The neuroscience of pain has been a hot topic in the field of physical therapy in the last decade. But, despite our profession’s obsession with understanding and treating pain, we know that many patients would benefit from a deeper understanding of it. We hope this short article clears things up for you. If this leaves you with more questions than answers, please ask your physical therapist to explain your pain picture in more depth, factoring in your unique circumstances.
Biopsychosocial framework
We used to think of pain as an unpleasant sensation that resulted from some sort of tissue damage. That can still be a factor. Tissue damage, autoimmune disease and genetic factors are all considered biological factors (the “bio” in biopsychosocial). However, psychological and social factors equally contribute to pain. Understanding this helps healthcare providers view pain in a more holistic and compassionate way. It’s also helpful for patients to understand that their pain might be more multi-dimensional than they originally thought.
Ways to classify pain
Currently, there are two ways that we classify pain. Neither way adequately addresses pain for an individual, but they are the methods we have. First, we have time-based classification. This is simple, and easy to define, the downside is that it does nothing to address where pain is coming from or how to treat it. Second, we have mechanism-based classification. This method delves deeper into understanding where the pain is coming from which informs treatment. There are a few downsides to this method of classifying pain. First, it is difficult to validate the categorization chosen between testers. Next, there can be overlapping features that place your pain in more than one category. And finally, the current research hasn’t proven that treatment plans that utilize this method result in improved outcomes.
Time-based pain classification:
- Acute: Pain lasting less than 4-6 weeks
- Sub-acute: Pain lasting 6-12 weeks
- Chronic: Pain persisting past 12 weeks
Mechanism-based pain classification:
- Nociceptive: Localized sharp pain that is related to tissue injury and can be aggravated and eased in a predictable way. This type of pain is discovered by taking a detailed history of when and how the pain started. Following that, the physical therapist does an examination that reveals findings consistent with known musculoskeletal pain patterns. Oftentimes, this type of pain is something you can “point to” because it is localized.
- Neuropathic: Pain in this category has a history related to nerve injury or compression. Symptoms follow nerve pathways and are eased and aggravated in a predictable way. After taking a detailed history of when and how the pain started, the physical therapist does a comprehensive examination. The exam reveals symptoms with well-defined referral patterns known as dermatomes and myotomes. Pain and symptoms in this category are easy to diagram because although the pain isn’t localized, it consistently occurs in the same way.
- Nociplastic: Pain in this category is disproportionate to the history, and is diffuse & non-predictable. Psychosocial factors are usually present, and one cannot aggravate or ease the pain in a predictable way. When this classification of pain is part of the picture, it is indicative of either a more chronic and complex pain picture, or a nervous system that cannot adequately process pain. At this stage, the brain has begun to adapt by making permanent physiological changes. Think of jumping into cold water, how your body adapts pretty quickly and the water no longer feels cold after a minute. This is an example of an adaptive nervous system response. For people with nociplastic pain with accompanying brain changes, jumping in cold water doesn’t result in it no longer feeling cold – the sensation of cold will stay the same or even become worse. Oftentimes, with pain in this category it is difficult to pinpoint the pain.
So, what should you do when you have pain?
The most important thing for patients to understand is that when you’re experiencing a new pain, it’s important not to “learn to live with it”. Get in touch with your physical therapist to begin a treatment plan to address your pain. If you ignore the pain, your brain could eventually undergo permanent changes and you are more likely to end up with chronic pain.
If you already have chronic pain, you’re not a lost cause! The research shows that movement, exercise, manual therapy and modalities are all proven to help block the pain channels to your brain which helps your brain and nervous system recalibrate. Adequate sleep is regenerative and helps your body to heal. Addressing your mental and social wellbeing are paramount. Finally, any medications prescribed by a doctor who understands chronic pain can give you the boost you need to help your progress.
If there are affiliate links on this page, we may earn a small commission on qualified purchases. We only endorse products that we trust or have used. We hope you find value in our recommendations and utilize the provided links to purchase.
Disclaimer