4 types of pain and how to manage

Muscle and Joint


Owen Wiseman
@AVogel_ca


07 March 2019

What causes me to feel pain?

Pain is simply a response to a strong, potentially harmful stimuli that may cause damage to the tissue. When a sensation threatens tissue, free nerve endings pick up the signal and this is transmitted to the brain and converted into a pain signal.

What sort of stimuli will cause me to experience pain?

The receptors in the layers of tissue respond to mostly three categories of stimuli:

 

  • Chemical – This form of pain is associated with the inflammatory response, a complex chemical cascade meant to aide tissue damage by releasing an array of molecules. It often has a constant, throbbing quality and doesn’t change with motion.
  • Mechanical – Any stress placed on tissue or a joint may cause mechanical pain, such as trying to bend a part of the body past the appropriate range of motion. You can create this sort of pain by bending your fingers back, but when you remove the stretch, the pain disappears. A quality that defines mechanical pain.
  • Thermal - Free nerve endings are very adept at picking up changes in temperature and responding quickly. There are fibers that respond to sensations of hot and others that respond to cold. They send warning signals to the brain to do something about the change in temperature as extremes engage the pain system, something the term ‘biting cold’ or ‘blistering heat’ describe quite accurately!

Are there different types of pain?

  • Cutaneous – as you might have already guessed, this category refers to pain arising from the skin and subcutaneous tissue. It often has a burning or prickling quality to it.
  • Deep – this form is structures deeper to the skin such as tendons, ligaments, and muscles. For example, if you were to have a muscle spasm, sprain an ankle, or fracture a bone, the descriptor that comes to mind is that it’s a, “deep pain doc”. The quality is often achy with difficulty if we try and pinpoint the location.
  • Visceral – from the Latin viscera, the plural form of viscus meaning “internal organs”. This form of organ pain has a variety of causes, but most often occurs due to inadequate blood supply. A hollow organ such as the intestines may experience a strong spasm, a part such as the urinary bladder may become over-stretched, or a blood clot may form. The organs are also very sensitive to chemical irritation such as a perforated ulcer in the stomach lining that allows stomach acid to eat away at other tissues.

What about when I feel pain, but there’s nothing there?

A fourth type of pain can be deceiving in the case of referred pain. This form is when pain is experienced at a site away from where the pathology or injury actually lies. This type of pain is often associated with visceral pain. The organs are supplied by nerves, and when they become irritated, the signal travels along the nerve allowing pain to show up in a variety of locations along that pathway.

 

With advancements in medicine, physicians and researchers are starting to understand these pathways far better than before. For example, researchers are now familiar with gall bladder pain referring to the right shoulder, or how cardiac pain may refer to the jaw or left arm. Now, before you go playing detective and self-diagnosing the unexplained pain in your right shoulder or jaw, speak to your primary care provider.

Are there any other symptoms that accompany pain that I should be aware of?

Pain itself is often accompanied by two friends known as hyperalgesia and allodynia.

Hyperalgesia means the tissue becomes more sensitive to pain while allodynia means a painful response occurs to something that is normally considered painless such as a soft poke. These are protective mechanisms to ensure no further damage is done while the body focuses on healing the already injured tissue. In response, you find yourself being more careful with the sensitized area and when it’s healed, you can go back to your normal way of living.

How can I manage the different types of pain?

Treating cutaneous pain depends on the extent and severity of the injury and could involve anything from burns to simple cuts. The focus should be on reducing inflammation and controlling the cause of the pain.

Deep pain might be treated using the principle of RICE - rest, immobilize, cold, and elevate. It’s important to put cold on an acute injury to prevent swelling, rest and reduce movement to allow the injury time to heal, and elevate the injury to reduce too much blood flow and prevent leakage. Finally, visceral pain takes a more involved approach such as reducing nerve compression and identifying the cause. The approach to this type of pain will involve working closely with your primary care provider.

An herb known as Harpagophytum procumbens, in layman’s terms known as Devil’s Claw, is a species native to south Africa. The harpagosides, the active constituent of the plant act as an anti-inflammatory and can be taken internally in conjunction with a topical application of Arnica.

Products such as Joint Pain Relief tablets can provide this benefit, but the European Medicines Agency notes that it could take 2-3 months to notice significant benefits as the harpagosides accumulate in the tissues of the body with patients noticing decreased pain and increased joint mobility.

References

https://www.ema.europa.eu/documents/herbal-report/final-assessment-report-harpagophytum-procumbens-dc/harpagophytum-zeyheri-decne-radix_en.pdf

https://www.ncbi.nlm.nih.gov/pubmed/22940241

https://www.ncbi.nlm.nih.gov/pubmed/26119468

https://www.ncbi.nlm.nih.gov/pubmed/28275210

 

 

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