Pain types

Pain types do differ. There are 3 widely accepted pain types relevant for musculoskeletal pain:

1. Nociceptive pain (including nociceptive inflammatory pain). This pain is common with acute pain when there is tissue damage like a torn muscle or sprained ankle
2. Neuropathic pain
3. ‘Nociplastic pain – ‘pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain’ [IASP definition].

It 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 you¹.

Your pain management is never decided just on pain type, but this can be an important factor in considering what pain treatments and care are best suited to your problem.

Nociceptive pain can be thought of as pain associated with tissue injury or damage or even potential damage: nociceptors are sensory endings on nerves that can be excited or sensitized and signal potential tissue damage. Examples of nociceptive pain include jamming your finger in a car door, spraining your ankle or touching the hot plate on the stove.

Whether or not this nociceptor excitation is experienced as pain, depends on many factors including the context of the experience and the priority your brain/mind gives to the potential threat of injury.

Sometimes, there may be no tissue injury and only very momentary pain is experienced, for example, if you are quick to withdraw your hand from the hot plate, which rapidly resolves. Here, the pain indicates potential tissue damage and has been an effective early warning system, helping you to pull your hand away from the hot stove or car door.

Once there has been tissue damage, it is normal to have an inflammatory response and this is a good thing. Inflammation is a coordinated body system response that is designed to help heal the tissue damage. The inflammatory response involves blood-borne chemicals, immune system chemicals and some chemicals released from specialised nerve fibres. These chemicals talk to each other to help coordinate tissue repair.

Examples of nociceptive pain include acute injuries like a sprained ankle, acute low back pain or neck pain, broken bones, or pulled muscles. There may be signs of tissue injury such as swelling, redness and later purple or yellowing of the skin, a limb that looks distorted, or just increased sensitivity to touch and movement. Such signs are part of acute tissue healing. Use our pain self-checks to help guide your management: you can print out the main findings and discuss this with your health team.

Simple analgesia such as paracetamol or non-steroidal anti-inflammatories (NSAIDS) may be helpful in managing nociceptive inflammatory pain (for example, post surgery) by reducing pain and allowing you to get active early¹. Getting active early, in a sensibly paced way usually means less stiffness and pain and a quicker return to your daily tasks.

If you have episodes of pain or pain flares associated with osteoarthritis or other nociceptive musculoskeletal pain, simple analgesia may be helpful and is the current recommended medicine for care^1-4 in addition to staying active and engaged in your normal day to day activities¹.

For more info about simple analgesics see the medicines and procedures pain management module. Note: If you have Rheumatoid Arthritis, or Ankylosing Spondylitis, the pain medications you use will also typically be simple analgesics. However, there are additional and very specific arthritis medications you require in order to manage these chronic inflammatory conditions, so see your medical or health professional as soon as possible^3,4.

These medications are very important because, given early, they can prevent lasting joint damage. The combination of these disease modifying anti-rheumatic drugs (DMARDs) and simple analgesia can help you to keep moving and stay active. You can read more about Rheumatoid Arthritis and Ankylosing Spondylitis in the pain conditions: Rheumatoid Arthritis and Ankylosing Spondylitis section of our website.

Neuropathic pain is pain associated with injury or disease of nerve tissue. People often get this type of pain when they have shingles, sciatica, neck or back radiculopathy, trigeminal neuralgia, or diabetic neuropathy.

Neuropathic pain is often described as burning, shooting, stabbing, prickling, electric shock-like pain, with hypersensitivity to touch, movement, hot and cold and pressure. When you have neuropathic pain, even a very light touch or gentle movement can be very painful.

If you have neuropathic pain, it is important to get the right treatment as early as possible, and in some cases, this may mean the use of medicines⁵. This early care can reduce the chance that your pain will become persistent and is also associated with better outcomes (less pain and better function and quality of life). It is always important to ask your doctor about the relative risks and benefits of any medicines you use. You may also find our painDETECT or CRPS pain self-checks helpful as these screen for neuropathic pain.

Medication can play an important role in helping you manage neuropathic pain, especially if the pain is acute and severe. The medications are different from what is used for nociceptive pain, although sometimes, if there is also nociceptive pain (“mixed” pain), simple analgesias such as paracetamol or non-steroidal anti-inflammatories, may be helpful¹.

Medications for neuropathic pain are designed to calm the nerves or reduce their excitability. For more information on neuropathic pain see the medicines and procedures training module.

Nociplastic pain is defined as ‘Pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain’⁷.

This type of pain may reflect changes in the way the nervous and immune systems function. The net effect is that pain can be amplified, may be widespread, involve various tissues (body, viscera) and be greater than would be expected given the amount of identifiable tissue or nerve damage.

Other symptoms are common such as fatigue, poor sleep, memory, and low mood. This type of pain is often associated with conditions such as fibromyalgia, chronic pelvic pain, tension-type headaches or chronic low back pain. This type of pain does not respond to most medicines and usually requires a tailored program of care that involves addressing factors that can contribute to ongoing pain (lifestyle, mood, activity, work, social factors).

Major advances have occurred in understanding how glia and immune cells in the nervous system respond to inputs and contribute to unhelpful immune-mediated pain⁶.

Immune-like cells in the brain, spinal cord and peripheral nerves appear to play a major role in all forms of pain. These immune-like cells are called microglia, astrocytes, T cells and natural killer cells. When there is further danger as well as current pain, this can be a recipe for chronic or ongoing pain. The implication of this is that feelings of stress, worry and being under threat need to be helpfully managed.

For autoimmune disorders, our gut makeup, or microbiota, appears especially important to our health and wellbeing. Emerging studies suggest that the gut microbiota may play an important role in regulating our immune function, changing gut leakiness and potentially contributing to autoimmune diseases ⁸ such as rheumatoid arthritis.

Differences between genders in immunity may also be relevant with gut microbiota shaping and being shaped by male and female sex hormones. Here, the gut and endocrine systems talk with each other, with bacteria being capable of producing hormones (such as serotonin, dopamine), responding to hormones (such as estrogen) and regulating hormones⁸.

We do not yet have strong enough evidence from high quality studies to understand what this may mean for treatment of people with pain-related conditions.

How our diets can influence individual experiences of musculoskeletal pain suggests this is an important factor to consider especially where people are living with co-morbid conditions such as autoimmune diseases such as rheumatoid arthritis, and gut conditions such as coeliac disease and irritable bowel syndrome.

If this sounds like you, discuss your experiences with your family doctor or health professional to see what care might be helpful for you.

For further information we recommend Cochrane Summaries. If you need to speak to your GP or health care professional, please seek further assistance.