What is pain?

You might feel pain in various parts of your body, but did you know that pain is always produced in the brain not the part of the body that hurts? Body parts can only send messages that something is wrong (known as nociception), the brain must interpret that message and sometimes it creates the experience of pain. Here we learn about nociceptive pain (healthy pain), neuropathic pain (pain from damaged nerves), and nociplastic pain (pain created mostly in the central nervous system). Treatment can look very different depending upon which type or types of pain you are experiencing.

Pain Mechanisms

There are three mechanisms that can give rise to the perception of pain. Below is a description of each type of pain.

Nociceptive pain

Nociceptive pain is an example of the body’s pain mechanism working properly and adaptively. It warns you of threat and danger. Examples include pain stemming from acute injury, pain after surgery, and pain associated with tumors. Short-term inflammatory pain is another example of adaptive pain, where the immune system warns of danger by causing inflammation which can be interpreted by the brain as being painful. Most forms of nociceptive pain are short lived and serve a motivational function to urge you to act in accordance with health, safety, and survival.

Neuropathic pain

Neuropathic pain refers to pain associated with damage to either the peripheral or central nervous system. These nervous systems help take nociceptive messages from a site of injury to the brain. If the nerves carrying messages to the brain get damaged, they may fire excessively or in abnormal patterns. The excessive firing or abnormal firing patterns can be interpreted by the brain as sharp or burning pain. Neuropathic pain is a pain disorder that has lost its adaptive function. Examples include diabetic neuropathy, severed nerves, and nerve damage to the brain or spinal cord.

Nociplastic pain

Nociplastic pain or “centrally augmented pain” is a disorder of how the brain processes nociceptive signals. In such cases, non-nociceptive or minimally nociceptive signals from the body can become augmented by the brain leading to the production of a painful experience. It should be noted that pain experienced in response to an injury is indistinguishable from pain associated with central augmentation. Both are “real” forms of pain and both can result in comparable levels of suffering. Many factors can contribute to central pain augmentation including genetics, infections, hormonal abnormalities, physical and/or psychological trauma, repetitive injuries, and sustained physical/psychological stress. Examples of conditions thought to be associated with augmented pain processing include fibromyalgia, some forms of low back pain, and some forms of headache.

Approaches to Pain Management

Doctors and other professionals can use procedures, therapies, medications, and devices to help you modify how the brain processes pain; but the person with the best access to your brain -is you. Thus the best approach for managing chronic pain is a partnership between what your doctor can do (i.e., professional care) and what you can do (i.e., self-care). Current approaches to chronic pain management follow a step-by-step algorithm that personalizes treatment to the type of pain you are experiencing at any given time. Below is an example of this step by step approach.

• Diagnosis. Chronic pain management starts with careful diagnostics of what type or types of pain you are experiencing.
• Education and Self-Care. Self-management is the foundation of optimal pain care because it can directly impact how your brain produces the experience of pain. Pain Guide is a resource that offers instruction for using many different self-management techniques each of which have been demonstrated to influence how the brain forms the experience of pain.
• Professional Care. In addition to self-management, your doctor may want to include professional care such as medications, professional therapies, devices, and procedures. These approaches can also work to influence the perception of pain. Pain Guide provides a description of various professional care options so that you can have an informed conversation with your health care provider to determine what combinations of self-care and professional care are right for you.