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Reviewing 3 Pathophysiologic Types of Chronic Pain

Reviewing 3 Pathophysiologic Types of Chronic Pain

Clinicians commonly evaluate patients for the cause of chronic pain but do not always diagnose the type of pain. The pathophysiology of pain, if accurately determined, can help in the selection of appropriate treatment.1

Three main types of pathophysiology can be considered to result in pain in the majority of patients: nociceptive pain, neuropathic pain, and sensory hypersensitivity. It is important to recognize that multiple pain conditions may coexist, and chronic pain may change over time.1

Reference

  1. Phillips K, Clauw DJ. Central pain mechanisms in chronic pain states—maybe it is all in their head. Best Pract Res Clin Rheumatol. 2011;25(2):141-154. PMID: 22094191

Nociceptive Pain

Pain related to the damage of somatic or visceral tissue, due to trauma or inflammation, is called nociceptive pain.1 In nociceptive pain, the pain originates from outside of the nervous system, and the nerve cells transmitting the pain impulses are believed to be functioning normally.

Nociceptive pain can be acute—such as that associated with trauma, burns, or surgery—or chronic. Examples of chronic nociceptive pain, meaning pain lasting 3 months or longer, include rheumatoid arthritis, osteoarthritis, and gout.1,2 Patients often describe nociceptive pain as sharp or throbbing. It is usually well localized.2

References

  1. Phillips K, Clauw DJ. Central pain mechanisms in chronic pain states—maybe it is all in their head. Best Pract Res Clin Rheumatol. 2011;25(2):141-154. PMID: 22094191
  2. Mirchandani A, Saleeb M, Sinatra R. Acute and chronic mechanisms of pain. In: Vadivelu N, Urman RD, Hines RL, eds. Essentials of Pain Management. New York, NY: Springer Science + Business Media; 2011:45-54.

Neuropathic Pain

Pain related to the damage of peripheral or central nerves represents neuropathic pain. Painful diabetic peripheral neuropathy and postherpetic neuralgia are classic examples.1

Neuropathic pain may be burning, lancinating, or electric.1 Patients with neuropathic pain may experience allodynia (pain resulting from a nonpainful stimulus, such as a light touch) and hyperalgesia (increased sensitivity to a typically painful stimulus).2

References

  1. Mirchandani A, Saleeb M, Sinatra R. Acute and chronic mechanisms of pain. In: Vadivelu N, Urman RD, Hines RL, eds. Essentials of Pain Management. New York, NY: Springer Science + Business Media; 2011:45-54.
  2. Phillips K, Clauw DJ. Central pain mechanisms in chronic pain states—maybe it is all in their head. Best Pract Res Clin Rheumatol. 2011;25(2):141-154. PMID: 22094191

Sensory Hypersensitivity

Pain in the absence of identifiable damage to nerves or other tissues1 represents a type of pain that may be called sensory hypersensitivity. This type of pain is hypothesized to be the result of persistent neuronal dysregulation or dysfunction. An example of sensory hypersensitivity is fibromyalgia.1

Patients with sensory hypersensitivity may experience allodynia (pain resulting from a nonpainful stimulus, such as a light touch) and hyperalgesia (increased sensitivity to a typically painful stimulus).1

Reference

  1. Phillips K, Clauw DJ. Central pain mechanisms in chronic pain states—maybe it is all in their head. Best Pract Res Clin Rheumatol. 2011;25(2):141-154. PMID: 22094191