The Difference Between Nociceptive And Neuropathic Pain

The most common form people experience is nociceptive pain, this develops when the nociceptive nerve fibers are triggered by chemicals, inflammation, and physical events such as a dental procedure, sports injury, or stubbing your toe as well as arthritis. 

This type of pain is typically acute and will develop in response to a specific situation and it tends to go away as the affected part of the body heals, such as the pain due to a broken arm getting better as the arm heals. 

Specialized nociceptor nerve cells detect noxious stimuli or things that can damage the body like pressure, pinching, chemicals, and extreme cold/heat to create warning signals that are passed along the nervous system to the brain which results in the nociceptive pain. Additionally, nociceptors are also found within internal organs, but these alarm signals are less easy to pinpoint and may not always be consciously felt. 

Neuropathic pain develops when the nervous system is damaged or not working properly due to disease, deterioration, or injury. This type of pain doesn’t develop in response to any specific circumstance or outside stimulus, and it is not uncommon for people to experience neuropathic pain even when the body part is not there; this is called phantom limb pain which can occur after amputation. 

This type of pain is referred to as nerve pain, it is typically chronic and caused by many different conditions and diseases such as diabetes, stroke, cancer, amputation, cytomegalovirus, and multiple sclerosis. 

An individual can experience both nociceptive and neuropathic pain in the lower back. The “painDETECT questionnaire” diagnostic test was developed to assist doctors in identifying the presence of nociceptive and neuropathic pain in patients with chronic lower back pain which is the most common complain, but in about 90% of the cases doctors are not able to identify a physical cause as often some of the discomfort is neuropathic pain. This test is commonly used to evaluate pain in many different conditions and diseases including rheumatoid arthritis. 

The patient is asked nine questions, seven of which ask the patient to rate different sensations from their pain on a scale of 0-5, as well as how long the pain lasts rated from -1 to +1, and whether or not the pain radiates rated from 0-2. Higher scores may indicate higher levels of neuropathic pain that a patient is likely to be experiencing. 

Those with diabetes are advised to watch for symptoms of neuropathic pain, specifically in the feet as neuropathy in the lower limbs is common among those with diabetes, and it is a leading cause of amputation. Neuropathic pain in those with diabetes often begins with numbness, weakness, or burning in the toes which may get worse at night making it difficult to sleep. 

The most common areas to experience nociceptive pain are in the musculoskeletal system which includes the bones, tendons, joints, muscles, and skin. Internal organs can also be subject to this type of pain such as the heart, lungs, intestines and the smooth muscles. 

Over 1.6 million Americans are estimated to have lost a limb, this number is expected to increase to 3.6 million by 2050 due to vascular problems, cancer, trauma, accidents, and armed conflicts. 42.2-78.8% of those who have had a limb amputated are estimated to suffer from phantom limb pains; this kind of neuropathic pain can develop anywhere a limb has been removed. 

Around half of all people with diabetes will experience diabetic peripheral neuropathy nerve pain affecting the hands and feet, typically the toes are the first part of the body to be affected. Those with diabetes may also develop neuropathy in other parts of the body as well, including near the front of the thighs, near the eyes, and the wrists. 

Cancer patients can also experience neuropathic pain in their legs, chest, shoulders, and back due to tumours affecting the spinal cord. Additionally certain medications and surgery can also cause cancer patients to experience neuropathic pain. 

Such as with the lower back, an individual can experience both nociceptive and neuropathic pain at the same time. Paying attention to differences can help to improve quality of life for those dealing with pain and help to get the right treatment. 

Nociceptive pain can develop at any point on the body in response to trauma or heat and it can have a variety of characteristics; typically this pain is most severe at the time of the injury but it may also be bad first thing after waking up as well as during activity. Treatment varies depending on cause, but this type of pain typically responds well to opiates. 

Those with neuropathic pain typically report numbness, tingling sensations, sharp/shooting/searing/stabbing pains, sensitivity to touch, insensitivity to heat/cold, muscle weakness, and pain worsening at night. It is important to treat the underlying condition with neuropathic pain. Patients should work with their doctors to find medication that may help to control their condition, treatments will vary between individuals and the specific cause of pain.