Skip to main content

Pain Mechanisms

There are three mechanisms involved in perception of pain: nociceptive, neuropathic, nociplastic.

Nociceptive pain is pain associated with peripheral injury or inflammation. The goal of nociceptive pain is to warn you of threat and danger, and this pain is thought to be adaptive or protective (for example, teaches you not to touch a hot stove). Most episodes of nociceptive pain are short lived and are fairly localized to one area of the body. Examples include pain resulting from acute injury, pain after surgery, and pain associated with infection or inflammation.

Neuropathic pain refers to pain associated with damage to either the peripheral (nerves around your body) or central nervous system (spinal cord and brain). These two parts of the nervous systems work together to take a pain signal from a site of injury to the brain. If the nerves carrying messages to the brain get damaged, they send signals excessively or in abnormal patterns. This abnormal signaling is often interpreted by the brain as sharp or burning pain. Examples include diabetic neuropathy, carpal tunnel syndrome, or sciatica.

Nociplastic pain, also called "central sensitization" or "central pain amplification," is a disorder of how the brain processes nociceptive signals. In this case, your nerves send a signal that should be relatively mild or not bothersome, but your brain triages it incorrectly, which causes the signal to be amplified and interpreted as severe or dangerous. It is critical to note that nociceptive pain experienced in response to an injury is indistinguishable from nociplastic pain associated with central amplification. Both are very real forms of pain and both can result in significant suffering. There are many reasons that someone may develop nociplastic pain, including recurrent nociceptive pain (from repetitive injury, inflammation, or infection), genetics, or long-term stress (both physical and/or psychological). Nociplastic pain probably contributes to many chronic pain conditions, including fibromyalgia, irritable bowel syndrome, and vulvodynia.

Most people with chronic pain conditions have more than one mechanism contributing to their pain symptoms. It is actually very common to see both nociceptive and nociplastic pain contributions in many pain conditions, such as endometriosis.

It is important to identify and address ALL of the pain mechanisms that are active in your situation. The very best treatments for one mechanism are unlikely to result in complete resolution of your pain if you have other mechanisms that are still active.