Table of Contents

Pain types

   Nociceptive

   Neuropathic

   Nociplastic

Pain and expectation

Pain is simply a warning from the nervous system

Acute Vs Chronic Pain

   Acute Pain

   Chronic Pain

Neuroplasticity

   Rubber hand illusion

Understanding Nociplastic Pain

References

Pain types

Nociceptive

Actual or potential damage detected by the sensory receptors (nociceptors) in our tissues (skin, muscles, tendons, fascia, ligaments, discs, and organs) causing pain.

Dr Mike explains the physiology of nociception very well in this 2 min video:

https://www.youtube.com/watch?v=RD6QY5KWiko

Neuropathic

Damage, dysfunction, or disease of the nervous system (nerves, spinal cord and brain) causing pain.

Nociplastic

Also called central sensitisation. Pain that arises with no clear evidence of actual or potential tissue damage. Pain arising from a sensitised (overactive) nervous system.

This is a far more complicated form of pain that will be discussed in greater detail below…

Pain and expectation

Brain scans show that the frontal cortex lights up when pain is experienced, meaning this area of the brain is involved in the pain experience.

This area of the brain is also responsible for setting expectations. Therefore, expectation plays a big role in our perception of pain.

E.g. if you’re told that getting your ears pierced is going to be incredibly painful, you’re likely to experience exactly that. However, the reverse is also true.

Pain is simply a warning from the nervous system

It’s a protective mechanism that allows us to act to avoid harm.

So, anything that appears dangerous or potentially damaging to our bodies can cause pain, even if there is no physical damage.

Chronic Pain

Chronic pain is an umbrella term for a variety of long-term painful conditions. It used to be defined as any persistent or recurrent pain lasting more than 3 months. More recent research has established that the classification of Chronic pain is far more complicated than this. 

To try and put it simply:

• Acute pain is biological in nature and is a proportional reaction to actual or potential tissue damage.
• While chronic pain may or may not have an initial mechanism of injury.

If there was initially tissue damage, the pain may become recurrent or persistent (outside of normal tissue healing times), due to a variety of biological, psychological, or social factors. If there was not initial tissue damage, there was likely some other form of trigger, either; biological (e.g. infection), psychological (e.g. traumatic event), or social (e.g. loss of job) in nature.

Neuroplasticity

This is a big confusing word that simply means our brains are capable of changing/rewiring themselves. Our brains use our senses (touch, vision, taste, smell, hearing) as well as our thoughts and feelings to gather information and adapt to the world around us.

Rubber hand illusion

The video below demonstrates how flexible our mind is when it comes to touch sensation. Research has proven that this can also be replicated with painful sensations (e.g. a needle in the rubber hand).

Watch here: https://www.youtube.com/watch?v=sxwn1w7MJvk

Understanding Nociplastic Pain

This is the basis for the development of nociplastic pain/central sensitisation. Typically, it starts with some form of trauma, physical or otherwise (as discussed in the “chronic pain” section). When coupled with ongoing “danger signals” whether biological, psychological or social the brain can undergo change that reduces our pain threshold, sensitizing the system to pain signals.

As a result, you may experience;

• Hyperalgesia; increased intensity of pain
• Allodynia; Pain with stimuli that do not warrant pain (e.g. pain with brushing your hand over your skin)