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Neuropathic Pain

Welcome to our blog on understanding your pain problem! In this comprehensive guide, we will explore the different types of pain you may experience – Neuropathic Pain, Nociceptive Pain, and Nociplastic Pain. Identifying the specific nature of your pain is crucial for effective treatment and management. So, let’s delve into each type, gain clarity, and equip ourselves with valuable insights to better comprehend and address our pain concerns. Knowledge is power, and by the end of this blog, you’ll be empowered to navigate your pain journey with confidence. Let’s get started!

Do you know how when you encounter an iceberg, you only see a small portion of it.? There is much more below the surface and hard to comprehend. Chronic Pain conditions are like icebergs. The majority of the time, traditional medicine treats only the tip of the iceberg – the part that is easy to see..

No matter what your diagnosis is – Chronic back pain, fibromyalgia, complex regional pain syndrome, ankle sprain, neck pain, rheumatoid arthritis, chronic fatigue syndrome, or degenerative disc disease – all kinds of painful diagnoses or conditions are divided into 3 types of pain:


Nociceptive pain: from tissue injury
Neuropathic pain: pain from peripheral nerve injury
Nociplastic pain: central nervous system (CNS) dysfunction

Let’s dive deep into each to understand them more.

Nociceptive pain[1]: From Tissue Injury

  • Occurs due to tissue injury. 
  • Can be either mechanical, thermal, or chemical trauma like an ankle sprain, fractures, tendonitis, bursitis, surgery, burns, etc. 

Current health care does a decent job of treating nociceptive pain.

Nociceptive pain due to tissue injury

Most of the time, with proper and timed treatment, nociceptive pain is resolved really quickly. For example, if you fractured a bone, once your bone is stabilized in a cast, brace or surgically with plates and screws, within 2 weeks, the pain subsides even though it will take 3-4 months for the bone to heal. Or if you had surgery, the first 7-10 days, you have severe pain, but each day pain gets better even though the tissue will take a little more time to heal. Even in the most severe conditions, Nociceptive pain gets better within 6 months.

According to Keith Smart, it is 100% likely if a person has the following 4 signs that, it is a Nociceptive pain.

  • Proportionate pain: Mild injury: less pain, Severe injury: more pain
  • Aggravating and easing factors: very specific activity causes the pain, and specific activity relieves the pain. For example, Ankle sprain pain gets worse the more weight you put on it, and there is less pain when you are resting. 
  • Intermittent sharp, dull ache or throb at rest: some pain at rest. 
  • No night pain, dysesthesia, burning, shooting, or electric kind of pain

Neuropathic pain[2]: pain from peripheral nerve injury

There are about 400 nerves in the body. And when they come out of the spinal cord, they pass into tunnels, canals, in between the muscles etc, and spread throughout the body.

When Nerves are compressed, pinched, stretched, torn, or nipped off, they can get inflamed which causes pain. Examples of neuropathic pain are:

  • Peripheral Neuropathy
  • Dorsal root ganglion irritation
  • Nerve injury from falls, fractures, disease, chemotherapy, radiation
  • Nerve radiculopathy – for example, Sciatica.
  • Carpal tunnel syndrome
  • Piriformis syndrome

Neuropathic pain is usually a deep ache, tingling, numbness, or sharp, shooting pain.  Sufferers may have resting pain and night pain as well. Sometimes even after the tissue injury is resolved, a nerve remains “ramped up” because nerves are very delicate and sensitive structures.

Below is an image known as “Harriet”, dissected by a Pennsylvania Anatomy professor in the 1880s. It beautifully shows this intriguing nervous system, is recognized as an important teaching tool, and is still on display at Drexel University, PA.

Nerves usually need three things to be happy and keep you pain-free.

Nerve needs 3 things to relieve neuropathic pain

1)   Space: Nerves exist in tunnels, canals, joints, and foramina between muscles; we call them nerve containers. And when this nerve container gets pinched or squeezed, it causes neuropathic pain. Examples are Carpal Tunnel (an $8B industry in the US!), tarsal tunnel, piriformis syndrome, etc. Sometimes having a brace around the area actually reduces the space around the nerves, making the problem worse.

2)   Blood flow: The entire nervous system requires a lot of blood to function normally. Nervous tissue weighs about 2-3% of the body weight but consumes 20-25% of glucose and oxygen from the blood. They are like bloodthirsty vampires. This is the reason it is important to do aerobic, oxygen-healthy exercises consistently to decrease neuropathic pain.

3) Free Movement:  Nerves are like wet spaghetti; they love to slide and glide. The nerve moves up and down and also moves from side to side. When you bend forward, the dura, a sort of covering over the spinal card, gets extended by 7-10 cm.

Cadaver studies show that when you extend your arm from full flexion, the nerve gets 20% longer. With Carpal Tunnel Syndrome, there is a 30% reduction in longitudinal movement. But remember, nerves like to move – but only to a certain extent.

Nerves can get irritated and block blood flow with over-stretching.

  • 6-8% stretching from its normal length will slow blood flow
  • 15%: stop the blood flow
  • 20%: cells die in the dorsal horn, possibly causing Demyelination or injury to the protective sheath around a nerve.. DON’T BE AGGRESSIVE WITH THE NERVE MOBILIZATION if you are dealing with Neuropathic Pain.

According to Keith Smart, it is 150 times more likely to have Peripheral Neuropathic pain if you have these three signs present: 

  • Pain in the dermatomal or cutaneous distribution:  Pain distributed per nerve distribution, like only the back side of the leg, outside of the arm, and 1-2 fingers. 
  • Positive neurodynamic & palpation (mechanical tests) : When you do a Nerve tension test, it will be positive and nerves are tender where they are superficial in the body
  • History of nerve pathology or compromise.

 

 NOCIPLASTIC PAIN[3]: Central Nervous System (CNS) Dysfunction

Nociplastic pain is usually due to structural and physiological changes in the nerves, spinal cord, and brain from processing the pain for a long time.

Answer this: How do you become good at tennis, piano, and chess?  You practice, right?? Practice makes things perfect, just like most skills in the world. When you repeat certain tasks, it will help to “train” the neural pathways. According to the Hebbian theory,   “Nerves that wire together fire together.”

Hebbian's theory, nerve that fires together, they wire together.

Pain works the same way. The longer you have been in pain, the stronger those neuronal pathways have become. Research has shown there are actual physiological and structural changes in the nerves, spinal cord, and brain from dealing with chronic pain.

Signs and symptoms of Nociplastic pain[3]:

Everything hurts:  Nothing makes it better.

Mirror pain is common:: looking at someone with the same problem causes the pain.

The extreme intensity of the pain: 16/10

Summation and Latency: This doesn’t hurt while doing a task but hurts later.

Lack of stimulus/response consistency: Sometimes you poke, and it hurts, and sometimes it doesn’t.

A wide spread of pain: Starts small and spreads into a neighboring area

Pain has a mind of its own:  one day it’s your neck; one day back, one day shoulder. 

Cyclical and seasonal: usually related to emotional events in life like the anniversary of a divorce/accident/death of a loved one, etc

Traumatic events in life: 30% of people with chronic pain had some kind of trauma in the past, e.g., emotional, physical or sexual abuse.

Decreasing response to the treatment: Initial treatment gives the best relief; the same treatment next time makes the pain worse.

Miracle cures are possible: something significant happens in their life, like getting out of an abusive relationship, a work change, or moving to a different town. This usually happens when people are usually at the end of their rope.

According to Keith Smart:  it is 486 times more likely it is Nociplastic pain if you have the following 4 signs present. 

  • Disproportionate pain: Pain is much more intense as the amount of tissue injury indicates 
  • Disproportionate aggravating and easing factors: even a very small amount of activities causes pain. 
  • Diffuse palpation tenderness:  Tenderness to the touch is present throughout the body. 
  • Psychosocial issues: You’re dealing with fear, anxiety related to injury, financial issues, and high levels of stress. 

What type of pain are you dealing with?

Have you ever experienced persistent pain and not known where it came from or what type of pain you are dealing with? I compiled a bunch of scientific research and put it into a guide with one quiz to help you get some answers.

It will help you to find out what type of pain you are dealing with. Whether you have  Nociceptive pain, Neuropathic pain, or Nociplastic pain, this quiz will tell you your pain problem. If you know what type of pain you are experiencing, you’ll be able to find the right treatment for that pain!

Find out if you have a tissue issue or a neurologic pain problem with the help of the provided guide. Along with that, I’ll give you tips to help you overcome your specific pain condition.

Grab the guide now and then email me and let me know what results you got! The results may surprise you.

Share with someone you know with chronic pain so they too, can find some relief from this debilitating condition. Here is the video explanation of the three types of pain.

References:

[1]Smart, Keith M et al. “Mechanisms-based classifications of musculoskeletal pain: part 1 of 3: symptoms and signs of central sensitization in patients with low back (± leg) pain.” Manual therapy vol. 17,4 (2012): 336-44. doi:10.1016/j.math.2012.03.013

[2]Smart, Keith M et al. “Mechanisms-based classifications of musculoskeletal pain: part 3 of 3: symptoms and signs of nociceptive pain in patients with low back (± leg) pain.” Manual therapy vol. 17,4 (2012): 352-7. doi:10.1016/j.math.2012.03.002

[3]Smart, Keith M et al. “Mechanisms-based classifications of musculoskeletal pain: part 2 of 3: symptoms and signs of peripheral neuropathic pain in patients with low back (± leg) pain.” Manual therapy vol. 17,4 (2012): 345-51. doi:10.1016/j.math.2012.03.003

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