Principles of Pain Management

Types of Pain & Examples	Typical Description	Nonpharmacologic Treatments and Effective Drug Classes
Peripheral
Nociceptive: somatic (eg, tissue injury of bones, soft tissue, joints, muscles)
Arthritis, low-back pain, myofascial pain	Well localized, constant; aching, stabbing, gnawing, throbbing	Exercise, PT and CBT, other nondrug tx, APAP, topical anesthetics/NSAIDs, intraarticular corticosteroid, salsalate, NSAIDs, duloxetine, tramadol, hydrocodone/APAP, oxycodone, fentanyl, methadone
Acute postoperative, fracture, bone metastases	Well localized, constant; aching, stabbing, gnawing, throbbing	APAP, topical anesthetics/NSAIDs, nondrug tx (eg, massage, music), NSAIDs, opioids
Nociceptive: visceral (eg, tissue injury of visceral organs including heart, lungs, testes, and biliary system)
Renal colic Constipation	Diffuse, poorly localized, referred to other sites, intermittent, paroxysmal; dull, colicky, squeezing, deep, cramping; often accompanied by nausea, vomiting, diaphoresis	Tx of underlying cause, APAP, IV NSAID, opioids with nondrug tx
Neuropathic: peripheral nervous system (eg, injury to nervous system—nerves and spinal cord)
Cervical or lumbar radiculopathy, postherpetic neuralgia, trigeminal neuralgia, diabetic neuropathy, phantom limb pain, herniated intervertebral disc, drug toxicities	Prolonged, usually constant, but can have paroxysms; sharp, burning, pricking, tingling, pins-and-needles, shooting electric-shock–like; associated with other sensory disturbances, eg, paresthesias and dysesthesias; allodynia, hyperalgesia, impaired motor function, atrophy, or abnormal deep tendon reflexes	Nondrug tx, topical anesthetics, TCAs, SNRIs, anticonvulsants, opioids
Nociplastic or Mixed (eg, pain from altered nocicpetion despite no clear evidence of actual or threatened tissue damage; neurologic dysfunction or combined and uncertain causes)
Myofascial pain syndrome, somatoform pain disorders, fibromyalgia; poststroke; temporomandibular joint dysfunction, tension HA	No identifiable pathologic processes or symptoms out of proportion to identifiable organic pathology; widespread musculoskeletal pain, stiffness, and weakness; fatigue, sleep disturbance; taut bands of muscles and trigger points; sensitivity to sensory stimuli	Exercise, PT and CBT, other nondrug psychologic tx, antidepressants, antianxiety agents
NOTE: Cancer pain may present with any of the types described above.