Video Transcript: 3 Types of Musculoskeletal Pain

Hi, everyone! Dr. Orit Hickman here from Pain Science Physical Therapy. 

Today, we’re going to talk about the three different types of musculoskeletal pain that you can be experiencing in your body.

The first type is the most common that patients are familiar with, which is called nociceptive pain. Nociceptive pain is pain that occurs in the tissue and if tissue has been injured. So, for example, if I step on something sharp, if I cut my hand, if you have pain in the area where that tissue was damaged, that is what we call this nociceptive pain. Typically, that pain lasts for anywhere from a few hours to up to three to six months depending on the type of tissue injury. So, if you have a very severe injury, for example, you’ve torn a muscle, you’ve broken a bone, [it] takes longer for that tissue to heal. So, you might have pain in those areas for the duration of the time [that] the tissue needs to heal, but once the tissue is healed, that pain should go away. So, that’s nociceptive pain.

The second type of pain which you also may be very familiar with is pain that occurs if a nerve has been injured or irritated or has become hypersensitive. And, that’s known as peripheral neuropathic pain. And, peripheral neuropathic pain occurs in the nerves themselves. [The] typical symptoms are sharp, shooting, electrical, numbness, tingling. These are the types of symptoms and descriptors that patients will use. That pain usually will bother you when you’re not doing a lot. So, the more that you’re resting, even [at] night time, those symptoms can be increased. Nerve symptoms, peripheral neuropathic pain, is also pain that can occur for a period of time while a nerve is injured and then can also go away and should go away when the nerve is healed. 

The third type of pain that is not as familiar to most patients but is incredibly common is called nociplastic pain. [It] used to be called central sensitization. And, this is pain that is produced by the brain because the brain has gotten potentially in the habit of producing pain or because there was an injury, and now the brain is hyper-responding to sensory information that’s coming from that area. So, a patient will describe pain that is disproportionate to the sensory input. By that I mean for example, I do light touch on their hand, and the patient says that it feels very heavy, it feels very sharp, [and] it feels very intense. Those are not symptoms or descriptors that you would expect if you do light tough on the hand. But, if that’s the area that the patient has been experiencing pain for an extended period of time, it may be that the type of pain that they’re experiencing is more this nociplastic pain. 

Because these pains are all different and have different causes, they have different treatments. The traditional physical therapy model of treatment which includes exercise, manual therapy, modalities, this is a very, very effective treatment approach for patients that are having nociceptive pain. You go to the gym. You lift weight. You feel something pop in your shoulder, and you go to have physical therapy. And, they go through a series of exercises. They do stuff to mobilize the tissue and mobilize the joint. And, typically, within a few sessions, you feel better. That’s nociceptive pain. [It] has a very predictable symptom pattern to it and responds really well to traditional physical therapy approaches. 

That second type of pain, which is your peripheral neuropathic pain, sometimes responds well to PT, but oftentimes would benefit from physical therapy combined with other approaches, sometimes the right medication from your physician [or] potentially more aggressive treatment approaches to really calm the nerves down in conjunction, so at the same time as doing physical therapy. And, if you check out, I have a number of videos on this YouTube channel for nerve glides, which are also very effective at calming down nerves that are very sensitized or have gotten very painful.

This third type of pain, this nociplastic pain, is one that doesn’t respond as well to those traditional approaches that we see with this nociceptive or tissue-based pain. And so, you might find that you go to physical therapy. You feel better for a while. Then, you have a flare up. You back into PT, [and] maybe you feel a little bit better the second go around, but it’s not as good as the first. You wait a little while. You go find another physical therapist, or maybe you go see an acupuncturist, chiropractor, [or] a different physician. You start round-robining through many providers. These providers are all fantastic. What may be happening is they may not have diagnosed you correctly, and they may have said, “This is a tissue-based problem, so we’re going to go ahead and treat this with a tissue-based approach.” At the end of the day, the correct diagnosis is incredibly important for you to have the results that you are looking for when you are treating musculoskeletal pain.

So, these are the three different types of pain. Something to note is that you often are experiencing more than one of these at any one time. So, you can be having tissue-based pain at the same time as having nociplastic pain. The key for your providers [is] to be able to definitively figure out what’s the thing that’s really bothering you the most right now and keeping you from progressing. Oftentimes, if patients are having nociplastic pain, we need to address that pain first and do a whole bunch of other types of treatment that might include education, sensory integration, graded motor imagery before the patient will be able to tolerate the more tissue-based approaches of manual therapy and exercise. So, a clinic such as ours which is very skilled, we’re very skilled in treating patients with persistent pain, we’re typically going to utilize treatments from all [of] these different realms so that we can help you reach your movement goals.

I hope that this video was helpful. If you have any questions or comments, please feel free to message down below. If you thought this was a great video, I’d love a thumbs-up. And, if you’d like to receive or know when I have more videos that come out that are about persistent pain, then please subscribe to the video. I’d appreciate it. Have a great day! Thanks!