Arthritis is a general term given to a broad group of conditions that cause inflammation of the joint structures such as the capsule, articular cartilage, meniscus, bone, tendon, and/or ligament. Arthritis is often accompanied by chronic pain and can lead to severe physical disabilities, augmented by the aging process. Depending upon the type of arthritis, symptoms can be manifested in many ways, ranging from mild to severely debilitating pain, swelling, and/or stiffness.

Many cancer patients experience pain due to their disease process or its treatment.  As much as half of all cancer patients experience pain severe enough to require treatment, more so with those in advanced stages. Having cancer does not mean that you must live with severe pain or with no recourse. More than 90% of all cancer patients can benefit from a variety of effective treatments to ease symptoms and allow resumption of more normal activities.

Chronic pain syndrome (CPS) is a term used to define patients with severe persistent pain from virtually any source which has resulted in marked changes in behavior, self-imposed restriction of daily activities, and heavy, largely ineffective use of the healthcare system.  CPS overwhelms all other medical symptoms to the point of becoming the problem itself.  It is often accompanied by bouts of irritability, uncontrolled anger, and depression.

Post-operative pain (as a result of surgery) is usually considered normal. However, when poorly controlled, the pain can cause increased heart and respiratory rate, anxiety, nausea and vomiting, urinary retention, and elevated adrenaline and cortisol levels, or reduced immune response and increased risk of infection.

Back pain is a wide-spread problem affecting four out of five American adults during their lives. It is one of the most common reasons for healthcare visits and missed work. Symptoms can range from a dull, constant ache to a sudden, sharp, crippling pain. It can be the result of trauma – a sudden accident, cough/sneeze, sports injury, fall, or lifting something too heavy or improperly – or it can develop slowly, almost imperceptibly as with age-related changes to the spine. Pain may accompany simple movement; jarring movement, such as coughing or sneezing; or with no provocation at all. You may also experience pain, numbness or tingling in your legs often referred to as sciatica. Whatever the cause, when there is recurring or lasting back pain over time it is often referred to as “chronic back pain.”

Mild disc degeneration is a normal part of the aging process and is generally not a problem in and of itself.  However, for certain individuals an even relatively mildly degenerated disc may cause pain of varying intensity. DDD is thought to be one of the most common causes of persistent low back pain.  Disc degeneration is not technically a disease, but rather a condition in which the discs dry out and shrink very slowly over  time.  Once discs begin the process of degeneration, potential related problems may arise in the spine due to the shrinkage, e.g. facet arthritis, muscle guarding pain.

Fibromyalgia is a medical disorder characterized by chronic widespread pain and a heightened, painful response to pressure. Fibromyalgia symptoms are not restricted to pain, leading to the use of the alternative term, “fibromyalgia syndrome,” for the condition. Other symptoms include debilitating fatigue, sleep disturbance, and joint stiffness. Some patients may also report difficulty with swallowing, bowel and bladder abnormalities, numbness and tingling, and cognitive dysfunction.

Fibromyalgia is frequently experienced simultaneously with psychiatric conditions, such as depression, and anxiety and stress-related disorders such as post-traumatic stress disorder. Not all people with fibromyalgia experience all associated symptoms. Fibromyalgia is estimated to affect 2–4% of the population, with a female-to-male incidence ratio of approximately 9:1. It is most commonly diagnosed in individuals between the ages of 20 and 50, although onset can occur in childhood.

Facet syndrome (FS) is a pattern of back pain (sometimes with buttock and leg pain) that is generated by a unique set of joints between each vertebrae, called the facet joints. Facet joints occur in pairs at each vertebral level. The facet joints work with the corresponding disc to link the vertebrae directly above and below to form a working unit that lends stability and weight-bearing capacity while permitting flexibility and movement of the spine. Pain from facet syndrome is often experienced in the vicinity of the inflamed joint, though occasionally the pain spreads away from the spine several inches or more, sometimes into the limbs.

Failed back syndrome (FBS) or post-laminectomy syndrome, refers to chronic back and/or leg pain that is experienced after spine surgery. FBS is, therefore, not so much a specific diagnosis as it is a description. The term implies that the patient still has significant pain despite apparently appropriate surgery. Common symptoms associated with FBS include dull, persistent and aching pain in the back, often at the incision site, and/or legs; sharp, pricking, and stabbing pain in the extremities may also be experienced, especially with movement.

Frozen joint syndrome, technically known as adhesive capsulitis, is a painful disorder that results from the chronic inflammation, scarring, thickening and shrinkage of the capsule that surrounds the involved joint, classically occurring in the shoulders or knees.

A disc that is herniated has ejected some of it’s jelly like interior through a crack or rupture in it’s outer core. The jelly can impact a nerve root or the spinal canal causing a combination of leg and back pain.

The spine is a complicated and versatile structure that supports our weight, allows for twisting and bending of the trunk, and houses the spinal cord. The spine is divided into segments, each containing a vertebral body, a cylinder of bone lying just in front of the spinal cord. The vertebral bodies are separated by the discs which act as cushions yet allow enough flexibility for twisting and bending. The discs can bulge, protrude (bulging even more), or herniate (rupture).

Meralgia paraesthetica is a condition that occurs when the lateral femoral cutaneous nerve providing sensation to the outer part of the thigh becomes compressed.  Patients often experience numbness, a tingling or burning sensation, a dull ache, or itching that can cause mild to severe discomfort on the side of the thigh.
It is generally seen in middle-aged individuals who are overweight and is more prevalent in men than women. However, it may also be seen in diabetics or women who are pregnant or are prone to wearing slacks with tight waist bands.

Migraines are severe, incapacitating headaches, usually beginning on one side of the head. They are often accompanied by extreme sensitivity to light, sound and smells, nausea and vomiting, sleep disruption, as well as anxiety and depression. In its full-blown state, simple activities such as combing hair or shaving can be painful.  Sometimes a migraine can be preceded by an “aura” (a visual disturbance that appears as flashing lights, zig-zag lines) or by a temporary loss of vision.
Approximately 10% of all Americans suffer from migraines, affecting women (mostly during the reproductive years) three times more often than men. The tendency to experience migraines often runs in families and may occur at any age, though they usually begin between the ages of 10 and 40 and diminish after age 50.
Migraine is often misdiagnosed as sinus headache and sometimes as tension headache.

Peripheral neuropathy is a technical term used to describe a disorder of the peripheral nervous system, i.e., the nerves that branch out from the spinal cord to all parts of the body.

Peripheral neuropathy usually affects the long sensory nerve endings, especially to the body’s extremities – arms, hands, legs and feet – occasionally to the face and trunk. When peripheral nerves become damaged by neuropathy, they can create pain themselves, usually characterized as burning or pins and needles. These symptoms are usually accompanied by a marked sensitivity to touch of the affected region – very similar to a very severe sun burn  – and usually progress over time from the fingers and toes to more central locations such as calves/forearms. Usually more than one nerve is affected at the same time.

Pain that follows a stroke is termed post-stroke pain. Stroke (a cerebrovascular accident, or CVA) is the leading cause of long-term disability in adults. Most strokes do not cause pain, only numbness. However, sometimes this numbness is accompanied by a deep burning, pins and needles sensation and often by muscle contraction.

Pudendal neuralgia is a painful condition that can affect both men and women. It presents as pain in the genitals, urethra, anus and perineum when sitting, which is usually alleviated by standing up or lying down. Those affected describe the quality of the pain as everything from stabbing or stinging to aching, burning and pins and needles. This condition can also cause bladder and rectal problems/dysfunction, as well as sexual dysfunction and chronic constipation.

“Sciatica” is the common or lay term for lumbar radiculopathy. Sciatica refers to compression, irritation, disease or dysfunction of the spinal nerve roots often causing pain, numbness, or weakness into the legs (the area innervated by the sciatic nerve).

Shingles (herpes zoster) is an often very painful reactivation of childhood chicken pox (varicella zoster), typically affecting adults older than age 45, and has affected over half of all adults above the age of 60.  When a child has chicken pox, the rash, fever, cough, and fatigue clears up over a number of weeks, and health is restored.  Remnant virus particles not destroyed by the immune system can lie dormant in the nerve roots close to the spine for decades.  If the virus is reactivated at a later date, it travels along nerve pathways often to the skin.

Although the shingles rash heals, the after effects of the outbreak can linger for months or years. Sometimes the nerves become severely or permanently damaged creating a painful chronic condition known as postherpetic neuralgia which can last 2-3 years, and sometimes much longer.  The pain is identical to that experienced during a shingles outbreak:

• sharp, burning, or deep aching
• extreme sensitivity to touch and temperature change
• itching and numbness

The chances of developing postherpetic neuralgia increases with age. PHN constitutes a significant case of chronic pain in the elderly.

Spasticity is a condition in which muscles involuntarily remain in a continuous state of contraction for long periods.  As muscles contract they becomes rigid and tight, resistant to the normal stretching that occurs during use.
The degree of spasticity can vary from mild muscle stiffness to severe, uncontrollable spasms that permanently shorten muscles. Spasticity may be very painful, particularly if it causes the joints to pull into abnormal positions and/or normal movement of the joints is prevented. Interference of normal movement can cause significant disability in a patient, hindering simple daily activities or even speech.
Spasticity may not be present at all times and may be triggered or aggravated by stimulus such as pain, temperature, humidity, or certain disease processes.
Although it most commonly affects the legs and arms, spasticity can affect any part of the body including the trunk, neck, eyelids, face, or vocal cords.

Trigeminal neuralgia is an often excruciatingly painful syndrome involving a portion of one side of the face.  The pain, which is usually paroxysmal (occurring in episodes) and profoundly disabling, may be triggered by speaking, chewing, or brushing teeth.  This syndrome most frequently targets older populations, but can be occur at any age.

Spinal stenosis is a narrowing of the open spaces within your spine, which can put pressure on your spinal cord and the nerves that travel through the spine. Spinal stenosis occurs most often in the neck and lower back.

While some people have no signs or symptoms, spinal stenosis can cause pain, numbness, muscle weakness, and problems with bladder or bowel function.

Spinal stenosis is most commonly caused by wear-and-tear changes in the spine related to aging. In severe cases of spinal stenosis, doctors may recommend surgery to create additional space for the spinal cord or nerves.