We're going to conclude our three part discussion and "characterization" of the various types of pain, by next looking into "bone pain." Finally, I will describe with clinic examples how all of these pains can actually combine together to form a "gang-like" presentation, producing complex pain syndromes. Some of these diagnoses may be ones that you or a friend may have heard about, and some may be ones that you have dealt with personally in a prior experience.
Let's move onward, shall we...
Outside of various disease processes like cancer and sudden fractures from trauma, bones usually don’t cause too much pain in and of themselves. They’re very tough… thankfully, since they do support your entire body. However, bones actually have a skin, called a periosteum, covering them. This can really hurt if some connective tissue pulls on it or if something hard presses against it. In fact, our discussion earlier about tendon pain from tennis elbow can also overlap with a similar aching pain from the “bone skin.” If the periosteum begins to become inflamed in the area where the tendon attaches to the bone, it is going to feel like a very stubborn tendinitis that can actually last long after the 6 to 8 weeks of tendon healing.
Imagine bones as tall but delicate body guards covered in thick armor. They can take quite a beating, but once you break through their protective exterior, it is game over. Bone pain will shut you down and totally arrest your normal function, and it usually occurs the day after the provoking injury. That is because bones are filled with blood, and the slow leakage delays the onset of swelling until later.
At the deepest level of your body, bones provide the framework for every other soft tissue and muscle to anchor off of. In other words, bone healing takes priority — even if everything else suffers just so that it can slowly recover. That’s why doctors are okay with muscle wasting while you’re in a cast or splint. Because, if the bone doesn’t heal properly, then the whole biomechanics of your body’s function will be off.
The problem with bone healing is that it takes quite a long time to heal — usually around 3 months under normal conditions — and yet you can still feel soreness in that injured spot on damp days years later. Bones are very sensitive to atmospheric pressure changes.
A good example of common bone pain would be a condition in your feet called metatarsalgia. This happens when too much ground pressure from walking or running irritates the little bones in the arch of your foot. I often treat this condition in patients by constructing orthotics, so that their arch will receive more support and their metatarsal bones can slowly heal. It’s a very stubborn condition to treat. Many patients won’t feel the worst pain until after they’re done running, so it’s hard for them to know when to stop.
Strong, but delicate, and very slow to heal — that is bone pain.
The “Gang” Combination
So we’ve discussed many different types of pains, thus far, and personified many different “villains” here, but the honest truth is that in reality it is usually never just as simple as one isolated type of problem. Most of the time these pains will overlap with each other in more or less of a gang-type mentality, like a bunch of deviant characters from some sort of twisted cartoon show.
I know that’s a bit of a stretch on the imagination here, but it really does make actual medical diagnoses much easier to understand if you visualize them in a simplified, stylized way.
For example, let’s say you have an arthritic knee and are dealing with a host of all different types of symptoms. You have the deep bone pain from loss of cartilage. Then you have the sinew pain from joint capsule inflammation, and possibly even a deranged and damaged meniscus. Because the nerves are constantly feeling pain, the muscles in your thighs and calves will become tense and begin to ache.
It’s a whole cast of villains cloaked in the “smog” of inflammation, where everything seems to blend into everything else.
Let’s take another common example, the herniated disc in your neck. It starts as a derangement, where the disc is pushed out of alignment and breaks through the ligaments of the spine into the nerve roots. Immediately you’ll have severe stiffness and a crooked neck due to the derangement. The pressure from the disc and other damaged connective tissue will swell with inflammation and cause compression on the nerve, which then, in turn, produces strong electrical or numbing pain. Because this nerve’s “wiring” extends all the way down your arm to your fingertips, if the damage is severe enough you can even have loss of grip strength or function of your hand. Once again, the electrical malfunctioning of the nerve will cause tightness and spasming of every muscle it touches, especially in the upper trap regions.
I’ll give you one more typical diagnosis, rotator cuff tendinitis, but will try to present it to you from a different, atypical perspective.
Let’s picture a scenario where you injured your shoulder lifting something heavy or awkward — like a big organizing bin — and now you feel this sharp stabbing pain on the side of your arm. More than likely you’ve damaged or inflamed the tendon of the rotator cuff muscle. This injury is immediately detected by the local nerves of your shoulder that sense pain. As a protective mechanism, the nerves signals to your brain to tighten your muscles and restrict your movement. If the nerve sensitivity is strong enough, it will travel all the way to its source — your spine — and cause neck pain.
You see how a vicious cycle can develop here? Shoulder pain can cause neck pain, which can worsen your shoulder pain even more… and on… and on…
Witnessing this troubling, never-ending-cycle of pain being reborn over and over reminds me of a pathogen in the world of Chinese Medicine, called “Phlegm.” This is not exactly the same mucus-like goop that you cough up into a tissue after getting over a head cold. Phlegm, according to the ancient doctors, was an ominous pathogen known as the “father of 100 illnesses.” It was also said that even the mildest of conditions — if left untreated and given enough time — would begin to behave in strange and unpredictable ways, making traditional cures impossible to provide.
Phlegm sounds a lot like what we think of today, in terms of modern medical terminology, as “chronic pain.” It is very difficult to treat, and very easy to self-perpetuate.
So how do you stop a painful cycle like “Phlegm” or chronic pain?
You can “start to stop” this cycle by seeking out a qualified healthcare professional and seriously beginning to examine your lifestyle to avoid harmful, pain-producing behaviors. From my experience in the clinic, you really need the support and skilled outside perspective of a good doctor, physical therapist, acupuncturist, or even registered dietitian, depending upon the root problem of your underlying condition.
If you would like to schedule a visit to talk with us at Alté View regarding your specific type of pain, then please reach out to us here.