Learn about the various pain types and how to manage them with our advice and tips
Pain types do differ. There are 3 widely accepted pain types relevant for musculoskeletal pain:
- Nociceptive pain
- Nociceptive inflammatory pain
- Neuropathic pain
A fourth pain type has also been proposed and this is referred to as glial mediated immuno-responsive pain (or ‘alloplastic pain’)
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 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 injury2.
Sometimes, if you are quick to withdraw your hand from the hot plate, there may be no tissue injury and only very momentary pain is experienced, which rapidly resolves. Here, the pain indicated potential tissue damage and acted as an effective early warning system, helping you to behave by pulling your hand away from the stove or car door.
Nociceptive inflammatory pain
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 is well coordinated and 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 a sprained ankle, non specific 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, increased sensitivity to touch and movement. Such signs are part of 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) can be helpful in managing nociceptive inflammatory pain 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 is the current best practice approach to pain management 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 nociceptive inflammatory pain and your pain condition is Rheumatoid Arthritis, or Ankylosing Spondylitis, the pain medications you use will also typically be the simple analgesics. However, there are additional and very specific arthritis medications you require in order to manage this chronic disease, so see your health professional as soon as possible3,4.
These medications are very important because, given early, they prevent the joint destruction associated with Rheumatoid Arthritis. The combination of these disease modifying anti-rheumatic drugs (DMARDs) and simple analgesia helps 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, cervical or lumbar 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 possible5. This reduces the chance that your pain will become persistent and is also associated with better outcomes (less pain and better function and quality of life). You may find the painDETECT or CRPS pain self-checks helpful as these screen for neuropathic pain.
Medication has an important role in helping you manage neuropathic pain, especially if the pain is acute. The medications are different from what is used for nociceptive pain, although sometimes, if there is also nociceptive pain (“mixed” pain), simple analgesia 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.
Linking the Neuro-Immune-Endocrine Systems
Major advances have occurred in understanding how glia and immune cells in the nervous system respond to painful 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 danger as well as pain input this is a recipe for chronic or ongoing pain. The implication of this is that feelings of stress, worry and being under threat need to be removed.
- Schug SA, Goddard C. Recent advances in the pharmacological management of acute and chronic pain. Ann Palliat Med 2014; 3(4): 263-75. [PubMed]
- Moseley GL, Flor H. Targeting cortical representations in the treatment of chronic pain: a review. Neurorehabilitation and neural repair 2012; 26(6): 646-52. [PubMed]
- Smolen JS, Landewe R, Breedveld FC, et al. EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease-modifying antirheumatic drugs: 2013 update. Annals of the rheumatic diseases 2014; 73(3): 492-509. [PubMed]
- Zangi HA, Ndosi M, Adams J, et al. EULAR recommendations for patient education for people with inflammatory arthritis. Annals of the rheumatic diseases 2015; 74(6): 954-62. [PubMed]
- Finnerup NB, Attal N, Haroutounian S, et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet neurology 2015; 14(2): 162-73. [PubMed]
- Grace PM, Hutchinson MR, Maier SF, Watkins LR. Pathological pain and the neuroimmune interface. Nat Rev Immunol 2014; 14(4): 217-31. [PubMed]
This module has been developed by Associate Professor Helen Slater, PhD, FACP, School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia and Professor Stephanie Davies, MBBS, FANZCA, FFPMANZCA, Pain Medicine Specialist, WA Specialist Pain Services, Perth, Australia. The information in this module is based on current best evidence research and clinical practice.