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 .



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