Treating Chronic Pain
Spinal Interventions and Regenerative Care
Pain is as unique and complex as we are. At Advanced Pain Care, we offer a broad spectrum of options to effectively treat and manage your chronic pain. Dr. Greenberg’s knowledge and experience in pain care, from traditional techniques to modern regenerative treatments, allows us to identify and treat the source of your specific pain, focusing on healing rather than temporary fixes. View our Spinal Interventions and Regenerative Care pages to learn about treatments available at Advanced Pain Care.
What is Pain?
The IASP (International Association for the Study of Pain) defines pain as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage”. This definition emphasizes the complex, multidimensional nature of the pain experience. Pain is different for different people, and is influenced by both internal and external factors, such as biology and environment. Your pain is unique and internal, and must be respected as such.
How Does Pain Happen?
The scientific descriptions of pain include four processes:
Transduction is the conversion of energy from a potentially damaging thermal, mechanical, or chemical stimulus into electrical energy. When nerves located in our skin or internal organs are exposed to high temperatures, dangerous chemicals, or high pressure, they respond by converting this energy into electrical signals that travel to the brain.
Transmission is the movement of the electrical signals along the nervous system. The signals move from the Peripheral Nervous System (closer to the outside of the body) to the Central Nervous System (inside the body—the spinal cord and brain).
Modulation happens as the signals travel to the brain and are changed—either amplified or suppressed along the way. This process can explain why the same level of stimulation can lead to a different perception in different people, or even the same person at different times. Many pain medications work by affecting pain modulation.
Perception occurs when the electrical signals arrive in the thinking center of the brain. This is where that electrical signal is “interpreted” by our brain as the sensation of pain. This then leads to our reaction to the pain, which can include withdrawing physical movements, protective avoidance of movement, negative emotions, and an impression on our memory—all of which alter future behavior.
Pain Due to Injury
Pain begins with stimulation of nociceptors, which are specialized nerve endings located in the skin that are sensitive to tissue trauma or stimulus that could cause tissue damage. Pain due to this stimulation is called Nociceptive Pain. This is the type of pain that we are all familiar with. We experience this type of pain from any internal or external injury—be it a fall, a cut, or surgery. This is the typical cause of acute pain.
Acute pain is when the stimulus is of recent origin. Usually the source of the pain is easy to identify—we know “where it hurts”. Moreover, this pain has important biological function—it is protective. Put your hand on the hot stove, your brain “tells” your arm to move, and prevent further damage. Without this type of pain we would not be able to protect ourselves from injury. In fact, there is a rare genetic condition in which the victims cannot feel this type of pain, and everyone afflicted with this condition will die from injury before reaching adulthood.
In addition to nociceptive pain, there is another type of pain called neuropathic pain. Neuropathic pain occurs when there is injury or dysfunction in a part of the nervous system itself. This can occur either in the central or peripheral nervous system.
Chronic is very different than acute pain. Chronic pain occurs when there is ongoing damage or dysfunction in the nervous system. Chronic pain persists—it will last for a long time, even after the initiating injury has healed. It does not serve a biologically useful purpose; it is not protective. While acute pain is a symptom of an injury or a disease, chronic pain is a disease in and of itself. The medical field is learning that chronic pain is very different than acute pain, and that the treatments for these conditions are very different. We are also learning that acute and chronic pain affect people in very different ways. We understand that eventually all acute pain resolves; however chronic pain is indefinite and can be unremitting.
Chronic pain has profound effects on our function, our physical and psychological well-being, and even our social and family relationships. Dr. Greenberg has a deep understanding of this, and approaches acute and chronic pain as different entities with different causes and treatments.