Palliative Care: Nociceptive & Neuropathic Pain Types
Pain is a protective factor; a signal in a person’s nervous system indicating potential or actual damage1,2. Pain is subjective, and each person feels pain differently, even if the reason for the pain is the same2. Understanding a person’s pain type can help us know how best to treat it.
Acute pain is short term, less than 3 months, and is usually caused by injury or illness 1,2. Acute pain is the result of injury to the body stimulating local nociceptors and innervation of the nervous system 1,2. It can develop into chronic, persistent pain if not treated in the acute phase appropriately 1,2.
Chronic pain is greater than 3 months 2. It may have an underlying pathology that does not explain the presence or severity of the pain1. It can be caused by changes in the peripheral or central nervous system when neurochemical and structural changes begin to take place in the body’s pain pathways 1,2.
Nociceptive Pain
Caused by the stimulation of free nerve endings by noxious stimuli that follow normal sensory pathways2,3
- Somatic Nociceptive Pain Pain signal originates in the bones, muscles, tendons, joint. Described as: well localized, tender to touch, gnawing, aching, throbbing, cramping, sore, sharp2,3
- Visceral Nociceptive Pain Pain signal originates from stretching or distension. Found in organs and deep tissue/ viscera caused by stretching or distention of viscera, peritoneum/pleural cavity, injury to organs deep tissues, referred pain to different regions. The following visceral organs can cause referred pain: liver and gallbladder; small intestines; ovaries; appendix; ureter; lung and diaphragm; heart; stomach; pancreas; colon; urinary bladder & kidneys1,2,3
Described as: diffuse, hard to localize, radiates- pain is felt elsewhere or in another part of the body, band like pain, colicky pain1,2,3
Neuropathic Pain
An abnormal processing of sensory input within the nervous system. Neuropathic pain occurs as a result of nerve cell damage to some part of the nerve pathway, peripheral or central (by pressure, invasion or destruction of peripheral or central nervous tissues) or changes that occur in the pain pathways when a source of pain continues unabated (continuous noxious stimuli). Neuropathic pain can be categorized into two types which are neuralgic or dysesthetic 1,2,3.
- Neuralgic Neuropathic Pain Described as: shooting, stabbing, intermittent electric shocks, or pins and needles1,2,3.
- Dysesthetic Neuropathic Pain Described as: burning or sensation changes such as numbness and touch perception changes1,2,3.
- Mixed Dysesthetic and Neuralgic Pain: Elements of both types 1,2,3
Resources
- The Pallium Palliative Pocketbook (E-book): a peer-reviewed, referenced resource. 2nd Cdn ed. Ottawa, Canada. Pallium Canada, 2020.
- HPC Consultation Services of WW LHIN (2019). Effective pain management: a palliative approach.
- Health Canada. (2019). Chronic Pain in Canada: Laying a Foundation for Action: A report by the Canadian Pain Task Force. Ottawa, Canada.
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