The Difference Between Neuropathy and Nociceptive Pain (and why it matters)

neuropathic vs nociceptive pain neckNeck pain can have a variety of causes, some more serious than others, and the way that we describe that pain is important for understanding its likely progression and appropriateness of treatments.

We all recognize that the body is a complicated system where the mind can affect pain perception and pain perception can affect the mind. In some cases mind-over-matter really is key to resolving neck pain as both internal mental factors and external environmental factors within our control can have a significant effect on how pain is felt, if at all.

Two Types of Pain

Pain is typically divided into two clear types: neuropathic pain (which we talk a lot about here on and nociceptive pain. The latter includes things such as burns, bruises, muscle strains and ligament sprains and inflammation from things like arthritis and infections. The pain signals we get in these kinds of cases are caused by physical damage, or impending damage, to bodily tissues and act as a trigger to remove the cause of injury. For example, if a heavy backpack is not fitted quite right and is causing muscles in the neck and shoulders to become stressed then nociceptive pain signals will alert us to a problem and prompt us to either reduce/remove the heavy load or find a different way to carry it.

Relieving Nociceptive Pain

Nociceptive pain is usually localized and its causes easily identifiable. However, in the case of neck pain it may be that a combination of factors such as text-neck, iPhone-related shoulder pain, a non-ergonomic messenger bag or briefcase, and even an ill-fitting bra are all contributing to the pain, making it tricky to relieve tension quickly and effectively through a single action.

Pain of this kind is usually constant, aching or throbbing but not normally chronic as the body heals the damage once the cause is removed. Burns and bruises are good examples of this, while conditions such as arthritis, or chronic muscle tension which goes unresolved do persist. Visceral nociceptive pain can also arise, although this is usually less localized, and may be due to an infection causing inflammation in an internal organ. Again, this will often be limited, timewise, and is, like most nociceptive pain, usually responsive to opiate medications for pain.

What is Neuropathic Pain?

In contrast to nociceptive pain, neuropathic pain involves trauma to the nerves, leading to abnormal pain sensations or persistent pain sensations even upon light touch (allodynia). There are many causes of nerve trauma, some specifically involving the nerves and others where the nerves are damaged secondarily to other tissues. Conditions that can lead to neuropathic pain include herpes and shingles (i.e. post-herpetic neuralgia), cancer, limb amputation, carpal tunnel syndrome (a form of entrapment neuropathy), and diabetic neuropathy.

Diabetes is the most common cause of neuropathic pain in peripheral nerves, although many others triggers exist for peripheral neuropathy, including:

  • Chronic alcohol use/abuse
  • Toxic exposure (neuropathy may be a side effect of chemotherapy)
  • Vitamin deficiencies (especially B vitamins)
  • Numerous medical conditions

Neuropathic pain can occur to varying degrees and secondary to undiagnosed conditions, meaning that it is often unrecognized and untreated. The condition may improve through direct treatment of the trigger, i.e. better control of blood sugar in diabetes, but many patients have undiagnosed neuropathic pain that can significantly lower their quality of life.

Physical Effects of Nerve Damage

Some patients have neuropathic pain caused by the growth of a tumor which presses on the nerves, or of scar tissue causing pinched nerves or nerve adhesion. Spinal tumors do arise but are a relatively uncommon cause of back pain or neck pain. Instead, herniated discs pressing on spinal nerves or leaking inflammatory fluid onto spinal nerves are more likely to be the cause of cervical spinal neuropathy. This kind of pain may persist months after the actual trigger for the tissue damage has been removed.

Healing Nerve Damage to Relieve Neck Pain

Nerves take a long time to heal or may not heal at all in some cases of severe damage. In such cases, the neuropathic pain is no longer acting as an alert to tissue damage but is a sign of nerve signal dysfunction, which tends to respond less well to opiate drugs. There are alternative pain medications, however, such as anti-depressants and anti-seizure drugs which patients may need to take at low doses in perpetuity as some neuropathic pain is irreversible.

Nociceptive and Neuropathic Neck Pain

Of course, neck pain may be caused by both nociceptive and neuropathic pain signals. For example, a patient may have both muscle strain and inflammation from working out at the gym and also have an underlying inflammatory joint condition affecting the spine, such as arthritis. Or, it may be that diabetic neuropathy is adversely affecting nerve function and a patient accidentally burns themselves because of a loss of feeling and coordination.

Treating Neck Pain – Whatever the Cause

Some of the mechanisms behind systemic inflammation and neurogenic inflammation are shared or influence each other while in other conditions, such as fibromyalgia, it may be that abnormal nerve activity (neuropathy) triggers altered muscle activity that then causes nociceptive pain. As such, even neck pain that appears to be clearly linked to one cause may have a number of complex underlying factors that warrant a range of interventions including opioids, anti-inflammatories, improved nutrition, and alternative therapies such as meditation and mindfulness to help apply the gate control theory of pain management.

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