The Three Types of Pain
For you to understand what you’re feeling, there are a few things about pain that may surprise you. There are three types of pain: somatic, neuropathic, and interpretive:
1. Somatic or Outside-In, Pain
Somatic pain is always associated with inflammation and occurs as a result of tissue injury or disease in a muscle, joint, or tooth, for example. The pain comes from injured somatic tissue, which contains cells that are capable of renewal and repair.
Pain signals from inflammation are carried by healthy nerve fibers to your brain, which then interprets them. This is called outside-in pain.
Most toothaches that respond to dental treatments are due to the inflammation arising from somatic tissues, like your dental pulp. But there is more complexity. Even though you may feel like you have a toothache, the source of your pain could be an inflamed muscle, joint, gland, or other somatic tissues near or far from your tooth. Over time, tissue injury or disease in these body parts can refer pain to your teeth. So, a broad evaluation beyond the teeth themselves is often necessary in order to make the correct diagnosis.
2. Neuropathic, or “Inside-Out” Pain
This type of pain occurs not as the result of tissue injury but as a result of abnormalities in your nerve tissues. In these situations, the source is an injury, disease, or dysfunction in your peripheral and central nervous system. In essence, there is a circuitry malfunction within your nervous system. Your nerves are sensitized and have a lower firing threshold, similar to what you experience with a sunburn.
Neuropathic pain is inside-out pain because it comes from inside your nervous system itself, not from tissue injury. You may have a persistent toothache, for example, but your dentist finds nothing wrong because your tooth structures look normal and appear normal on your x-rays and CT scans.
3. Interpretive Pain
Interpretive pain results strictly due to how your brain interprets incoming signals. In fact, all pain experiences are the result of your brain rendering an opinion. You can’t feel pain until your brain says so, so everything that has happened in your life near and far from your current pain experience has the potential to influence your brain’s opinion.
Often it takes a while for your brain to interpret pain signals, which is why soldiers can experience a battlefield injury but not feel the pain for hours, or even days.
With interpreted pain, your tissues appear normal, and the nerves conducting the pain information to the brain appear normal. That is why your dentist has likely told you everything looks OK – yet you still suffer from pain.
At New York TMJ and Orofacial Pain, the three types of pain problems are common and familiar to us. Every day we see patients suffering from facial pain, persistent toothaches, TMJ problems, nerve problems, and unexplained headaches. If facial pain is taking over your life, call us to make an appointment at one of our offices in the NYC metropolitan area (Manhattan, Westchester County, or Long Island). Call 888-560-6674 or