(Below is the trascript of the video above)
Knowing what type or types of pain someone has is not much use if you don't know how to use the knowledge and clinically reason your way to an effective management. In today's video I'll attempt to briefly explain what it all means.
It's necessary to know the types (or more accurately "mechanism") of pain, simply because each type of pain has different physiology that is driving the pain, and thus requires different interventions or INTENTION behind interventions. But first, we need to recognise different mechanisms of pain when we see one.
- a 1-day-old ankle sprain is probably full of inflammation, whereas pain four months after a sprain is more likely to be dysfunctional.
- a chronic neck pain may be to do with central sensitisation which is dysfunctional, or muscle insufficiency which may be more nociceptive.
- a carpal tunnel syndrome may be quite neuropathic and inflammatory, or it may be more dysfunctional.
- a back pain could be nociceptive due to the pain straight from a disc that's been stressed beyond its adaptive capabilities , it may have a neuropathic component if it has an acute nerve root compression, and if chronic it may be dysfunctional due to central sensitisation. There may even be some inflammation around the area as well.
And of course, in most cases it's a mixture of the these four mechanisms of pain. It's simply a matter of recognition and prioritising.
Then how do we recognise the different mechanisms of pain of a given person? That is a pretty big question, and while there are some typical presentations or patterns for each mechanism of pain I just can't go into it in this video.
Same with proposed interventions for pain. It's a big topic with complex and conflicting evidence. We must also acknowledge that perspectives, working paradigms and biases vary greatly across health disciplines AND within each discipline as well, so a same patient can receive quite different treatments from different clinicians and it's very difficult to say who is right and wrong.
However what I can say is that it would be wrong NOT to consider these four mechanisms when caring for patients with pain. At least an attempt at differentiating them will give us much clearer picture of management pathway.
And then we must decide whether the particular mechanism or mechanisms of pain actually needs active management (since most pain self-resolves), and if it does need management how we, the clinicians can positively influence it, with firm consideration of multidimensional nature of pain (1,2).
1. Melzack R, Katz J. Pain. Wiley Interdiscip Rev Cogn Sci. 2013;4(1):1-15.
2. Borrell-Carrio F, Suchman AL, Epstein RM. The biopsychosocial model 25 years later: principles, practice, and scientific inquiry. Ann Fam Med. 2004;2(6):576-82.