CAUSES OF PAIN
The causes of pain can be very complex. To discover the root of your pain and develop a treatment plan, we will likely ask for the location, onset and severity of your pain. When coming to our office, you should provide your diagnostic imaging and relevant medical records to determine the best treatment options.
COMMON PAIN GENERATORS:
- Irritation of the large nerve roots in the back that can cause pain in extremities
- Spinal cord impingement
- Sprain, tear, or other damage to muscular tissue
- Damage of the bones, ligaments and joints
- Intervertebral disc disorders
COMMON PAIN COMPLAINTS:
- Difficulty moving that can be severe enough to prevent walking or standing
- Radiating pain
- Non-localized soreness, numbness, tingling and pain
- Muscle spasms
- Local pain
- Headache, fatigue, and depression secondary to onset of pain
Osteoarthritis is the most common form of arthritis, affecting millions of people around the world. It’s sometimes known as “wear and tear” arthritis as it worsens with time and age. Osteoarthritis can affect any joint in your body, including the spine. There are several factors that contribute to the likelihood of a person developing osteoarthritis including genetics, obesity and injury.
Sciatica is not so much a condition but actually a symptom. It refers to pain that begins in the hip and buttocks and continues all the way down the leg. This symptom is often accompanied by low back pain, which can be more or less severe than the leg pain. The term sciatica indicates that the sciatic nerve, which travels from the lower back through the buttocks and into the leg, is thought to be the cause of the pain in this condition. True sciatica is a condition that occurs when a herniated disc or osteoarthritic bone spurs compress and pinch one of the contributing roots of the sciatic nerve. This is known as a pinched nerve.
Radiculopathy is caused by an inflamed nerve root, and referred pain, which is a result of a musculoskeletal sprain or strain. Doctors use the term radiculopathy to specifically describe pain, and other symptoms like numbness, tingling, and weakness in your arms or legs that are caused by a problem with your nerve roots. The nerve roots are branches of the spinal cord that carry signals to the rest of the body at each level along the spine. This disease is often caused by direct pressure from a herniated disc or degenerative changes in the lumbar spine that cause irritation and inflammation of the nerve roots. Radiculopathy usually creates a pattern of pain and numbness that is felt in your arms or your legs in the area of skin supplied the by sensory fibers of the nerve root, and weakness in the muscles that are also supplied by the same nerve root.
Disc Herniation describes an abnormality of the intervertebral disc that is also known as a "bulging," "ruptured," or "torn" disc. This process occurs when the inner core (nucleus pulposus) of the intervertebral disc bulges out through the outer layer of ligaments that surround the disc (annulus fibrosis). This tear in the annulus fibrosis causes pain in the back at the point of herniation. If the protruding disc presses on a spinal nerve, the pain may spread to the area of the body that is served by that nerve. Between each vertebra in the spine is a pair of spinal nerves, which branch off from the spinal cord to a specific area in the body. The treatment for the vast majority of people with a herniated disc does not normally include surgery. Many patients will respond to non-surgical treatments. The primary element of non-surgical treatment is controlled physical activity. Usually, treatment will begin with avoidance of exacerbating activities followed by a gradual return to normal activities.
Spondylolisthesis occurs when one vertebra slips forward onto the vertebrae below it. This produces both a gradual deformity of the lower spine and also a narrowing of the vertebral canal. It is often associated with pain. The most common symptom of spondylolisthesis is lower back pain. Sometimes, a person can develop the lesion (spondylolysis) at a younger age and not have any symptoms until they are 35 years old, when a sudden twisting or lifting motion will cause an acute episode of back and leg pain. The degree of vertebral slippage does not directly correlate with the amount of pain a person will experience. Some people with spondylolisthesis will associate an injury with the onset of their symptoms. In addition to back pain, someone with a spondylolisthesis may complain of leg pain. In this situation, there can be associated narrowing of the area where the nerves leave the spinal canal that irritates a nerve root.
As discs lose their water content because of disease or age, they lose their height, bringing the vertebrae closer together. As a result, the nerve openings in your spine become more narrow. When this happens, the discs don’t absorb the shocks as well, particularly when you are walking, running, or jumping. Degenerative changes develop in the vertebrae as the spinal disks become flatter and less flexible. Without the cushioning that these disks normally provide, the joints (facets) between vertebrae press tightly against each other. This can cause back pain and stiffness. Wear and tear, poor posture, and incorrect body movements can also weaken the disc, causing disc degeneration. Degenerative disc disease may cause back and/or leg pain, as well as functional problems such as tingling or numbness in your legs or buttocks, or difficulty walking.
Spinal Stenosis is a disorder that is caused by a narrowing of the spinal canal. This narrowing happens as a result of the degeneration of both the facet joints and the intervertebral discs. In this condition, bone spurs (also calledosteophytes) grow into the spinal canal. The facet joints also enlarge as they become arthritic, which contributes to a decrease in the space available for the nerve roots. This condition is known as facet arthropathy. The ligaments of the spinal column, especially the ligamentum flavum, become stiff, less flexible, and thicker with age, which also contributes to spinal stenosis. These processes narrow the spinal canal and may begin to impinge and put pressure on the nerve roots and spinal cord, creating the symptoms of spinal stenosis. Stenosis may occur in the central spinal canal (central stenosis) where the spinal cord or cauda equina are located, in the tract where the nerve root exits the central canal (lateral recess stenosis), or in the lateral foramen (foraminal stenosis) where the individual nerve roots exit out to the body. Some distortion of the spinal canal will occur in virtually every person as they age, but the severity of the symptoms will depend on the size of a person's spinal canal and the encroachment on the nerves. The rate of deterioration varies greatly from person to person, and not everyone will feel weakness or pain. Treatments can vary depending on the severity of your symptoms and how much they limit your everyday activities.
Facet Arthropathy The facet joints connect the vertebral bodies to one another, and like the hip and the knee, they can also become arthritic and painful, and can be a source of back pain. The facet joints are located at the back of the spine and counterbalance the intervertebral discs. They help keep the normal alignment of the spinal vertebrae and limit motion. The pain and discomfort that is caused by degeneration and arthritis of this part of the spine is called facet arthropathy, which simply means a disease or abnormality of the facet joints. Most people with facet arthropathy will complain of lower back pain that becomes worse when twisting, standing, or bending backward. Usually, the pain is confined to a particular point in the spine, and unlike the pain and numbness often caused by a slipped disc or sciatica, it doesn’t usually radiate into the buttocks or down the legs. As the facet joints become arthritic, they often develop bone spurs—tiny outgrowths or projections of bone—that can decrease the amount of space available for the nerve roots as they exit the spinal canal. This can contribute to the development of spinal stenosis, another condition that may cause pain, numbness, and weakness in the buttocks and legs. In fact, people who have facet arthropathy often have other conditions that may be contributing to their symptoms. Aside from spinal stenosis, it’s possible that arthritis in other parts of your spine or degenerative disc disease—a natural part of the aging process where our intervertebral discs lose flexibility, elasticity, and shock absorbing characteristics—could be contributing to your symptoms.
Sacroiliac dysfunction is a common cause of back pain. In most instances, the discomfort that comes with it can be managed through conservative treatment; however, some cases may require back surgery. The sacroiliac joint is located in the lower back between the spine and hip joint, and normally does not move much. Inflammatory arthritis degeneration of the sacroiliac joint, or misalignment of this joint can cause pain associated with sacroiliac dysfunction. Sacroiliac joint pain is usually located in the buttock, just to the side of the midline. It is usually one-sided, but not always. The pain may radiate down the back of the thigh to the knee. Typically, it is difficult to find a comfortable position when lying in bed. Sacroiliac joint pain can become severe and disabling if not treated.
Failed back Syndrome is a condition that can occur despite careful diagnosis and a successful operation, some patients may still experience pain after their back surgery. This persistent pain or continuation of symptoms is known as failed back syndrome (sometimes called failed back surgery syndrome), and it can affect your ability to complete daily tasks. The failure is not of the surgery itself, as the goals of the surgery, which may include decompression and stabilization, may have been achieved. The failure is to achieve complete resolution of symptoms. Several factors affect the outcome of spine surgery. One possibility is that the lesion that was operated on was not the only cause of the pain. Sometimes the main problem has not been adequately fixed. In rare cases there may also be damage from the surgical procedure itself that is causing pain. When back surgery does not help to relieve your pain or leads to new pain, it’s easy to feel discouraged.
Peripheral neuropathy, a result of nerve damage, often causes weakness, numbness and pain, usually in your hands and feet, but it may also occur in other areas of your body. People generally describe the pain of peripheral neuropathy as tingling or burning, while they may compare the loss of sensation to the feeling of wearing a thin stocking or glove. Peripheral neuropathy can result from problems such as traumatic injuries, infections, metabolic problems and exposure to toxins. One of the most common causes is diabetes. In many cases, peripheral neuropathy symptoms improve with time, especially if the condition is caused by an underlying condition that can be treated. A number of medications are used to reduce the painful symptoms of peripheral neuropathy.
Cervical spondylosis is a general term for age-related wear and tear affecting the spinal disks in your neck. As the disks dehydrate and shrink, bone spurs and other signs of osteoarthritis develop. Cervical spondylosis is very common and worsens with age. There also appears to be a genetic component involved because some families will have more of these changes over time, while other families will develop less. More than 90 percent of people older than age 65 have evidence of cervical spondylosis and osteoarthritis that can be seen on neck X-rays. Most of these people experience no symptoms from these problems. When symptoms do occur, nonsurgical treatments often are effective.
Myofascial pain syndrome is a chronic pain disorder. In myofascial pain syndrome, pressure on sensitive points in your muscles (trigger points) causes pain in seemingly unrelated parts of your body. This is called referred pain. Myofascial pain syndrome typically occurs after a muscle has been contracted repetitively. This can be caused by repetitive motions used in jobs or hobbies or by stress-related muscle tension. While nearly everyone has experienced muscle tension pain, the discomfort associated with myofascial pain syndrome persists or worsens. Treatment options for myofascial pain syndrome include physical therapy and trigger point injections. Pain medications and relaxation techniques also can help.
Complex regional pain syndrome is an uncommon form of chronic pain that usually affects an arm or a leg. Complex regional pain syndrome typically develops after an injury, surgery, stroke or heart attack, but the pain is out of proportion to the severity of the initial injury. The cause of complex regional pain syndrome isn't clearly understood. Treatment for complex regional pain syndrome is most effective when started early. In such cases, improvement and even remission are possible.
A migraine headache can cause intense throbbing or a pulsing sensation in one area of the head and is commonly accompanied by nausea, vomiting, and extreme sensitivity to light and sound. Migraine attacks can cause significant pain for hours to days and be so severe that all you can think about is finding a dark, quiet place to lie down. Some migraines are preceded or accompanied by sensory warning symptoms (aura), such as flashes of light, blind spots, or tingling in your arm or leg. Medications can help reduce the frequency and severity of migraines. If treatment hasn't worked for you in the past, talk to your doctor about trying a different migraine headache medication. The right medicines, combined with self-help remedies and lifestyle changes, may make a big difference.