Causes of Nociceptive Somatic Pain

What Is Somatic Pain?

Somatic pain is observed in skin, subcutaneous tissue, muscles, tendon, ligament, joint and bone. Pain is transmitted by somatic nervous system.

Causes of Nociceptive Somatic Pain

Describe Somatic Nervous System?

Somatic nervous system consist of following elements of nervous system-

  • Peripheral pain receptors.
  • Sensory cranial and spinal nerve fibers carrying pain impulses to spinal cord.1
  • Inter-neuron fibers exchanging information in spinal cord with nerve cells and inter-neurons.
  • Ascending sensory nerve fibers carries pain impulses to brain and higher pain centers.

How Many Cranial And Spinal Nerves Are Involved In Somatic Pain?

  • Cranial Nerves-twelve
  • Spinal nerves- thirty-one.

Described Inter-Neuron and Inter-Neuron Sensory Fibers Involved In Somatic Pain?

  • There are several hundreds Inter-neuron fibers in spinal cord and brain stem.
  • Interneurons are nerve cells in spinal cord. Interneuron communicates with other interneurons by interneuron fibers.
  • Interneuron receives pain impulses from peripheral receptors and transfers information NMDA receptors, which transmit pain impulses to brain or muscles.2 Information to muscles triggers abrupt and rapid removal of the body from harmful stimulation. Regulating function of Interneuron is known as modulation.

What Are The Different Types Of Somatic Pain?

Somatic pain is described as

Acute Pain-

  • Acute Nociceptive pain
  • Acute Neuropathic Pain

Chronic Pain-

  • Chronic Nociceptive pain
  • Chronic Neuropathic Pain

What Is Normal Transmission Of Pain Impulses?

Pain impulses are transmitted to spinal cord by sensory nerve fibers from peripheral receptors when receptors are irritated or stimulated.3 Pain impulses are relayed over neurons (nerve cells) in spinal cord. Neurons modulate or regulate pain impulses.

What Is Nociceptive Somatic Pain?

Nociceptive somatic pain is sharp and well localized shooting or stabbing pain. Irritation or stimulation of peripheral pain receptors generates acute pain, which is known as nociceptive pain. Prostaglandin, arachnoid acids and substance P are the neurotransmitters causes irritation or stimulation of pain receptors.4

What Is Neuropathic Somatic Pain?

Neuropathic somatic pain is burning and shooting type of pain. Neuropathic somatic pain is caused by abnormalities of impulse transmission and modulation of pain impulses at neurons (nerve cells) in spinal cord. Neuropathic pain follows malfunction of pain receptors, neurotransmitters and sensory neurons in spinal cord and brain. Somatic neuropathic pain continues in spite of absent obnoxious stimuli.

What Is Acute Nociceptive Somatic Pain?

Nociceptive somatic pain is known as acute nociceptive somatic pain when pain last for 3 to 6 months.

What Is Chronic Nociceptive Somatic Pain?

Chronic nociceptive pain is pain lasting more than 6 months and pain caused by irritation or stimulation of peripheral pain receptors.

What Causes Chronic Nociceptive Pain?

Chronic nociceptive pain is intermittent pain and pain is observed only when pain receptors are stimulated or irritated. Example of nociceptive pain lasting beyond 6 months is pain caused by either peripheral scar tissue or malignant cancer. Scar tissue or malignant cancer encroaches in to surrounding soft tissue and entraps or pinches peripheral sensory pain fibers or pain receptors resulting in chronic nociceptive somatic pain. Chronic nociceptive pain is rare because nociceptive pain if continues longer than 6 months become neuropathic pain.

What Is Modulation Of Pain Impulses?

Pain impulses are relayed over nerve cells at spinal cord. Nerve cells modulate pain impulses. Modulation involves multiple neurotransmitters. Modulation regulates the impulse transmission to brain and controls local reflexes. Modulation also discontinues impulse transmission to brain when peripheral impulses are stop coming to spinal cord.

Describe The Causes Of Nociceptive Somatic Pain?

Cause of nociceptive pain is divided as follows-

  • Traumatic injuries resulting in somatic pain
    • Domestic injury
    • Sport Injury
    • Work accident
    • Automobile accident
  • Nerve irritation or injuries
  • Non-cancer disease and
  • Cancer disease.

Traumatic Injuries Causing Nociceptive Somatic Pain

Injuries caused by domestic, sport, work and automobile accidents are as follows-

A. Blunt Trauma Or Injuries-

  • Head and Neck
  • Chest
  • Abdomen
  • Extremities

B. Penetrating Or Gunshot Wound

  • Head and Neck
  • Chest
  • Abdomen
  • Extremities

Blunt Trauma Causing Nociceptive Somatic Pain

a. Head and Neck-

  • Headache - secondary to concussion or contusion and intra-cerebral or subdural bleeding
  • Skull fracture
  • Skin contusion or subcutaneous bleeding

b. Chest-

  • Rib fracture
  • Intercostal neuralgia- intercostal nerve injury
  • Pneumothorax- Air pocket compresses lung and causes severe somatic pain.
  • Skin contusion or subcutaneous bleeding.

c. Abdomen

  • Fracture vertebral column,
  • Facet joint injury
  • Skin contusion or subcutaneous bleeding.

d. Extremities Injuries-

  • Skin laceration
  • Subcutaneous hematoma
  • Muscle contusion
  • Ligament injury
  • Tendon rupture
  • Joint dislocation or
  • Fracture.

Penetrating Injury Causing Nociceptive Somatic Pain

a. Head and Neck-

  • Skin laceration and cut- Bleeding and subcutaneous blood clot causing pain
  • Skull fracture- associated with cerebral bleeding

b. Chest Injuries

  • Rib contusion or fracture
  • Intercostal neuralgia- penetrating injury may cause intercostal nerve injury and lung laceration. Pain caused by pleural or lung injury is a visceral pain and not somatic pain.
  • Pneumothorax- Air pocket compresses lung and causes severe somatic pain results in somatic pain.
  • Skin contusion or subcutaneous bleeding.

c. Abdominal Injuries

  • Fracture vertebral column,
  • Facet joint injury,
  • Skin contusion or subcutaneous bleeding.

d. Extremities Injuries-

  • Skin laceration and cut causing external bleeding and subcutaneous bleeding.
  • Subcutaneous hematoma
  • Muscle contusion and tear
  • Ligament injury or tear
  • Tendon rupture
  • Joint dislocation
  • Fracture

Nerve Injury Causing Nociceptive Somatic Pain

A. Post Herpetic Neuralgia-

  • Shingles or herpes zoster is a viral inflammatory disease mostly affects nerve cells in spinal cord.
  • Herpes zoster causes severe shooting nerve pain known as post herpetic neuralgia. Post herpetic neuralgia is observed in trigeminal, intercostal (thoracic spinal nerve), cervical and lumbar nerve.
  • Trigeminal post herpetic neuralgia pain is spread over one side of face. Intercostal neuralgia is observed over chest wall under the ribs.
  • Cervical and lumber post-herpetic neuralgia shooting pain is observed over arms and legs.

B. Radicular Stabbing Pain-

  • Disc herniation or bulge disc causes pressure over spinal nerve resulting in shooting pain along the nerve known as radicular pain.
  • Most of the radicular pain results in shooting pain.
  • Cervical radicular pain is observed along the arm, thoracic radicular pain is spread along chest wall under the ribs and lumbar radicular pain is spread along the nerves in leg.

C. Peripheral Neuropathy-5

  • Most of the peripheral neuropathy is chronic neuropathic somatic pain. Peripheral neuropathy caused by nerve injury is nociceptive during initial phase of the disease.

Diseases Causing Acute and Chronic Nociceptive Somatic Pain

  • Skin diseases- Boil, skin abscess and dermatitis causes nociceptive somatic pain.
  • Myalgia- myalgia is an inflammation of muscles, which causes severe pain following muscle spasm and muscle trauma.
  • Tendonitis- Inflammation of tendon causes tendonitis, which result in severe nociceptive somatic pain.
  • Pneumothorax- Sudden rupture of parietal pleura or visceral pleura causes pneumothorax, which results in sudden air pocket outside lungs and severe stabbing pain. Such condition may or may not be associated with difficulties in breathing.
  • Ligaments Sprain- Ligamental inflammation or injury causes severe pain in ligaments.

Cancer Growth Causing Acute Or Chronic Nociceptive Pain

Cancer is classified as benign or malignant. Irritation of pain receptors or nerve fibers causes nociceptive somatic pain.

  • Benign Cancer- Benign cancer grows in size and eventually causes pressure over surrounding organs. Pressure over surrounding nerve and nerve plexus causes severe stabbing pain mostly distributed along the nerve, which affected by pressure.
  • Malignant Cancer- Malignant cancer penetrate through surrounding organs and often causes rupture of blood vessels resulting in stabbing pain. Similarly local spread of cancer encroaches into surrounding nerve and nerve plexus resulting in severe stabbing pain.
  • Metastatic Malignant Cancer- Metastatic cancer spreads through distant bones and soft tissue. Spread over vertebrae causes pressure over spinal cord and stabbing pain in lower leg.

Is It Difficult To Treat Nociceptive Pain?

Nociceptive pain is less difficult to treat than neuropathic pain. Nociceptive pain is treated with NSAIDs or opioids.

References

1. Myelinated afferent fibres innervating the primate skin and their response to noxious stimuli. Perl ER. J Physiol 1968;197:593-615.

2. Evidence for involvement of N-methyl-D-aspartate receptors in ``wind-up'' of class 2 neurons in the dorsal horn of the rat. Davies SN, Lodge D. Brain Res 1987;424:402-406.

3. Functional properties of primary afferent units probably related to pain mechanisms in primate glabrous skin. Georgopoulos AP. J Neurophysiol 1976;39:71-83.

4. Contributions of arachidonic acid derivatives and substance P to the sensitization of cutaneous nociceptors. Cohen RH, Perl ER.. J Neurophysiol 1990;64:457-464.

5. An experimental model for peripheral neuropathy produced by segmental spinal nerve ligation in the rat. Kim SH, Chung JM. Pain 1992;50:355-363.

Written, Edited or Reviewed By:

, MD, FFARCSI

Last Modified On: May 2, 2016

Pain Assist Inc.

Pramod Kerkar
  Note: Information provided is not a substitute for physician, hospital or any form of medical care. Examination and Investigation is necessary for correct diagnosis.

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