What is nociceptive pain

Nociceptive pain

The term “nociceptive pain” describes the body's normal pain response to a pain stimulus. Nociceptive pain can affect the internal organs or joints, skin, muscles, connective tissue, or bones. Nociception is the perception of pain, whereby the localization and sensation of pain can be different.

What is nociceptive pain?

The normal physical response to a stimulus such as heat, cold, pressure, injury, poisoning, or inflammation is nociceptive pain. This pain has a protective and warning function, because the pain sensation can be used to react - for example by pulling your hand away from the hot stove. The pain receptors - the so-called nociceptors - are responsible for the perception of pain. They react sensitively to irritation and cause visceral or somatic pain: the stimulus is picked up by the pain receptors and passed on to the brain via the nerve tracts.

Nociception - An Explanation

The technical term for the perception of pain is nociception. To maintain health, it is important to perceive pain so that it is possible to react to the stimulus that triggers the pain.

Nociceptors are found in any tissue that is sensitive to pain and terminate in the spinal cord. They consist either of C-fibers (myelinated fibers) or of Aδ-fibers (thin fibers containing myelinated). The nature of the fibers determines the form of pain:

  • If nociceptors from thin, medullary fibers pick up a pain stimulus, pain is felt immediately, but it is short-lived. This sharp, bright pain is easy to localize and is the first reaction to superficial pain. Usually a defensive or flight reflex is triggered. This protects the person concerned from the pain stimulus.
  • If nociceptors from non-myelinated fibers pick up a pain stimulus, the pain cannot be felt immediately. This transmission of the pain information through the C-fibers takes place more slowly and the person affected feels a longer lasting wave of pain, which is perceived as burning or dull. Most of the time, the pain cannot be precisely localized.

Nociceptive pain is divided into somatic pain and visceral pain:

Somatic pain

This pain is caused by the joints, muscles, bones, connective tissue, or skin. They are often dependent on movement or pressure and are usually perceived as stinging. Somatic pain is related to disease processes such as wounds or inflammation. This can be deep pain or surface pain.

Pain in the connective tissue, muscles, bones or cartilage is referred to as deep pain. Headache or muscle cramps are deep pain.

Surface pain can be felt on the surface of the skin and occurs immediately after the pain stimulus. One square centimeter of skin has fifty to two hundred pain points. After a stimulus such as heat or a sting, pain is felt immediately.

Visceral pain

The triggers of visceral pain are the internal organs. These pains are perceived as cramp-like, colicky, piercing or dull. Pain associated with gastritis or intestinal cramps are examples of visceral pain.

Pain processing in the brain

The pain stimulus is picked up by the nociceptors, converted into electrical impulses and transmitted to the spinal cord and the brain. The triggering of the defense or flight reflexes takes place in the spinal cord. In the brain, pain processing takes place in different areas:

  • The triggering of vegetative body reactions takes place in the brain stem, more precisely in the area of ​​the reticular formation. Examples of such body reactions would be the induction of nausea or an increase in blood pressure.
  • The emotional evaluation of pain takes place in the limbic system.
  • The somatosensory cortex in the cerebral cortex is responsible for the localization of the pain.

The reaction to a pain stimulus varies from person to person. The perception of pain depends on various factors and is subjective. On the one hand, the perception of pain is linked to genetics, such as the metabolism of neurotransmitters or the nature of the tissue.

On the other hand, the psyche also plays an essential role in perceiving and feeling pain. So the pain can be felt stronger or weaker depending on the expectations and mood of the person concerned: A positive mood and expectations dampen the pain, while a negative expectation and mood intensifies the pain.

The different brain activities in certain areas, especially in the islet cortex and in the anterior cingulate cortex (ACC), can be recognized by imaging methods. The ACC is involved in, among other things, emotions and expectations. The islet cortex plays a role in perception.

The perception of pain therefore not only depends on the biological, physical factors, but the psyche also determines the perception of pain. In addition, the social environment is also decisive for the perception of pain: How was or is pain dealt with and reacted to within the family?

In children - but also in adults - distraction has a pain-relieving effect, or the intensity of the pain remains lower if one cannot concentrate on the pain.

Researchers at Northwestern University of Chicago studied the effect on distraction pain in children after surgery. The children in this study were between nine and fourteen years old. Some of the children listened to an audio book or their favorite music about thirty minutes after the operation. The other children were in the control group and received no auditory distraction.

The children who were distracted with audio books or music felt their postoperative pain significantly less than the control group.

Treatment options

For acute nociceptive pain, pain relievers such as paracetamol, ibuprofen or acetylsalicylic acid are usually used. In special cases and always only for a short time, opioids are prescribed for severe nociceptive pain.

While TENS (transcutaneous electrical nerve stimulation) works well for neuropathic pain, this method has little or no effect on nociceptive pain.

Basically, pain should be treated in good time so that the risk of a chronic course is kept as low as possible. Nociceptive pain can become chronic, especially after tissue damage. Chronic nociceptive pain includes, for example, tumor pain as well as back pain and inflammatory pain with a chronic course.

Treatment of Chronic Nociceptive Pain

In the case of chronic pain, it is often not possible to achieve complete freedom from symptoms. Rather, the therapy aims to reduce the intensity of the pain and to learn how to deal with the pain in a different way. The focus of the treatment of chronic nociceptive pain is on improving the quality of life so that those affected have as few restrictions as possible in their private and / or professional life despite their pain.

Chronic pain is best treated with multimodal pain therapy. The treatment concept consists of drug and non-drug procedures and is always tailored to the individual. Nociceptive pain is relieved with pain relievers. Physical therapies, physiotherapy and the like take place at the same time. In addition, the person concerned learns through behavior therapy and relaxation methods how to better deal with the pain.

In the case of chronic nociceptive pain that has existed for a long time, multimodal pain therapy in a pain clinic is recommended. Another option is outpatient therapy with a pain therapist.

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  • Christian Rieger, Horst von der Hardt, Felix Hans Sennhauser, Ulrich Wahn, Maximilian S. Zach: Pediatric Pneumology. Springer-Verlag, 2013
  • Wachter, M. from: Chronic Pain, Springer Verlag, 2012
Manuel Kress

Manuel Kress has been active as a pain therapist for more than 10 years. He mainly deals with the treatment of chronic pain and prefers a holistic approach. He has been writing for German pain relief for more than 7 years.