Chronic Pain Conditions
The experts at the Pain Center at North Shore-LIJ Health System's Cushing Neuroscience Institute specialize in the diagnosis and treatment of diverse conditions involving chronic pain, ranging from low back and neck pain to shingles pain, headache and migraine pain, fibromyalgia and peripheral neuropathy pain. Conditions treated at the Pain Center include:
Chronic and Acute Neck and Low Back Pain
There can be many underlying causes of moderate to severe back pain, including:
- Overuse, strenuous activity, improper use or repetitive heavy lifting
- Trauma, injury or fractures
- Stress on the muscles and ligaments that support the spine, resulting in degeneration
- Increased weight on the spine and pressure on the discs, as a result of obesity
- Poor muscle tone
- Sprain or strain
- Ligament or muscle tears
- Joint problems, such as arthritis
- Protruding or herniated (slipped) disc and pinched nerve
- Congenital (present at birth) abnormalities
Axial Back Pain
This type of lower back pain can vary. Symptoms of axial back pain can be a sharp or dull pain, felt constantly or intermittently. Axial back pain symptoms can range from mild to severe pain. The most common type of axial back pain is “mechanical” and is characterized by low back pain that:
- Gets worse with certain activities, such as sports
- Gets worse with certain positions, such as sitting for long periods
- Is relieved by rest
Axial pain is the most common type of lower back pain, and it is usually non-specific – meaning that the anatomical structure responsible for the pain need not be identified because symptoms are usually self-limited and resolve.
Abnormal wear on the cartilage and bones of the neck causes spondylolysis. There are often no symptoms of spondylolysis.
- Lower back pain
- Muscle tightness (tight hamstring muscle)
- Pain in the thighs and buttocks
- Tenderness in the area of the slipped disc
- The space at the center of the spine
- The canals where nerves branch out from the spine
- The space between vertebrae (the bones of the spine)
Atypical intractable facial pain
Atypical facial pain is a pain disorder of the face which shares some features with nerve pain conditions such as trigeminal neuralgia. The pain may be different – most often longer in duration (minutes, hours, or continuous), and of a dull, aching, burning, sharp, squeezing or crushing quality. Sometimes, the causes of atypical intractable facial pain may be sinus surgery, dental work, facial trauma or an injury to a small branch of one of the three divisions of the trigeminal nerve.
Complex regional pain syndrome
Complex regional pain syndrome (CRPS) is a chronic pain condition. One of the common symptoms of complex regional pain syndrome is a continuous, intense pain, out of proportion to the severity of the injury. The pain gets worse rather than better over time. CRPS most often affects one of the arms, legs, hands, or feet. Often the pain spreads to the entire arm or leg. Other typical symptoms of complex regional pain syndrome include dramatic changes in the color and temperature of the skin over the affected limb or body part, accompanied by intense burning pain, skin sensitivity, sweating, and swelling. Doctors aren’t sure what causes complex regional pain syndrome.
Headaches are defined as pain in the head located above the eyes or the ears, behind the head (occipital), or in the back of the upper neck. There are two types of headaches: primary headaches and secondary headaches. Primary headaches are not caused by other diseases. Examples of primary headaches and their causes are migraine headaches, tension headaches and cluster headaches. The causes of secondary headaches can be associated diseases and conditions such as brain tumors, strokes, meningitis, subarachnoid hemorrhages, caffeine withdrawal or discontinuation of analgesics.
Some migraine headaches are preceded or accompanied by sensory warning symptoms (aura), such as flashes of light, blind spots, or tingling in your arm or leg. Symptoms of migraine headaches can include intense throbbing or pulsing in one area of the head, nausea, vomiting and extreme sensitivity to light and sound. Migraine headaches can cause significant pain for hours or days. The pain can be so severe that those suffering can only think about finding a dark, quiet place to lie down. Common migraine headache causes or triggers include:
- Hormonal changes in women
- Sensory stimuli
- Sleep changes
- Environmental changes
Fibromyalgia pain is a syndrome rather than a disease. A syndrome is a collection of signs, symptoms and medical problems that tend to occur together, but are not related to a specific, identifiable cause. A common and chronic disorder, fibromyalgia syndrome is characterized by symptoms such as:
- Widespread pain
- Diffuse tenderness
- Cognitive and memory problems (sometimes referred to as “fibro fog”)
- Sleep disturbances
- Morning stiffness
- Irritable bowel syndrome
- Painful menstrual periods
- Numbness or tingling of the extremities
- Restless legs syndrome
- Temperature sensitivity
- Sensitivity to loud noises or bright lights.
Some stroke survivors experience post-stroke pain, ranging from mildly uncomfortable to severe pain that hinders stroke recovery. In some instances, post-stroke pain symptoms can simply go away with no explanation. Symptoms may occur right after a stroke or weeks or even months later. Stroke survivors may experience different types of post-stroke pain such as aching, burning, sharp, stabbing or itching pain.
Symptoms of post-stroke pain may include:
- Local or “mechanical” pain in a joint or joints
- Centralized pain caused by damage to the brain
- Chronic pain that comes and goes
- Pain on part or all of the side of the body affected by the stroke
- Pain on the face, arm, leg or torso
Causes of cancer pain are the cancer itself, the cancer treatments such as chemotherapy and the side effects of cancer treatment:
- The cancerous tumors can press on the body’s organs, bones or nerves and cause pain. When tumors obstruct blood vessels, pain can occur.
- Cancer surgery
- Cancer treatments -- Chemotherapy treatment-related pain can include:
- Mouth sores (mucositis)
- Peripheral neuropathy (numb and sometimes painful sensations in the feet, legs, fingers, hands and arms)
- Constipation or diarrhea
- Nausea, vomiting and abdominal cramps
- Bone and joint pain
Most types of cancer pain can be managed with drug and non-drug therapies.
Usually, sciatica is caused by a prolapsed disc in the spine that presses on the sciatic nerve. Sometimes, a cause cannot be identified. Common causes of sciatica may include tumor, abscess, blood clot, awkward sitting position and nerve disorders. Sciatica symptoms may include:
- Lower back pain that radiates down the buttock and back of one thigh
- Pain that extends from the buttock down to the foot
- Numbness (in severe cases)
- Weakness (in severe cases)
Most of the feeling in the back and top of the head is transmitted to the brain by the two greater occipital nerves. One nerve is located on each side of the head. Occipital neuralgia (pain) can be caused by damage to these nerves. One of the most common symptoms of occipital neuralgia is a chronic headache localized in the back of the head and around or over the top of the head. The pain can be a very intense sharp, jabbing, electric shock. Other occipital neuralgia symptoms may include:
- Aching, burning, and throbbing pain that typically starts at the base of the head and radiates to the scalp
- Pain on one or both sides of the head
- Pain behind the eye
- Sensitivity to light
- Tender scalp
- Pain when moving the neck
Causes of occipital neuralgia may be trauma (usually concussive), physical stress on the nerve, repetitious neck contraction, flexion or extension or a result of medical complications.
The infraorbital nerve (ION) is a branch of the trigeminal nerve-the main nerve that provides sensation to facial skin. The infraorbital nerve supplies sensory innervations to the mid face, from the cheek to the nose. Causes of infraorbital neuralgia (nerve pain) may include trauma, plastic surgery, shingles or other viral infections that lead to nerve irritation. Symptoms of infraorbital neuralgia include sharp, shooting and tingling pain. Areas of the face may become very sensitive to touch. When the pain is severe, it can be disabling.
The supraorbital nerve (SON) is a branch of the trigeminal nerve-the main nerve that provides sensation to facial skin. The SON provides superficial sensation from the forehead into the scalp line. Causes of supraorbital neuralgia (nerve pain) may include trauma, plastic surgery, shingles or other viral infections that lead to nerve irritation. Symptoms of supraorbital neuralgia include sharp, shooting and tingling pain. Areas of the face may become very sensitive to touch. When the pain is severe, it can be disabling.
Trigeminal neuralgia is an extremely painful condition that usually involves one side of the face. It can occur spontaneously, but can also be associated with trauma or dental procedures. A feeling of “shock-like” pain travels through the face in just seconds and can be repetitive. The most commonly accepted theory of what causes trigeminal neuralgia is vascular compression. There are blood vessels that travel with the trigeminal nerve, and if they cause pressure on the nerve or irritate it, pain can occur.
Phantom Limb Pain
Many amputees experience some kind of “phantom” sensation in their amputated limbs. However, up to half of those who have phantom pain do not receive any treatment or relief from their pain. Phantom limb pain can be debilitating and may happen in a continuous cycle or brought on by outside factors such as temperature change or stress. The pain is more common in the immediate months after amputation, but can reoccur much later, too. Amputees describe their pain as if it were coming from their missing feet, toes or hands. Phantom limb pain symptoms include burning, stabbing and throbbing pain known as neuropathy. Possible causes of phantom limb pain include:
- Memory of limb pain – Some researchers theorize that after a limb is damaged beyond repair, the brain is accustomed to feeling the pain.
- Nerve bundle stimulation – The severed nerves around the amputation site either misfire or are stimulated in some way, sending a pain message to the brain.
- Rewiring of the nervous system – Some evidence shows that when a limb is amputated, changes take place in the brain and spinal cord that cause pain to be interpreted differently than before.
Stump pain is located at the end of an amputated limb's stump. Unlike phantom limb pain, it occurs in the body part that actually exists. Symptoms of stump pain are described as a sharp, burning, electric-like or skin-sensitive pain. Damaged nerves in the stump region are the causes of stump pain.
Sickle Cell Disease
The symptoms of may vary widely from mild to very severe symptoms requiring hospitalization. Symptoms of sickle cell disease include:
- Shortness of breath
- Coldness in the hands and feet
- Paler than normal skin or mucous membranes (the tissue that lines your nose, mouth and other organs and body cavities)
- Jaundice (a yellowish color of the skin or whites of the eyes)
Pain of the Extremities
Pain of the extremities is a condition that describes the cramping pain (claudication) that occurs when blood flow cannot be increased to a muscle mass in response to the increased metabolic demands of exercise. Causes of extremity pain include wide-ranging conditions such as:
- Carpel tunnel syndrome
- Biceps tendonitis
- Reynaud’s phenomenon
- Sickle cell anemia
- Black widow spider bites
- Cat scratch disease
- Post herpetic neuralgia
Osteoarthritis, a degenerative joint disease, is the most common type of arthritis and is caused by inflammation of the joints. Common symptoms of osteoarthritis are:
- Joint aching and soreness, especially with movement
- Pain after overuse or after long periods of inactivity
- Bony enlargements in the middle and end joints of the fingers (which may or may not be painful)
- Joint swelling and joint fluid accumulation
Polyneuropathy is a neurological disorder that occurs when peripheral nerves throughout the body malfunction simultaneously. It may be acute and appear without warning, or it may be chronic and develop gradually over a longer period of time. Symptoms of polyneuropathy can include weakness, loss of feeling or pins-and-needles sensations that frequently affect the feet and hands.
Neuropathy is a collection of disorders that occurs when nerves of the peripheral nervous system (the part of the nervous system outside of the brain and spinal cord) are damaged. The condition is generally referred to as peripheral neuropathy. Symptoms include pain and numbness in the hands and feet. Neuropathy causes result from traumatic injuries, infections, exposure to toxins and metabolic disorders such as diabetes.
Myofascial Pain Syndrome
Myofascial pain syndrome is a chronic form of muscle pain. The causes of myofascial pain syndrome center around sensitive points in your muscles called trigger points. The trigger points can be painful when touched, and the pain can spread throughout the affected muscle. Most people experience muscle pain that generally goes away in a few days. People with myofascial pain syndrome have muscle pain symptoms that persist or worsen. The syndrome has been linked to many types of pain, including headaches, jaw pain, neck pain, low back pain, pelvic pain and arm and leg pain.
Signs and symptoms of myofascial pain syndrome may include:
- Deep, aching pain in a muscle
- Pain that persists or worsens
- Muscle stiffness
- Joint stiffness near the affected muscle
- Area of tension in your muscle that may feel like a knot or tight spot and may be particularly sensitive to touch
- Difficulty sleeping due to pain
Shingles and Postherpetic Neuralgia (PHN)
Postherpetic neuralgia is a painful condition affecting nerve fibers and skin. The burning pain associated with postherpetic neuralgia can be severe enough to interfere with sleep and appetite. Postherpetic neuralgia is a complication of shingles, a condition caused by the chickenpox virus. Shingles usually clears up within a few weeks. But if the pain lasts for months or years after the shingles rash and blisters have disappeared, the pain is called postherpetic neuralgia. Symptoms of postherpetic neuralgia generally occur in the area of the skin where the shingles outbreak first occurred and may result in:
- Burning, sharp, jabbing, deep or aching pain
- Sensitivity to light touch - even the touch of clothing
- Itching and numbness - a less common symptom
- Muscle weakness or paralysis - in rare cases
Make an appointment at the Pain Center:
Cushing Neuroscience Institute’s Pain Center makes it easy for you to take the first steps in ensuring the best neurological and neurosurgical care for yourself or your family. Simply fill out our Request an Appointment form, email us at firstname.lastname@example.org or call us at (516) 325-7070.