In my previous post I wrote all about the importance of writing a diary to describe your pain and what you were doing when it all started.
My visit to see an osteopath to help me with my SI joint pains was a real eye opener for me as his description of pain was quite different to mine.
When he asked me what I think pain means I said it means something is wrong and that is why it hurts. We spoke of the importance of really understanding the pain mechanisms and that these can relate to threat more than damage. This leads to abnormal and overprotective pathways being laid down within your brain, resulting in pain and muscle spasm and these have been practiced for a while now. But understanding this can have a big impact on the level of threat and can start to change these abnormal pathways away from painful ones. He went on to explain that I should remember if something feels OK it is and if it doesn’t then it isn’t.
There are also different types of pain from sharp, dull, stabbing to tingling, numbness, swelling, sensitivity, and neuropathic. Pain Health writes there are 3 widely accepted pain types relevant for musculoskeletal pain:
- Nociceptive pain (including nociceptive inflammatory pain)
- Neuropathic pain
- Nociplastic pain
They also write that t is not uncommon to have a “mix” of pain types. Current research suggests that understanding pain types is important because it may influence what pain management treatments are best for you.
Healthline write that there are six types of pain from acute, chronic, nociceptive, visceral, somatic, neuropathic. Spine Med write there are four major types of pain –
- Nociceptive Pain: Typically the result of tissue injury. Common types of nociceptive pain are arthritis pain, mechanical back pain or post surgical pain.
- Inflammatory Pain: An abnormal inflammation caused by an inappropriate response by the body’s immune system. Conditions in this category include gout and rheumatoid arthritis.
- Neuropathic Pain: Pain caused by nerve irritation. This includes conditions such as neuropathy, radicular pain and trigeminal neuralgia.
- Functional Pain: Pain without obvious origin, but can cause pain. Examples of such conditions are fibromyalgia and irritable bowel syndrome.
Pain Science write a detailed account about three types of pain. They say there are two well-recognized broad categories of pain:
- pain from damage — the common sensical sort (but sometimes weirder than you’d think)
- pain from damage to the pain system itself, the nervous system — which is weird by default
That’s roughly the difference between alarms and false alarms, or actual engine trouble and trouble with that light on your dashboard that says there’s engine trouble. Again with more technical detail:
- Nociceptive pain arises from various kinds of trouble in tissues, reported to the brain by the nervous system. This is the type of pain everyone is most familiar with, everything from bee stings and burns and toe stubs to repetitive strain injury, nausea, tumours, and inflammatory arthritis. Nociceptive pain typically changes with movement, position, and load.
- Neuropathic pain arises from damage to the nervous system itself, central or peripheral, either from disease, injury, or physical irritation (e.g. pinching). The simplest neuropathies are mechanical insults, like hitting your funny bone or sciatica, but this is a big category: anything that damages neurons, from multiple sclerosis to chemotherapy to alcoholism to phantom limb pain. It’s often stabbing, electrical, or burning, but nearly any quality of pain is possible. Unfortunately, it’s also more likely to lead to chronic pain: nerves don’t heal well.
Migraine? Still tough to classify! Some experts consider it a major category of its own, parallel to nociceptive and neuropathic pain, but it’s probably just a complicated neuropathy.
Obviously these kinds of pain can and do overlap. Some medical problems, like injuries, can affect both nerves themselves and other tissues, causing both kinds of pain. However, it’s surprising how little obvious overlap there is: look at any list of the most painful conditions , or the great variety of pain causes, and they mostly fit into one category or the other. But “under the hood,” most pain does involve elements of both types. Pain is predictably unpredictable, thanks to brains. Regardless of type, all pain is weird in some typical ways, because it’s all under the total control of our brains, and brains have complicated and conflicting priorities for us that we are oblivious to. The result is that pain is often weird, a somewhat paranoid guess about how much danger we’re in, and that’s when everything’s working correctly. If the nervous system is damaged (neuropathic pain), then the brain is getting bad information, and pain gets even weirder. But when the nervous system misbehaves, pain can get so wonky that a whole new category of pain might be needed.
So, there are clearly a number of different meanings for pain. To the average lay man if asked what sort of pain they were in they would probably come back with sharp, dull, stabbing, etc. It is important to try and understand which type of pain you have so it can help your health professional to decide on the type of treatment that will be right for you.