Differentiating nociceptive from neuropathic pain is essential in an osteopathic assessment
Definitions
Nociceptive pain: nociceptors are the nerves which sense and respond to parts of the body which suffer from damage. They signal tissue irritation, impending injury, or actual injury. When activated, they transmit pain signals (via the peripheral nerves as well as the spinal cord) to the brain. The pain is typically well localized, constant, and often with an aching or throbbing quality.
Visceral pain is the subtype of nociceptive pain that involves the internal organs. It tends to be episodic and poorly localized.
Nociceptive pain is usually time limited, meaning when the tissue damage heals, the pain typically resolves. (Arthritis is a notable exception in that it is not time limited).
Neuropathic pain: Neuropathic pain is the result of an injury or malfunction in the peripheral or central nervous system. The pain is often triggered by an injury, but this injury may or may not involve actual damage to the nervous system. Nerves can be infiltrated or compressed by tumors, strangulated by scar tissue, or inflamed by infection. The pain frequently has burning, lancinating, or electric shock qualities. Persistent allodynia, pain resulting from a non-painful stimulus such as a light touch, is also a common characteristic of neuropathic pain. The pain may persist for months or years beyond the apparent healing of any damaged tissues. In this setting, pain signals no longer represent an alarm about ongoing or impending injury, instead the alarm system itself is malfunctioning.
Joint pain is frequently considered a pure nociceptive pain. Recent studies suggest that patients frequently report neuropathic symptoms and that neuropathic mechanisms are involved in joint pain.
Differentiation
Differentiating nociceptive pain from neuropathic pain is essential in the manual treatment of the patient.
In the case of nociceptive pain, we have to address the tissues that generate the pain.
In the case of neuropathic pain, we have to consider not only the pain causing structure but the whole patient. For example, in neuropathic foot pain, we have to address the foot, the knee, hip, pelvis and lumbar spinal segments, even non-related somatic dysfunctions up to the upper cervical spine and cranium. In these neuropathic pain cases, even diet, lifestyle and consciousness about the pain mechanism can be important to help the patient.
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