Types of Pain and Pain Management

Posted by Nurse Linda in Daily Dose on September 29, 2022 # Health

brainPain is a significant issue for those with neurological disease and injury. In particular, is neuropathic pain; however, there are other pain issues as well. Each type of pain comes from different sources requiring different treatments. Pain is a body protection mechanism that indicates something is wrong as a signal to take action to correct the issue.

Globally in the body, pain is classified in different ways. Pain throughout the body is organized as acute, chronic, or emotional.

Acute pain occurs from a sudden onset. It can last for a few seconds or longer if not corrected. Acute pain can occur anywhere in the body. It can be minor, requiring no treatment as it resolves quickly or may be treated with medication for pain such as aspirin, acetaminophen, or non-steroidal anti-inflammatory drugs (NSAIDS). Sometimes, other medications will be used to treat the underlying cause of pain, such as an antibiotic for an infection, reducing the pain source. Opioids are avoided due to addiction issues. Examples of acute pain are wide-ranging but can include injuries such as cuts, muscle aches, toothache, a broken bone, or infection, to name just a few. Surgical pain and childbirth are examples of acute pain because it resolves over time.

Chronic pain is pain that lasts over three months, even with medication treatment. Treatment for chronic pain varies by type of injury. Medication may be needed. Some individuals opt for treatments that may include slow, gentle movement, neuromuscular stimulation, injections at the site of the pain, acupuncture, cognitive behavioral therapy, or in extreme cases, surgery. Chronic pain typically results from chronic medical conditions such as diabetes, arthritis, back pain, or neurological issues.

Emotional pain is often overlooked as a painful experience but is very much a pain issue. It can be acute or chronic. When circumstances affect mental well-being, the body releases hormones that put people into flight or fight mode. This causes the body to tense and increases anxiety, leading to feeling unwell. If you have ever had your feelings hurt, you have experienced emotional pain. Chronic physical pain can lead to emotional pain. Some effects of mental challenges can make a person ache all over or in specific areas, such as a headache, muscle aches such as across the shoulders, jaw, or other body areas, or depression. The goal is to uncover the source of the emotional pain so the underlying issue can be addressed while providing treatment to reduce the symptoms.

Physiologically, pain has different classifications. Even though these processes often overlap, they are differentiated for ease of understanding.

Nociceptive pain occurs in the organs and tissues of the body. Something in the body is disturbed, which is reported to the brain by body nociceptors (sensory pain receptors) for adjustment or to get further help. This type of pain can be acute or chronic. It can change with body movements such as moving your body to reduce discomfort, positioning by changing your location in space to reduce the force on the area, and load, such as reducing the amount of work the body is doing in the nociceptive pain area (as in taking pressure off of a boney prominence to let blood flow through the arteries to reduce the risk of pressure injury).

Individuals with neurological issues may encounter nociceptive pain as muscular pain at the zone of transition. This is where the part of the body that is not affected by paralysis is working overtime to accommodate the part of the body that is affected by paralysis. Or there may not be protective mechanisms of nociceptive pain, such as not feeling a body part trapped or fallen.

Treatment of nociceptive pain is provided to the underlying source of the pain. This might involve movement, medications, physical therapy, electrical stimulation, nerve blocks, acupuncture, yoga, or surgery. Often, the pain reduces as the area heals with the resolution of the underlying issue.

Neuropathic pain is pain directly from a nerve. It is a pain in your nervous system. Neuropathic pain generally appears from damage to your nervous system. This includes brain injury (traumatic or stroke), spinal cord injury from trauma or disease, or other neurological issues that affect your nervous system, such as multiple sclerosis, diabetes, alcoholism, amputation, shingles, and tumor, among diseases. In addition, some chemotherapy drugs can affect the nerves. The nerve can also be compressed in issues such as carpal tunnel syndrome or at other nerve compression pressure points.

Neuropathic pain can present in various ways. It may be spontaneous as numbness, tingling, shooting pain, burning, or other pains. It may appear as an overreaction to normal stimuli such as extreme pain reactions from cold or warmth, or even a gentle touch. Neuropathic pain can also be an underreaction to something painful. It can lead to mental fatigue.

Treatment is required for neuropathic pain. This may include physical therapy to strengthen and stretch the area. Provision of adaptive equipment to enhance function and safety. Psychological interventions to improve coping, sleep, and mental wellness.

Medications created specifically to treat nerve pain are gabapentin and pregabalin. Modified dosages of medications that treat seizures are also effective, including topiramate, carbamazepine, and lamotrigine. Antidepressants in low doses are also useful, including amitriptyline, nortriptyline, venlafaxine, and duloxetine. Analgesic skin patches placed on specific areas where neuropathic pain occurs have aided in pain control. Nerve blocks with medication injected into the area of concern are a higher level of treatment. Other higher-level treatments are spinal cord stimulators, peripheral nerve stimulators, and brain stimulation.

Nociplastic pain is caused by ongoing or continuous nerve damage to nerves and tissues. Pain researchers have developed this new term. Nociplastic pain is multifocal, widespread, and intense. It appears in individuals with a combination of nociceptive and neuropathic pain. The hallmark example of nociplastic pain is the disease, fibromyalgia, but it also may play a part in tension headaches and low back pain. Unfortunately, the treatment of neuropathic pain does not always work in this diagnosis. More research and development of treatment protocols are underway. This new classification will stimulate the development of new treatments that will assist these groups of individuals who have not had many options.

Some pain control strategies:

Medications work differently for different people. Adjusting pain medication is a process. Some medications can take up to six weeks to see comfort.

Your healthcare provider has information about the best medication to treat your type of pain. However, if the prescription is not working, talk to your healthcare provider about changing dosages to trying something else.

Pain medications absolutely must be weaned off. Never just stop your pain medication. Get a schedule from your healthcare provider. Suddenly stopping or stopping ‘cold turkey’ leads to withdrawal symptoms, increases your pain, and makes it far more difficult to start a new pain medication.

Use gentle exercise to help reduce your pain. Quick, jerky, strenuous exercise will increase your pain, but gently moving can greatly reduce pain.

Try swimming or aquatic therapy for pain reduction.

Try electrical stimulation, biofeedback, acupuncture, meditation, and yoga for pain control.

Control of pain is a challenging process. Because most of us are accustomed to having pain, receiving treatment, and then feeling better, it can be difficult to understand the challenges of these chronic pain situations. Pain is a unique situation in each of our unique bodies.

Pediatric Consideration:

Pain in children can be difficult to understand. Some children have had pain for so long, or it has come on so slowly that they think it is just life. They may not recognize that something is not right. They may not have the communication skills developed to let you know about their pain. Watching for changes in temperament, behavior, guarding part of their body, and not sleeping or eating can all be signs of pain in children. You know your child best. If something has changed, investigate with their healthcare provider.

Linda Schultz is a leader, teacher, and provider of rehabilitation nursing for over 30 years. In fact, Nurse Linda worked closely with Christopher Reeve on his recovery and has been advocating for the Reeve Foundation ever since.

The National Paralysis Resource Center website is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $8,700,000 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.