Understanding Different Pain Types
Different pain conditions can cause very different kinds of pain. However, due to the subjective nature of pain, it’s hard for doctors and patients alike to know what’s making us hurt in a certain place at any given moment. For those of us with widespread pain, that can make it really hard to recognize it when a new pain condition comes up—and that means delays in diagnosis and treatment.
Something that can help is understanding the experiences of others when it comes to different varieties of pain. We can also learn proper pain terminology so we can communicate better with our doctors.
Some pain types originate in the central nervous system (CNS) while others are structural pain tied to a muscle, connective tissue, bone, or joint.
Fibromyalgia pain is widespread and can strike anywhere at the body at any time. It can frequently be in certain areas or be completely random. It is made up of myriad pain types. We’ve got:
- Hyperalgesia, which doesn’t cause pain on its own but amplifies all of your pain signals;
- Allodynia, which is pain from stimuli that aren’t normally painful (such as a loose waistband, mild heat, or air moving across your skin) and is often described as feeling similar to a sunburn;
- Paresthesias, a type of nerve pain/abnormal sensation that includes tingling and burning;
- Ischemic pain, which is when blood flow is low to an area and then rushes back, like when your foot falls asleep and then gets pins and needles;
- Fascial pain, which may stem from inflammation in the fascia (a web of connective tissues that covers and connects pretty much everything in your body—muscles, tendons, ligaments, organs, etc.)
- Other pain types that aren’t yet medically classified but are commonly described by those of us who have the condition.
Ischemic, fascial and nerve pain will be discussed later in this article. You can learn more about types 1, 2, 3, and 6, including how they’re treated, here:
Fibromyalgia pain is unpredictable. Mine is currently in a long-term remission, but I used to get horrible stabbing, searing pain in my abdomen that would seem to bounce and ricochet around at random. One day, I could handle a fair amount of exertion before they started; the next, it might just take getting out of bed and walking to the kitchen. Other times, they’d hit out of the blue, not tied to exertion at all.
Flares would take me out of commission entirely. I’d lay in bed or on the couch all day, with level 10 pain that felt like I was being stabbed repeatedly. It was common for me to curl up in a ball and cry several times a day because I simply couldn’t do anything else. My flares lasted anywhere from 3 to 10 days and could hit at any time.
A lot of fibromyalgia pain comes from the nerves, so descriptions of it are much like those of neuropathy (pain from damaged nerves.) In fact, the drug Lyrica (pregabalin) is approved for both neurology and fibromyalgia.
Nerve pain can be tingly and burning, and it can feel like a bolt of electricity. Anyone who’s touched a live wire or the tines of a half-in electrical plug knows what that’s like. Another good example of nerve pain is bashing your “funny bone”—it’s not the bone that causes that distinctive and intense pain, it’s the nerves.
My nerve pain (from carpal tunnel, fibromyalgia, and mild neuropathy in one foot and leg) feels like it’s right at the surface. When it’s mild, I sometimes confuse it for an itch, and then I REALLY regret scratching it!
“Ischemia” means “inadequate blood supply.” It’s also called “hypoperfusion.” The most common reference most of us have is a foot or hand falling asleep. You don’t feel much while the blood flow is low, but we all know what happens when you move or try to stand on the affected part. Ow!
In fibromyalgia, some research suggests low-level ischemia in the muscles. That means they’re deprived of oxygen, which makes them weak. Then, when blood flow does increase, you can get that distinctive prickly, burning sensation.
Exercise increases blood flow to the muscles, which is a possible reason that appropriate exercise, tailored to your specific exercise tolerance and fitness level, can reduce fibromyalgia pain.
In my experience, ischemic pain is most similar to nerve pain.
Connective Tissue Pain
Tendons attach muscles to bones, while ligaments connect bones to each other. The fascia holds pretty much everything inside your body together. You know the white filmy coating on a chicken breast? That’s fascia.
On top of having had several connective-tissue injuries, I have myofascial pain syndrome, which causes injuries to heal improperly. That leads to trigger points, which can cause both local and referred pain. (Trigger points are NOT the same as the tender points sometimes used to diagnose fibromyalgia.)
In my experience, connective tissue pain is achy, with sharper pain when you use the damaged part.
Fibromyalgia doesn’t typically cause joint pain. If you have joint pain from another source, such as arthritis, hyperalgesia will make it worse. However, if you have sore joints, and especially if those joints sometimes get hot and/or red, it’s NOT from fibromyalgia.
Joint pain, for me, is distinctly different from fibromyalgia pain types. It feels like it comes from deeper in the body, it’s extremely localized, and it feels hot. Sometimes I can feel that heat on the outside, like when it’s in my hands and knees, but other times it just feels hot inside.
My arthritis pain is most similar to my fascial pain, and that caused a big delay in recognizing it. By the time my rheumatologist was convinced something “new” was going on, it had hit the majority of my joints. Just a few years later, it’s in all of them, to varying degrees. Even if I found a treatment today that stopped the disease from progressing, I’d still be living with a lot of joint damage.
Joint pain, for me, has been a lot easier to treat, though. I usually have good results from ice and anti-inflammatories, which have little to no effect on my fibromyalgia pain. Narcotics work better, too. Those treatments don’t necessarily make my joint pain go away, but they do ease the pain and increase function. Steroid treatments help, too.
Even so, arthritis pain is constant. The same places hurt every day, and while the intensity may rise and fall to a degree, for me, it always stays within certain parameters. For example, I can count on my hip pain to be a dull ache, somewhere between 4 and 6 on the pain scale, when I’m not very active. Then, a certain amount of movement will predictably increase it to a 9 or 10 and make it seize up.
Notice I said “predictable.” That’s something no one says about fibromyalgia.
Fibromyalgia vs. Arthritis
I’m not going to say that one of these conditions is “worse” or “more painful” than the other. They’re completely different and both vary considerably in severity from one person to another.
For me, fibromyalgia was completely debilitating during flares and caused considerable pain during remissions. At the same time, it involved dozens of other symptoms, including cognitive dysfunction (fibro fog), fatigue, dizziness, environmental sensitivities, and a lot of other things that made life difficult.
However, now and then it would really back off and I’d feel pretty darned good. During those times, I could get a lot done and felt almost “normal.” With arthritis, I don’t have those breaks. I have better times and worse times, but the variance is a lot less. Arthritis also causes a much smaller set of symptoms.
With fibromyalgia, I was fortunate and found a combination of treatments that put it into remission. I still have some symptoms, but they’re a lot milder. So far with my arthritis, I’ve been unable to tolerate treatments that slow the disease progression. I’m able to treat the pain, but my immune system continues to damage my joints.
That’s just my experience, though. Someone else may be able to slow the arthritis but be powerless against fibromyalgia. I’m sure every possible combination of outcomes exists. Every case is different.
Recognizing New Pain
The important thing for each of us is to pay attention to our bodies. Know your pain types and what appears to trigger them. That way, if something else crops up, you’ll be able to recognize it sooner. It can help to keep a symptom journal.
When you approach your doctor about new pain types, be sure to emphasize that it’s new and different from your other pain. Describe its nature—achy, burning, stabbing, etc.—and, if it’s similar to a pain type you’ve had before, mention that. You want to make sure your doctor understands that it’s not a worsening of fibromyalgia pain so that he/she will be willing to investigate.
Katz DL, et al. Medical hypotheses. 2007;69(3):517-25. The pain of fibromyalgia syndrome is due to muscle hypoperfusion induced by regional vasomotor dysregulation.
Kulshreshtha P, Deepak KK. Clinical physiology and functional imaging. 2013 Mar;33(2):83-91. Autonomic nervous system profile in fibromyalgia patients and its modulation by exercise: a mini review.
Liptan GL. Journal of bodywork and movement therapies. 2010 Jan;14(1):3-12. Fascia: a missing link in our understanding of the pathology of fibromyalgia.