There are two main types of pain, of which include nociceptive and neuropathic pain. Each of these has particular characteristics that define the type of pain and the ideal way in which it should be managed.
This article consists of an overview of both nociceptive and neuropathic pain, followed by the distinct differences in their cause and management.
Nociceptive pain is the most common type of pain and is caused by the detection of noxious or potentially harmful stimuli by the nociceptors around the body.
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Nociceptors are receptors that are specifically designed to detect stimuli that may cause harm to the body, which may be mechanical, chemical, or thermal in nature. For example, these pain receptors may sense when there is physical damage to the skin, muscles, bones, or connective tissue in the body, or when they are exposed to toxic chemicals or extreme temperatures.
Nociceptors typically have a high threshold; however, when they are activated, these receptors will send electrical signals of pain to the central nervous system to deliver the perception of pain to the affected site.
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Neuropathic pain is associated with damage to the neurons in the body, following an infection or injury to the area, either of which will result in messages of pain being sent to the central nervous system.
Neuropathic pain is often described as shooting pain, as it travels along the nerves in an abnormal manner. Some patients with neuropathic pain report a constant sensation of pain, whereas others experience intermittent episodes, which may or may not be aggravated by stimuli or touch.
Differentiating causative factors
The cause of nociceptive and neuropathic pain is a significant differentiating factor between the two types. Therefore, it is important to understand the appropriate management techniques for each type of pain.
Nociceptive pain occurs when nociceptors in the body detect noxious stimuli that have the potential to cause harm to the body. This includes mechanical pressure, chemical toxins, and extreme temperatures, all of which may harm the body. Nociceptors will then send electrical signals via the nervous system to the brain, which will ultimately lead to the perception of pain.
Neuropathic pain is caused by damage to the neurons that are involved in the pain signaling pathways in the nervous system. There are a variety of circumstances that may lead to nerve damage, including certain infections, diabetes, and surgery, among many others.
Differentiating management factors
As the pathology of nociceptive and neuropathic pain differs considerably, the recommendations in the management of the pain contrast accordingly.
For nociceptive pain, the first-line management is with pharmacological analgesic medications, such as paracetamol, ibuprofen and aspirin. For more severe pain, prescription medications such as opioids can often help to provide effective pain relief. These medications have different mechanisms of action; however, each of these drugs aims to disrupt the transmission of pain signals from the nociceptors to the brain.
For neuropathic pain, the goal of treatment is to relieve the pain caused by damage to the nerves. In most cases, analgesic medications are unable to provide effective relief; therefore the nerves themselves must be targeted. Neurostimulation therapy is often used to excite the nervous tissue in the central nervous system, as this treatment option can alter the conductivity of the nerves, which subsequently helps to relieve symptoms.