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Last week, we learned that we have special receptors, called nociceptors, on the ends of our nerves that send pain signals through the nerves to the spinal cord to the brain. These signals warn us about temperature, injury, irritation, or potential injury. Today, we'll cover neuropathic pain - what it is and how it's treated.
Neuropathic pain comes directly from the nerves, not the nociceptors. Nerves from the peripheral nervous system or the central nervous system may be affected. One or more nerves may be injured, damaged, irritated, 'pinched' (compressed from inflammation, disc material, or other matter), or functioning improperly. If you herniate a disc in your spine, some of the jelly-like material (the nucleus pulposus) may squirt into and block the passage designed for the nerves that are exiting from the spinal cord and going into an arm or leg. When that happens, the nucleus pulposus may touch or compress the nerve bundle which can cause severe neuropathic pain. Excessive repetitive motion, or a disease like Diabetes, can cause damage to nerves so that they function improperly and cause pain that may tingle and burn (called peripheral neuropathy). Phantom limb pain also falls in the category of neuropathic pain. Neuropathic pain is more likely to be chronic and can be more difficult to treat. While OTC analgesics can help with nociceptive pain, they do very little (if anything) to relieve neuropathic pain. Finding and resolving the cause of such pain is the first step in treating it. However, if the cause is known but cannot be remedied, other steps become necessary. Stronger medications, like opioids will probably be prescribed, but may or may not help. Using devices like TENS Units or Spinal Cord Stimulators may help block neuropathic pain signals from reaching the brain. For the naturalist, aromatherapy and herbal remedies may be the answer. What I find in my own case is that a combination of therapies is most effective. I have both nociceptive pain from osteoarthritis (all joints), and neuropathic pain from multiple bulging, herniated, degenerative, and fused discs. Opioids are not an option for me because they make me violently ill. Herbs and essential oils do help, and in combination with spinal cord stimulators, I get enormous relief. Because the stimulators interrupt the pain signals, they provide significant relief for both types of pain. The most important thing for those of you who suffer with neuropathic pain is to work with your health care practitioner to find the best therapies for your individual case. Sources: 1. Dresden, Danielle, Nociceptive and neuropathic pain: What are they?, Medical News Today, Last reviewed November 2, 2017 https://www.medicalnewstoday.com/articles/319895.php Accessed June 19 - 25, 2019 2. Smith, Yolanda, What is the Difference Between Nociceptive and Neuropathic Pain? , News-Medical Life Sciences, Last updated August 23, 2018, https://www.news-medical.net/health/What-is-the-Difference-Between-Nociceptive-and-Neuropathic-Pain.aspx Accessed June 19 - 25, 2019 3. Booth, Keley John, MD, Understanding Nociceptive and Neuropathic Pain, Pain-Health, Last updated September 27, 2018, https://www.pain-health.com/conditions/chronic-pain/understanding-nociceptive-and-neuropathic-pain Accessed June 19 - 25, 2019 4. Webberley, Helen, Dr., What is peripheral neuropathy?, Medical News Today, Last updated November 27, 2017 https://www.medicalnewstoday.com/articles/147963.php Accessed June 19 - 25, 2019 We've discussed pain from a personal perspective over the last two weeks. For these next two blogs, we'll explore what scientists have learned about pain. This week, the focus will be on nociceptive pain, and next week it will be about neuropathic pain.
In looking at the definition of pain, I find articles that define it as physical or mental discomfort caused by stimulus to nerve endings that signal harm or possible harm being done to the body. More simply stated, some thing (i.e. heat, pressure, sharp object, infection) triggers your nerves to send an "It hurts!" message to the brain. The Mayo Clinic explains the pain process clearly. We have a central nervous system (CNS) which is made up of our brain and spinal cord. The rest of the nerves in our bodies are called the peripheral nerves and are part of the peripheral nervous system (PNS). On the ends of the peripheral nerves are receptors called 'nociceptors'. Nociceptors are found throughout our bodies -- in joints, skin, bones, soft tissue (muscles, cartilage, ligaments, etc), and around internal organs. They sense stimuli that may cause harm and send electrical impulses through the peripheral nerves to the spinal cord. If you develop an infection in your appendix you feel visceral nociceptive pain. Visceral refers to pain in the abdomen or organs. If you stub your toe or twist your ankle, you feel somatic nociceptive pain, Somatic refers to pain everywhere else. From the spinal cord, the 'messages' are prioritized (or triaged) before being sent to the brain. The signal(s) sent in the case of a minor bump may be sent to the brain more slowly than signal(s) from a smashed finger. In the case of a minor bump, the brain's response may only focus on sending messages to your immune system to start the healing process. (Did you ever see a bruise on your leg and have no idea how it got there? You may not have noticed the bump, but your brain signaled your immune system to repair the minor damage.) If your finger is smashed in a door, your brain will immediately signal your body to remove your finger from the door and to start the healing process. The signals are sent so fast that your reaction is considered to be a reflex -- your brain uses pain to tell you to remove the damaging condition. In all of these situation, nociceptors initiate chemical and electrical messengers which travel through the peripheral nerves to your spinal cord, and your spinal cord relays those messages to your brain. This seems relatively straightforward, but there's more to pain. Scientists are finally trying to learn exactly how pain signaling works in our bodies, and they have made some interesting discoveries and hypotheses. First, pain physically changes brain and spinal cord cells and creates 'pain memory'. It's believed that this pain memory may play a role in chronic pain that occurs even after an injury has healed. Second, genetics may affect how a person responds to pain stimuli - whether that person is very sensitive to pain or has a high tolerance for it. When someone is very sensitive to pain, it's because the signaling is faster, and possibly stronger, in their PNS and CNS. Third, there is a gene called COMT which has different activity rates in different people. Those with a very active COMT may tolerate much higher levels of pain. So what does this mean for those with chronic nociceptive pain? One belief is that those with higher sensitivity to acute pain have a higher likelihood of eventually experiencing chronic pain. I'm not convinced that this is the case because I know many people who have a very high pain tolerance who live with severe chronic pain. I expect more studies need to be done in this area. Pain is considered chronic when it lasts beyond the time when an injury has healed. It's possible that the initial injury caused the nerves to become extra sensitive so that pain is felt more easily in that area. Again, I am left with questions. Given that it takes about 42 weeks (that's nearly a full year) for a damaged ligament to heal, is it really 'pain memory' causing us to imagine that there is still pain? Is it possible that chronic nociceptive pain is caused by micro damage that takes much longer (i.e. years) to heal? Scientists don't have answers to these questions yet. Perhaps one day they will. Sources: 1. Mayo Clinic, Understanding Pain, June 26, 2016 https://www.mayoclinic.org/understanding-pain/art-20208632 Accessed June 10 - 18, 2019 2. Felman, Adam, What is pain and how do you treat it?, Medical News Today, Last updated July 27, 2017, https://www.medicalnewstoday.com/articles/145750.php, Accessed June 10 - 18, 2019 3. Weir, Kirsten, Owww! The science of pain, Science News for Students, June 25, 2014 https://www.sciencenewsforstudents.org/article/owww-science-pain, Accessed June 14 - 18, 2019 4. Stace, Richmond, What is Pain? A Modern Scientific Perspective, Ezine Articles. April 9, 2010, https://ezinearticles.com/?What-is-Pain?-A-Modern-Scientific-Perspective&id=4074205, Accessed June 14 - 18, 2019 Last week, we discussed pain levels from a personal perspective. This week, we'll investigate how to describe different kinds of pain - again from a personal perspective.
When you go to the doctor's office, (s)he may give you a chart or ask you to describe your pain. Many of those charts will contain the following list (or something very similar): ache, sharp, burning, stabbing, throbbing. These adjectives are usually enough for those who occasionally experience pain, but if you live with chronic pain, describing that pain can be more complicated. It's okay (and probably more helpful) to give a detailed description of your pain to your doctor. For example, when you tear soft tissue, like cartilage or a ligament, initially, it's a severe, intense sensation like scissors were used to cut something inside your body. (It's a feeling you never forget and will recognize if/when it happens again.) Over a few minutes, the severity of the pain diminishes to a strong feeling of pressure. Depending on where the tear occurs, mobility of a limb may be partially or totally impaired, but by the time you get to a doctor, you may only feel a mild ache (or no pain) at rest, and moderate to severe heaviness, pressure, and/or tearing pain with motion or weight bearing. Nerve pain, like sciatica, can feel like a blowtorch is shooting down your back into your butt and/or leg(s). That pain may start suddenly or gradually and may be fleeting or last for hours/days/weeks/months. Other nerve pain may feel like you're being pricked with a thousand pins or like you're being seared with an iron bar fresh out of a forge. Bursitis may feel like a foam-filled balloon is stuck in your joint and is trying to explode - the pressure moves from the center outward. Blocked Eustachian tubes or an ear infection may have a similar sensation. Breaking a bone feels like a combination of an initial snap followed by the sensation of a molten iron poker being stuck in the bone. Unlike a soft-tissue tear, it takes days for this intense pain to subside. These are just a few examples from my perspective. You may have different descriptions for similar conditions -- it's important to give your doctor as accurate a picture of your pain as possible. For more serious pain, that description should go beyond ache, sharp, burning, stabbing, throbbing. Next week's blog will delve into the scientific perspective of pain - its purpose, how the body knows to "feel pain", and how the pain signals are sent through the body. Most of us have experienced physical pain at some point in our lives. Sometimes, it's minor, other times it's major. Doctors have a 1 - 10 scale they ask us to use to quantify our pain. For some, pain is something that occurs occasionally; for others, it's chronic - daily, perhaps 24/7. Today's blog will talk about pain from a personal perspective.
Doctors say level 1 is no pain. A mosquito bite itches. A paper cut stings. These are examples of mild/minor pain -- probably a level 2 - 4 on the doctor's scale. Sore muscles, bumps, and bruises may cause moderate pain - levels 5 - 7. Sprains, ligament tears, some migraines are examples of severe pain -- levels 8 - 10. A broken bone would be an example of level 10 pain -- a level that physicians consider to be the most severe. This scale works quite well for those who sometimes experience pain, but there is pain that goes beyond these levels. Sciatica, neuropathy, extreme migraines are a few examples of excruciating pain - what I call levels 11 - 13. Level 11 is stronger pain than a broken bone. It reduces the ability to concentrate and to function, and leaves the person exhausted, but unable to sleep for more than an hour or two at a time. Level 12 further reduces concentration, the ability to function, and memory. The person might be able to get 1/2 to 1 hour of sleep at a time. At this level, when going to bed at night, the person thinks 'It's okay if I die before I wake up because I'll be out of pain.' (I know, this is unimaginable to many, but those who live with this level of pain understand exactly what I'm saying.) Level 13 is pain so intense that the person is no longer able to think or function - (s)he is only able to moan, groan, and cry. What do we do about pain? For mild to moderate pain, we may just put up with it, ignore it, or take acetaminophen or ibuprofen. For severe pain, most people will take an analgesic, OTC medication, or get a stronger, prescription medication. Excruciating pain needs greater intervention. It may need stronger medications, bracing, or even surgery. Severe and excruciating pain levels definitely require a visit to the doctor for diagnosis and treatment plans. But, what if pain meds make you so sick you can't take them? There are many of us who experience that. Fortunately, there are alternatives for those of us who are adversely affected by pain meds -- and for those who prefer to use natural methods as much as possible. What are those alternatives? Alternatives include physical therapy, chiropractic care, acupuncture, use of herbs (TCM, Ayurveda, Western Herbalism), and using essential oils and fixed/carrier oils. If you are looking for more natural methods of soothing your pain, check with an expert in one (or more) of these therapies. You can also start your own journey studying these fields! |
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February 2021
CategoriesAuthorKaren Dragoo |
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