COMMON TYPES OF SEVERE AND PERSISTENT PAIN

Below are types of severe and persistent pain, including diabetic peripheral neuropathy and conditions that originate or are common to the low back. Patients with severe and persistent pain conditions may have both a neuropathic and a nociceptive component.1

Illustration of DPN nerve pain

DIABETIC PERIPHERAL NEUROPATHY (DPN)

A complication of diabetes in which high blood glucose and high levels of fats may damage the small blood vessels carrying oxygen and nutrients to the nerves in the hands and feet.2

Illustration of compressed nerve pain

INTERVERTEBRAL DISC DISEASE

A condition typically caused by aging in which discs in the vertebral column deteriorate or herniate, causing them to lose flexibility, elasticity, and shock‑absorbing capabilities.3

Radiculopathy

RADICULOPATHY

Nerve damage typically caused by inflammation or impingement of a nerve root, causing weakness and/or pain radiating the length of the nerve.4

Illustration of sciatic nerve pain

SCIATICA

A form of radicular nerve pain, often caused by pressure on the nerve root at L5‑S1, causing pain that radiates down the back of the leg.4

Illustration of an arthritic spine

ARTHRITIS

There are several forms of arthritis of the spine (known altogether as spondyloarthropathies).5 These include:

Osteoarthritis

Occurs when the cartilage that protects the bones of the spinal area breaks down, resulting in movement of the bones that can cause irritation and formation of spurs that press against nerves.5

Ankylosing Spondylitis

An inflammatory disease in which the ligaments and bones of the spine fuse together, resulting in a stiff, fused, painful spine.6

Rheumatoid Arthritis

Occurs when the immune system attacks the thin membrane that lines the joints of the spine, which can place pressure on the spinal cord or spinal nerve roots and cause pain.5

Spondylolisthesis

A condition in which an upper vertebra slides forward on top of the vertebra below it, commonly between L4 and L5, causing low back pain.7

References:
  1. Pergolizzi JV, Schung SA, Raffa RB, et al. Tapentadol and dual pain inhibition: a new strategy for a pain relief in Australia. Chronic Dis Int. 2015;2(1):1011.
  2. Diabetic neuropathy. National Institute of Diabetes and Digestive and Kidney Diseases website. https://www.niddk.nih.gov/health-information/diabetes/overview/preventing-problems/nerve-damage-diabetic-neuropathies. Accessed June 3, 2024.
  3. Intervertebral disc disease. In: Lewis S, Dirksen S, Heitkemper M, Bucher L. Clinical Companion to Medical‑Surgical Nursing. 9th Ed. St. Louis, MO: Elsevier Health Sciences; 2014:362-363.
  4. Laroche F, Serge P. Managing Sciatica and Radicular Pain in Primary Care Practice. New York, NY: Springer Science & Business Media; 2013.
  5. Arthritis and diseases that affect the back. Arthritis Foundation website. http://www.arthritis.org/about-arthritis/where-it-hurts/back-pain/causes/back-arthritis.php. Accessed June 3, 2024.
  6. Spondylitis Association of America. Possible complications: how is a person affected? https://spondylitis.org/about-spondylitis/possible-complications/. Accessed June 3, 2024.
  7. Frymoyer JW. Degenerative spondylolisthesis: diagnosis and treatment. J Am Acad Orthop Surg. 1994;2(1):9-15.