Different Ways to Categorise Pain
Did you know there's all sorts of different types of pain? I bet you've only ever thought about pain, as in how it feels to experience it. I know I used to.
If someone asked me what type of pain I had, I would describe it as either sharp or dull etc. But actually, people that study pain, scientists and medical professionals, have a lot of different ways of talking about pain.
I'm going to try to explain them. Because if we know more about this, it gives us a better chance at knowing what we need to do to get out of pain when we experience it. And that can’t be a bad thing, can it?
There are different ways to categorise pain. Either by what causes it (nociceptive, neuropathic, or psychogenic), the length of time we've had pain (chronic or acute), or how it feels (subjective). Let’s start with the one we know.
Subjective Pain (How Pain Feels)
The one we all know instinctively is how pain feels, right? Well actually that isn’t as easy as it sounds. How do you know if your version of an 8 out of 10 stabbing pain in your back, is the same as someone else’s?
Pain is not a fixed entity. It is an emotional, subjective experience. This means it is highly personal. And the language we use to describe it also depends on the individual and their previous knowledge. So, two people could experience the same event that logically would cause the same pain, but they would each feel it and respond to it differently.
Then to further complicate things. It would also depend on their current situation as well. If one person was feeling stressed when it happened and the other more relaxed, then the person who was more relaxed would experience less subjective pain. Argh! How does that work?? Well, it’s to do with endorphins (more about them another day).
Suffice to say describing pain subjectively is instinctive but does little to tell us about the cause of the pain and, more importantly, what to do about it.
So, let’s look at the potential causes then.
Nociceptive, Neuropathic, or Psychogenic Pain (How Pain is Caused)
Argh…medical jargon. Don’t panic I’m going to simplify it.
Basically, Nociceptive Pain means anything that is sensed by the nervous system as harmful or even potentially harmful to us physically. So, this could be a broken bone, poisonous substance, hot surface, etc.
Once sensed by the nociceptors they alert us to the potential harm by creating a physical sensation that we experience as unpleasant (pain). This encourages us to withdraw or avoid further contact with the harmful stimulus.
For example, if you go to take a mouthful of dinner and suddenly experience a clenching of your stomach and feel nauseous. This can be nociceptive pain alerting you that the meat is off and is potentially harmful. If you continue to eat it you could become very sick.
Neuropathic Pain is the type of pain caused when the actual nerves have been damaged. This can occur as a result of diabetes, infection, or certain surgical procedures.
An unofficial term that is used to describe pain associated with psychological distress. However, as explained earlier, all pain is a subjective experience. In fact, the definition of pain is:
"An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage,"
(https://pubmed.ncbi.nlm.nih.gov/32694387/ Accessed 17/03/2022)
Therefore, we can assume all pain is psychogenic!
Acute or Chronic Pain (Duration of the Pain)
Acute Pain does not mean intense, or severe as it does in other parts of life. The word ‘acute’ in medicine means sudden onset and of short-term duration. This is an example of how the English language can cause confusion when talking with doctors or other professionals.
Acute Pain can be Nociceptive, Neuropathic, or Psychogenic in origin and will be experienced subjectively, both physically and emotionally.
However, we are all programmed to survive. Our DNA has survived millennia. Humans have an innate power to recover. From the smallest grazed knee to the most horrendous accidents seen on T.V. programs such as 24 hours in A&E, we are miraculous. Our bodies heal themselves. Yes, we sometimes need a helping hand to straighten out the bones, or some antibiotics to fight an infection. But for the most part when we get sick, it is for a limited period of time.
Within a few weeks, or months, depending on the extent of the damage, we recover. The pain is short-lived. It is still extremely unpleasant, but it is normal, and temporary.
Chronic Pain can develop when Acute Pain does not end once the tissue damage or the infection has healed.
There is no consensus on the length of time it takes for Acute Pain to start being called Chronic Pain. Some state 6 weeks, some 8 and others 12.
But what we do know is that Chronic Pain can also develop without an injury or infection. For example, when we feel stressed over a long period of time, or have endured a traumatic event, then our nervous system becomes sensitized to further stress, and we can become psychologically and biologically reactive to it. Thus, we can enter a Flight/Fight state with a minimal trigger.
This means our system operates with additional cortisol and adrenaline which can have further effects on your physiology e.g., the immune system, and inflammatory processes which in turn can cause more pain, frequent infections, and discomfort. And these add to Chronic Pain and symptoms.
So Chronic Pain (long-term) is proceeded by a period of Acute Pain (up to 3-months). And can be initiated by Nociceptive (body), Neuropathic (nerve), or Psychogenic (psychological) Pain. And can be maintained by further Psychogenic Pain experienced subjectively, both physically and emotionally.
Why Does it Matter
Knowing about the different types of pain, and how they can contribute to our Chronic Pain, helps us see a way to heal.
When we understand that however the Chronic Pain started, via the body, nerves, or psychologically, the route to pain relief starts the same. We need to find ways to calm the nervous system to reduce the additional cortisol and adrenaline we release into our blood stream.
If you would like to start now, CLICK HERE for my guide to Calming Techniques.