Pain Causes & Assessment

Dr. Prem Pillay , Singapore Brain Spine Nerves Center, Singapore

Senior Consultant Neurosurgeon with super speciality training in Neurosurgical Oncology

(Fellow at MD Anderson Cancer Center and Hospital, U of Texas, USA)

The IASP (International Association for the Study of Pain) defines pain as an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.

Chronic Pain is defined as pain that persists for more than 3 months. Chronic discomfort can be either nociceptive or neuropathic. Nociceptive pain is linked with an external stimulus. Neuropathic pain is caused by nerve damage. Neuropathic discomfort occurs in the absence of detectable ongoing tissue damage.

Faces – pain scale chart

Terms

Allodynia Discomfort due to a stimulus which does not normally provoke agony.

Analgesia Absence of discomfort in response to stimulation which would normally be painful.

Anesthesia Dolorosa Ache in an area or region which is anesthetic.

Causalgia A syndrome of sustained burning discomfort, allodynia, and hyperpathia after a traumatic nerve lesion, often combined with vasomotor and sudomotor dysfunction and later trophic changes.

Central Pain Ache initiated or caused by a primary lesion or dysfunction in the central nervous system.

Dysesthesia An unpleasant abnormal sensation, whether spontaneous or evoked.

Hyperalgesia An increased response to a stimulus which is normally painful. Hyperesthesia Increased sensitivity to stimulation, excluding the special senses.

Hyperpathia A painful syndrome characterized by an abnormally uncomfortable reaction to a stimulus, especially a repetitive stimulus, as well as an increased threshold.

Hypoalgesia Diminished suffering in response to a normally painful stimulus.

Hypoesthesia Decreased sensitivity to stimulation, excluding the special senses.

Neuralgia Ache in the distribution of a nerve or nerves.

Neuritis Inflammation of a nerve or nerves.

Neuropathic Pain Ache initiated or caused by a primary lesion or dysfunction in the nervous system.

Neuropathy A disturbance of function or pathological change in a nerve: in one nerve, mononeuropathy; in several nerves, mononeuropathy multiplex; if diffuse and bilateral, polyneuropathy.

Nociceptor A receptor preferentially sensitive to a noxious stimulus or to a stimulus which would become noxious if prolonged.

Noxious Stimulus A noxious stimulus is one which is damaging to normal tissues.

Pain Tolerance Level The greatest level of discomfort which a subject is prepared to tolerate.

Paresthesia An abnormal sensation, whether spontaneous or evoked.

Peripheral Neurogenic Suffering initiated or caused by a primary lesion or dysfunction or transitory perturbation in the peripheral nervous system.

Peripheral Neuropathic Agony initiated or caused by a primary lesion or dysfunction in the peripheral nervous system.

Common Problems

Headaches can be caused by muscle tension, migraine, neck problems (cervical disc prolapses) and less commonly by strokes, brain tumors and head injury.

Face Pain: A condition called Trigeminal Neuralgia is caused by pressure on the Vth Cranial nerve next to the brainstem. This is often due to an abnormal position of a blood vessel compressing this nerve. Rarely tumors and arteriovenous malformations can cause this problem.

Neck and Back Pain: This can be caused by slipped discs or herniated discs, spine tumors and spine infection which press on nerve roots in the spine. Other causes include facet degeneration and bony spurs pressing on the nerve roots. Chemicals produced by degenerating discs can also be a cause of such discomfort. Instability in the spine can cause a severe agony. This can be degenerative or subsequent to an injury.

Sciatica: This refers to an ache shooting down a leg. This is often a sign of nerve root compression by a slipped disc.

Hand Pain: This can be caused by herniated discs in the neck or by thickened ligaments pressing peripheral nerves in the wrist – carpal tunnel syndrome (median nerve) or in the elbow-cubital tunnel syndrome (ulnar nerve).

Other syndromes: Reflex sympathetic dystrophy (RSD), fibromyalgia, amputation/phantom pain, post-herpetic neuralgia, brachial/lumbar plexus avulsion pain, T2 syndrome etc.

Conclusions

It is important to determine the root causes of pain and not just treat the symptoms. There are causes of pain that if not found early could lead to nerve damage and weakness or paralysis. A detailed clinical and neurological examination is needed by a Neurosurgeon and Pain expert. This is followed by selecting the appropriate tests to find the source of the pain. These tests include one or more of the following:

1. X-rays of the spine and/or limbs

2. MRIs (Magnetic Resonance Imaging) of the Spine, Nerves in the limbs, or the Brain

3. Nerve Conduction Tests (NCS) and ElectroMyography (EMG)

4. Blood tests for biomarkers of inflammation, infection or cancer

5. CT (computed tomography) of painful areas

   
   

Your Neurosurgeon will then determine the pain source and design less invasive or non invasive treatments including more advanced anti pain agents, and day procedures to treat the root cause of the pain.