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Types of pain explained

There a three different types of pain. Understanding what type of pain you are experiencing is important in determining the correct treatment plan. Here we explain nociceptive pain, neuropathic pain and nociplastic pain.

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There are three different types of pain.  Before we explain these it is important to understand what pain is.  Here is my definition of pain:

“Pain is a unique and individual sensation that is often unpleasant.  It is processed in the brain as a result of many different inputs.  It is our human warning system, trying to give us a message about something.”

When we understand the different types of pain, we are better able to find the most suitable treatment plan.

Nociceptive pain 

This type of pain occurs when a specialised nerve fibre called a nociceptors, detects tissue damage.  These nociceptors are located throughout the body and respond to various stimuli such as mechanical pressure, temperature extremes and chemical irritants.  Nociceptive pain typically serves as a warning signal, alerting the brain to potential injury or harm.  Think of standing on a nail, experiencing the sensation of pain and quickly removing your foot from the nail.  The nociceptor in the foot picks up the mechanical pressure and sends a signal to the brain.  The brain (control centre) receives this information along with visual information of where you are, and memories, and many other pieces of information.  It concludes that this is dangerous, so gives the sensation of pain in order to stimulate the motor nerves to the muscles to remove the foot.  This all happens within a matter of seconds.  After all, pain is a protector.  Pain killing drugs work well on this type of pain as they intercept the nerve pathway.  Nociceptive pain is a normal physiological response to tissue damage and typically resolves as the injury heals which is normally around 3 months.  Pain beyond this starts to become nociplastic (see below).  Examples of nociceptive pain include bruises, sprains, strains, fractures, cuts and other injuries.

Neuropathic pain 

This type of pain tends to be more chronic and is associated with damage to nerve cells and the malfunctioning of the nervous system. Unlike nociceptive pain, which results from injury/ tissue damage, neuropathic pain occurs when nerves themselves are damaged, sending malfunctioning messages to the brain.  The cause of this type of pain tends to be associated with disease such as diabetes, multiple sclerosis, shingles and more.  Patients describe this type of pain using words like numbness, tingling, burning and like an electrical shock.  Sometimes one can experience pain in a part of the body that isn’t even there. This is called phantom limb pain. Treatments for this type of pain includes drugs that target nerve function.  Opioids must be prescribed for short term use as they can lead to addiction especially in chronic conditions.  Cannabinoids can also have some benefit.  Some therapies aimed at managing symptoms and improving quality of life can be beneficial.

Nociplastic pain 

This is a new classification of pain introduced in 2018.  Unlike nociceptive pain (caused by tissue damage) or neuropathic pain (caused by nerve damage dysfunction), nociplastic pain arises from alterations in the central nervous system’s processing of pain signals, leading to an amplification or distortion of pain perception.  It’s like a faulty wiring system.  This is rather like a car alarm system becoming over sensitive to stimulus and would go off at the drop of a feather.  Often people with persistent pain such as lower back pain, neck pain, and fibromyalgia, experience this type of pain.  This type of pain may not have a clear cause making diagnosis challenging and thus leading to frustration.  One could experience nociceptive pain such as a pulled muscle in the back, but after time, beyond the 3 months tissue healing stage, move into nociplastic pain.  Pain killing drugs rarely help with this kind of pain and opioids can make this type of pain worse and cause addiction due to its chronic nature.  Treatment involves a multidisciplinary approach including manual therapy, cognitive behavioural therapy, nutrition therapy and exercise rehabilitation.  The BEAT pain methodology works really well with this type of pain.  The ‘plastic’ term in this definition reflects that the nervous system can be re-wired and changed with mind-body therapies.  By understanding that this type of pain is a result nervous system sensitivity, although the sensation of pain is real, we can work towards reducing the fear of pain through education and lifestyle changes.

Patients can experience different types of pain at the same time or move from one type to another.  It is important to identify the type of pain in order to determine the most suitable treatment plan.  Doctors will attempt to diagnose pain using blood tests, and scans, orthopaedic tests and more, however these don’t always lead to answers and can lead the patient feeling frustrated.  It is important to also take a thorough history, and look at the patient in a holistic manner in order to understand the root causes of their pain.