About Pain Pain Types

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Classifying the type of pain you have in the pain clinic is an essential first step to make, allowing
you to choose the correct pain killer / reliever, and achieving better pain management. any
chronic pain syndromes are made up of different types of pain, and therefore combining medicines
from different appropriate groups can help improve pain relief. To find out how to use over the
counter pain relieving medicines more effectively, please look at Analgesic !low Chart.
Pain Classification
Nociceti!e Pain arises from the stimulation of specific pain receptors. These receptors can
respond to heat, cold, vibration, stretch and chemical stimuli released from damaged cells.
Non Nociceti!e Pain arises from within the peripheral and central nervous system.
"pecific receptors do not e#ist here, with pain being generated by nerve cell dysfunction.
"omatic Pain
"ource $ tissues such as skin, muscle, %oints, bones, and ligaments $ often known as
musculo$skeletal pain.
Recetors acti!ated $ specific receptors &nociceptors' for heat, cold, vibration, stretch
&muscles', inflammation &e.g. cuts and sprains which cause tissue disruption', and o#ygen
starvation &ischaemic muscle cramps'.
C#aracteristics $ often sharp and well localised, and can often be reproduced by touching
or moving the area or tissue involved.
$seful Medications $ may respond to combinations of Paracetamol, (eak Opioids O)
"trong Opioids, and *"A+,s &see Analgesic !low Chart'.
-isceral Pain
"ource $ internal organs of the main body cavities. There are three main cavities $ thora#
&heart and lungs', abdomen &liver, kidneys, spleen and bowels', pelvis &bladder, womb, and
ovaries'.
Recetors acti!ated $ specific receptors &nociceptors' for stretch, inflammation, and o#ygen
starvation &ischaemia'.
C#aracteristics $ often poorly localised, and may feel like a vague deep ache, sometimes
being cramping or colicky in nature. +t fre.uently produces referred pain to the back, with

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pelvic pain referring pain to the lower back, abdominal pain referring pain to the mid$back,
and thoracic pain referring pain to the upper back.
$seful medications $ usually very responsive to (eak Opioids and "trong Opioids .
*erve Pain
"ource $ from within the nervous system itself $ also known as pinched nerve, trapped
nerve. The pain may originate from the peripheral nervous system &the nerves between the
tissues and the spinal cord', or from the central nervous system &the nerves between the
spinal cord and the brain' $ see *erve Pain.
Causes $ may be due to any one of the following processes
o *erve ,egeneration $ multiple sclerosis, stroke, brain haemorrhage, o#ygen
starvation
o *erve Pressure $ trapped nerve
o *erve +nflammation $ torn or slipped disc
o *erve +nfection $ shingles and other viral infections
Recetors acti!ated $ the nervous system does not have specific receptors for pain &non
nocicpetive'. +nstead, when a nerve becomes in%ured by one of the processes named
above, it becomes electrically unstable, firing off signals in a completely inappropriate,
random, and disordered fashion.
C#aracteristics $ These signals are then interpreted by the brain as pain, and can be
associated with signs of nerve malfunction such as hypersensitivity &touch, vibration, hot
and cold', tingling, numbness, and weakness. There is often referred pain to an area where
that nerve would normally supply e.g. sciatica from a slipped disc irritating the >2 spinal
nerve produces pain down the leg to the outside shin and big toe i.e. the normal territory in
the leg supplied by the >2 spinal nerve. "pinal nerve root pain is also often associated with
intense itching in the distribution of a particular dermatome. People often describe nerve
pain is often described as lancinating, shooting, burning, and hypersensitive.
$seful Medications $ only partially sensitive to paracetamol, *"A+,s, Opioids. ore
sensitive to Anti$depressants, Anti$convulsants, Anti$arrhythmics, and *,A Antagonists.
Topical Capsaicin, may be helpful.
%o& do ' find out if my ain is neuroat#ic( $ try using the following "creening Tests.
"ymat#etic Pain
"ource $ due to possible over$activity sympathetic nervous system, and central / peripheral
nervous system mechanisms. The sympathetic nervous system controls blood flow to tissues
such as skin and muscle, sweating by the skin, and the speed and responsiveness of the
peripheral nervous system. $ see "ympathetic Pain.
Causes $ occurs more commonly after fractures and soft tissue in%uries of the arms and legs,
and these in%uries may lead to Comple# )egional Pain "yndrome &C)P"'. C)P" was
previously known as )efle# "ympathetic ,ystrophy &)",'.
Recetors acti!ated $ like nerve pain there are no specific pain receptors &non nociceptive'.
The same processes as mentioned above in *erve Pain may operate in C)P".
C#aracteristics $ presents as e#treme hypersensitivity in the skin around the in%ury and also
peripherally in the limb &allodynia', and is associated with abnormalities of sweating and
temperature control in the area. The limb is usually so painful, that the sufferer refuses to use
it, causing secondary problems after a period of time with muscle wasting, %oint
contractures, and osteoporosis of the bones. +t is possible that the syndrome is initiated by
trauma to small peripheral nerves close to the in%ury.
$seful medications $ many of the features of sympathetic pain are similar to those of nerve
pain, and therefore nerve pain medications may be useful &Anti$depressants, Anti$
convulsants, and Anti$arrhythmics'. ,rugs which lower blood pressure by causing
vasodilatation &nifedipine' may also be useful when used in combination. Treatment should
include appropriate multi$modal medications, sympathetic nerve blocks, and intensive
rehabilitation combining occupational and physiotherapy.
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