Key Takeaways

• The definition of pain. 
• 7 main types of pain.
• 3 categories of back pain.
• Causes of back pain.
• Types of headaches.
• Medical pain management and lifestyle adjustments.

Pain was recently redefined in 2020 as “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage,” by The International Association for the Study of Pain (IASP). The IASP is a global task force created to facilitate the collaboration of scientists, healthcare providers, and policymakers to improve treatments and processes for pain relief. The IASP reconsidered their understanding of pain to include also the perception that potential or real tissue damage may occur. 

Experts have learned that pain can cause emotional, psychological, and physical responses which may cause real or perceived limitations that require specialized treatment to recover.

Pain is not necessarily always harmful it’s often protective and typically temporary.

Your nervous system responds to information provided by your senses that you are experiencing potential or real bodily damage. Your nerve cells decipher the information as something to take notice of and initiate a physical and emotional reaction. It’s like an information superhighway between your brain and the nerves branching outward, and your eyes, ears, nose, fingers, and toes.

Pain can be complex and sometimes requires specialty providers to help you manage it.

Pain management is a broad term for treatment designed to decrease or control pain. Treatment takes on various forms depending on the categorization of the pain. Newly experienced pain is treated differently than long-term pain or the way nerve-related pain is managed. 

Let’s face it, a lot has changed since 2020. The intrusion of COVID-19 into our lives has altered what it means to lead a healthy life, i.e.physical and mental health are equally important. Proper management of pain is part of that equation for people who battle chronic pain.

We’ll explain the basic details of pain, types of pain, and some common pain scenarios people experience such as back pain and headaches. Then we’ll look at what pain management involves and how it can improve your quality of life.

Types Of Pain

First, we must discuss the main types of pain to understand how to manage it effectively. Pain is categorized based on several factors: intensity, duration, source, and specific characteristics. Within the pain spectrum are seven classifications used for clinical diagnosis. 

1. Acute pain.
2. Chronic pain.
3. Nociceptive pain.
4. Neuropathic pain.
5. Nociplastic pain (previously known as Psychogenic pain).
6. Idiopathic pain.
7. Referred pain.

While we don’t recommend diagnosing your pain yourself, understanding what type of pain you’re experiencing is a crucial step toward being able to communicate to your healthcare provider — who will determine the appropriate direction of treatment. 

Each classification has specific characteristics. Important note: you can be affected by more than one type of pain at the same time. 

For example, you may have chronic pain from an old back injury, but recently you bent over to pick up your kitty, and bam!… now you’re feeling a new sharp pain. This new pain is acute and intense and probably different than your usual achy back. Both types of pain now coexist and you’re couch-bound for the day with an ice pack…and that darn cat. 

All of that being said, learning about the differences between pain types and their management can be helpful on the road to living your best life.  

Acute Pain

Have you ever burned your hand while cooking? That is a typical scenario of acute pain — a specific episode resulting in intense, short-term pain. It often happens suddenly and feels severe. Acute pain may last for a few minutes or a few months but not past six months.

Acute pain may be associated with injuries like a broken finger or back strain, following a surgical procedure, or even a headache. The intensity varies and affects other body systems besides the original pain site. Acute pain can cause changes in your vital signs — increased blood pressure, heart rate, breathing rate, and body temperature.  

These vital signs and the symptoms you feel during an acute pain situation are responses from your nervous system. Medical care is necessary in cases where you cannot regulate yourself. In most scenarios, your body should return to baseline naturally, then the typical healing process will begin. 

However, if the expected healing does not occur and the pain continues, you enter the chronic phase, which we’ll discuss a little later.

Acute Pain Management Overview   

Managing acute pain once it’s diagnosed is essential to a timely recovery. Early treatment based on determining the mechanism or cause of pain and the related symptoms can shorten the pain duration. This may be easier said than done in some cases.

Using the previously mentioned scenario, you burn your hand while cooking so you may know to cool the skin’s surface immediately to minimize the effects of the burn. It’s likely your mom told you to put your hand in cold water when you were a kid. Of course, this is a basic example of an incident and a treatment. In the real world, there may be many variables, but the point is a quick response is best. 

On the contrary, a back strain is likely a more complex scenario. 

Let’s say, you’re cleaning the attic, so you twist, reach, and bend your body repeatedly over a few hours. Later after dinner, you get up from your chair and feel a sudden sharp pain in your lower back. You decide to rest and apply ice to the area thinking it will go away. However,  a couple of days later you cannot get out of bed. 

Initially, the pain didn’t seem severe enough to consult a doctor, but when your mobility to perform everyday tasks becomes limited, it’s a problem. Now, the pain is stopping you from going to work or you have to cancel your pickleball game. This reduced ability to live your normal life causes you to consider treating it with stronger medication than what you have in the house, calling your doctor, or going in for urgent care services to manage your pain.

Common methods to manage acute pain include using:

• First-aid practices: bandages, salves, or ointments for cuts, burns, and abrasions.
• Non-steroidal anti-inflammatory drugs (NSAIDs): Tylenol, Advil, Naproxen. 
• Cold therapy: ice packs or cold ointments.
• Splinting or immobilization.
• Rest. 

The sooner treatment begins to address the inflammation, i.e. swelling, redness, increased surface temperature, and pain, the sooner healing will start in most cases. Effective early treatment can decrease the chances of the acute phase becoming chronic and more difficult to treat.

Chronic Pain

Pain that lasts longer than three to six months and is persistent or recurring is generally considered chronic pain. Chronic pain continues beyond what is the usual and expected recovery time. When the typical tissue healing time has elapsed but pain persists, there may also be psychological implications. 

Imagine three months after the moving day back strain, your still hurts enough to keep from doing activities you enjoy including social events. Missing those things can cause you to feel sad, depressed, or even angry. Pain lasting longer than you or your healthcare provider expected can have a trickle-down effect on your quality of life.

On another note, chronic pain can involve more complex situations than injuries or post-surgical complications. Chronic health conditions such as arthritis, diabetes, cancer, and autoimmune disorders may cause persistent pain. Back pain and migraines are common sources of recurring pain.

There’s a growing understanding of chronic pain regarding its health and quality of life implications. If you’re a person dealing with persistent or returning pain, you know managing it can take a toll on your mental health. You may also have sleep disturbances or depression which are common side effects of prolonged pain.  

Chronic Pain Management Overview

The chronic classification frequently coincides with other types of pain like neuropathic or nerve tissue injury and idiopathic which has no known cause. Therefore, managing this pain phase is more complex and involves caregivers utilizing a multi-faceted and integrative approach. An integrative approach involves combining physical health and mental and considers other factors such as social and emotional effects on your health.

Treatment for persistent conditions typically involves multiple healthcare providers or specialties, medication, psychological counseling, physical therapy, and holistic or complementary medicine. Learning to live with pain to create an acceptable quality of life can be a lengthy process that evolves.

Nociceptive Pain

Nociceptors are nerve fibers that sense and respond to potentially harmful stimuli. They are protective acting as an alert system and motivating your response. In the previous scenario mentioned where you burn your hand while cooking, nociceptors cause you to withdraw your hand from the hot stove. 

Nociceptive pain is physical pain. It is essentially caused by your nervous system’s response to being irritated — it typically continues until the irritant is removed, i.e. removing your hand from the stovetop. 

Nociceptive pain is a normal response from a normally functioning nervous system. The pain is caused by actual or threatened tissue injury and is categorized into two types, somatic and visceral. 

• Somatic nociceptive pain arises from the skin, muscles, joints, bones, and connective tissues. It’s often localized and can be caused by cuts, sprains, and broken bones.
• Visceral nociceptive pain originates from the internal organs and the linings of cavities in the body. This type of pain can feel vague and pressure-like or squeezing, making it harder to localize due to the fewer nerve endings in the internal organs.

Nociceptive Pain Management Overview

This type of pain and the treatments are specific to the cause of the pain. Somatic pain, see above scenario removing your hand from the heat source stops the damage.

In more complex cases involving visceral or internal organ pain, sourcing the location of the irritation is more difficult. Belly pain could be caused by irritation in your stomach, intestines, appendix, or maybe your gall bladder. These situations may require a medical provider visit if they keep happening.    

That being said, whether the source of nociceptive pain is traumatic injury or caused by inflammation, managing the pain may be very different. This is another example where you could have multiple types of pain happening simultaneously and thus may require different types of treatments or management techniques.

Neuropathic Pain

The root word neuro means relating to nerves or the nervous system. Neuropathic pain is caused by nerve tissue damage or disease affecting the nervous system. This type of pain is often described as burning, numbness, shooting, or tingling and may occur without any obvious injury or damage. 

Causes of neuropathic pain may be related to conditions such as:

• Diabetes.
• Viral neuropathy: Post-herpetic neuralgia (a complication of shingles); HIV/AIDS.
• Nerve constriction injury or entrapment: Carpal Tunnel Syndrome; Tarsal Tunnel Syndrome.
• Sciatica.
• Effects from a stroke, multiple sclerosis (MS), or spinal cord injury. 

Neuropathic Pain Management Overview

On the pain spectrum, it tends to be challenging to manage. The diagnosis relies on a person’s description of their symptoms and often imaging or nerve testing procedures. Managing neuropathic pain is complex and may require some trial and error as the affected person reports their response and the provider adjusts treatment as needed.

An integrative approach that includes specialists, medication, physical therapy, and counseling is likely necessary to manage nerve-related pain.

Nociplastic Pain

This type of pain is difficult to diagnose because it does not adhere to a standardized account of cause and effect or incident and resulting symptoms. Nociplastic pain is characterized by altered nociception. A glitch in the nervous system causes pain without a clear origin or evidence of tissue damage.

Nociplastic pain has been re-classified from being called psychogenic pain. The previous thought that for some folks the pain is “all in your head,” has evolved and is now understood as real pain you feel without rhyme or reason.

Health providers can perform medical testing to indicate you are responding to something irritating your nerves — even though there is no apparent tissue damage. Below are examples of conditions within the nociplastic pain class which are also called functional pain syndromes.

• Fibromyalgia.
• Chronic fatigue syndrome.
• Complex regional pain syndrome type 1, formally known as reflex sympathetic dystrophy.
• Irritable bowel syndrome. 

As a result of the altered sensory perception causing pain, a variety of symptoms such as depression and fatigue can accompany these conditions causing a person’s function to become impaired. A person with this type of pain is generally not unable to function but requires a significant amount of energy to perform everyday activities.

Nociplastic Pain Management Overview

Nociplastic pain is complex to manage. Experts report the same treatments used for neuropathic and nociceptive pain have not proven effective for this type of pain. Researchers are performing trials to improve current methods of treatment. 

Idiopathic Pain

Idiopathic means unknown cause, therefore idiopathic pain has no known origin. A person with this type of pain feels real pain symptoms but does not have an account of how the pain started or what caused it. Idiopathic pain can overlap with other classifications such as chronic and nociplastic pain. 

Though the existence of idiopathic pain has been known for decades, there’s still a lack of a full understanding of its process. An unfortunate outcome of dealing with an unknown cause of pain is that it can have long-term effects. 

Consider a scenario where you have pain that you don’t know where it started and your doctors have not been able to treat it effectively. It can take an incredible toll on your mental health, not to mention the financial strain it can cause due to the ongoing medical care required.

Idiopathic Pain Management Overview

This type of pain requires multi-disciplinary and integrative care to manage. Treatment likely includes medical specialists and medication along with psychological and physical therapy. It is important to assess all factors associated with idiopathic pain, like social and behavioral aspects, since that may influence treatment.

Referred Pain

Referred pain symptoms are felt in a different area of the body than the origin or cause of the pain. The nervous system directly affects muscles causing them to move, but also has pathways through the body that cause pain in generalized areas. You may feel the pain superficially on the skin or in the muscles but not in the structure causing the pain. 

Common examples of referred pain include: 

• Groin pain, which could be neuropathic or nerve-related, where the original site of irritation may begin in the spine or pelvis. A sacroiliac joint dysfunction (the joint where the pelvis connects to the spine) can cause pain felt in the groin but not the pelvis or spine.

• Pain caused by a heart attack is sometimes felt in the arm, neck, or jaw. Visceral pain caused by internal organs can show up in other areas of the body, e.g. back pain caused by the gall bladder. 

Referred pain patterns may coincide with dermatomal patterns. These are pathways that travel to the outermost nerves and affect specific body areas. For instance, a neck muscle with a trigger point can cause pain in the arm. On the contrary, radicular pain such as sciatica is caused by nerve root irritation, which happens where the nerves exit the spinal column.

Referred Pain Management Overview

An analysis of your symptoms and possible causes, known as differential diagnosis, is key to treating this type of pain. A person dealing with referred pain should give a detailed report of their symptoms and suspected origin for best results. Healthcare providers must try to determine what factors are causing your pain to manage referred pain effectively. 

Doctors typically opt for conservative measures initially, such as medication and physical therapy, to treat this pain class.

Types Of Back Pain

Did you know back pain is the number one cause of disability across the globe? According to the World Health Organization (WHO), a reported 169 million people are living with low back pain. These folks represent a substantial health and economic concern with potential societal impacts due to lost work time and potential disability.

The National Institute of Health (NIH) reports that “approximately 75 percent of those with chronic severe back pain reported disability, with 60 percent noting mobility problems and work limitations, 34 percent self-identifying as having limitations with social participation, and 16 percent stating that they had limitations with self-care (getting dressed, washing, etc.).“

Refining treatments and guidelines to improve back pain management and enhance the quality of life for those dealing with it could be life-changing. Understanding the type of back pain you are experiencing is an important step toward managing it. Giving your health provider a good history or report is essential for them to accurately diagnose your back pain to determine the most effective treatment plan.  

Back pain can be classified based on duration, location, and cause. Reporting the amount of time you have experienced your back pain assists healthcare providers in how to begin treatment. The timeline breakdown looks like this: 

1. Acute Back Pain: Lasts for a few days to a few weeks. It’s typically sudden and is often caused by a specific event or injury. Acute back pain usually resolves on its own with self-care.
2. Subacute Back Pain: Lasts between 4 to 12 weeks. It may persist after the initial injury or acute episode but generally improves with time.
3. Chronic Back Pain: Lasts for more than 12 weeks. It may be persistent or intermittent and can arise from various causes, including unresolved issues from acute or subacute pain, chronic health conditions, or factors that are harder to identify.

Once the timeline is established the provider will focus on the location of your back pain. Your back is divided into three spinal sections: cervical, thoracic, and lumbar. 

• Upper back pain may include a combination of the neck or cervical spine, shoulder blades (scapulae), and upper rib areas.
• The mid-back or thoracic spine involves the areas between the shoulder blades, and the lower ribs, and usually stops just above the lower back.
• The lower back is the most common pain area reported. It contains the lumbar spine, sacrum, and tailbone or coccyx. It often involves the pelvic bones.

Causes Of Back Pain

If you’ve made it to your 30s and lived a moderately active lifestyle, chances are you have experienced back pain. Low back pain is the most commonly reported back pain type. It can be caused by a variety of incidents and ailments such as:

• Mechanical and structural problems.
• Inflammatory conditions.
• Neuropathic and referred pain.

Mechanical And Structural Back Pain

The spine is meant to bend forward, backward, and sideways, as well as twist. The structures including bones, discs, and soft tissue such as ligaments and muscles support the spine and create a foundation for your body. Sometimes these parts don’t function properly whether due to an injury or something else and the result is back pain.

Some occupations are more prone to back injury but not necessarily the jobs you think. Physical and manual labor jobs involving bending and lifting seem most obvious, however, sedentary positions can cause back pain as well. Sitting and staring at a computer daily can take its toll on the postural muscles that hold your body upright and cause back pain. 

The above examples are situations possibly resulting in mechanical back pain, the most prevalent type. This type of back pain is often linked to an injury such as muscle strains and herniated discs, but also degenerative disc disease and spinal stenosis may be to blame. Poor postural support or overdoing certain movements repeatedly can lead to muscle imbalances and movement dysfunctions resulting in mechanical back pain sometimes referred to as functional pain.

Inflammatory Back Pain

Inflammatory conditions of the spinal and pelvic joints cause this type of back pain. Ankylosing spondylitis and several forms of arthritis including psoriatic and reactive arthritis are the conditions most often associated with inflammatory back pain. These conditions are known as rheumatic which involve pain, swelling, and inflammation of the soft tissue surrounding the joints as well. 

Inflammatory pain falls under the umbrella of chronic pain with symptoms that come and go intermittently. These conditions are dealt with on a long-term basis and require a multi-disciplinary approach to manage them effectively.   

Neuropathic Back Pain

Back pain caused by nerve fibers being damaged or compressed is neuropathic or nerve-generated. Sciatica, where pain radiates from the lower back down to the legs, is a common example. 

Side note: It is important to understand there are several conditions with sciatica-like symptoms that have other origins, so make sure to give your healthcare provider an accurate and thorough report of your symptoms.

Nerve compression or pressure on the nerve fibers could be the result of conditions such as a herniated disc, a tumor, or a spinal joint dysfunction pinching a nerve. If you have this type of back pain, you likely report burning, tingling, or numbness in one or both legs or arms. It is often chronic and complex to treat because of many variables associated with nerve damage.  

Referred Back Pain

Referred pain originates in a different area than where it’s felt. Back pain is sometimes caused by or referred to the back by the internal organs or viscera. Likely suspects causing back pain could be kidney or gall bladder inflammation, or possibly lung disease.

You can also experience referred back pain in the leg without nerve compression such as with radicular pain. In that scenario, a back issue causes pain symptoms somewhere other than the back. 

A thorough subjective report and diagnostic exam are important to discover the pain’s origin. Providers will assess if red flag symptoms are coinciding with back pain and determine if a serious disease process is occurring and treat accordingly.

Don’t wait too long to consult with a healthcare professional if you are having pain in your back. It might be the difference between months of suffering or the resolution of your back symptoms. As always, early intervention is the best way to manage pain.

Types of Headaches

Another common and potentially significant health issue many face is the prevalence of headache pain. The Journal of the American Medical Association (JAMA) reports that about 90% of Americans have experienced a headache at one time or another. Not every headache is the same and some can significantly impact your quality of life, such as migraines.

Migraines are one of four primary types of headaches and they can be debilitating for some. JAMA reports migraines are the second leading cause contributing to those living with a disability throughout the world. 

Typically headaches are categorized by their symptoms, causes, and locations. Primary and secondary headache causes are broken down into subcategories detailing specific characteristics. Understanding the types of headaches and their origins can help determine an effective treatment plan.

Primary Headaches

Primary headaches are unrelated to underlying medical conditions and are classified into four main types but the first three constitute the majority of headaches.

1. Migraines are known for causing severe, throbbing pain, often on one side of the head. They may be accompanied by nausea, vomiting, and sensitivity to light and sound. Some people experience auras, and visual or sensory disturbances before the headache begins.
2. Tension-type headaches are the most common type, characterized by a dull, aching pain that feels like a tight band around the forehead or back of the head. Tension headaches are often associated with stress, muscle strain, or anxiety.
3. Cluster headaches are extremely painful and occur in clusters or cyclical patterns. They are characterized by intense, piercing pain behind one eye and can be accompanied by teary eyes, nasal congestion, or swelling around the eye on the affected side.
4. Other primary headache disorders include rare conditions such as hemicrania continua and paroxysmal hemicrania. Both are included in the trigeminal autonomic cephalgia group which are nerve-related and most often present with one-sided pain. 

Secondary Headaches

Secondary headache disorders are caused by underlying medical conditions. These headache symptoms are activated by conditions that can activate the pain-sensitive nerves of the head.

They are classified according to whether they are caused by vascular (blood vessels), neoplastic (abnormal tissue or tumor growth), infectious, or intracranial pressure (increased fluid volume causing pressure on the skull). 

Secondary headache causes include:

• Sinus headaches – caused by a sinus infection or inflammation, leading to pain around the forehead, cheeks, and nose. The pain usually worsens with movement or pressure.
• Medication overuse or rebound headaches can develop from frequent use of headache medication. This type of headache often occurs daily, typically waking the person in the early morning.
• Caffeine headaches are caused by either caffeine withdrawal or excessive caffeine consumption. Symptoms can include throbbing pain, irritability, and nausea.
• Post-traumatic headaches can occur after head injury and can mimic migraines or tension-type headaches. Symptoms can last from a few months to a year after the injury.
• Giant Cell Arteritis (Temporal Arteritis) headaches are due to inflammation of the temporal arteries, causing sharp pain in the head, scalp tenderness, jaw pain, and vision problems
• Spinal headaches result from low cerebrospinal fluid pressure, often due to a leak following a spinal tap or spinal anesthesia. The pain typically worsens when standing and decreases when lying down.

Medical Pain Management and Lifestyle Adjustments

So, we’ve learned that back pain and headaches are the most common reasons people may live with persistent and recurring pain that requires pain management. If you are a person dealing with chronic pain, you’ll want to know how to begin receiving pain management care. 

Medical Pain Management

Managing pain medically involves medication to decrease inflammation and pain. Usually, treatment begins with a visit to your primary care provider or possibly the emergency department or urgent care. Seeing a specialist such as a neurologist, orthopedic, or rheumatologist may be the next step if symptoms continue.

Given the problems resulting from the opioid crisis and the overuse of highly addictive narcotic pain medicines, health professionals now look toward other means to treat and manage pain. NSAIDs are typically the first medicine you try because several are over-the-counter (OTC) and non-addictive, but they don’t work for everyone. 

Doctors can try medications that are indicated for problems other than back pain that seem to help certain patients. Muscle relaxers, anti-seizure medicines, corticosteroids, injections, and anti-depressants are helpful for some folks even though they’re meant to treat other problems.

Physical therapy (PT) is an integral but underutilized part of the pain management equation. PT assists with education about your condition, self-management, and exercises. They perform manual techniques to improve structural problems and use modalities to decrease pain such as electrical stimulation or traction. Holistic or alternative treatments such as massage or acupuncture may be helpful for some.

Lifestyle Adjustments That Help Manage Pain

Lifestyle changes can improve certain conditions causing pain such as postural reeducation using exercises and feedback, body mechanics education for proper bending and lifting, learning to manage stress better, changes to your diet to help decrease inflammation, and improving sleep hygiene. 

Many people may not realize they can help themselves manage pain with a few lifestyle adjustments in combination with medical interventions. There’s enough information available that supports making healthier lifestyle choices improves overall well-being.

Is it easy? Nope. However, if you are interested in having a high-level quality of life, it is worth the effort to eat and sleep well, regularly engage in physical activity, and learn how to manage stress.