Pain is an unpleasant feeling that lets you know that something may be wrong. It is one of the body's warning signals that indicates a problem that needs attention. Pain starts in receptor nerve cells located beneath the skin and in organs throughout the body. When there is an illness, injury, or other type of problem, these receptor cells send messages along nerve pathways to the spinal cord, which then carries the message to the brain. Pain medications work by reducing or blocking these messages before they reach the brain.
Chronic pain is long standing pain that persists beyond the usual recovery period or occurs along with a chronic health condition, such as arthritis. Chronic pain may be intermittent or continuous. It may affect people to the point that they cannot work, eat properly, participate in physical activity, or enjoy life. Chronic pain is considered a major medical condition that can and should be treated.
Chronic pain involves all aspects of a person's life; therefore, the most effective treatment includes not only relief of symptoms, but also other types of support. A multidisciplinary approach to pain management can often provide the needed interventions to help manage the pain. Pain management programs are usually conducted on an outpatient basis. Many skilled professionals are part of the pain management rehabilitation team.
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Neuralgia & Neuropathy
Pain disorders such as the neuralgias and neuropathies affect nerves throughout the body.
Peripheral neuropathy is a type of damage to the nervous system. Specifically, it occurs when there is a problem with your peripheral nervous system, the network of nerves that transmits information from your central nervous system (your brain and spinal cord) to the rest of your body. The symptoms of peripheral neuropathy can vary greatly depending on what part of the body is affected. Symptoms can range from tingling or numbness in a certain body part to more serious effects such as burning pain or paralysis. Peripheral neuropathy has many different causes. Some people inherit the disorder from their parents, and others develop it because of an injury or another disorder. In many cases, a different type of medical problem, such as a kidney condition or a hormone imbalance, leads to peripheral neuropathy. One of the most common causes of peripheral neuropathy in the U.S. is diabetes. About 60 to 70 percent of Americans with diabetes have some form of nerve damage. There are more than 100 types of peripheral neuropathy, each with its own set of symptoms and prognosis. To help doctors classify them, they are often broken down into the following categories:
Motor neuropathy. This is damage to the nerves that control muscles and movement in the body, such as moving your hands and arms or talking.
Sensory neuropathy. Sensory nerves control what you feel, such as pain or a light touch. Sensory neuropathy affects these groups of nerves.
Autonomic nerve neuropathy. Autonomic nerves control biological functions that you are not conscious of, such as breathing and heartbeat. Damage to these nerves can be serious.
Combination neuropathies. You may have a combination of two or three of these other types of neuropathies, such as a predominantly motor neuropathy or a sensory-motor neuropathy.
Trigeminal neuralgia is a type of nerve pain that affects your face. You may feel an intense burst of pain in part of your face, usually one side of the jaw or cheek. The pain may be burning or sharp and so severe that you can’t eat or drink. A flare-up begins with tingling or numbness in the area. Then pain starts to come and go, often in bursts that last anywhere from a few seconds to two minutes. During a flare of the condition, these bursts of pain may become more and more frequent until the pain almost never stops. Although the intensity of the pain can make it hard to get through your day, it’s not life-threatening. This chronic pain condition can flare up for a few weeks or months. Then the pain disappears for a while, sometimes years.
This pain condition happens most often in people older than 50, though younger people can also experience it. Trigeminal neuralgia is more common in women than men. The condition may run in families. Pressure on your cheek, such as from a razor when shaving or from your fingers when applying makeup, can trigger the pain. Brushing your teeth, standing in the wind, washing your face, eating, drinking, and even talking also may cause it. Experts think that a blood vessel pressing against the trigeminal nerve triggers the pain. Sometimes multiple sclerosis or, rarely, a tumor causes the pain. People with trigeminal neuralgia may experience these symptoms:
- Tingling or numbness in the cheek or jaw
- Dull aching in the cheek or jaw
- Flashes of severe pain in the cheek or jaw
- Anxiety from the thought of the pain returning
The first line of treatment for patients with trigeminal neuralgia is always medication. Even minimally invasive surgery carries risks and should be considered a last resort. The drugs most commonly used for treating trigeminal neuralgia are medications that were originally developed for the treatment of epilepsy, such as carbamazepine, but are also quite effective in treating trigeminal neuralgia pain, and provide at least partial pain relief for up to 80% to 90% of patients. Unfortunately, these medications frequently cause side including dizziness, drowsiness, forgetfulness, unsteadiness, and nausea. Furthermore, these medications do not always remain effective over time, requiring higher and higher doses or a greater number of medications taken concurrently.
Trigeminal neuralgia surgery is reserved for people who still experience debilitating pain despite best medical management. Surgical management can include microvascular decompression (sometimes referred to as the Janetta procedure), radiofrequency rhizotomy and stereotactic radiosurgery (Gamma Knife®). The Gamma Knife is a device that delivers precise, controlled beams of radiation to targets inside the skull, including the brain and associated nerves. When treating trigeminal neuralgia, these radiation beams are aimed at the trigeminal nerve to stop the transmission of pain signals in to the brain. The procedure requires little or no anesthesia, and is performed on an outpatient basis. This procedure provides significant pain control or reduction in approximately 80% of patients within 4 to 6 weeks post-treatment. Side effects may include mild tingling or numbness in the face in 20% of patients.
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A headache is pain or discomfort in the head or face area. Headaches vary greatly in terms of pain location, pain intensity, and how frequently they occur. As a result of this variation, several categories of headache have been created by the International Headache Society to more precisely define specific types of headaches.
Migraines. This type of headache is distinguished by the fact that symptoms other than pain occur as part of the headache. Nausea and vomiting, lightheadedness, sensitivity to light (photophobia), and other visual symptoms typically occur. Migraines are also unique in that they have distinct phases. Not all individuals experience each phase, however. The phases of a migraine headache may include:
- Premonition phase. A change in mood or behavior that may occur hours or days before the headache.
- Aura phase. A group of visual, sensory, or motor symptoms that immediately precede the headache. Examples include hallucinations, numbness, changes in speech, and muscle weakness.
- Headache phase. Period during the actual headache with throbbing pain on one or both sides of the head. Sensitivity to light and motion are common, as are depression, fatigue, and anxiety.
- Headache resolution phase. Pain lessens during this phase, but may be replaced with fatigue, irritability, and difficulty concentrating. Some individuals feel refreshed after an attack, while others do not.
Tension headaches. Tension headaches are the most common type of headache. Stress and muscle tension are often factors in tension-type headaches. While symptoms may differ, the following are common symptoms of a tension-type headache: Tension type headaches typically do not cause nausea, vomiting, or sensitivity to light (photophobia).
- Slow onset of the headache
- Head usually hurts on both sides
- Pain is dull or feels like a band or vice around the head
- Pain may involve the back (posterior) part of the head or neck
- Pain is mild to moderate, but not severe
Cluster headaches. Cluster headaches usually occur in a series that may last weeks or months, and the headache series may return every year or two. While people often experience symptoms differently, the following are the most common symptoms of a cluster headache:
- Severe pain on one side of the head, usually behind one eye
- The eye that is affected may be red and watery with a droopy lid and small pupil
- Swelling of the eyelid
- Runny nose or congestion
- Swelling of the forehead
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