Chronic Nociceptive Pain- Causes, Risk factors, Symptoms and Treatment

Pain, none of us like this agonizing perception of getting hurt or injury. The intensity of pain might differ and it is very important to determine the exact cause of pain in order to get it treated. Chronic pain is categorized in 4 categories

  • Nociceptive
  • Neuropathic
  • Mixed
  • Epidemiologic studies

Here we are going to understand all about Chronic Nociceptive Pain which is again categorized in three categories

  • Cutaneous
  • Somatic
  • Visceral

Nociceptive pain starts as soon as you get a tissue injury. If healing of the tissue remains inadequate and tissue trauma exists for more than six months the pain becomes chronic. When the nociceptive pain reaches the chronic state it secrets neurotransmitters continuously within injured healing tissues or scar tissues. Nociceptive pain goes off only when the damage caused to the tissue is healed

Chronic Nociceptive pain – Causes and Risk Factors

Nociceptive pain is considered as acute pain if it remains for 3-6 months. If it continues beyond 6 months it becomes chronic.

Nociceptive pain- Cutaneous

  1. Confined within subcutaneous tissue and skin
  2. Tissue trauma like abrasion, laceration, repeat injury- it increases the intensity of pain and its duration, non healing skin burns, skin ulcers, bruise, bump or inflammations

Nociceptive pain- Somatic

  1. Gets triggered due to muscle or ligament trauma or injury, joint dislocation, fracture, tendon rupture, muscle tear, injury etc.,
  2. Sprains : to the muscles or ligaments
  3. Arthritis: osteo or rheumatoid arthritis
  4. Inflammation : of muscles followed by infection or injury
  5. Muscle disease : myofascitis, myofascial pain, fibromyalgia
  6. Joint pain and pain in bones: injuries, arthritis, laceration, periosteum or fractures.

Nociceptive Pain- Visceral

  1. Involves : interior organ trauma, injury or inflammation
  2. Ischemic : can be because of ulcers that are non healing, ischemic colitis, and myocardial infarction.
  3. Obstructions: these can be adhesions, strictures, and obstruction of kidney, bile duct, gallbladder, ureter and bladder.
  4. Inflammation and inadequate blood supply

Symptoms of  Chronic Nociceptive Pain

Nociceptive Pain

  • Constant
  • Reduced ligament or joint, muscle function
  • Moderate pain while taking rest
  • Aching quality
  • Well localized

Activities of Muscles, Joints or Ligaments

  • Pain can be intractable and severe
  • Pain that lasts for a limited time: healing of tissue resolves pain
  • Arthritis is an exception and isn’t time limited
  • Nociceptive Pain responds well to opioids and NSAIDs

Chronic Nociceptive pain- Treatment


  • Muscle Relaxants: Flexeril, Baclofen etc.,
  • Opioids : if there are certain side effects or not getting relief from NSAIDs, it can be used
  • Antibiotics: Right Antibiotics are used
  • NSAIDs : pain appears due to inflammation in tissues.

Manual Therapy for treating Chronic Nociceptive pain

  • Massage
  • Acupuncture
  • Physical therapy
  • Chiropractic treatment
  • Osteopathic manipulation for joints


  • Excision of gallbladder and appendix
  • Surgical procedure for treating fracture
  • Removal of skin lesions through abscess incision
  • Nerve Ablation
  • Epidural Injections

Causes of Nociceptive Somatic Pain Illustrated

Somatic pain is seen in muscles, tendon ligament, skin, subcutaneous tissue, bone and joint. Nociceptive Somatic Pain is stabbing, sharp shooting pain. Let us understand the possible causes of nociceptive Somatic Pain

Nociceptive Somatic Pain- Causes

They can be divided as below:

Somatic pain caused due to traumatic injuries

  • Sport injury
  • Domestic injury
  • Automobile accident
  • Work accident
  1. Nerve injuries or irritation
  2. Cancer disease
  3. Non-cancerous diseases

Injuries caused due to automobile, work or domestic accidents are as below

  • Chest
  • Abdomen
  • Neck and head
  • Extremities

Gunshot or Penetrating Wound

  • Chest
  • Abdomen
  • Neck and head
  • Extremities

Nociceptive Somatic Pain caused due to Blunt Trauma

  1. Neck and Head
  • Skull fracture
  • Subcutaneous bleeding or skin contusion
  • Headache
  1. Chest
  • Subcutaneous bleeding or skin contusion
  • Rib fracture
  • Inter-costal injury of nerves
  • Pneumothorax- Air pocket causes compression of lungs and leads to somatic pain
  1. Abdomen
  • Injury in facet joint
  • Fracture in vertebral column
  • Subcutaneous bleeding or skin contusion

d.      Extremities Injuries

  • Muscle contusion
  • Fracture
  • Joint dislocation
  • Skin laceration
  • Subcutaneous hematoma
  • Ligament injury
  • Tendon rupture

Nociceptive Somatic Pain caused due to penetrating injury

  1. Neck and Head
  • Skin laceration subcutaneous blood clot leading to pain and cut-bleeding
  • Skull fracture related to cerebral bleeding
  1. Chest Injuries
  • Subcutaneous bleeding or skin contusion
  • Rib fracture
  • Inter-costal injury of nerves
  • Pneumothorax- Air pocket causes compression of lungs and leads to somatic pain

c.       Extremities Injuries

  • Muscle contusion
  • Fracture
  • Joint dislocation
  • Skin laceration
  • Subcutaneous hematoma
  • Ligament injury
  • Tendon rupture

Nociceptive Somatic Pain caused due to Nerve Injury

  1. Stabbing Pain- Radicular
  • Bulge disc or disc herination results in pressure on your spinal nerve leading to shooting pain along with the nerve is known as radicular pain
  • Most radicular pain leads to shooting pain
  • Cervical radicular pain in seen in arm, thoracic radicular pain spreads along your chest wall beneath the ribs and lumbar radicular pain spreads through nerves in the leg.
  1. Peripheral Neuropathy

Most peripheral neuropathy is chronic neuropathic somatic pain.

Diseases that cause Chronic and Acute Nociceptive Somatic Pain

  • Pneumothorax- sudden rupture caused in parietal pleura causes pneumothorax, which results in stabbing pain and its gets severe at times. Such conditions sometimes may also result in breathing problems.
  • Skin diseases- skin abscesses, dermatitis, boil causes nociceptive somatic pain
  • Tendonitis- tendon inflammation causes tendonitis, which further results in nociceptive somatic pain.
  • Myalgia- muscle inflammation is called as myalgia, which results in severe pain and thereby leads to in nociceptive somatic pain.
  • Ligaments sprain- ligamental inflammation or various injuries cause pain in ligaments.

Cancer growth also causes Acute or chronic nociceptive somatic pain. Different cancer types have their affect on bones, different organs nerves, soft tissues, which leads to nociceptive somatic pain. We need to be careful if we are suffering from cancer or any other disease.

Pain processing in the brain and Gate control theory of pain

The experience of pain is complex and subjective, and is affected by factors such as cognition (eg distraction or catastrophising), mood, beliefs and genetics. The somatosensory cortex is important for the localisation of pain. However, imaging techniques such as functional magnetic resonance imaging (fMRI) have demonstrated that a large brain network is activated during the acute pain experience. This is often called the ‘pain matrix’.  There are mechanisms that act to inhibit pain transmission at the spinal cord level and via descending inhibition from higher centres

The gate control theory of pain was proposed by Melzack and Wall in 1965 to describe a process of inhibitory pain modulation at the spinal cord level. It helps to explain why when we bang our head, it feels better when we rub it. By activating Aβ fibres with tactile, non-noxious stimuli inhibitory interneurones in the dorsal horn are activated leading to inhibition of pain signals transmitted via C fibres .



Nociception – The Pain Transmission System

Pain is a vital function of the nervous system in providing the body with a warning of potential or actual injury. It is both a sensory and emotional experience, affected by psychological factors such as past experiences, beliefs about pain, fear or anxiety.

When you roll your ankle, or pull a muscle in your lower back, pain is usually immediate. In these cases, pain is “acute“ – meaning new or sudden. Acute pain often originates from nociception – the nervous systems way of detecting, transmitting and processing potential damage. This potential damage is detected by nociceptors – a kind of nerve ending (sensory receptor) found all over your body.

Nociceptors are the specialised sensory receptors responsible for the detection of noxious (unpleasant) stimuli, transforming the stimuli into
electrical signals, which are then conducted to the central nervous system. They are the free nerve endings of primary afferent Aδ and C fibres.
Distributed throughout the body (skin, viscera, muscles, joints, meninges) they can be stimulated by mechanical, thermal or chemical stimuli.
Inflammatory mediators (eg bradykinin, serotonin, prostaglandins, cytokines, and H+) are released from damaged tissue and can stimulate nociceptors
directly. They can also act to reduce the activation threshold of nociceptors sothat the stimulation required to cause activation is less. This process is called primary sensitisation.

Once nociceptors are activated, they send signals through peripheral nerves to the spinal cord, which then travel to the brain.  The signals are processed at each stage of transmission, with the brain arguably playing the largest role in how pain is consciously experienced.


People often refer to nociceptors as “pain receptors” – but that’s not quite right. Nociceptors actually detect the same sensations as other receptors (pressure, temperature, etc). However, nociceptors have a higher threshold of activation, meaning that they require a stronger than usual stimulus before sending a signal to your brain. In a way, they are the “danger” nerves, telling you that something intense is happening – and therefore, you should pay some attention! Nociceptors are kind of like alarms.


Three main categories of nociceptors

Three main categories of nociceptors:

  • Mechanical – Mechanical pressure is perhaps the most common cause of pain. If you roll your ankle, your ligaments are being stretched too far, which can set off mechanical nociceptors.
  • Temperature – Extreme temperatures are another common cause of pain – if you touch something very hot, you’ll set off temperature nociceptors, which may signal pain even before you get burned!
  • Chemical – Chemicals can activate nociceptors too. For example, when you have an injury or infection, the affected area becomes inflamed. Inflammation is an important first step in your body’s healing process – it brings blood and important chemicals to the damaged area to aid in the the repair process. Some of these inflammatory chemicals also affect pain in a couple of ways. Chemical might activate nociceptors to produce pain (sometimes constantly), and some chemicals can lower the threshold of activation in other nociceptors, making you more sensitive to pain in general!

Breast Pain

It is very common for those experiencing breast pain to be concerned that it is a symptom of breast cancer. Of course this may be the case, but there really is no need to be concerned, the best thing to do is to get it checked by your doctor as soon as you can, and get a mammogram done. It has been known for a long time that this kind of pain is normally associated with the menstrual cycle. The pains begin almost immediately after ovulation and amplify its intensity until the beginning of menses. After this it slowly disappears. Mostly, cycle related pains affect both breasts.

The study was revealing and confirms what many women with breast cancer who’ve had surgery or other breast procedures think. The pain they’re having in their breast or breasts is directly related to the treatment, therapy or surgery they had even if it occurs two years later. For most women, the real fear of Mastodynia is that it is an indication of the dreaded breast cancer. The good news is it usually is not. Breast cancer usually presents as a lump and the lump is rarely painful. Mastodynia, on the other hand, is often more a result of pain in joints surrounding the breasts or an underlying arthritic condition. In short, we are talking apples and oranges.

One of the common causes of benign breast lumps is dehydration – not drinking enough water – and/or drinking too much coffee. How coffee causes the lumps is not exactly known. Many of my patients have found that giving up coffee and drinking more water results in a great improvement, with less swelling before their periods and no pain or tenderness. Consult the doctor, he may suggest heat compress to avoid much pain in the breast. Taking medicines to ease the pain is also helpful. Antibiotics are prescribed to relieve the pain, but after two weeks of intake and no results, the doctor should suggest medical check up and surgery.

Pain in the left side of the body can be because of pancreatitis, stomach ulcer or ovulation pain. Pancreatitis is a common health problem having two types which are acute and chronic. In acute pancreatitis, the pain is sharp, short-lived and mostly severe. The pain can spread to the back or below the left shoulder blade. It is mainly caused by alcoholism, gallstones and gallbladder disease. Stress can intensify breast pain by making you more sensitive to normal hormonal changes. So do try to reduce stress in your life, whether it is by listening to music or by learning a relaxation technique such as biofeedback.

Lung Pain

If you are experiencing lung pain you could be a victim of lung cancer, in this day and age it is very important to keep a check on your body and health. Understand with a reported scary only 15% of all people that get lung cancer living past 5 years, it is important to be aware of when you experience pain and other lung cancer signs if they posited for a period of time.

Knowledge is your biggest asset and lack of knowledge your biggest curse when is come to” lung pain” or any other diseases or sickness. So many people for lack of knowledge have paid the price with their lives, breasts and other parts of their body. Learning how to avoid lung pain, cancer and other diseases is better than finding a cure for it, as once you have damages even with a cure you can’t get back what you have lost. I understand pain whether it be lung pain, back pain or any other pain, I have lived with pain most of my life, until I understood what it was and how to overcome it.

Now I am free and you too can get there, never let any one tell you what you can do and what you can’t even if you have the late lung cancer stages it is never too late to improve your life and start to fight. Cancer does not like a fighter. Lung cancer and most other aliments do not like an oxygen enriched body as they find it hard to live and grow in that environment, but rather they prefer a depressed, negative run down and oxygen deficient body.

Today choose to no-longer live with lung pain, start taking control of your life by understanding what you are dealing with and what you can do about it

Joint Pain

You need ten thousand steps a day to meet the guidelines for physical activity to improve health. However , if you are like most people, who find walking painful or you fear your joints might buckle beneath you, each step might as well be a mile.

Your knees and hips are your largest joints. They support your body’s weight and they must work in close coordination to provide the mobility most people take for granted until injury, arthritis, or other problems interfere.

Depending on the cause of your pain, the solution might be a set of exercises designed to strengthen and stretch the muscles that support the joint, taking some of the stress off the joint itself. Minor surgery may also help.

For many people, knee and hip problems become so intractable that the best solution is to replace a worn-out knee or hip with a mechanical joint. In 2003, there were about 902, 000 knee replacement and 728, 000 hip replacement procedures performed worldwide. The average age at which a person has such surgery is 65 to 70.

Physically, your knees and hips are closely interdependent, located as they are at either end of the thighbone. This proximity means the angle of your hip affects the pressure on your knee. A hip disorder may cause knee pain, and knee disorders can aggravate hip problems.

People live longer than they used to, so joints need to stay strong and healthy through those additional years. Nevertheless, both knees and hips are subject to wear and tear as you age, and you can traumatize them further if you increase your physical activity suddenly.

Medical care has changed in recent years. Doctors used to follow surgery by immobilizing the joint with a plaster cast. Weeks of immobility caused the muscles to weaken and shorten, resulting in long-lasting stiffness and poor function. Today, you can wake up from surgery with your knee already being gently bent and straightened by a machine. In addition , knee and hip replacements have freed thousands of patients from life in a wheelchair or on crutches.

Surgical techniques have also advanced. More surgery is performed through tiny incisions using an arthroscope, often on an outpatient basis. Pain relief has moved away from mind-clouding narcotics toward pain relievers that tackle the twin problems of pain and inflammation.

And finally, prevention has moved to center stage, alongside surgical repair and rehabilitation. More strength training added to your daily exercise routine helps support the joints and protect them from injury.

Water exercises support your weight, reducing stress on your joints. One in five people over age 60 has experienced significant knee pain, and one in seven people over age 60 reports significant hip pain.

The Importance of Finding Pain’s Cause

Recurring headaches, migraines, joint pain, muscle aches, back problems: these are just some of the things that send us straight to the painkillers. However , often these conditions deserve a closer look.

Treating pain without discovering the cause is a common problem in medicine. For instance, many people make the mistake of thinking of a headache as a condition – it’s really a symptom. And it can be a sign that something is seriously wrong.

So is there a way to know when pain is just pain and when it is a telling symptom?
It starts with identifying exactly what the pain is.
There are a few types of pain:

– Nociceptive
– Neuropathic
– Mixed
– Psychogenic

Nociceptive pain is something people have a really hard time describing. It is usually not in any isolated area and is rather dull or occasionally throbbing. It is caused by an overstimulation of the peripheral nerve fibers. Nociceptive pain has some subtypes as well: visceral pain – in the organs; deep somatic pain – in the ligaments, bones, blood vessels, tendons, and muscles; and superficial somatic pain – on the skin or surface of the body.

Neuropathic pain is usually describes as burning, piercing, itchy, electric, cold, shooting, etc . The specific painful area is typically very sensitive and the skin in the area may be numb. Neuropathic pain occurs when the nervous system malfunctions or is damaged by something: trauma, disease, drugs, etc . It is subdivided into Centrally and Peripherally Generated Pain. Central pain comes from the brain or spinal cord while peripheral comes from everywhere else.

It is common for a person to experience a mixture of the two.
Psychogenic is less common than the others, but still fairly common. It occurs with mental factors, like stress, anxiety, and depression. Contrary to popular belief, this is not just “in the head”. It is a very real type of pain.

Doctors generally treat nociceptive pain with a painkiller, like Tramadol, but unless you already know the cause and know it is okay, you should be examined because nociceptive pain often comes with potentially life-threatening conditions or diseases.

Neuropathic pain should be diagnosed by a doctor always, even if they usually treat it with a painkiller. If it is unusually persistent or it’s also causing other symptoms, such as fever or vomiting, see a doctor immediately.

Psychogenic pain is difficult to treat and most painkillers are not long-term solutions. For many conditions, psychiatrists can prescribe antidepressants, SSRIs, antipsychotics, and anxiolytics, but painkillers like Tramadol are often used to supplement treatment while the underlying condition is on its way to being controlled. Psychotherapy is commonly recommended as well.

A lot of times, you can just use common sense.

A small cut or a scrape doesn’t warrant at trip to the Emergency Room. However , if you feel like your organs are melting, call an ambulance. Back pain? If you experience it after falling on your tailbone or spine, you should get to a doctor as soon as you can.
The problem with relying on painkillers is that they are habit-forming, have side effects, and build tolerance. Even Tramadol should not be your only way of attacking the most serious pain-causing conditions.

Online pharmacies are great – they really are! Just make sure to look into your condition a bit first.

Ear Non-nociceptive Health Care Earphone

Considering the health of people ears, SFYH. com introduce two earphones for you:

First one is Ear Non-nociceptive Earphone: The utility model provides a pair of pain-free earphones, mainly comprising a sounder and a signal wire. The utility model is characterized in that the two ends of the deckplate which can be worn on the head are both provided with a connecting box, wherein the interior of the connecting box is connected flexibly with an L-shaped radius rod, and the other end of the radius rod is connected with a link rod via a threaded shaft and a nut; the end of the link rod is connected with the sounder, wherein the front par of the sounder is provided with a microphone, and the rear part of the sounder is provided with a signal wire which is provided with a plug and volume control switch. As the length of the radius rod in the connecting box is adjustable and the position of the link rod is movable around the end of the radius rod, the top of the head and the temples in the face bear the weight of the earphones and the radius rod, and the sounds produced by the sounder are transmitted into the antrum auris via the microphone, which transfers the stress point from the ears to near the temples, eliminating the feelings of distending pain and discomfort of the ears caused by the prior earphone. The terminal of the link rod can also be connected with a pickup, i. e., a transmitter besides a sounder, to produce earphones suitable to be used with MP3, computer, radio receiver or used in Internet bar.

The second one is Health Care Earphone: The utility model provides a pair of health-care earphone, which solves the problems that the prior earphone do harm to the hearing of the audience, the wearing is uncomfortable, the sound is not soft, and the communication with others is inconvenient, etc . The technical proposal is that the utility model comprises a pair of earphones (1) and a pair of semiclosed earflaps, wherein the earphones (1) are arranged fixedly in the round holes (4) in the earflap shells (3). The utility model avoids hearing loss of users, the use is convenient and comfortable, the sounds are clear and soft, and the utility model ensures normal communication with others.