Nociceptive Pain and Pain Management
Nociceptors are the nerves which sense and respond to parts of the body which suffer from damage. They refer to the discomfort that results when a stimulus causes tissue damage to the muscles, bones, skin or internal organs. When most people think of pain, they think of nociceptive pain. The receptors signal tissue irritation, impending injury or actual injury. When activated, they transmit pain signals (via the peripheral nerves as well as the spinal cord) to the brain. The pain is typically well localized, constant, and often with an aching or throbbing quality. When any kind of stimulus injures the body in any manner (i.e., heat burning your finger), the nociceptors detect it and send pain signals to the brain.
Causes of Nociceptive Pain
Nociceptive pain is one of the most common types of pain. Because a variety of stimuli can trigger this form of pain, the causes of it can be endless. However, many people can easily identify the source of their nociceptive pain, as both the affected area and the stimulus tend to be obvious. Examples include:
- Bone fractures
- Inflammation (from an infection or arthritic disorder)
- Myofascial pain (which may indicate abnormal muscle stresses)
Generally localized to the area the stimulus targets, nociceptive pain usually causes people to experience sensations they describe as:
Nociceptive pain is usually time-limited, meaning when the tissue damage heals, the pain typically resolves. (Arthritis is a notable exception in that it is not time limited.) Another characteristic of nociceptive pain is that it tends to respond well to treatment with opioids.
Organs deep within the body have few nociceptors. The skin and joints are highly concentrated with them. Visceral pain is the subtype of nociceptive pain that involves the internal organs. It tends to be episodic and poorly localized.
When the damage heals, the pain generally ends (with the notable exception of inflammation caused by arthritis).
Types of Nociceptive Pain
The medical community is still debating on how to characterize the different types of nociceptive pain. Typically, however, most experts distinguish nociceptive pain as either:
- Somatic pains — pain that results from some injury to the body. Generally localized to the affected area and abates when the body repairs the damage to that area. Getting a paper cut, recovering from surgery and suffering from a burn are all forms of somatic nociceptive pain.
- Visceral pain — pain originating in the body’s internal organs or their surrounding tissues. This form of pain usually results from the infiltration of harmful cells, as well as the compression or extension of healthy cells. Patients suffering from visceral pain tend to feel generally achy, as this pain tends to not be localized to a specific area. Cancer is a common source of visceral pain.
Nociceptive vs. Neuropathic Pain
These two types of pain are distinguished by the particular cause of each one. While neuropathic pain results from damage to nerve cells, an injury or disease outside of the nervous system (typically in the form of tissue damage) causes nociceptive pain.
The patient’s experience of the pain also differs depending on the type of pain he feels. In general, people describe neuropathic pain as burning or stabbing, whereas they describe nociceptive pain as aching or throbbing. Keep in mind that these are generalizations as the individual pain experience is highly subjective.
The other major difference between nociceptive and neuropathic pain is in how long each lasts. In general, nociceptive pain vanishes after the injury heals, whereas neuropathic pain is chronic because the underlying cause is usually irreversible.
Although most types of pain are categorized as either nociceptive or neuropathic, some types of pain, like migraines, can actually be a combination of the two. In these cases an outside stimulus triggers a chronic source of pain.
Diagnosis and Treatment of Nociceptive Pain
In the process of diagnosing nociceptive pain, doctors will ask patients about their medical histories, as well as their experience with their identifiable symptoms. Since nociceptive pain results from an outside stimulus and is typically localized to the affected area, doctors can usually diagnose it after performing a thorough physical exam and conducting some imaging tests (such as X-rays, CT scans and/or MRIs).
Because nociceptive pain subsides once the body has had the proper time to heal the damaged tissues, most cases of this pain are highly treatable. In general, treatment for nociceptive pain revolves around taking
- Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or acetaminophen
- Tri-cyclic antidepressants. (Because these medications are less effective against short-term acute pain and can have significant side effects, doctors tend to use them as a last resort when prescribing medication for the treatment of nociceptive pain.)
To promote faster healing, doctors may also recommend that patients undergo physical therapy or try alternative treatments, such as acupuncture.
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