Got Pain?

Pain is one of the most common complaints I see in clinic. Whether it is acute or chronic pain, whether a recent injury, an old injury or old pain that is now flaring up, most of us live with some degree of pain and it can worsen overtime.

So, what are some of the most common causes of pain and how can you manage them on your own or know when you have to seek medical advice?

Pain is typically musculoskeletal or nerve pain. Depending on when your symptoms started and how, you might need additional imaging or we might try some conservative management before sending you out for Xrays and MRIs.

Here I touch briefly on a few of the most common causes of pain and their management.

Arthritis

The most common arthritis we all know and hear of is called Osteoarthritis, it is a result of wear and tear and loss of cartilage in our joint space. On occasion, a patient can have Rheumatoid Arthritis. Rheumatoid Arthritis presents a bit differently and can be of a more autoimmune etiology- basically when your immune system starts to attack itself.

Sometimes a physical exam can help us distinguish the two. However, additional labs and Xrays can be performed to determine which type of arthritis a patient might have.

Muscle Pain

In clinic, muscle pain is the most common reason I see patients for pain.

Overuse, poor posture, sedentary lifestyle and dehydration can cause swelling and knots in the muscles. Overtime muscles can become fatigued and unable to perform their own functions. This can lead to other muscle groups doing work they were not designed to do and can cause additional trauma and pain. The korean plastic surgery before and after have some muscle challenges that one must face while healing.

Trigger points are “knots” that form in the muscle and soft tissue, causing myofascial pain and inflammation. Myofascial treatment to help reduce these trigger points, can help reduce the scar tissue and inflammation, and improve mobility and functionality of the muscles.

Myofascial therapy along with trigger points injections to release the knots in the muscle would be beneficial to help reduce the inflammation and improve mobility. According to Trinity Louderback, in combination with trigger point injections, physical therapy, chiropractic interventions and massage therapy, these muscles can be strengthened to help improve myofascial function and prevent recurrent symptoms.

Acute Injury

With an acute injury such as a fall or sports injury, muscles, ligaments and tendons can become strained or sprained and cause pain. Depending on the type of injury, Xrays are not always necessary. If a medical provider suspects a possible fracture, Xrays will be ordered. Otherwise, if the injury seems to be due to muscle or soft tissue injury, other interventions are usually sought first.

If appropriate, patients can be given anti-inflammatory meds- such as Motrin or Aleve. If symptoms are really severe, sometimes a steroid medication can be used. Steroids help reduce pain and inflammation in the short term.

In the setting of an acute injury, often providers will recommend RICE protocols: rest, ice, compression and elevation. It is important to monitor for worsening symptoms and prevent blood clots.

Typically, if symptoms persist, a provider might consider referring a patient to physical therapy, chiropractor or massage therapy.

Thereafter, if symptoms persist imaging might be considered, such as an MRI.

Chronic Pain

Chronic Pain can be a result of several underlying factors such as Osteoarthritis, Rheumatoid Arthritis, chronic trauma or injury, or even some autoimmune disease.

Autoimmune disease can be due to underlying inflammation and causing your immune system to attack your own body. When you develop autoimmune disease, it can cause chronic pain and inflammation leading to worsening symptoms and continued loss of function.

There are several autoimmune diseases. Many are chronic and require a visit with a specialist, require medications and aggressive monitoring.

Depending on your symptoms, personal history and family history, your medical provider will decide which ones you are at risk for and perform additional testing to rule them in or out.

Nerve Pain

Lastly, we will briefly discuss neuropathy, or nerve pain. Nerve pain can cause numbness, tingling, burning sensation to the areas the nerve innervates, usually in the feet or legs depending on the cause, nerves affected or underlying disease.

Several diseases can cause neuropathy, such as Diabetes Mellitus or Vitamin B12 deficiency. Controlling or resolving the underlying cause can sometimes resolve your symptoms. Usually lab tests and simple studies can be done to rule out the underlying cause.

Occasionally, additional imaging or tests might be required such as an MRI or EMG test. An MRI can help determine if you have a herniated disc, pinched nerve or other disease affecting your nerve and causing your symptoms. An EMG tests for nerve and muscle conduction to identify which nerve might be affected and can be causing your pain.

There are medication options to help manage symptoms of neuropathy as you undergo workup. However, to truly treat the pain, the underlying cause of the nerve pain should be treated.

Obviously, pain and muscle injury are not always clear, patients can have multiple reasons for pain and underlying causes. It is important to have a frank conversation with your provider and discuss what the right treatment plan for you might be. You might be surprised to find, that the right treatment is not always with medication. Have that conversation to see how you can help heal your body in a more natural and nurturing way!

-Asma Bhaidani, PA-C

Asma Bhaidani