MOOCS Entendendo Dor Crônica - 03 - Quais são os tipos de dor

Hi! Today I will talk about the types of pain. Therefore, the objective of this lesson is to touch on types and characteristics of pain.

But did you know there are three types of pain? Pain is categorized into nociplastic, neuropathic and nociceptive. During this class I will talk about what this means, how diagnoses are done, and how important diagnosis is in order to plan an adequate intervention for each type of pain.

Initially, it is important to understand how the brain's pain perception, transmission and processing system works. To start this, it is important to remember that pain is our organism's warning sign and, just like any warning sign, I will use a home alarm system to explain to you how pain transmission, perception and processing works. An alarm system in a house or in a company, there are sensors, which receive information such as movement, smoke and also shifts.

So, there are cameras and motion sensors, smoke detectors, and our bodies also have such equipments. There is also that little box on the alarm wall, in which we enter the number to turn on or off the system, and regulate signals and information. There are also wires that connect this box to the managing center, where they process information and decide, through storage, processing and analysis of information, if they need to, for example, to call firefighters at the signs of smoke.

So, how does the pain alarm system works inside our bodies? Just like the home alarm I mentioned, with movement sensors, cameras and smoke detectors, our skin has sensory receivers of signals such as temperature and pressure changes, sense of touch, vibration. These signals are taken in by receivers and directed through wires, which are our sensory nerves, reaching spinal cord, which would be that little alarm box on the wall.

After the spinal cord receives the sensory information, it transmits the information to the alarm processing center, that is, our brains. Then, it is really in the brain that the storage and comparison of memories of pain we experienced in the past happens. The brain, then, decides if the stimulus received is harmful or not, dangerous or not, and, this way, it can elaborate an adequate response to the phenomenon perceived by the sensory receptors.

Just to give you an example. When you are hammering a nail to a wall and the hammer hits your finger, the skin sensory receivers perceive the pressure information and lead it to the afferent pathways and the spinal cord through the peripheral nerves the spinal cord retransmits this to the brain, and, then, the brain processes this information to elaborate a response. And the responses given can be, for example, to move the finger away from the hammer or to seek some sort of health treatment for the injury.

So, these reactions are elaborated by our brains. What I mean to say is that pain is a sensory experience elaborated by our brains. Therefore, the first type of pain is related to the origin of pain, which is the nociceptive pain.

The nociceptive pain is linked to wounds or diseases that occasionally lead to tissue injury. So, when we talk about pain with nociceptive origin, we often think about injuries like, for example, a sprained ankle, fractures or wounds. Pain with nociceptive origin has some characteristics.

In general, it is intense, self-limited, that is, when the lesion is healed, the pain tends to stop. Another characteristic of nociceptive pain is its protective role, for which the alarm system is responsible for in our organisms. So, nociceptive pain is related to the organism's protection system.

The other type of pain is linked to the origin of pain through nervous system injuries, in the nervous system itself. This type of pain is called neuropathic. So, back to that initial example I gave of an alarm system for you to understand, nociceptive pain, as I said before, is like there was a burglar breaking the cameras or motion sensors: nociceptive pain.

And the neuropathic pain is like there is a burglar cutting the wires that transmit information, such as the afferent pathways, which are part of the nervous system. Therefore, neuropathic pain is related to, for example, when trauma occurs, in a car accident, if there is a pinched nerve, or when someone has a malignant tumor that puts pressure on the spinal cord or on an afferent pathway. The third and last type of pain that I want to tell you about is a bit more complicated: it is called nociplastic.

Nociplastic pain is related to the brain's capacity to adapt to the changes that happen inside our brains, which is called neuroplasticity. So, nociplastic pain may be related to a previous phenomenon, of nociceptive or neuropathic pain. What happens?

Our experiences with other people's pain, our previous experiences with pain promote memories and storage information. When the alarm processing center is elaborating a response to pain, it takes into consideration all information it already has in storage. The stored information promote significant changes in our brains.

Nociplastic pain is related to, for example, to long-lasting pain, such as that of fibromyalgia, migraine and complex regional pain syndrome. Nociplastic pain has some very important characteristics that differentiates it, for example, when an injury is healed, meaning there is no injury anymore, and the person still feels pain. There are also patients that feel afraid, incapable and that catastrophize due to pain.

For nociplastic pain, it usually lasts over six months. It is diffused and undefined, and, nowadays, the pain is deemed as the illness itself. So, today, the World Health Organization considers chronic pain by itself as an illness.

Patients with nociplastic pain have some distinguished characteristics, such as, the patient is afraid to move, they are afraid to feel pain again, they rest, in general, to ease the pain, and avoid moving, becoming increasingly sedentary. They also stop taking part in work and leisure activities, and displays other compromises, such as compromising adequate sleep. So, a patient with nociplastic pain, their pain is caused by the brain, and it is real, although its entire processing is unconscious.

It is great that now, in science, we know that the way we learn and respond to pain is processed by the brain, And the brain is also responsible for how we unlearn this process and how we resignify pain. So, there are treatment strategies to help people resignify their pain and improve nociplastic pain. So, it is important for us, those that live with people with chronic pain or those that have it, to know that there are strategies able to treat each type of pain.

And knowing these treatments and seeking professionals able to specifically care for each need is very important. For that, continue watching our videos, continue learning. Thank you very much.

[Thank you! Keep on learning!