Basic Types of Pain and Response
posted by : Dr. Barnetton: 23 February, 2019
Nociceptive Pain - Nociceptive pain is presumed to involve direct stimulation of intact mechanical, chemical, or thermal nociceptors and transmission
of electrical signals along normally functioning nerves. It can be subdivided into 2 subgroups: somatic and visceral pain. Somatic pain (e.g., skin, soft tissue, muscle, and bone) is due to stimulation of the somatic nervous system.
Patients may describe this as sharp, aching, and/or throbbing pain that is easily localized. Visceral pain (e.g., cardiac, lung, GI and GU tracts) results from stimulation of the autonomic nervous system. Patients may find this pain difficult to describe or localize. Nociceptive pain generally responds well to opioids and/or non opiate analgesics.
Neuropathic Pain - Neuropathic pain is presumed to result from disordered function of the peripheral or central nervous system due to any of many potential causes. There are varied subtypes, including those sustained by peripheral processes (e.g., painful neuroma), those sustained by CNS processes (e.g., phantom pain), and complex regional pain syndromes (previously referred to as causalgia or reflex sympathetic dystrophies). These pains can also be classified by syndrome (e.g., malignant plexopathy, painful polyneuropathy, phantom pain, postherpetic neuropathy, etc.).
Patients tend to describe neuropathic pain with words like burning, tingling, numbness, shooting, stabbing, or electric-like feelings. Although neuropathic pain may respond well to opioids, it is usually considered generally nonresponsive to Opiates requiring adjuvant analgesics (tricyclic antidepressants, anticonvulsants, etc) to achieve adequate relief.
Regardless of the source and type of pain, it goes without saying that a multifaceted approach after discerning the origin of the pain, combining all aspects of care is the best treatment plan. The designs of my treatment plans are twofold: help to increase function and decrease dependence on medications.
My practice focuses on the Interventional side of Pain Management. I do have some patients on low dose narcotics as well as non-opiates and adjuvants. I utilize nerve blockade, spine and joint injections, nerve ablation, Kyphoplasty, Medtronic Spinal Cord Stimulators and Intrathecal Medication Delivery Systems.