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Pain is broadly divided into two types - nociceptive pain and neuropathic pain.
Nociceptive pain
This is the type of pain that all people have had at some point. It is caused by actual, or potential damage to tissues. For example, a cut, a burn, an injury, pressure or force from outside the body, or pressure from inside the body (for example, from a tumour) can all cause nociceptive pain. The reason we feel pain in these situations is because tiny nerve endings become activated or damaged by the injury, and this sends pain messages to the brain via nerves.
Nociceptive pain tends to be sharp or aching. It also tends to be eased well by 'traditional' painkillers such as paracetamol, anti-inflammatory painkillers, codeine and morphine.
Neuropathic pain
This type of pain is caused by a problem with one or more nerves themselves. There is often no 'injury' or tissue damage that triggers the pain. However, the function of the nerve is affected in a way that it sends pain messages to the brain. Neuropathic pain is often described as burning, stabbing, shooting, aching, or like an 'electric-shock'.
Neuropathic pain is less likely than nociceptive pain to be helped by traditional painkillers. However, other types of medicines often work well to ease the pain (see below).
The rest of this leaflet is just about neuropathic pain.
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What causes neuropathic pain?
Various conditions can affect nerves and may cause neuropathic pain as one of the features of the condition. These include the following:
Trigeminal neuralgia
Post herpetic neuralgia (pain following shingles)
Diabetic neuropathy - a nerve disorder that develops in some people with diabetes
It is estimated that about 1 in 100 people in the UK have persistent (chronic) neuropathic pain. It is much more common in older people who are more prone to developing the conditions listed above.
What is the treatment for neuropathic pain?
Treatments include:
Treating the underlying cause - if possible
Medicines
Physical treatments
Psychological treatment
Treating the underlying cause
If this is possible, it may help to ease the pain. For example, if you have diabetic neuropathy then good control of the diabetes may help to ease the condition. If you have cancer, if this can be treated then this may ease the pain.
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But what if my lumbago is chronic?
Chronic lumbago is defined as backache which has persisted for more than three months, and obviously this type of pain will have an effect on your life. It is difficult to ascertain what type of treatment is most suitable for chronic back pain, but a range of treatments will probably be applied in the hope that one will succeed in relieving the pain. Unfortunately, some patients fail to find long-lasting relief from chronic back pain for a number of reasons.
Treatments which may be helpful include physiotherapy, a graded exercise programme and swimming. Some people with chronic low back pain find massage helpful.
What are the future prospects?
The prospects for sufferers of lumbago are good provided early treatment is sought and the patient remains as active as possible.
The vast majority of people are born with a healthy spinal column, which continues to perform heroically throughout the average lifespan, despite the fact that it is very often abused. It is a well-known fact that weak back and stomach muscles can contribute significantly to the risk of developing back pain.
Therefore, it is essential that a programme of moderate exercise to strengthen these muscles is embarked upon.
Prevention is the key when dealing with the back, as very often it is too late to try to protect the back after the damage has been done.
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