Pain is a universal experience, but not all pain works the same way. Understanding whether your pain is nociceptive or neuropathic can help guide treatment and improve your quality of life.
Pain is something everyone understands. Maybe itis as standard as a sore knee that you easily brush off. Or maybe it is a numbness in your back that you do not know the root of, causing you to lay in bed trying to search for answers on your phone until 2am.
The problem is that for an experience so universal, pain is not always straightforward, as underscored by four medical experts who weigh in on the issue.
Pain has a way of taking over, from stealing our focus and energy, to rewriting our daily reality. Even worse – it is easily misidentified, and often undertreated.
This is especially true for two major types of pain: nociceptive and neuropathic.
Nociceptive Pain
For many of us, when we think of pain, this is likely the type we associate the concept to most.
It involves incidental injuries. For instance, let’s say we tripped and fell to our knee. This can cause damage to the tissue around our knee, including our muscles, ligaments and cartilage. These tissues then trigger a biological response known as inflammation.
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According to Dr Kelvin Tan, a Senior Consultant and Specialist Orthopaedic Surgeon at Singapore Sports and Orthopaedic Clinic under Basel Medical Group, this inflammation leads to two main reactions: one by way of the vessels, and the other, the cells.
“Both bring about increased amounts of chemicals to the area of tissue that is injured,” he explains.
“What happens to the vessels is that more chemicals leak out from the blood vessels to the area of injury, and more blood flow goes to the area of injury.”
Then there are the cells typically involved in inflammation.
“It can be neutrophils, which I liken to the example of a policeman, where they fight away the bad guys. They can be in terms of macrophages, for which I use the firemen as an example, to help put out the fire and evacuate the people. Last but not least are the platelets and clotting factors, which are, for example, akin to builders trying to repair the process of the damaged tissues.
“All these can bring about more cellular debris, and more fluid to the area of injury, making you feel like your joint is swollen, tight and difficult to move.”
Chronic Inflammation
The swelling normally goes down after a few days, but what happens when we’re still feeling the ache weeks later?
“We know that inflammation is your body’s natural healing mechanism. It shows up with swelling, redness, and warmth to repair damaged tissue after an injury,” says Dr Eileen Tay, a Senior Consultant with a special interest in shoulder and elbow surgery at The Orthopaedic Practice and Surgery.
Regardless, when inflammation sticks around for too long, it can be counterproductive to the healing process.
“Immune cells meant to clean up damage can start releasing enzymes and chemicals that harms healthy cells nearby,” she highlights. “Chronic inflammation also interferes with tissue repair. It can delay recovery, cause further stiffness, and even lead to long-term structural issues, especially in muscles and even joints that don’t get a chance to properly heal.”
So if the ache has been nagging at you for more than three weeks, despite the use of ice compressions and over-the-counter medication, then it’s time to see a doctor for more effective care.
Neuropathic Pain
This is the pain that we do not always talk about, the pain that confounds us – because we have no idea why we are even feeling it.
“Not all pain comes from a sprain, strain, or swelling,” stresses Dr Lim Chin Tat, a Senior Consultant and Orthopaedic Surgeon at The Orthopaedic Practice and Surgery. “Some pain starts from deep inside your nervous system – even when there’s no obvious injury. That’s what we call neuropathic, or nerve pain.”
It can develop when our nerves are dysfunctional or damaged, and can be caused from a variety of conditions, ranging from diabetes and HIV, to shingles and spinal nerve compression. It can even originate from an injury, with the hurt lingering long after the nociceptive pain has been treated.
“When the nerves are damaged, irritated, or misfiring, instead of sending signals only when something goes wrong, they start sending pain messages on their own – constantly, and often unpredictably,” he adds.
“Unlike nociceptive pain, which is your body’s natural response to injury or inflammation, neuropathic pain is often disconnected from what’s happening on the surface.”
You end up perceiving unusual, intense prickles under the skin, including:
- A burning sensation
- Electric shocks
- Sharp or stabbing pains
- A pins-and-needles feeling
- Creepy-crawly sensations
- Numbness
- Buzzing stings
Managing Pain
Neuropathic Pain: The Quicker the Treatment, the Quicker the Recovery
The good thing about nociceptive pain is that it can often be resolved.
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According to Dr Tay, a three-pronged approach is commonly suggested, involving:
- R.I.C.E. – an acronym for self-care measures such as rest, ice, compression and elevation
- Physiotherapy
- Medication
R.I.C.E. is best performed during the initial stages of the injury, to help calm the flare.
“Beyond that, patients often benefit from gentle stretches or physiotherapy to restore mobility to the injured limb or joint,” she states.
Medication is prescribed to ease inflammation at its source.
“One of the most common types of medication we use is a group called non-steroidal anti-inflammatory drugs, or NSAIDs. These work by targeting a key chemical: prostaglandins.
“When your body is injured, the inflammatory response produces prostaglandins at the site of injury. Prostaglandins cause pain, redness, warmth and swelling around the injured area as part of your body’s natural defence system. NSAIDs blocks the production of prostaglandins, which then helps to reduce inflammation, swelling, and pain.”
And if you are worried about the side effects of certain medications, don’t be. Your healthcare provider can suggest other options depending on your needs, with the ultimate goal of alleviating your discomfort.
Neuropathic Pain: A Process Requiring Patience
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Unfortunately, neuropathic pain is not as easily resolved. Painkillers that work well for inflammation and tissue damage – like paracetamol and NSAIDs – aren’t quite as effective.
“Neuropathic pain is caused by nerves that are overactive or damaged. In these cases, doctors turn to special medications that target the nerves. These work on the nervous system directly, binding to special sites on nerve cells to reduce the abnormal firing of signals that have been causing your burning, electric, or tingling pain,” Dr Lim elaborates.
“In simple terms, it quiets the nerves, helping to settle that burning, tingling, or electric pain at its source.”
However, these medications can take a fair bit of time to kick in. Furthermore, because their effect on patients can vary, doctors will prescribe it in low doses at first, and continually adjust it over time.
“Treatment for nerve pain is never a cookie-cutter plan. Your doctor will work with you to create a management plan. That might include multiple modalities from nerve medication, physical therapy, or other strategies based on how your symptoms evolve,” explains Dr Bernard Lau of The Orthopaedic Practice and Surgery, an Orthopaedic Surgeon with a special interest in foot and ankle surgery.
“Along the way, the plan can be tweaked based on how you are responding, or if you’re experiencing side effects.”
But take note – there’s no guarantee of a progressive improvement in your condition, even with a fine-tuned treatment plan.
“The pain may come and go. It may flare up at night, it might feel like it’s improving one day, then suddenly worsen the next. This does not mean the treatment is not working; it just means your nervous system is recalibrating.” he assures.
Non-pharmacological Treatment
It takes time for medications to build up to an effective level – and most of the time, medication may not be enough.
The pain can affect every part of your life – which means that if you want to reclaim it, you will need to switch up your lifestyle. This involves the development of healthy habits, such as a regular exercise regime and a balanced diet.
At the end of the day, the objective is to understand the pain you are facing, and follow through with the best strategy for managing it – all the while ensuring that it is not weighing down on you, physically or emotionally.
“Nerve pain is often chronic, and can feel isolating. But the first step is to name what you are feeling – and talk to a doctor about it,” advises Dr Lau. “This opens the door to treatment, support, and a plan that works for you.”
Our Name Your Pain campaign aims to bridge the gap between science and lived experience, empowering you to reclaim your quality of life.
To access our pain assessment quiz, pain management plan, and other helpful tips and resources, visit here.
