Pain has troubled the human race since our beginnings. It is distressing and inconvenient. But what is pain? What combination of words can pin it down? What types of pain exist? There's such a colourful variety of pains and there’s more to pain than meets the eye. Pain is a protective and normal motivator to help us avoid danger. But it can also be maladaptive and serve no role but to create suffering.
Let's start with a definition. Nobel Prize winner Charles Scott Sherrington described pain as "the psychical adjunct of a protective reflex".
Put simply, pain is the mental counterpart to our bodies' reaction to threat. It is our body’s way of warning and protecting us. This means pain can be useful. Take for example Congenital Insensitivity to Pain (CIP) syndrome. CIP is a rare condition "in which a person cannot feel physical pain". CIP is dangerous as the suffering grapple with untreated injuries. By alerting us to damage and discouraging us from threats, pain can be useful.
The different types of pain
Not all pain is the same. There are numerous categories that pain can fit into. Acute and chronic pain are defined according to the time frame they persist. Three months being a common, but arbitrary figure. Here we will look at types of pain according to cause: nociceptive, neuropathic and nociplastic. Watch out, trying to pronounce these can cause a fair amount of mental pain!
Let’s take a closer look:
What is Nociceptive pain?
The International Association for the Study of Pain (IASP, 2017) defines nociceptive pain as ‘pain that arises from actual or threatened damage to non-neural tissue and is due to activation of nociceptors’ - an event that causes a reaction.
This definition is medical. But it can be considered part of Sherrington's words, being the mental result of a threat to tissue. Nociceptive pain being our guardians against body injury. Imagine the red hot feeling you get when you put your hand near a hot stove. You feel this pain as nerves in your hand feel the heat and send warning signals to your brain. This is nociceptive pain at work!
What is Neuropathic pain?
Neuropathic pain isn’t caused by threat to tissue like your hand being burnt on the stove. Instead, it’s caused by a disease or lesion of the nervous system.
The disease or lesions cause damage to the pain communication system, which creates painful signals. Sciatic pain; the shooting pain going from your back down to your foot, is a famous example.
But sometimes we can feel neuropathic type pain in the absence of disease or lesion. In fibromyalgia people feel pain all over their body with widespread tender points making the simplest activity like wearing clothes distressing and painful. But where are the signals? There is no threat to tissue and the nervous system does not have any observable disease or lesion.
How is it helpful to feel pain that has no protective role? The third pain category may hold the answer!
What is Nociplastic pain?
This is the type of pain which continues without a clear threat to tissue and without damage to the nervous system. It’s pain without an obvious cause. The IASP (2017) define nociplastic pain 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". What a set of painful words! Put simply it is pain that is not nociceptive or neuropathic and therefore is not threatening our bodies.
Imagine a computer. The keyboard, monitor and hard drive are all parts of the body. The cables are the nervous system that communicates signals to the different body parts. The computer fails, it glitches, it slows down. The hardware of the communication system is working, but it is still failing? The software signals are the failure and it serves no purpose but to inconvenience and distress us. So in nociplastic pain our hardware has no problem, but the software signals it creates do!
So what is pain?
We finish with more accuracy to our original question. The IASP (2017) once again delivers to us with:
“An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.”
Even though the threat may not always exist - in our minds, it is always connected to pain.
How can I stop pain?
Understanding pain and different types of pain is stage one, now it’s time to manage it.
Disclaimer
Anodyne is a multidisciplinary medical centre in Perth Western Australia. With a focus on patient centred approaches for pain and mental health recovery.
Any advice posted on our blog, website, or app is of a general nature and for informational purposes only. It is not intended to replace or substitute for any medical or other advice.
Anodyne makes no representations or warranties and expressly disclaim any and all liability concerning any treatment, action by, or effect on any person following the general information offered or provided within or through the blog, website, or app. If you have specific concerns or a situation arises in which you require medical advice, you should consult with an appropriately trained and qualified medical practitioner.
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