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Understanding Nociceptive Chronic Pain: A Comprehensive Guide 2024

Key Takeaways

  • Nociceptive chronic pain is chronic pain that is associated with ongoing tissue damage, due to a disease process, inflammation or injury
  • Also called Chronic Secondary Pain.
  • Nociceptive chronic pain is akin to acute pain that happens every day.

What is Nociceptive Chronic Pain?

Living with chronic pain is a trial both overwhelming and isolating. Nociceptive chronic pain, often termed chronic secondary pain, is a type of chronic pain that is related to the activation of nociceptors and involves ongoing tissue damage. In this detailed exploration, we cut through the medical jargon to provide valuable insights and strategies for managing this relentless companion.

Nociceptive chronic pain is one of several chronic pain types that individuals endure, each characterized by unique underlying mechanisms and therapeutic nuances. Its distinction from neuropathic chronic pain and nociplastic chronic pain is crucial for accurate diagnosis and tailored treatment plans.

Nociceptive chronic pain
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Symptoms of Nociceptive Chronic Pain

The common definition of ‘chronic pain’ is pain that persists long after an injury has healed but this is NOT the case with nociceptive chronic pain. Like acute nociceptive pain, in chronic nociceptive pain there is ongoing tissue damage which drives the pain experience. Chronic nociceptive pain is best thought of as acute pain that happens every day and should be treated as such. This is very different to chronic nociplastic pain, which is due to dysfunction of the central nervous system and the faulty processing of pain signals.

Nociceptive pain often feels sharp, aching, or throbbing. People commonly experience nociceptive pain in the musculoskeletal system, which includes the joints, muscles, skin, tendons, and bone. Common types of nociceptive chronic pain include osteoarthritis, inflammatory arthritis, bursitis or ongoing injuries, like rotator cuff tears, or plantar fasciitis.

Chronic nociceptive pain is often related to inflammatory or autoimmune diseases or cancer. It is also called chronic secondary pain. This is because the pain is secondary to an ongoing disease process or injury. There are a great many diseases that can cause ongoing, nociceptive pain and the pain can be mild, moderate or severe.

Symptoms commonly described include:

  • Sharp, throbbing or deep aching pain:  The pain is usually well-localised and remains in the same body area or part, and does not move around. 
  • Soreness: Muscles and soft tissues around the affected area feel tender or overworked.
  • Stiffness: Reduced mobility and a sensation of stiffness or rigidity in the affected joint or body part.

The persistence and severity of these symptoms can lead to significant disruptions in daily life, impacting work, social activities, and mental well-being.

How Nociceptive Chronic Pain is Diagnosed

Accurate diagnosis is the lynchpin of effective nociceptive chronic pain management. Traditionally, diagnosis is carried out through a detailed history and physical examination. Medical imaging or other diagnostic tests may be necessary to confirm findings and rule out other potential causes of chronic pain.

In evaluating chronic pain, doctors look for the primary site of the pain and the tissue that gives rise to it—muscle, bone, or visceral organs—indicative of a peripheral source. This often leads to findings such as inflammation, necrosis, altered vascular flow, or direct physical injury.

Nociceptive chronic pain is primarily biological/structural/pathological but may be influenced or amplified be a range of psychosocial factors. The underlying structural cause of the pain must never be discounted, however, and therapy must be directed at the structural cause of the pain.

Treatment

Multidisciplinary treatments tends to have the best outcomes in nociceptive chronic pain, which often means using a range of treatment modalities, both pharmacological and non-pharmacological.

Non-Pharmacological Therapies

Non-pharmacological interventions are first line treatments in the management of nociceptive chronic pain, targeting sources external to the nervous system. These approaches can be quite effective and have the added bonus of avoiding the risks associated with long-term medication use.

  • Physical Therapy: Exercises and techniques to improve strength, flexibility, and reduce pain.
  • Occupational Therapy: Focused on adapting the environment and daily activities to minimize pain and enhance quality of life.
  • Acupuncture and Acupressure: Traditional Chinese practices that have shown benefits in pain reduction for many.
  • Chiropractic Care: Manual therapy directed at the musculoskeletal system to alleviate pain and improve function.
  • Transcutaneous Electrical Nerve Stimulation (TENS): A small battery-operated device that delivers low-voltage electrical current, disrupting pain signals to the brain.
  • Heat and Cold Therapy: Alternating applications to ease muscle tension and reduce inflammation.
  • Counselling, Cognitive Behavioral Therapy (CBT) and Acceptance and commitment therapy (ACT): Psychological interventions that are helpful in coping with chronic pain and addressing the emotional toll it takes on individuals.

These interventions have the capacity to bring about meaningful improvements however treatment is very individual. What works well for one person may not work for another and it can be a lot of trial and error in finding a regimen that successfully manages nociceptive chronic pain.

Pharmacological Therapies

When non-pharmacological interventions do not provide adequate relief, several classes of medications can be used to manage nociceptive chronic pain.

  • Non-steroidal anti-inflammatory drugs (NSAIDs): Over-the-counter and prescription medications that reduce inflammation and alleviate pain.
  • Acetaminophen/paracetamol: A safe and effective pain reliever that’s often used for milder forms of chronic pain.
  • Opioids: Reserved for moderate to severe pain that is unresponsive to other treatments, due to risk of dependence.
  • Antidepressants and Antiepileptic Drugs: Effective in some individuals for their pain-altering properties, as well as their psychological benefits in managing chronic pain.

The goal with pharmacological interventions is always to find the lowest effective dose for the shortest duration to minimise long-term potential adverse effects.  However, some people do require medication daily for life.

Lifestyle Changes

Multidisciplinary care is the gold standard for treating chronic pain of all types. Adopting a comprehensive, multifaceted approach to managing nociceptive chronic pain is crucial to achieving lasting relief. Lifestyle changes can play a significant role in this regard.

  • Regular Exercise: A consistent exercise regimen can increase strength and fitness, improve function, decrease pain levels and improve overall physical health.
  • Healthy Diet: Nutrition plays a role in inflammation and pain. A diet rich in fruits, vegetables, whole grains, and lean protein can be beneficial. The Mediterranean diet has been shown to reduce inflammation.
  • Adequate Sleep: Sleep is essential for the body’s natural healing processes. Chronic pain and sleep affect each other with pain preventing sleep, and lack of sleep in turrn worsening pain. Therefore, good sleep hygiene practices and addressing any sleep disorders are important for those with chronic pain.
  • Stress Management: Stress and chronic pain also have a bidirectional relationship. Reducing stress through mindfulness, meditation, or other relaxation techniques can aid in pain management.

Implementing these changes may seem daunting, but they can have a profound impact on your daily comfort and function. These changes can be made gradually, addressing one small change at a time, with the cumulative effect ultimately having a significant impact on reducing pain and improving quality of life.

Diseases Commonly Associated with Nociceptive Chronic Pain

Nociceptive chronic pain can arise from a variety of conditions and injuries. Some of the most common sources include:

  • Osteoarthritis: Degenerative joint disease causing pain, swelling, and decreased mobility.
  • Rheumatoid Arthritis: An autoimmune disease affecting the joints, leading to inflammation and pain.
  • Traumatic Injury: Such as fractures, wounds, and post-surgical pain that can evolve into a chronic pain state.
  • Endometriosis: A painful disorder in which tissue that normally lines the inside of the uterus grows outside.
  • Some forms of lower back pain.

Diagnosing and treating the underlying condition is crucial for effective management of nociceptive chronic pain.

Prevalence of Nociceptive Chronic Pain

Prominent pain researchers estimate that nociplastic, or chronic primary pain, accounts for upwards of 95% of chronic pain states. However, there is a dearth of research to support the accuracy of this claim.   

It’s often quoted that chronic secondary pain, or nociceptive chronic pain, accounts for only 5-15% of people living with chronic pain.   Given that an estimated 3.6 million (15%) people in Australia reported having painful arthritis (excluding gout) in 2017–18 this figure seems low, as there are many other causes of nociceptive chronic pain in addition to arthritis.

There are also significant challenges in classifying chronic pain as there is overlap between different pain mechanisms, and the co-existence of both nociplastic and nociceptive pain may complicate estimates of prevalence.

What is clear is that nociceptive pain is currently vastly under diagnosed, with many health care professionals assuming that all chronic pain is nociplastic pain.  This is an area of research that needs to be urgently addressed, as many people living with chronic nociceptive pain are not able to access appropriate treatments.   Accurate diagnosis and classification of pain types are crucial for effective management and treatment strategies.

Conclusion

Nociceptive chronic pain presents multifaceted challenges to individuals and health professionals. By understanding its nature and the myriad strategies available for management, you can take a proactive approach to your health.

Every individual’s experience with chronic pain is unique, and what works for one person may not work for another, even if they have the same disease or diagnosis. It’s essential to collaborate closely with your healthcare team to find a comprehensive and multimodal treatment plan tailored to your needs.

Ultimately, the path to pain management is one of exploration and resilience. While there may not be a universal cure, there are universal opportunities for improving your quality of life. Seek support, stay informed, and remain hopeful as you navigate this complex terrain.

FAQs

Is nociceptive chronic pain treatable?

Yes, nociceptive chronic pain is treatable. The multidisciplinary approach to chronic pain management typically yields the best outcomes. Treatments depend on the underlying cause of the pain and will focus on treating that cause first and foremost. Treatments range from non-pharmacological interventions like physical therapy, acupuncture, and heat therapy, to pharmacological options such as NSAIDs, opioids, and adjuvant medications like antidepressants.

How can I distinguish nociceptive chronic pain from nociplastic chronic pain?

Nociceptive chronic pain arises from actual tissue damage or inflammation, and it can be associated with damage to the body’s tissues. On the other hand, nociplastic pain arises from altered central nervous system processing, without a clear source of ongoing peripheral nociception. The distinction is crucial because the treatment approaches for these two pain types are quite different.

Will lifestyle changes really help with my pain?

Yes, lifestyle changes such as regular exercise, a healthy diet, adequate sleep, and stress management can significantly aid in managing nociceptive chronic pain. Implementing these changes can enhance the effectiveness of other treatment options and improve your overall quality of life.

Are there any new treatments or technologies I should be aware of?

Several emerging treatments and technologies are showing promise in the management of chronic pain. For example, regenerative medicine techniques like stem cell therapy or platelet-rich plasma are being explored for their potential to regenerate injured tissues and reduce pain. Additionally, neuromodulation techniques like dorsal root ganglion (DRG) stimulation or high-frequency spinal cord stimulation have demonstrated positive results in certain populations of chronic pain sufferers. Virtual reality is another area being researched for its utility in reducing chronic pain.  It’s crucial to stay informed and discuss these options with your healthcare provider to see if they might be appropriate for you.

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