Hi, and welcome to this video on somatic pain! Today, we’ll be looking at the different types of somatic pain, where it comes from, and what sort of treatment options are available.
Pain caused by noxious stimuli to non-neural tissue is classified as nociceptive pain. In contrast to neuropathic pain, which results from a maladaptive process in either the central or peripheral nervous system, and serves no biological function, nociceptive pain is the appropriate physiological response from a normally functioning, intact nervous system, and serves as a protective mechanism, essential to our survival.
Mechanical, thermal, or chemical stimuli that are damaging or potentially damaging to normal tissue, known as noxious stimuli, stimulate nociceptors located in internal organs, the skin, joints, bones, and muscles. Activation of nociceptors (A-delta fibers and C fibers) launch a cascade of complex and interrelated processes, which leads to the perception of pain. The sensation of nociceptive pain continues only as long as the noxious stimulus is present, and removal or resolution of the stimulus alleviates the pain.
Nociceptors are peripheral sensory neurons, which are specifically activated by noxious stimuli and respond only when the intensity of these stimuli is high enough to damage tissue; however the activation of a nociceptor does not necessarily result in the experience of pain. Whether or not nociceptor activation is experienced as pain, depends on a wide variety of physiological and psychological factors.
Traumatic injuries, diagnostic and therapeutic procedures, the inflammatory process, disease, surgery, and endogenous chemical stimuli such as prostaglandins, and histamine, all can cause nociceptive pain.
Anyone who has ever sustained even a minor injury has first-hand experience with nociceptive pain. It is considered the most common type of pain and can be divided into 3 types:
- Visceral Pain is pain originating from internal body organs. It is often vague and poorly localized; typically described as dull, cramping, or squeezing; and may be referred to as a distant, superficial body structure. Visceral pain may be intermittent and last longer than somatic pain. The pain associated with irritable bowel syndrome (IBS) and angina are examples of visceral pain.
- Superficial Somatic Pain originates in the skin, mucous membranes, or other superficial tissues of the body. Often described as sharp or stabbing, superficial somatic pain is usually well-defined, localized to the area of injury, and constant. Examples of injuries that produce superficial somatic pain include lacerations, abrasions, and minor burns.
- Deep Somatic Pain originates from joints, ligaments, tendons, muscles, bones, and fasciae. This type of somatic pain may be described as dull or aching, and often it is generalized or felt over a wide area of the body. This type of pain may be intermittent and can radiate around the injured area. Examples of deep somatic pain include arthritis pain, pain related to a fracture, metastatic bone pain, and post-operative pain.
The etiology and pathogenesis of somatic pain is diverse. Additionally, somatic pain may be acute or chronic; and it may be mixed, or combined, with another type of pain. Treatment must not only alleviate the pain but whenever possible, should address the underlying cause or condition activating the nociceptive fibers.
Management options will vary depending on the severity and duration of the pain, the type of pain, the complexity of symptoms; the presence of comorbid conditions, biopsychosocial factors contributing to the pain condition, and the care setting.
Treatment goals for both types of somatic pain include:
- Adequate pain control (balancing relief and patient safety),
- Resolve the underlying causes of pain,
- Optimize patient functioning,
- Enhance quality of life.
It is important to note the negative impact that inadequate management of acute pain can have on a patient’s quality of life, as well as placing them at risk for both post-op complications and the development of chronic pain.
Treatment strategies applicable to all pain conditions include the use of different pharmacological and non-pharmacological modalities. Clinical best practice guidelines for most acute and chronic pain conditions recommend a patient-centered, multimodal, and coordinated multidisciplinary approach to achieving optimal outcomes. A multimodal approach combines two or more interventions, and can include:
- Pharmacologic therapy – including analgesics (both opioid and non-opioid prescription or over-the-counter pain relievers), adjuvant/coanalgesic drugs
- Non-pharmacologic therapy, such as massage, physical therapy, thermotherapy, relaxation techniques, acupuncture, behavioral and interventional therapy.
A combination of interventions is most effective in the management of somatic pain.
Analgesics are considered the gold standard in pain management and the pharmacological approach to the treatment of most types of pain is very similar. Somatic pain responds well to the primary analgesics, (opioids, acetaminophen, and non-steroidal anti-inflammatory drugs); however, as a general rule, non-steroidal anti-inflammatory drugs (NSAIDS) are the drugs of choice. The selection of the most appropriate drug should be guided by the World Health Organizations (WHO) Analgesic Ladder recommendations. The WHO ladder, originally developed as a concept model in 1986, is a 3-step algorithm for pharmacological therapy, which has achieved worldwide consensus promoting its use for the medical management of both acute and chronic pain.
An important caveat in pain management is while not all pain is curable, all pain is treatable.
Ok, before we go, let’s review:
1. Which of the following statements is false?
- Inadequate control of acute somatic pain can have a negative impact on the health and wellbeing of the patient and can put them at risk for both post-op complications and the development of chronic pain.
- Nociceptive pain is the most common type of pain and includes superficial and deep somatic pain as well as visceral pain.
- When weighing pharmacologic treatment options in managing acute somatic pain, among the factors a provider should take into consideration are severity or intensity of the pain, the presence of any comorbid conditions and biopsychosocial factors contributing to a pain condition.
- Unlike the underlying cause of superficial somatic pain, deep somatic pain is caused by abnormal sensations from normally non-painful stimuli.
The correct answer is D.
2. Which of the following statements about somatic pain is true?
- Deep somatic pain is caused by stimulation of nociceptors located in the internal organs, joints, and bones, by noxious stimuli, and can be either acute or chronic.
- Somatic pain is a type of nociceptive pain and can be either superficial, or deep, is caused by stimulation of nociceptors located in the skin, joints, bones, or muscles by noxious stimuli; and may be either acute or chronic
- Somatic pain includes nociceptive pain and neuropathic pain, which is caused by stimulation of nociceptors located in the skin, joints, bones, or muscles by noxious stimuli
- Deep somatic pain caused by stimulation of nociceptors located in the skin, joints, or muscles by noxious stimuli, is usually localized, well-defined, and described as sharp, or stabbing
The correct answer is B.
3. Which of the following statements about managing somatic pain is true?
- Treatment of somatic pain is primarily aimed at resolving the underlying cause or condition activating the nociceptive fibers and the use of analgesics, coanalgesic, or non-pharmacologic therapies are not recommended.
- NSAIDS are the drugs of choice for the treatment of somatic pain and the use of different non-pharmacological modalities, such as massage, physical therapy, relaxation techniques, or acupuncture is generally not recommended.
- Treatment of somatic pain requires a patient-centered, multimodal approach that may include the use of different pharmacological and non-pharmacological modalities, such as massage, physical therapy, thermotherapy, relaxation techniques, or interventional therapies.
- The selection of the most appropriate NSAID for the treatment of somatic pain should be guided by the WHO Analgesic Ladder; and as a general rule, the use of adjuvant drugs or non-pharmacological modalities, such as massage, relaxation techniques, acupuncture, or physical therapy are highly recommended.
The correct answer is C.
Thanks for watching, and happy studying!