Pain Medicine

Treating Pain

As with most all physicians (and certainly Pain specialists), Dr. Williams is committed to managing pain so that patients can continue to live their everyday lives productively and without limitation. His goal is to improve quality of life and avoid the complications associated with acute and chronic pain. Certainly, no physician wants their patients to experience life limited by pain. But also as a Sports Neurologist, Dr. Williams is acutely aware of the importance of exercise, and physical fitness on the brain. He knows that the brain loves exercise and understand one of the most powerful approaches to optimizing and extending peak Neurological function is through regular and effective physical exercise. Dr. Williams wants to enhance the quality of life and extend what has been called the “Healthspan” – meaning not only the length of life (lifespan), but the length and duration of a healthy, active, and productive life. As a result, he is dedicated to treating pain so that my patients can exercise, which results in important contributions to Neurological health across the lifespan.

Approach to Pain Medicine

As a neurologist specializing in Pain Medicine, Dr. Williams’ approach to pain is based on a thorough knowledge of how the nervous system works and how the brain contributes to suffering from pain; not just how injections and pills can "cover" or "block" pain. Pain science reveals that "pain is in the brain." That is not to say that feeling pain is "all in your head." The brain is the most critically important organ in Pain Science because it is the brain (not the back, neck, foot, ankle, or other affected body part) that actually causes the hurt. Electrical signals from various body parts are transmitted to the brain. All kinds of electrical signals. The signals are from nerves transmitting information about heat/temperature, sharpness, cold, vibration, touch, pressure, and other sensory data. When those signals reach the brain (after having been transferred from on nerve to another within the spinal cord), the brain interprets them and produces an experience that is framed based on a wide range of varying factors:

• Has this sensation been experienced before? Under what circumstances?
• Is there evidence of injury? Would continuing the activity causing these signals result in damage or injury?
• What else is going on at the moment? How important is this signal?
• Is there associated fear, stress, anxiety, urgency?
• Is there associated excitement, happiness, motivation, pleasure, or benefit?

The sum total of all of this and other kinds of information will result in the brain experiencing the signals as no pain, mild pain, moderate pain, or severe pain. The electrical signal itself can be localized as coming from specific body parts. The signal is (only) part of the input the brain uses to produce (or not produce) pain. But make no mistake. The experience of pain resides in the brain.

UNDERSTANDING ASCENDING AND DESCENDING PAIN PATHWAYS 

In order to successfully manage chronic pain, two things must be addressed. The first involves ascending pain pathways. These neural highways allow the brain to locate the source and sensation of pain and assign to it an emotionally unpleasant response. Equally important are the descending pain pathways. These neural highways descend from the central structures of the nervous system and serve to lessen the pain signals that are travelling up from the ascending neural pathways in the body to the brain.

PAIN MEDICINE BEGINS WITH AN ACCURATE CLASSIFICATION OF PAIN 

Beyond addressing the ascending and descending pain pathways, also important to successful pain management for patients is an accurate classification of the pain they are feeling. After all, the best treatment depends largely upon matching it with the kind of pain that is being felt. Pain classifications generally fall into the following categories:

• Neuropathic Pain – This type of chronic pain can have various causes but develops as a result of problems with nerve signals, usually resulting from damage to or diseases affecting the nervous system. Neuropathic pain is frequently felt as shooting or burning pain or tingling and numbness which is often accompanied by damage or injury to the nerve fibers themselves. This type of pain doesn't typically respond well to traditional pain medications like anti-inflammatories.
• Nociceptive Pain – This type of pain is usually caused by tissue damage or injury – like a severe cut or broken bone, for example. The sensation of nociceptive pain is typically felt as a dull or sharp aching pain which can vary from mild to severe. This is a type of pain that can be temporary or chronic. Cancer and arthritis, for example, are chronic conditions that elicit nociceptive pain. However, unlike neuropathic pain, this type of pain does usually respond well to certain pain medications including anti-inflammatories.
• Myofascial Pain Syndrome – This is a chronic pain disorder. It is characterized by something called "referred pain," when pressure on sensitive points in the body's muscles causes seemingly non-related pain in other areas of the body. The pain is usually caused by repeated muscle contraction as can be the case in certain manual labor jobs, sports or hobbies.
• Mixed Pain – In some cases, the chronic pain felt by the patient is a mixture of neuropathic and nociceptive pain. One example of mixed pain is migraine headaches. Mixed pain syndrome benefits greatly from a varied treatment approach.