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Are there different kinds of pain?, what is sciaticawhat are the most common medications used for back pain, neck pain and headaches?,which are the most common forms of chronic pain seen in a doctor's practice?

Are there different kinds of pain?

Yes. Pain is classified as neuropathic (derived from diseased or compressed nerves or nervous tissue structures) or inflammatory (caused by inflammation of tissues). Examples of neuropathic pain include peripheral neuropathies or nerve compressions caused by scars or tumors. Inflammatory pain can be very diverse in its specific cause such as inflammation associated with specific disorders, trauma, surgery, burns or arthritis. Inflammatory conditions can also cause tissue damage and nerve compressions and the pain may be mixed in nature (both, inflammatory and neuropathic). It is important that the physician identifies correctly the neuropathic or inflammatory mechanisms underlying a patient’s pain because the medications and strategies used to treat each of these are different.

What is sciatica?

It is a common form of neuropathic pain caused by compression of nerve roots in the lumbosacral area of the spinal cord. Sciatica is a form of leg pain that can be sometimes associated with back pain. The name derives from the sciatic nerve, the largest nerve in the body made up of fibers coming from the lumbar and sacral region. Not all the nerve root fibers from the lumbar or sacral regions go into the sciatic nerve. Compression of the sciatic nerve itself is less common and gives origin to a form of leg pain similar to that cause by compression of the nerve root fibers. Neurologists can easily identify the correct site of compression by performing a nerve conduction study or an EMG (electromyography) examination. This technique complements the standard neurological examination in the road to an accurate diagnosis of the mechanism and causes of back pain, neck pain, leg pain, arm pain or sciatica.

What are the most common medications used for back pain, neck pain and headaches?

Effective pain relief may involve a combination of prescription drugs. Patients should always check with a doctor before taking drugs for pain relief. Certain medicines, even those sold over the counter, may be unsafe during pregnancy, may conflict with other medications, may cause side effects including drowsiness, or may lead to liver damage. Your doctor may select medications depending on the cause of your pain and the presence of other associated medical conditions like hypertension, diabetes, sleep apnea or depression. These are usually prescribed in combination with several therapeutic modalities tailored to fit the problem causing the pain and to whether the type of pain is neuropathic or inflammatory.The most frequently used drugs include:

Nonsteroidal anti-inflammatory drugs Used primarily for inflammatory (not nerve generated) pain such as pain caused in acute traumatic injuries, arthritis, common forms of back and neck pain. These agents are taken orally to reduce stiffness, swelling, and inflammation and to ease mild to moderate low back pain or neck pain. Some medications can be applied topically to the skin as a cream or spray to stimulate nerve endings in the skin to provide feelings of warmth or cold and dull the sense of pain. Topical analgesics can also reduce inflammation and stimulate blood flow. NSAIDs are associated with potentially dangerous side effects including gastrointestinal bleeding, renal or liver damage and their long term use should be monitored by your doctor.

Anticonvulsants — certain drugs primarily used to treat seizures — may be employed in treating certain types of nerve generated pain and may also be prescribed with analgesics. They are also useful to stabilize mood.

Some antidepressants, particularly tricyclic antidepressants such as amitriptyline and desipramine or a newer one called duloxetine have been shown to relieve pain (independent of their effect on depression) and assist with sleep. Antidepressants alter levels of brain chemicals to elevate mood and dull pain signals.

Steroids and pain medications— These are powerful anti-inflammatory agents with also substantial potential side effects if used for prolonged periods of time. They are very useful to treat certain types of pain. Side effects can be minimized when injected directly into the source of pain and inflammation, such at the intervertebral joints, called facets or in sacroiliac joints.

Opioids such as codeine, oxycodone, hydrocodone, and morphine are occasionally prescribed to manage severe acute and chronic back pain but should be used only for a short period of time and under a physician’s supervision. Side effects can include drowsiness, decreased reaction time, impaired judgment and potential for addition. Most respected authorities in pain management are convinced that chronic use of these drugs is detrimental to the back pain patient, adding to depression and even increasing pain.

Which are the most common forms of chronic pain seen in a doctor's practice?

The most common forms of chronic pain are headaches and low back pain. Most cases of low back pain are caused by conditions that are not serious enough to last more than a few days or weeks and usually respond to non-surgical treatments such as simple non-opioid analgesics and anti-inflammatory medications. However, some of these patients develop chronic back pain which may become disabling. Once this happened, it is critical to reach a correct diagnosis of the cause and mechanisms of the pain for its successful management.

Neurologists and certain other medical specialists like Anesthesiologists or Physical Medicine and Rehabilitation doctors and Psychiatrists receive additional formal training in Pain Medicine, a specialty that focus in the diagnosis and treatment of the causes of chronic pain. These doctors can assist patients to reach a decision in determining which form of treatment may be more effective. Neurologists, for example, are Medical Doctors with extensive training in the diagnosis and non-surgical treatment of diseases the brain, nerves and muscles including the muscles and nerves of the back and the causes and treatment of pain.

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