Nociceptive Pain Management

• Nociceptive Pain that sounds like it is nerve related:

  • Patients can present with a subjective history of symptoms suggestive of nerve involvement such as referral below the buttock or shoulder, pin and needles, however on neural integrity assessment there is normal function of the somatosensory nervous system
  • The mechanism behind this type of pain is still ultimately nociceptive
• Nociceptive Pain that sounds nerve related:

  • Subjective symptoms:
  • Deep, aching pain
  • Pulling pain along line of nerve
  • Mild paraesthesia
  • reason for these neural related symptoms being of nociceptive mechanism is due to irritation of connective tissue around the nerve via inflammation, compression, repetitive loading or trauma impacting the connective tissue - this activates the nociceptors in that connective tissue
• Nociceptive Pain that sounds nerve related:

  • Objectively:
  • Normal conduction on neural integrity examination - myotomes and dermatomes are all normal
  • Positive response on neural tissue provocation testing (SLR, ULTT, PKB) - due to stress and strain put onto the connective tissue that surrounds the nerve
• Nociceptive Pain that sounds nerve related - Management recommendations:

  • Early graded movement
  • Active management > Passive management
  • Gentle mobilisation of the neural tissue – via exercises called sliders
  • Review areas of irritation of neural tissue
  • Responds to simple analgesia