Types of back pain: acute pain, chronic pain, and
neuropathic pain
Understanding how pain is defined is important in
order to learn how to better control it. For the purposes
of research and medical practice, pain can be separated
into three categories:
Acute pain
One common type of pain is acute pain, currently
defined as pain lasting less than 3 to 6 months, or pain
that is directly related to tissue damage. This is the
kind of pain that is experienced from a paper cut or
needle prick. Other examples of acute pain include:
-
Touching a hot stove or iron. This pain will cause
a fast, immediate, intense pain with an almost simultaneous
withdrawal of the body part that is being burned.
More of an aching pain might be experience a few
seconds after the initial pain and withdrawal.
-
Smashing one’s finger with a hammer. This
pain is similar to that of touching a hot stove in
that there is immediate pain, withdrawal and then “slower” aching
pain.
-
Labor pains. The pain during childbirth is acute
and the cause is certainly identifiable.
The longer pain goes on the more susceptible it is
to other influences and developing into a chronic pain
problem. These influences include such things as the
ongoing pain signal input to the nervous system even
without tissue damage, lack of exercise (physical deconditioning),
a person’s thoughts about the pain, as well as
emotional states such as depression and anxiety.
Chronic pain
There are at least two different types of chronic pain problems - chronic pain
due to an identifiable pain generator (e.g. an injury), and chronic pain
with no identifiable pain generator (e.g. the injury has healed).
Chronic pain due to an identifiable pain generator
This type of chronic pain is due to a clearly identifiable cause. Certain structural
spine conditions (for example, degenerative disc disease, spinal stenosis
and spondylolisthesis) can cause ongoing pain until successfully treated.
These conditions are due to a diagnosable anatomical problem.
If the pain caused by these types of conditions has
not subsided after a few weeks or months of conservative
treatments, then spine surgery may usually be considered
as a treatment option.
Chronic pain with no identifiable pain generator
This type of pain continues beyond the point of tissue
healing and there is no clearly identifiable pain
generator that explains the pain. It is often termed “chronic benign pain”.
It appears that pain can set up a pathway in the nervous
system and, in some cases, this becomes the problem
in and of itself. In chronic pain the nervous system
may be sending a pain signal even though there is no
ongoing tissue damage. The nervous system itself misfires
and creates the pain. In such cases, the pain is the
disease rather than a symptom of an injury.
The term “chronic pain” is generally
used to describe pain that lasts more than three
to six months, or beyond the point of tissue healing.
Chronic pain is usually less directly related to
identifiable tissue damage and structural problems.
Examples of chronic pain are: chronic back pain without
a clearly determined cause, failed back surgery syndrome
(continued pain after the surgery has completed healed),
and fibromyalgia.
Chronic pain is influenced by many factors, such
as ongoing pain signal input to the nervous system
even without tissue damage, physical deconditioning
due to lack of exercise, a person’s thoughts
about the pain, as well as emotional states such
as depression and anxiety. Chronic pain is much less
well understood than acute pain.
Neuropathic pain
Neuropathic pain has only been investigated relatively recently. In most types
of neuropathic pain, all signs of the original injury are usually gone and
the pain that one feels is unrelated to an observable injury or condition.
With this type of pain, certain nerves continue to send pain messages to
the brain even though there is no ongoing tissue damage.
Neuropathic pain (also called nerve pain or neuropathy)
is very different from pain caused by an underlying
injury. While it is not completely understood, it is
thought that injury to the sensory or motor nerves
in the peripheral nervous system can potentially cause
neuropathy. Neuropathic pain could be placed in the
chronic pain category but it has a different feel then
chronic pain of a musculoskeletal nature.
Neuropathic pain feels different than musculoskeletal
pain and is often described with the following terms:
severe, sharp, lancinating, lightning-like, stabbing,
burning, cold, and/or ongoing numbness, tingling or
weakness. It may be felt traveling along the nerve
path from the spine down to the arms/hands or legs/feet.
It’s important to understand neuropathic pain
because it has very different treatment options from
other types of back pain. For example, opioids (such
as morphine) and NSAID’s (such as ibuprofen,
COX-2 inhibitors) are usually not effective in relieving
neuropathic pain. Treatments for neuropathic pain include
certain medications, nerve “block” injections,
and a variety of interventions generally used for chronic
pain.
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