THREE DIFFERENT TYPES OF BACK PAIN…

1. Acute Pain

Acute Pain is a pain that lasts less than 3 to 6 months, or pain directly related to tissue damage. This is the type of pain caused by a paper cut or needle prick. Other examples of acute pain are like labour pains, the pain is acute and identifiable.

Acute low back pain is defined as a pain present for up to six weeks. It could feel like an aching, stabbing, burning, or dull pain. The actual intensity of this type of low back pain could range from mild to severe and could fluctuate or move to other areas of your body like your hip or thigh area.

2. Chronic Pain

Chronic pain describes 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. Chronic back pain without a clearly determined cause, failed back surgery syndrome (continued pain after the surgery has completely healed), and fibromyalgia are all examples of chronic pain. Chronic pain is much less well understood than acute pain.

Chronic pain can take many forms, but is often described as a pain with an identifiable cause, such as an injury. Certain structural spine conditions, including degenerative disc disease, spinal stenosis, and spondylolisthesis, can cause ongoing pain until they are successfully treated.

3. Neuropathic Pain

Neuropathic pain could be placed in the chronic pain category, but it has a different feel than chronic musculoskeletal pain. The pain is often described as severe, sharp, lightning-like, stabbing, burning, or cold. The individual may also experience ongoing numbness, tingling, or weakness. Pain may be felt along the nerve path from the spine down to the arms/hands or legs/feet.

It is thought that the pain is caused by damage or disease affecting the somatosensory nervous system. Neuropathic pain may be associated with abnormal sensations called dysesthesia or pain from normally non-painful stimuli (allodynia). It may have continuous and/or episodic (paroxysmal) components.

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MYOFASCIAL PAIN -v- DISC PAIN…

As most of my readers know I suffer from chronic back pain after four previous spinal fusion surgeries only alleviated the pain for a matter of years before it came back.

Nowadays spinal fusion is not used as the first choice for prolapsed discs with pain management being the first treatment and only if nerves are compressed is it used as another option.

The problem with spinal fusion especially if you have more than one surgery is the pressure it puts on the disc below and above your fusion.

Another condition which you can also suffer from after any type of surgery is Myofascial Pain Syndrome which is a chronic painful muscle disorder and is common if you have experienced a muscle injury. Over time these myofascial restrictions can lead to poor biomechanics, altered structural alignment, compromised blood supply and pain. Other causes of myofascial pain are injuries to an intervertebral disc, general fatigue, repetitive motions, and some medical conditions.

It is characterised by the myofascial trigger points and the symptoms include persistent or worsening pain, deep and aching muscle pain, tender knots located in the muscles and pain after exercise or sporting activity.

Myofascial Pain Syndrome (MPS) is the name given to pain caused by trigger points and fascia (connective tissue) adhesions in the body, usually in muscle tissue, and inflammation in the body’s soft tissues.

Myo = muscle
Fascia = the main connective tissue in the body
Release = to let go, ease pressure

Treatments include anti-inflammatory medication, pain killers, physical therapy, stretching, massage therapy and trigger point injections.

A trigger point injection is either a cortisone injection or dry needling. Pain relief is quick and helps in continuing physical therapy. Trigger point injections can also be used for people suffering from degenerative disc disease.

Understanding the cause of your pain is an important step to finding an effective solution. It may involve a series of sessions and an at home program to keep the area strong.

Disc pain can come from a disc bulge or prolapse but you can also get myofascial pain which could be treated conservatively instead of surgery. Fibromyalgia patients can also suffer from myofascial pain. According to history, Sir William Gowers introduced the term fibrositis for a common, but idiopathic, localized form of muscular rheumatism that is now recognised as myofascial pain syndrome in 1904. And, despite the intervening years, it still constitutes the largest group of unrecognised and undertreated acute and chronic pain problems. Some people (like myself) have also been told they could have Fibromyalgia, previously named ‘fibrositis’.

My neck and arm pain have been giving me a lot of problems since last summer and after extensive tests, MRI’s, ct scans and more it was decided that a nerve block would help with the pain. There is never any guarantee with any injection but they hope to give the patient a few months of pain relief.

Nerve block injections into your neck for a disc bulge can be quite dangerous as they are quite tricky to do and they go through the front of your neck. I had this injection about six weeks ago. It’s not a very nice injection (if any are) but I knew the pain consultant had hit the spot and soon felt total relief. Unfortunately, it was short lived and only gave me pain relief for a few weeks. Not all the pain has come back but most of it as did the pins and needles.

I then had another appointment at the pain clinic and after looking at my MRI’s etc I was given a quick check where my pain consultant felt that the pain I now have could well be myofascial and not from the bulging disc so he has booked me in for a series of steroid injections in my shoulders.

I guess with any spinal pain after you have had all the tests it’s then worth trying alternative treatments well before you resort to surgery which is something I have always said I would avoid having.

 

CERVICAL DISC PROTRUSION AND ARTHRITIS…

After the brilliant guest post from Neil Velleman on ‘All you need to know about a slipped discI found myself being diagnosed with yet another disc problem in my cervical spine.

For the last six months, I have been having constant pain going down my arm from my neck as well as pins and needles down to my little finger.  Initially, we thought it may have been my ulnar nerve again. I say ‘again’ as I had surgery last year for a trapped ulnar nerve which was a total success but they said it can come back even after surgery.

After a 2 hour consultation with a physiotherapist, it was decided that it could be one of two things. Either the ulnar nerve or a disc in my cervical spine so the first port of call was a nerve conduction test.

The nerve conduction test showed no problem with the ulnar nerve so I was then sent to have an MRI scan. Those results have shown that I have another disc bulge which is compressing a nerve and giving me the pins and needles and pain and it also showed that I have arthritis in that area.

Neil Velleman explained that ‘the spinal discs act as shock absorbers and through a variety of causes, including injury, poor posture and general “wear and tear” (meaning gradual deterioration), the walls of the disc can become weaker. If the centre of the disc pushes out, this can cause the disc wall to bulge and that can be when pain strikes!’

Mine is definitely in the ‘wear and tear’ category as I have had two previous surgeries on the C3/4 area of my spine which has meant the disc below it has had to do all the work. I have now been told I will need to see a consultant about the sort of treatment they can give me for the pain which could be IDD Therapy, Injections, Manual Therapy or Surgery.

Back in 1996 when I had my second surgery on the C3/4 discs they gave me traction first but IDD Therapy seems to have taken over from that method but I shall just have to wait and see what they suggest.

The worst pain is doing the simplest of things like cleaning my teeth or drying my hair so I am just hoping an appointment comes through sooner rather than later.

12 FASCINATING FACTS ABOUT FIBROMYALGIA…

1. In the past, it has been called ‘Rheumatism’ and ‘Fibrositis’.

2. It is now firmly established that a central nervous system (CNS) dysfunction is primarily responsible for the increased pain and sensitivity of Fibromyalgia.

3. The tendency to develop Fibromyalgia Syndrome may be inherited. Many mothers with Fibromyalgia have children with it as well.

4. It is the central nervous system that is disturbed.

5. You cannot have Fibromyalgia only in your back or in your hands. You either have it all over or you don’t have it at all.

6. Fibromyalgia is not a diagnosis of exclusivity. You may have co-existing conditions, such as MS, arthritis, and/or myofascial pain, and still, have Fibromyalgia pain.

7. It is not a disease but a syndrome, which means a specific set of signs and symptoms that occur together. Rheumatoid arthritis, lupus, and many other serious conditions are also classified as syndromes.

8. Fibromyalgia is not the same as chronic myofascial pain, there is no such a thing as a Fibromyalgia trigger point. Trigger points are part of myofascial pain and not Fibromyalgia.

9. Fibromyalgia is not the same as Chronic Fatigue Immune Dysfunction Syndrome.

10. Fibromyalgia is not just widespread pain or achy muscles.

11. Fibromyalgia is not an autoimmune condition.

12. Fibromyalgia can often be triggered off by an event that activates biochemical changes, causing a cascade of symptoms.