What is pain? The International Association of the Study of Pain defines it as, “An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage.” There is reason for the existence of pain. It can be lifesaving at moments in time. Pain alerts you when you touch a hot stove. Pain makes you aware of a broken bone despite not being able to visualize the damaged structure. Pain directs attention to a problem that requires attention.

Pain will usually resolve once the underlying cause of the pain is removed. Sometimes, however, the source of the pain is difficult to find or cannot be determined. Occasionally the source of the pain cannot be completely removed as in arthritis or cancer.

Pain is complex and can result from a myriad of causes and is often multifactoral. It can differ to an amazing degree between two patients, even in situations where illness or injury appear identical. As such, pain can be incredibly difficult to quantify as individual perception affects both severity and patient response to treatment.

Pain is common. The National Institute of Health estimates that pain affects more Americans than diabetes, heart disease, and cancer combined. Chronic pain is the most common cause of long-term disability in the United States today.

Pain is often segregated into two categories, acute and chronic. Acute pain is usually related to trauma or inflammation, often secondary to infection. While acute pain may be distressing and severe, it is often short lived and resolves with treatment of disease. Chronic pain is usually defined as pain lasting for at least three to six months and it can literally become a disease state within itself. Chronic pain can cause severe emotional as well as physical stress, often due to underlying causative factors that cannot be identified or may not be able to be treated. In many ways the key to treatment of chronic pain lies in the diagnosis of the underlying cause as much, or more so, than the actual plan of treatment of that cause.

There are many types of pain that may be described as acute or chronic:

Myofascial Pain is caused by painful trigger points that develop in a muscle or a group of muscles. A trigger point is a locally sensitive and tender area in a muscle or where a muscle and fascia (band-like tissue encasing muscle) meet. Myofascial pain may cause "referred pain" because when a trigger point is pressed the pain may be felt elsewhere. This pain may be chronic and described as nagging, burning, aching, or stabbing.

Psychogenic Pain presents as real physical pain caused by a psychological problem. This means the pain is caused by the patient's mental or emotional issues.

Radicular Pain, or radiculitis, is caused by inflammation of a spinal nerve root. Other associated terms are "cervical radiculitis" or "lumbar radiculitis" meaning the pain originates from a cervical (neck) or lumbar (low back) spinal nerve. Sciatica is a commonly used term to describe pain that descends into the leg. Different disorders can cause spinal nerve compression, inflammation, and pain. A spinal tumor or cyst, disc herniation, spinal stenosis, and osteoarthritis can cause radiculitis.

Somatic Pain is caused by bodily injury or other event affecting the pain receptors in the skin, ligaments, muscles, bones, or joints. This pain may be chronic and is sometimes associated with cancer.

Visceral Pain is caused by internal organs that are damaged or injured.

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Neck Pain

Almost all individuals will experience some neck pain at some point in their lives. Most episodes of neck pain will be mild and not particularly limiting and are likely to resolve with rest. However, if pain persists for more than a week or two, or is severely limiting to everyday activities, further evaluation may be needed. Neck pain may vary and may involve sharp or dull pain, may be associated with stiffness or inability to rotate the neck, and may present as pain shooting to the shoulders, arms or hands, perhaps even without perceived pain in the neck region itself.

Neck pain may occur secondary to many factors. Muscle strain from poor positioning or posture or, perhaps, athletic injury may give a sensation of pain. The joints between vertebrae in the neck may experience arthritic change just as any other joint in the body, limiting range of motion and causing stiffness. Disc disease occurs commonly with aging as the gelatinous disc material between vertebrae becomes dry and brittle, possibly limiting flexibility. This weakened disc material may push or protrude into the spinal canal in the neck and push on or irritate nerves or the spinal cord itself, resulting in sharp pain or altered sensations in the arms or legs (radiculopathy). More acute trauma, as in a car accident, may severely damage vertebrae, discs, or the surrounding muscles and ligaments and result in rapid onset of these same symptoms.

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Low Back Pain

Low back pain is one of the most common causes of disability in the United States and can, again, result from a very large variety of causes. Most cases of low back pain are degenerative in nature and related to either disc degeneration or arthritic change. As disc material between vertebrae ages, it becomes dried out or dessicated. This lack of effective cushioning leaves vertebrae vulnerable to injury. Bone may grow along the edges of the vertebrae to stabilize the vertebrae. This bony overgrowth may cause stiffness and loss of flexibility, but more importantly, may cause narrowing of the spinal canal (spinal stenosis) or its openings that allow nerves to pass out of the canal (foraminal stenosis). The dessicated disc material may also bulge through its outermost fibrous covering and extend into the spinal canal. This disc material can be extremely irritating to spinal nerves as they pass through and leave the spinal canal. These changes may all result in pain that is localized to the low back and/or may extend into and shoot through the buttocks, thighs and calves.

Low back pain may also result from arthritic change involving the bony facet joints. These facet joints can be affected by rheumatoid arthritis or osteoarthritis, just like any larger joint in the body. This degenerative change may, again, greatly impact mobility while the resultant inflammation greatly irritates the nerves that supply these joint spaces, as in any similar arthritic joint.

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Some other causes of acute and chronic pain:

Carpal Tunnel Syndrome
Coccydynia
Degenerative Joint Disease
Fibromyalgia
Hip Bursitis
Metastatic Cancer
Myofascial Pain Syndrome
Peripheral Neuralgia
Phantom Limb Pain
Whiplash (CAD Syndrome)