First of all, what is pain?
Pain is a sensation that occurs when pain receptors are stimulated and send signals to the brain. The brain then processes such information as pain. There are many kinds of pain: acute vs. chronic, chemical vs. mechanical, referred vs. local, sharp vs. dull, constant vs. intermittent
Acute Pain: results from an acute onset, like trauma.
Chronic Pain: results from a long history of an underlying abnormality.
Chemical Pain: is involved in an inflammatory process where swelling (edema) occurs—as in an acute injury.
Mechanical Pain: results from a mechanical failure such as frozen shoulder or disc herniation.
Referred Pain: originates in a location other than where the pain is felt. An example of referred pain can be seen in sciatica where pain is felt in a certain “patch” of the leg.
Local pain: is felt where the problem occurs.
Sharp pain: is perceived like blunt and violent pain, as in an electric shot or knife stab..
Dull Pain: is an ache, or soreness, like a tooth ache
Constant Pain: When pain is constant, it is hard to find any moment in the day without it.
Intermittent Pain: is a painful experience that comes and goes (as opposed to constant pain).
The Function of Pain
1. It is an Alert System
Pain often serves as an “Alert System.” Pain is the identifier and quantifier of an underlying problem. Our body has boundaries, but when something goes beyond these boundaries—as in an injury or an immune response, pain is usually perceived. Once it gives us the alerting signals, our body gets the information of where, when, and to what extent our body has a problem. The body will then attempt to correct, resolve, or avoid the problem.
2. It Provides Guidance for Treatment of Mechanical Malfunction
Most mechanical problems occur in joints, such as the shoulder, knee or spine. There are generally two major categories of mechanical malfunction in a joint—derangement and dysfunction.
A derangement occurs when a joint is not operating in its normal pattern. In such cases, certain movements or positions can worsen the symptoms whereas others can improve the symptoms. For instance, someone with low back pain may complain that the more he sits the more he feels pain, but the more he walks the better he feels. This is a very common presentation for lumbar derangements.
The painful sensation helps guide us into knowing the nature of the mechanical problem and its directional preference. Under the influence of the directional preference, a pain sufferer would experience more pain as he repeatedly moves away from that preferred direction. On the contrary, he would feel less pain as he repeats movements into the preferred direction. With such helpful information, the root of the mechanical failure can be identified and precise treatment can be prescribed.
A dysfunction, however, does not behave like a derangement. A dysfunction is caused by an inactive problem such as fibrosis, or scar tissue. Repeated movements do not tend to increase or reduce pain, or other symptoms.
Common Response to Pain
When our body senses pain, it automatically and subconsciously elicits a withdrawal response—both physical and psychological. For example, if your hand touches boiling water, your hand physically withdraws from it even before you perceive the heat and the pain. After this, you begin to associate pain with touching boiling water or anything that is very hot. As a result, you psychologically assure yourself not to make a career out of touching very hot things.
We have a similar response when we have pain in any body part. Once a part of our body begins to sense pain, we refrain from using that body part. In addition, our brain even tightens the muscles around the injured area to guard it. This prevents further damage. All this occurs at a subconscious level—that is, it happens without our decision or approval.
Ways to Treat Pain
Mechanical Diagnosis and Therapy
The Mechanical Diagnosis and Therapy (MDT) is an evidence-based method of ruling out symptoms that are chemical versus mechanical in nature and derangement versus dysfunction in origin. Pain, as well as other symptomology, can offer necessary information to help identify the source of the problem and directional preference. Once the correct diagnosis is determined by a certified practitioner, the appropriate mechanical therapy can be administered. The immediate response is that patients would have significant reduction in symptom and increase in mobility.
Modalities are used to temporarily reduce the sensation of pain. Heat, cold, ultrasound, various types of electrical stimulation, infrared, and lasers are among the common modalities used today.
At Core Rehabilitation and Spine Center, our goal is to get patients permanently pain-free and active by targeting the root of a mechanical malfunction. This is why we do not over-emphasize temporary methodology. Instead of temporarily covering-up pain, we investigate to determine the root of all related symptoms for a quick and long-term recovery.
Oral pain medication, or “pain killers” are used to temporarily reduce painful sensation. These should be taken with precaution since many pain medications present risk for side effects—such as gastric (stomach) ulcer, kidney failure, liver damage, addiction, stroke and heart attack. Corticosteroid (cortisone) injections are also used to temporarily reduce the pain caused by local inflammation. Depending on the location of injection, there is also a level of risk involved in this temporary remedy. Possible adverse reactions of cortisone injections include weakening or rupture of the soft tissues in the joint (such as ligaments and tendons), thinning of the cartilage, osteoporosis, nerve damage, and joint infection.