NOCICEPTIVE PAIN

Nociceptive pain is pain that occurs when nociceptors are stimulated. This is normal pain in response to injury of the body. This is the type of pain that prevents us from using injured body parts and extending the injury further. If a broken arm did not cause pain and we kept using it, we would damage the limb further and prevent proper healing. People with illnesses that prevent nociceptors from operating properly, such as Hanson's Disease patients, cause traumatic injuries that can become quite extensive. In the same way, we can exploit medications, such as local anesthetics, that temporarily eliminate nociceptor response to perform surgery, do dental work or allow manipulation of injured tissue, without causing pain.

In chronic pain, nociceptive pain can become a significant problem. In a chronically injured joint or a painfully degenerative disc, every time the area is moved, pain can be excrutiating. This occurs even if no further damage is going to occur from this type of movement, because the body cannot distinguish from nociceptive pain that will extend injury and that which will not cause further damage. The resultant disuse of a painful part of the body can cause further problems such as atrophy, frozen joints, osteoporosis and weakness. Additionally chronic nociceptive pain can lead to wind-up pain and other forms of central sensitization. Psychological and social adjustments occur, with phobic fears of jostling, social withdrawal, depression and anxiety.

Treatment of nociceptive pain usually follows from least to most. This can involve immobilization of an injured site with follow up physical therapy. Adding acetaminophen, an anti-inflammatory, or short acting opioids can often be helpful, especially early on in the course of injury. If the injury is chronic NSAIDs can be helpful and the use of long acting opioids can be quite effective. In fact, the combination of NSAIDs and a long acting opioid is synergistic and represents an excellent treatment strategy for chronic nociceptive pain. Regional nerve blocks and epidurals can help a great deal, both diagnostically and therapeutically. At times surgery is necessary to internally fixate or remove the injured tissue.