Pain has always been around since the beginning of time. It is a complex and intricate process that has affected billions of individuals worldwide. Pain is subjective and is caused by different factors. Most commonly it manifests as a result of a disease or a physical injury, but at times, it can be unseen and the root of the problem can be found in our nerves, muscles, and even in our brain. 

In 2016, the Global Burden of Disease Study confirmed that pain is the leading cause of disability and disease worldwide. (1) Billions of individuals have been suffering from pain which has become a silent and morbid problem. 

The problem that people face with pain is that it can linger and increase over time. Medication may not be enough to alleviate pain especially when it is a multifaceted process. Pain is not only physical but can be both mental and emotional as well. It is also important to note that pain has a lot of different factors: 

  • Duration 
  • Intensity
  • Effects 

Pain varies in every individual, but what is important is that there will always be something that can take the pain away. You just need to find what is the right solution for you. 

In this article, I will address the different types of pain and follow up with pain management treatments that address the root cause.  

Types of Pain

You have heard it a thousand times— people always differentiate pain into acute or chronic pain. But what is it really and how do both differ? 

Acute vs Chronic 

Acute pain is usually caused by a specific injury like falling from a ladder, getting a scrape on the knee, or bumping your toe on the edge of the bed. It is usually pain associated with the bones or the muscles and can last from hours to days. 

Chronic pain is more of a state of illness. It lasts for a long time with either a definite cause or an unknown one. Chronic pain is more difficult to treat and different approaches are used to help alleviate it. (2) 

Nociceptive pain

Nociceptive pain may sound foreign but it is very common, in fact, it is the most common type of pain. Nociceptors are pain receptors in our tissues that are activated when there is injury. The whole body has nociceptors and these are more commonly seen in the skin and the internal organs like the stomach, kidneys, and even the heart. 

When areas are injured, like for instance, a scrape on the skin, these nociceptors send signals to the brain to make you “feel” the pain. You can think of nociceptors as really fast mailmen who deliver signals to the brain that tell it that the action has caused pain. This is actually protective for you. It’s like a warning sign that tells you to stop touching a hot kettle so that no further damage can happen on your hand. 

Nociceptive pain can be further classified into visceral and somatic pain. 

Visceral pain is pain felt in your organs, such as your abdomen or chest like in the case of a heart attack, while somatic pain is pain felt in your tissues. 

Somatic pain can either be deep or superficial like when a sore in the mouth causes superficial pain while a tear on your knee can cause deep pain. 

Neuropathic Pain

Neuropathic Pain

Neuropathic pain, as its name suggests, is the pain you feel when there is damage in your nervous system. There is a dysfunction in the firing of pain signals of the nerves that causes pain that is hard to specify. 

Neuropathic pain is pain that is caused by something that should be painless, like a cool breeze or even just a simple touch on the skin. It is usually described as a freezing, numbing, shooting, or electrical- shock kind of pain that may happen in any part of the body without warning. 

Common causes of neuropathic pain may be the following:

  • Diabetes
  • Alcoholism
  • Nerve Problems such as Bell’s Palsy 
  • Nerve compressions in the spinal cord
  • Carpal tunnel syndrome 
  • Shingles
  • Radiation procedure
  • Multiple sclerosis
  • Chemotherapy drugs

Pain Management

The most common pain management treatment is medication but since pain is a complicated and varied process, a multidisciplinary approach should be done in managing your pain. What is regenerative medicine?

Below are some of the regenerative ways that can help you cope with pain: 

Perineural Therapy

Perineural Therapy

Perineural Therapy is done usually as a regenerative medicine treatment for neuropathic pain. What it does is target the damaged nerves in the body with a solution that will help attach the nerves together to reduce the pain signals sent to the brain. 

This therapy will also decrease the inflammation of the nerve. Perineural therapy is even used in anesthesia to prolong the effects of peripheral nerve blocks. (3) 

Perineural therapy is a regenerative medicine alternative to pain relief and can be used for a variety of condition including:

  • Bursitis
  • Fibromyalgia
  • Migraines
  • Sciatica
  • Sports injury
  • Arthritis
  • Bell’s palsy
  • Diabetic neuropathy 
  • Muscle and ligament injury

The procedure is quite simple. Most patients can tolerate the procedure well. You will usually be injected with a very thin needle on the area where you feel the pain. Depending on your pain scale, you may be injected several times to hit these target areas. 

These needles are very small and thin and it will cause very minimal to no pain at all. Most patients after injection feel instant or significant relief and there will be a numbing sensation afterward which is normal. A follow up of these injections are then done weeks after, depending on your pain level. 

Trigger Point Therapy

Trigger Point Therapy is done for the relief of both acute and chronic pain in the muscles. This kind of pain may be caused by spasms, injury, tension, or even muscle strains. Areas that are pressed on these muscle triggers will often give you sensations of pain, thus they are called trigger points. 

Trigger point therapy is similar to getting a massage in areas where pressure or trigger points are noted, to provide relief from pain. It has a similar principle to acupuncture and acupressure.   

Muscles on different parts of the body can be treated using trigger point therapy. It is used to alleviate the pain that may have been present for hours or even pain that has been present for several years. 

Myofascial pain syndrome (MPS) is a common reason for a referral to a pain specialist and has been known to respond well to trigger point therapy. It is more common in women than in men (4) and is one of the most common reasons for referral to a pain specialist. 

Trigger point therapy has been present since the early 1960s and over time, the procedure has improved and has evolved into several methods of injection. Oftentimes, lidocaine, a local anesthetic is used to inject to the trigger point areas. 

Other healthcare practitioners may also use other drugs to help alleviate your pain. The total treatment may last from weeks to months, depending on your need and your pain recurrence. 

Platelet Rich Plasma Therapy

Platelet Rich Plasma Therapy

Platelet-rich plasma (PRP) is made up of human plasma with a high level of platelet concentration. It is prepared by centrifuging your blood. It has abundant growth factors and mediators (5) that are concentrated through the centrifugation process. These growth factors help in the healing process of your body. 

Platelet Rich Plasma Therapy (PRP) has been medically proven to be an effective regenerative medicine treatment used in the reduction of pain and faster healing process of people who have had injuries like in the elbow or specifically, those with lateral epicondylitis who did not respond to physical therapy (5). 

Platelet Rich Plasma Therapy has helped a lot of patients coming in for osteoarthritis and sports injuries like Achilles tendinopathy, rotator cuff tendinopathy, and even plantar fasciitis. In a study done in 2015, it was noted that PRP has a role when conservative treatment has failed and the next treatment option is an invasive surgical procedure. (6)

What would you expect in a PRP procedure? Basically, your blood is extracted and it will undergo centrifuging. Centrifuging is the process by which your blood is separated to extract the plasma, where the platelets are also found. 

This plasma is then injected into the areas of your body where there is pain or inflammation. PRP is not only done to alleviate pain, but it is also used cosmetically to rejuvenate the skin (7) and to improve common dermatologic problems. 

Prolotherapy 

Prolotherapy, also known as proliferation therapy or regenerative injection therapy, is the kind of therapy that helps your body by stimulating it to regenerate soft tissues. It is used to alleviate pain because the soft tissues involved are your tendons and ligaments. These are the areas commonly associated with pain in the body. 

Dextrose (water containing sugar) or saline may be used to inject the areas where you are having problems.  

Analysis of several randomized controlled trials has suggested that prolotherapy can improve pain in patients with osteoarthritis and overuse tendinopathy (8). It is a quick procedure that can offer you a substantial amount of relief from pain.

Prolotherapy can help improve the strength, function, and even the mobility of joints; it can reduce pain and stiffness and can help ligaments to move better. Prolotherapy is for you if your main problem involves the joints and the ligaments compared to the muscles. 

Patients who come in with both problems with the muscles and joints can benefit from having two types of therapy done.

Exosome Therapy

Exosome Therapy

What is an exosome? The word may seem foreign but it may be the future of pain management. Exosomes are vesicles secreted by the different cells in the body. They exist in almost all of the body fluids that we have. 

They are rich in nucleic acid and protein, and are important as biomarkers for diseases (9) and can help alleviate pain.  

Exosome therapy can be used for a wide range of problems, such as:

  • Nerve injury
  • Ligament or tendon damage 
  • Muscular pain (back pain, neck pain, hip pain, knee pain, and shoulder pain) 
  • Knee injuries
  • Bone pain caused by cartilage degeneration 

It can be used for both acute and chronic pain. The improvement to the pain that you feel after an exosome therapy is explained because exosomes involve their action on the neuron and glial cells (10). The neuron and the glial cell are important cells involved in pain and pain perception. When excreted, exosomes do not only decrease pain but help in the healing of damaged or injured cells in the body that causes the pain. 

Exosomes are also inhibited in the level of the Tumor Necrosis Factor Alpha (TNF- α) and Interleukin 1 Beta (IL-1β), both mediators of the inflammatory process. This simply means that Exosome therapy does not only improve pain but finds the root cause and treats it. 

Prolozone Therapy

Prolozone therapy is used to help improve the healing process of tissues in the body by oxygenation. It is commonly used on trigger points and joints where the pain is commonly felt. It is used both as a treatment for pain and the core problem itself.

Injections using prolozone are done by combining ingredients that can:

  • Suppress pain
  • Improve blood flow
  • Increase the healing process of the tissues involved

Prolozone therapy may be used together with other pain therapies that can improve your pain and healing. 

Neural Therapy

Neural therapy is pain therapy aimed at treating chronic or deeper pains. This may include back pain that has been persistent for years or shoulder pain that has been present despite medications and other forms of pain therapies. 

Neural therapy is like acupuncture and perineural therapy. It can also be combined with different regenerative treatments depending on your type of pain.

Conclusion

As you can see, there are many different treatments and regenerative medicines available to help you optimize your pain management. It is my hope that this article brought some new natural treatments to your attention so you can strive to improve and preserve fitness and quality of life!

To recap, we discussed the following pain and regenerative medicine therapies. 

Table of Contents

  • Types of Pain
    • Acute vs Chronic
    • Nociceptive pain
    • Visceral pain
    • Somatic pain
    • Neuropathic Pain
  • Pain Management
    • Perineural Therapy
    • Trigger Point Therapy
    • Platelet Rich Plasma Therapy
    • Prolotherapy 
    • Exosome Therapy
    • Prolozone Therapy
    • Neural Therapy

With so many options available, it is important to discuss the best regenerative medicine treatment plan with your physician.

We here at PremierMED are a group of passionate physicians and enthusiastic athletes, that want you to become a better version of yourself and enjoy life to its fullest. 

Feel free to touch base with us so we can talk to you about the steps you should be taking to make sure you are getting the best treatment option for you! 

References:

  1. Mills, S., Nicolson, K. P., & Smith, B. H. (2019). Chronic pain: a review of its epidemiology and associated factors in population-based studies. British journal of anesthesia123(2), e273–e283. https://doi.org/10.1016/j.bja.2019.03.023
  2. Grichnik, K. P., & Ferrante, F. M. (1991). The difference between acute and chronic pain. The Mount Sinai journal of medicine, New York58(3), 217–220.
  3. Chong, M. A., Berbenetz, N. M., Lin, C., & Singh, S. (2017). Perineural Versus Intravenous Dexamethasone as an Adjuvant for Peripheral Nerve Blocks: A Systematic Review and Meta-Analysis. Regional anesthesia and pain medicine42(3), 319–326. https://doi.org/10.1097/AAP.0000000000000571
  4. Han, S. C., & Harrison, P. (1997). Myofascial pain syndrome and trigger-point management. Regional anesthesia22(1), 89–101. https://doi.org/10.1016/s1098-7339(06)80062-3
  5. Le, A., Enweze, L., DeBaun, M. R., & Dragoo, J. L. (2018). Current Clinical Recommendations for Use of Platelet-Rich Plasma. Current reviews in musculoskeletal medicine11(4), 624–634. https://doi.org/10.1007/s12178-018-9527-7
  6. Grambart S. T. (2015). Sports medicine and platelet-rich plasma: nonsurgical therapy. Clinics in podiatric medicine and surgery32(1), 99–107. https://doi.org/10.1016/j.cpm.2014.09.006
  7. Aust, M., Pototschnig, H., Jamchi, S., & Busch, K. H. (2018). Platelet-rich Plasma for Skin Rejuvenation and Treatment of Actinic Elastosis in the Lower Eyelid Area. Cureus10(7), e2999. https://doi.org/10.7759/cureus.2999
  8. Rabago, D., & Nourani, B. (2017). Prolotherapy for Osteoarthritis and Tendinopathy: a Descriptive Review. Current rheumatology reports19(6), 34. https://doi.org/10.1007/s11926-017-0659-3
  9. Yang, F., Liao, X., Tian, Y., & Li, G. (2017). Exosome separation using microfluidic systems: size-based, immunoaffinity-based and dynamic methodologies. Biotechnology journal12(4), 10.1002/biot.201600699. https://doi.org/10.1002/biot.201600699
  10. Shiue, S. J., Rau, R. H., Shiue, H. S., Hung, Y. W., Li, Z. X., Yang, K. D., & Cheng, J. K. (2019). Mesenchymal stem cell exosomes as a cell-free therapy for nerve injury-induced pain in rats. Pain160(1), 210–223. https://doi.org/10.1097/j.pain.0000000000001395

 

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