Causes of Pain and Chronic Pain Syndromes

Causes of Pain and Chronic Pain Syndromes

Disease, including cancer, infection, and post-infection syndromes, injury, or medical interventions, such as surgery, are the most common causes of chronic pain. Improper and incomplete healing of an injury may be the source of pain, and enhancing healing of the injury a sufficient approach in pain management. At other times, a pain sufferer may be able to identify a particular event as defining the origin of their pain, but caregivers and researchers may lack the ability to draw a straight line from injury to causation and onset of a pain syndrome.

Reflex sympathetic dystrophy syndrome (RSDS), formerly called causalgia, is described as intense, burning pain that develops after an injury, frequently long after the original insult, and usually involves the upper extremities. The initial injury may be relatively minor, while the pain resulting from the syndrome disproportionately intense. Damage to either the peripheral or central nervous tissue is believed to be involved in the cause of the pain, but there is disagreement on exact cause. The connection from the initial injury to the pain developed in the syndrome may not be clear, and therefore treatment may focus more on current syndrome symptoms than on the original injury.

An interesting case involves a report that a woman suffering from RSDS after a fall 12 years previous experienced exacerbations in her pain prior to rain showers, symptoms that would ease following the weather event. A hypothesis was developed that her symptoms increased as a result of changes in concentration of charges from positive and negative ions built up in storm clouds. It was believed changes in ion concentrations affected her nervous system through influence on ion pathways stimulating nerve response. She tested the hypothesis by installing a negative ion generator in a room, and found complete relief from the symptoms generated by storm clouds when she entered the room. Entering and exiting the room replicated the onset and relief of symptoms, suggesting the hypothesis was sound.

In functional pain syndromes, such as fibromyalgia, elevated levels of glutamate, a major excitatory neurotransmitter, have been found. Glutamate acts within the central nervous system to assist in the transmission of pain signals between nerve endings. Elevated levels of glutamate in cerebrospinal fluid of patients with pain syndromes are thought to heighten the pain response of innocuous stimuli in allodynia (pain due to a stimulus which does not normally provoke pain), or cause the intensified pain response of hyperalgesia from painful stimuli.

Neuropathic pain may result from inflammation mechanisms. Proinflammatory cytokines, chemical signaling factors, released at the site of trauma or disease can induce nerve damage and neuropathic pain. Inflammatory molecules such as histamines, the neurotransmitter serotonin, and prostaglandins are also thought to be involved.

Neuropathy can develop as a sequela of infectious disease, such as Lyme disease, or of metabolic disorders such as diabetes, or of autoimmune disorders such as rheumatoid arthritis or systemic lupus erythematosus (SLE). In SLE hyperactive dendritic cells, immune cells that "teach" other adaptive immune cells to respond to ostensible threats, are thought to trigger the dysfunctional immune response of the autoimmune disease. Vitamin D has shown promise in an ability to reduce the dendritic driven response. Neural damage and subsequent pain associated with the disease is believed to be a function of chronic inflammatory response.

Injuries involving the brachial plexus, a complex network of nerves radiating from the spinal column and forming the nerve pathways supplying the chest, shoulders and arms, are fairly common in motor vehicle, motorcycle, and bicycle accidents. Healing therapies that have shown nerve regeneration potential may help with the healing of these types of injuries. An integrative pain management plan to redirect pain perception, heighten the pain threshold, and manage pain is often indicated.

Causation of chronic pain may be a matter of identifying injury, or damage from infection or disease, and prescribing enhanced healing modalities to effect satisfactory resolution. In other cases, the cause of chronic pain may be elusive and require an integrative approach that focuses on several aspects contributing to pain to effect the best management plan.

Begin Your Journey to Wellness with Patients Medical

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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