Ep 4. Nociceptive Pain

Nociceptive pain, or body part pain, is the most common type of pain. Dr. Dan will break down the differences between somatic and visceral pain within this main category, and get into its different features including

• Myofacial Pain

• Mechanical Pain

• Vascular Pain

Justine and Dan will also talk about the different challenges both patients and provides face in communicating and diagnosing this type of pain, so you can do a better job recognizing and addressing the different aspects.

Introduction

In this episode of "It's Not in Your Head" podcast, Dr. Dan Bates and Justine Feitelson dive deep into the complexities of nociceptive, or body part pain, offering valuable insights for both patients and healthcare providers.

Three Types of Pain

Dr. Dan outlines the three main types of chronic pain:

1. Nociceptive pain: Body part pain

2. Neuropathic pain: Nerve pain

3. Nociplastic pain: Amplified body part or nerve pain

Characteristics of Nociceptive Pain

Nociceptive pain typically:

• Feels like an ache, sharp, dull, or throbbing sensation

• Is focal and intermittent

• Has proportional intensity to injury

• Has specific triggers that worsen or improve the pain

Subtypes of Nociceptive Pain

Dr. Dan explains two main subtypes:

1. Somatic pain:

   • Affects body parts like arms, legs, back, and head

   • Can be localized due to additional sensory input

2. Visceral pain:

   • Affects internal organs

   • Often more diffuse and harder to localize

Features of Nociceptive Pain

Dr. Dan describes several features that help in diagnosis:

1. Inflammatory: Worse in the morning, improves with warmup

2. Myofascial: Muscle tightness and trigger points

3. Bony: Pain at night and on impact

4. Mechanical: Painful clicking, clunking, or instability

5. Vascular: Pain on exercise, quick relief at rest

Challenges in Diagnosis and Treatment

Both patients and providers face difficulties:

1. Communication: Patients focus on pain intensity, while doctors need specific details about location and characteristics

2. Pain perception: Varies between individuals

3. Complexity: Multiple pain types often coexist

4. Provider limitations: Knowledge, experience, and available diagnostic tools

Diagnostic Approach

Dr. Dan's method includes:

1. Detailed pain history

2. Physical examination

3. Diagnostic blocks to identify pain source

4. Targeted interventions based on findings

Key Takeaways

1. Nociceptive pain is complex but more straightforward than other pain types

2. Effective communication between patients and providers is crucial

3. Diagnosis often requires a systematic approach and multiple tools

4. Provider limitations don't mean pain is "in the patient's head"

5. Ongoing research and technological advancements continue to improve pain diagnosis and treatment