NOT ALL PAIN IS THE SAME

Understanding Different Types of Pain | PAIN AWARENESS MONTH | POST 2

In the first post, we talked about something that sounds simple but really isn’t:

What exactly IS pain?

The big takeaway was:

PAIN IS AN EXPERIENCE — NOT A DIRECT MEASUREMENT OF TISSUE DAMAGE.

So the natural next question is:

If pain isn’t all the same… what different kinds of pain are there?

One useful way pain scientists and healthcare professionals classify pain is by the mechanism that appears to be contributing to it.

Three terms you’ll hear frequently are:

NOCICEPTIVE PAIN

This is probably closest to what most of us picture when we think about pain.

Nociceptive pain arises from actual or threatened damage to non-nerve tissue and activation of nociceptors — the sensory receptors that respond to potentially damaging stimuli.

Think:

You cut your finger.

Sprain your ankle.

Break a bone.

Irritate or inflame a joint.

Your nervous system receives information about what is happening in the tissues, and pain may be part of the protective response.

Nociceptive pain might be described as sharp, aching, throbbing or sore.

But remember:

The way pain FEELS does not, by itself, tell us exactly what is causing it.

NEUROPATHIC PAIN

Now we’re talking about something different.

Neuropathic pain is pain caused by a lesion or disease affecting the somatosensory nervous system itself.

In other words, the nerve — or another part of the sensory nervous system — is involved.

People may describe sensations such as:

• burning• shooting• tingling• electric-shock-like sensations• numbness• or pain from very light touch

Examples can include diabetic neuropathy, pain following shingles, or some cases involving nerve-root irritation.

But this part is important:

“Burning” or “tingling” does NOT automatically mean someone has neuropathic pain.

IASP specifically cautions that symptoms or signs alone are not enough to establish neuropathic pain.

Those sensations can provide clues.

They are not a diagnosis.

NOCIPLASTIC PAIN

This is probably the term fewer people have heard before.

Nociplastic pain arises from altered nociception when there is no clear evidence that ongoing tissue damage or a lesion or disease of the somatosensory nervous system fully explains the pain.

Fibromyalgia is one condition commonly discussed in connection with nociplastic pain.

Some people with chronic low-back pain may also have nociplastic features.

And this brings us right back to POST 1:

Someone can experience very real pain even when the amount of identifiable tissue or nerve damage does not fully explain the intensity or persistence of that pain.

That does NOT make the pain imaginary.

The pain is still real.

AND HERE’S WHERE IT GETS EVEN MORE INTERESTING…

These are not necessarily three perfectly separate boxes.

One person can have MORE THAN ONE pain mechanism occurring at the same time. IASP specifically recognizes that combinations of nociceptive, neuropathic and nociplastic pain can occur.

So someone with chronic low-back pain, for example, might have:

nociceptive input from tissues,

neuropathic pain involving a nerve,

nociplastic features involving altered pain processing,

or some combination of them.

SO WHAT ABOUT “ACUTE” AND “CHRONIC” PAIN?

Those words answer a different question.

They primarily describe the DURATION or course of pain rather than the mechanism producing it.

So:

CHRONIC PAIN does not automatically mean NOCIPLASTIC PAIN.

And:

ACUTE PAIN does not automatically mean NOCICEPTIVE PAIN.

Different ways of classifying pain tell us different things.

And honestly, this is where some of those colorful “What type of pain do you have?” infographics on the internet can get people into trouble. 😅

WHY DOES THIS MATTER FOR MASSAGE THERAPY?

Because:

“My back hurts.”

“My shoulder hurts.”

“My leg hurts.”

…doesn't tell a massage therapist WHY it hurts.

And different pain mechanisms should not automatically be approached as though they are the same thing.

As a massage therapist, my role is NOT to diagnose someone as having nociceptive, neuropathic or nociplastic pain.

But understanding that these distinctions exist absolutely matters.

It affects the questions we ask.

It affects how cautiously we approach treatment.

It helps us recognize when massage may reasonably be part of someone’s care — and when symptoms suggest another healthcare professional needs to be involved.

And it helps us avoid one of the easiest traps in massage therapy:

“It hurts, therefore a muscle must be tight.”

Human beings are considerably more complicated than that. 😂

POST 2 TAKEAWAY:

NOCICEPTIVE PAIN involves actual or threatened damage to non-neural tissue.

NEUROPATHIC PAIN involves a lesion or disease affecting the somatosensory nervous system.

NOCIPLASTIC PAIN involves altered nociception when tissue damage or nerve disease does not adequately explain the pain.

And one person can experience MORE THAN ONE mechanism at the same time.

NEXT UP:

POST 3 — BACK PAIN

“My lower back hurts” sounds straightforward.

It really, really isn’t. 😅

We’ll look at why low-back pain can be so difficult to pin down — and what the research actually says about where massage therapy may fit.

Malaika Ray-Lewis, LMT Tranquil Touch by Malaika

Sources: International Association for the Study of Pain (IASP); National Institute of Neurological Disorders and Stroke (NINDS).