffness in joints adjacent to affected muscle, and knotted, tight, or sensitive areas in affected muscle. Myofascial pain syndrome is related to fibromyalgia syndrome in that symptoms are similar, although MPS tends to be more regionally focused. Although commonly confused, a practitioner well-versed in pain syndromes can distinguish the subtle differences between features of these two pain syndromes.
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The effects of chronic pain can range from simple annoyance to debilitating and life-changing. Regardless of where you might find yourself on this spectrum of pain, the practitioners at Patients Medical offer a broad range of pain management therapies derived from modern and ancient traditions in the healing arts. Our integrative approach tackles your pain problem holistically, addressing the mind-body-spirit components of pain to help you manage your pain and live a full, satisfying life.
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Types of Pain and Chronic Pain Syndromes—Citations and Further Reading
Date of Publication: 09/05/2005
Article Last Updated: 11/17/2011