Understanding Pain: Types, Treatment, and the Mind-Body Connection

Pain is more than a physical sensation. It's a complex, multidimensional experience shaped by biology, psychology, and environment. At the  11th HR Clinic, we emphasise a biopsychosocial approach to understanding and treating pain. This article outlines the three key pain types: nociceptive, neuropathic, and nociplastic;   and highlights the crucial role of psychological support in managing persistent pain.

Nociceptive Pain: Responding to Tissue Damage

Nociceptive pain arises when nociceptors (pain receptors) in skin, muscle, bone, or internal organs detect noxious stimuli such as inflammation, trauma, or pressure. It’s typically acute and protective in nature.

• Somatic pain is well-localised and often described as sharp or throbbing.
• Visceral pain is diffuse, cramping, and originates from internal organs.

This type of pain usually responds well to common analgesics like NSAIDs or paracetamol and resolves when the underlying issue is addressed (Woolf, 2010).

Neuropathic Pain: Malfunction of the Nervous System

Neuropathic pain results from injury or disease affecting the somatosensory system. Unlike nociceptive pain, it’s not caused by tissue damage but by a dysfunction in nerve signaling.

Symptoms often include:

• Burning or shooting pain
• Tingling or numbness
• Allodynia (pain from non-painful stimuli)
• Hyperalgesia (increased sensitivity to pain)

Conditions like diabetic neuropathy, shingles (postherpetic neuralgia), and spinal cord injuries often involve neuropathic pain. It tends to be chronic and resistant to standard painkillers, requiring treatments such as tricyclic antidepressants, anticonvulsants, and nerve-targeted therapies (Jensen et al., 2011).

Nociplastic Pain: Pain Without Clear Damage

Nociplastic pain is a newer classification describing pain that arises from altered nociceptive processing without clear evidence of tissue damage or nerve injury. It’s common in syndromes like fibromyalgia, chronic fatigue syndrome, and irritable bowel syndrome.

This form of pain often presents as:

• Widespread, persistent pain
• Fatigue and cognitive disturbances
• Sleep disturbances and mood changes

It’s believed to be the result of central sensitisation, a state where the brain and spinal cord become overly responsive to pain signals (Kosek et al., 2016). Treatments include a multidisciplinary approach with low-dose medications, physical activity, and psychological therapies.

The Role of Psychology in Pain Management

Psychological factors play a profound role in how pain is experienced, interpreted, and managed, particularly in chronic and nociplastic pain conditions. Emotional distress, trauma, catastrophising thoughts, and poor coping skills can amplify pain perception (Tracey & Bushnell, 2009).

Evidence-Based Psychological Treatments

• Cognitive-Behavioural Therapy (CBT): Helps patients reframe negative pain-related thoughts, improve coping, and reduce emotional reactivity (Ehde et al., 2014).
• Mindfulness-Based Stress Reduction (MBSR): Teaches patients to develop non-reactive awareness of sensations, reducing distress and pain intensity.
• Acceptance and Commitment Therapy (ACT): Encourages patients to accept pain while committing to meaningful life goals.
• Biofeedback and Relaxation Techniques: Support nervous system regulation, especially in central sensitisation.

Integrating psychological support alongside physical and medical interventions improves outcomes, especially in persistent and complex pain presentations (Ehde et al., 2014).

Matching the Pain Type to the Treatment

Understanding the mechanisms behind different types of pain is critical for effective treatment planning.

Nociceptive pain  arises from actual or threatened tissue damage and is commonly associated with acute injuries such as sprains or inflammatory conditions. This type of pain typically responds well to conventional treatments like non-steroidal anti-inflammatory drugs (NSAIDs), physical therapy, and rest (Woolf, 2010).

Neuropathic pain  results from damage or disease affecting the somatosensory nervous system, as seen in conditions like diabetic neuropathy or postherpetic neuralgia. This pain often requires targeted pharmacological interventions such as tricyclic antidepressants (TCAs), gabapentinoids (e.g., gabapentin or pregabalin), or even neuromodulation therapies due to its poor response to standard analgesics (Jensen et al., 2011).

Nociplastic pain, describes pain that emerges without clear evidence of tissue or nerve damage, and instead reflects altered central pain processing. It is typical in disorders like fibromyalgia and irritable bowel syndrome, where patients experience widespread, persistent pain often accompanied by fatigue and cognitive symptoms. Management of nociplastic pain is best approached with a multidisciplinary strategy, incorporating regular physical activity, psychological therapies such as cognitive-behavioral therapy (CBT) or mindfulness, and patient education (Kosek et al., 2016; Ehde et al., 2014).

Recognising the distinction between different types of pain ensures more personalised, effective treatment and highlights the importance of including both physical and psychological care in pain management strategies.

If you would like to discuss pain management strategies with one of our psychologists contact us online.

References

Ehde, D. M., Dillworth, T. M., & Turner, J. A. (2014). Cognitive-behavioral therapy for individuals with chronic pain: Efficacy, innovations, and directions for research. American Psychologist, 69(2), 153–166. https://doi.org/10.1037/a0035747

Jensen, T. S., Baron, R., Haanpää, M., Kalso, E., Loeser, J. D., Rice, A. S. C., & Treede, R.-D. (2011). A new definition of neuropathic pain. Pain, 152(10), 2204–2205. https://doi.org/10.1016/j.pain.2011.06.017

Kosek, E., Cohen, M., Baron, R., Gebhart, G. F., Mico, J. A., Rice, A. S., & Sluka, K. (2016). Do we need a third mechanistic descriptor for chronic pain states? Pain, 157(7), 1382–1386. https://doi.org/10.1097/j.pain.0000000000000507

Tracey, I., & Bushnell, M. C. (2009). How neuroimaging studies have challenged us to rethink: is chronic pain a disease? The Journal of Pain, 10(11), 1113–1120. https://doi.org/10.1016/j.jpain.2009.09.014

Woolf, C. J. (2010). What is this thing called pain? The Journal of Clinical Investigation, 120(11), 3742–3744. https://doi.org/10.1172/JCI45178