Chronic Pain Causes & Treatment

Overview

Chronic pain is defined as any pain lasting more than 3 months and can range in intensity from mild to severe. This debilitating condition affects approximately one in every five Canadians, or a total of six million people suffering from it on a daily basis, reaching epidemic proportions. Since chronic pain is psychologically difficult to endure, it can often trigger anxiety and depression. Moreover, chronic pain is often associated with other health problems, including fatigue, sleep disturbance, decreased appetite, and mood changes.

What are the causes of chronic pain?

Chronic pain has many causes, which include degenerative diseases such as arthritis, car accidents, cancer, and disorders which produce neuropathic pain, which is a type of pain caused by malfunctioning of the nervous system. Typically, pain resolve after the physical injury heals. In contrast, chronic pain can last for months and even years after healing of the injury. In fact, chronic pain even occurs when there’s no known trigger for the pain. Essentially, chronic pain can change the way neurons (nerve cells in the brain and spinal cord) send, receive and process sensory information, so that they become hypersensitive to pain messages.

What is a nerve block?

A nerve block is an injection used to decrease inflammation or “interrupt” a pain signal along a specific nerve or bundle of nerves. Essentially, this is a method of producing anesthesia, and produces a loss of feeling to prevent or control pain sensation. Nerve blocks are an effective way of treating chronic pain, and can be performed on various nerves in many parts of the body, depending on the cause of the pain. Moreover, a nerve block can be used as a form of pain relief on its own, or combined with another type of pain treatment.

What are the different types of nerve blocks for chronic pain treatment?

There are different types of nerve block treatments, which depend on the cause of pain and the body region affected. Here are the most commonly used types of nerve blocks for treating chronic pain:

1. Facet Joint Injection

The facet joints connect vertebrae to each other along the back of the spine. The facet joint injection is typically used to treat pain from arthritis. This type of nerve block is performed to provide relief of chronic pain in the neck and back and is always performed under x-ray guidance. The facet joints assist with movement of the spine both in the neck and back. This type of injection is often used as a diagnostic tool to determine the source of pain.

2. Epidural Steroid Injection

This type of nerve block is typically done in the back or neck in to inject some anti-inflammatory steroid medication with or without a local anesthetic into the epidural space (the outermost space of the spine) close to the inflamed area which is causing the pain. These injections are generally done for pain involving the back and leg or the neck, as well as arm and/or hand.

3. Lumbar Sympathetic Block

A lumbar sympathetic block involves the injection of local anesthetic into or around the sympathetic nerves, which are located on either side of the spine or in the lower back. The lumbar sympathetic nerves are a small bundle of nerves which carries nerve signals from the legs. This is a type of nerve block often used to treat chronic pain in the leg caused by complex regional pain syndrome and is typically done under x-ray guidance.

4. Stellate Ganglion Block

This type of nerve block involves the injection of a local anesthetic into the front of the neck and is usually done to treat chronic pain caused by complex regional pain syndrome in the face, head, arms, hands and chest. In addition, this type of treatment can sometimes be used to improve blood flow to the arm or hand in some medical conditions which cause poor circulation.

5. Celiac Plexus Block

A celiac plexus block is usually done to relieve pain in patients with chronic abdominal pain or pancreatic cancer. The celiac plexus is a bundle of nerves that surround the aorta, which is the main artery supplying the abdomen. Injecting a local anesthetic into these nerves helps to block pain signals responsible for abdominal pain. This type of injection is usually done with x-ray guidance.

What can I expect after having a nerve block procedure?

After having a nerve block procedure, you may notice some temporary numbness, soreness or irritation in the area. These effects are not permanent and will fade with time. Sometimes, nerve blocks can also cause some temporary swelling in the injected area, which can compress the nerve and requires time to subside. It is important to contact your doctor if you find that the side effects of your nerve block last longer than expected.

What are the risks of nerve blocks?

The only way to decide if the nerve block is for you is to talk to your physician and pain management specialist. There are some risks associated with nerve blocks, especially if the procedure is done incorrectly, and these include muscle paralysis, weakness, or feelings of numbness. In some rare cases, a nerve block may actually cause more nerve irritation and result in an increased feeling of pain. However, when performed by a skilled and licensed health practitioner, nerve blocks can successfully reduce chronic nerve pain.

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