Different treatments for different types of pain

According to recent studies, chronic pain affects around 30% of adults in the UK. In 2/3 of cases, the pain is mild to moderate in intensity. Chronic pain tends to increase with age, and affects women more than men. People mostly experience pain in the back, neck, shoulders, head and abdomen. Pain is often associated with depression, sleep disorders and, of course, reduced quality of life.

The different types of pain 

Pain is about, first of all, how the patient feels. According to the official definition of the International Association for the Study of Pain (IASP), it is an unpleasant sensory and emotional experience associated with, or resembling, the pain associated with actual or potential tissue damage.  

Pain is classified according to its nature (acute or chronic) and duration. Thus there are:

Acute pain 

Acute pain acts as an "alarm", signalling the body to react and protect itself in the face of a chemical, mechanical or thermal stimulus. It is linked to intense stimulation, which immediately triggers a mechanism for transmitting information from nerve endings.

The pain receptors are called "nociceptors". They are located in the skin, muscles, joints, etc. and their job is to send a message to the brain. There are different types of nociceptors, each specialised in the transmission of a particular sensation (burning, stinging, temperature, etc.). When activated, they transform the information they receive into electrical impulses.

When acute pain lasts for more than 3 months, it is considered to be chronic pain as it is no longer perceived as an alarm signal. Pain is therefore no longer a symptom but an illness.

Chronic pain 

There exist various types of chronic pain according to the pathophysiological mechanisms that are involved. 

Inflammatory pain 

This type of pain is associated with inflammation that lasts over time. Examples include joint pain.

Neuropathic pain 

It is linked to damage to the central or peripheral nervous system, the spinal cord, an amputation or a stroke. These lesions directly affect the pain detection system. As a result, the 'alarm system' fails and becomes uncontrollable by conventional painkillers.

Mixed pain 

The mechanism of this pain combines an inflammatory component with a neuropathic component. This type of pain is often encountered in cancer patients or after surgery.

Nociplastic pain

It has been described more recently and is linked to alterations in nociception - the pain detection system - in which no lesion is found. Nociplastic pain is based on a change in the systems for controlling and modulating pain.

This type of pain is found in patients suffering from fibromyalgia, functional intestinal disorders or certain chronic headaches.

Which treatment for which type of pain? 

Drug treatments 

Inflammatory pain is now well treated with standard analgesics - paracetamol, aspirin, anti-inflammatory drugs, and morphine and its derivatives for severe pain.

However, these treatments have side-effects if taken for long time, such as gastric problems, kidney problems, and/or dependence.

On the other hand, neuropathic pain responds very poorly to analgesics, with the exception of certain opioids, but the side-effects of the latter make them unsuitable for long-term use.

The main treatments used to treat neuropathic pain are antidepressants and antiepileptics. These two categories of drugs are only moderately effective, although they have fewer side effects.

Local treatments such as anaesthetic or capsaicin patches, or injections can be used if the pain is not too widespread.

In recent years, botulinum toxin has been used to treat peripheral neuropathic pain when previous medications have not worked sufficiently. Botulinum toxin is administered by subcutaneous injection and has a duration of action of 3 months, with no notable adverse effects. However, because of the way it is administered, it is reserved for superficial neuropathic pain that does not affect a large area.

Non-drug treatments 

A number of non-medicinal approaches can also be helpful when treating pain, including sophrology, acupuncture, relaxation and hypnosis. For some patients, these complementary methods can reduce the number of medicines they have to take.

Another approach, known as transcutaneous electrical nerve stimulation (TENS), uses electrodes stuck to the skin to relieve pain.

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