Causes of Pain

This information is organized into sections related to the area of the body where you are experiencing pain: general body pain along with foot, ankle and knee; and pain in the head, neck and spine. While not fully inclusive, this information will provide an overview of the conditions or causes of your pain that you and your PCA physician may discuss together. Once your procedure is scheduled with PCA, our team will provide you with complete information on the procedure as well as what to do in advance and how to care for yourself afterwards.

CRPS is a type of chronic, long-lasting, pain that often develops in an arm or a leg that you have previously injured. With CRPS, you may have unexplained severe pain that may spread and won’t go away.  While the exact cause of CRPS is unknown, we do know that it is an abnormal response due to an injury. Like an allergy, CRPS seems to be a type of overreaction which can develop after any kind of trauma, such as a sprain, a fracture, a burn, or a medical procedure.

If you have CRPS, you may feel burning pain, or a “pins and needles” sensation. The pain from CRPS may spread such as pain from a hurt hand spreading to your entire arm or even to the other arm.  Your skin may change colors, feel warm or cool or may be so sensitive that even a light touch hurts. Other symptoms could include abnormal sweating, a change in hair or nails, or problems moving your limb.

The underlying goal of treating CRPS involves reducing pain/sensitivity of the area in restoring mobility and range of motion. This may involve a combination of different treatment modalities including physical therapy, injections, medications, or spinal cord or peripheral nerve stimulation.  . Medications or a nerve block are treatment options based on your situation. You may benefit from a device such as a pump which can deliver medication directly into the fluid around your spinal cord as you need it.

Peripheral neuropathy typically involves pain and burning in the upper and/or lower extremities. This may be the result of damage to your peripheral nerves from conditions such as diabetes, alcoholism, toxins, vitamin deficiencies, chemotherapy treatment, infection, traumatic injury, or disorders of the kidneys, liver and thyroid. 

Symptoms may include: numbness, tingling, painful sensations in your extremities, problems with strength and coordination, cramps, muscle spasms, heat and touch sensitivity, digestive and urinary problems, or heart rate and blood pressure changes.

Treatments vary based on the cause of your neuropathy, but may involve physical therapy, medications, physical therapy, nerve stimulation therapy or other options.

Cervical Radiculopathy is an irritation or compression of one or more nerve roots in the upper part of the spine known as the cervical spine. Because these nerves travel to the shoulders, arms and hands, an injury with the bones and tissues of the cervical spine can cause painful symptoms in these areas. Causes include a herniated disc, degenerative disc disease, and spinal stenosis. 

This condition is a weakening of one or more vertebral discs, which serve as a cushion between the 33 vertebrae on the spinal column.

Degenerative disc disease can develop as a natural part of the aging process, but it may also result from injury to the back. Degenerative disc disease typically begins when small tears appear in the disc wall causing pain. When the tears heal, scar tissue is created that is not as strong as the original disc wall. If the back is repeatedly injured, the process of tearing and scarring may continue, weakening the disc wall. Over time, the nucleus (or center) of the disc becomes damaged and loses some of its water content which is needed to keep the disc acting as a shock absorber for the spine. The nucleus collapses when it no longer acts properly.

As the vertebrae above and below this damaged disc slide closer together the improper alignment causes the facet joints – the areas where the vertebral bones touch – to twist into an unnatural position. Over time, this awkward positioning of the vertebrae may create bone spurs. If these spurs grow into the spinal canal, they may pinch the spinal cord and nerves which becomes a condition called spinal stenosis”.

Some people experience pain at the site of the injury along with numbness or tingling in the legs. Strong pain tends to come and go and bending, twisting and sitting may make the pain worse. Lying down relieves pressure on the spine. Your PCA physician will work with you to create an individualized treatment plan.

This condition is a deterioration of the facet joints which help stabilize the spine and limit excessive motion. The facet joints are lined with cartilage and are surrounded by a lubricating capsule that enables the vertebrae to bend and twist.

Facet joint syndrome occurs when the facet joints become stressed and damaged. This damage can occur from everyday wear and tear, injury to the back or neck or due to degeneration of an intervertebral disc. The cartilage that covers the stressed facet joints gradually wears away and the joints become swollen and stiff. The vertebral bones rub directly against each other which can lead to the growth of bone spurs along the edges of the facet joints. Pain from facet joint syndrome differs depending on which region of the spine is damaged.

If the cervical, or upper spine is affected, pain may be felt in the neck, shoulders, and upper or middle back and you also may experience headaches. If the lumbar, or lower spine, is affected pain may be felt in the lower back, buttocks and back of the thigh. The first treatment for facet joint syndrome is rest, ice, heat, anti-inflammatory medications, and physical therapy. Facet joint blocks may be administered not only to diagnose facet joint pain but also to treat it. If non-surgical methods fail to relieve pain, a facet rhizotomy or bone fusion may be performed. Your PCA physician will work with you to create an individualized treatment plan.

Between the vertebrae of your spine are soft discs that let your spine twist, bend and also absorb shocks. But a herniated disc happens when the vertebrae are damaged, allowing the disc’s soft center to push through the disc wall. This bulge presses against nerves in your spine causing pain. A herniated disc can be caused by the normal wear and tear of aging as your spinal discs become less flexible and more prone to cracks and tears as you age. Herniated discs also are caused by traumatic injury or heavy lifting.

Symptoms depend on the severity of the herniation, and at what level of your spine it has happened. Note that most herniated discs happen in the lumbar spine, or what is considered the lower back. Along with pain, you may experience numbness, weakness and tingling in the buttocks, leg or foot. A herniation in your cervical spine, or upper back, can cause problems in your neck, shoulders, arms and hands.

Your individualized treatment plan depends on your injury but you may benefit from rest, medications, injections and physical therapy. If these don’t help, you may need surgery. Your PCA physician will work with you to create an individualized treatment plan.

Sciatica is an irritation or compression of one or more nerve roots in the lumbar spine, or lower back. Because these nerves travel to the hips, buttocks, legs and feet, an injury in the lumbar spine can cause symptoms in these areas. Sciatica may result from a variety of problems with the bones and tissues of the lumbar spinal column.

One common cause is a herniated disc. A herniated disc is a rupture in the fibrous outer wall of a vertebral disc, which allows the soft nucleus of the disc to bulge outward. This bulge can press harmfully against a nerve root. Another common cause of nerve root injury is degenerative disc disease which occurs when a spinal disc weakens, allowing vertebral bones above and below the disc to shift out of position. When this happens, the bones can touch which pinches nearby nerve roots. Another cause is spinal stenosis which happens when bones, discs or joints of the spine degenerate and bone spurs form and push into the spinal canal creating harmful pressure against the nerve roots. Your PCA physician will work with you to create an individualized treatment plan.

This condition, also called “failed back surgery syndrome,” is a type of chronic pain which can develop in some people after spine surgery or a procedure called a laminectomy procedure. During a laminectomy, a bone at the rear of your vertebrae is removed in order to relieve pressure on your spinal nerves. But after the laminectomy, bone or soft tissue may still press on these nerves which can cause scar tissue to form.

Spinal joints may be irritated and inflamed. Pain from any of these issues may be called “post-laminectomy syndrome.” You may experience pain in your back at the site of your surgery and the pain may also radiate down to your buttock and leg. This pain may feel sharp, or it may feel dull and achy. Treatment depends on the cause and the severity of your pain and may include medications, injections or physical therapy. You may benefit from electrical nerve stimulation or other techniques. If these are not helpful, surgery may relieve your pain. Your PCA physician will work with you to create an individualized treatment plan.

Spinal stenosis is a condition that happens in the neck and lower back. Very simply, your spinal nerves travel through your spinal canal and exit through openings on the sides of your vertebrae which often are called “foramen”. If any of these spaces are too narrow, your nerves become compressed and the problem is diagnosed as spinal stenosis. The narrowness just mentioned can happen to some people born with a small spinal canal. But for many others, something happens to cause the narrowing. It might be due to bone spurs of osteoarthritis or caused by a herniated disc, another injury or even a tumor. 

Your symptoms depend on what nerves are affected and may start gradually but get worse over time. You may have neck or back pain. You may have trouble with balance, or numbness, weakness and tingling in your hand, arm, leg or foot. Some people develop bowel or bladder problems. If your stenosis is mild, medications, injections and physical therapy may give you relief. If those don’t help, you may need surgery. Your PCA physician will work with you to create an individualized treatment plan.

Spondylolisthesis occurs when a lumbar vertebra slips out of place and slides forward, distorting the shape of your spine. This occurrence may compress the nerves in the spinal canal along with compressing the nerves that exit the foramen (open spaces on the sides of your vertebrae). Pain and other problems can result from these compressed nerves. Arthritis and the loss of disc elasticity that come with aging are the most common causes of spondylolisthesis. Other causes include an overuse injury called “spondylolysis”, which is a stress fracture of the vertebral bone.

Spondylolisthesis also can result from a sudden injury that leads to a broken vertebra, as well as diseases or tumors that weaken the spine. Additionally, some people are born with a birth defect of the spine which can cause spondylolisthesis.  Symptoms vary from person to person with some people experiencing no symptoms at all.

You may feel pain in your lower back or have hamstring spasms. Pain may spread down your leg to your foot with foot numbness and tingling. Treatment options depend on the severity of your condition. You may benefit from rest, medications, a back brace and physical therapy.  If those methods are not successful, you may benefit from a surgical procedure to reduce nerve compression or to stabilize your spine. Your PCA physician will work with you to create an individualized treatment plan.