Different Types of Chronic Pain—and Why the Distinction Matters

Chronic pain affects over 50 million adults in the U.S. alone and is a leading cause of disability worldwide (Dahlhamer et al., 2018). Yet not all chronic pain is the same, and understanding what kind of pain you have is essential to finding the right treatment.

In this post, we’ll break down three major types of chronic pain, explain how they differ, and highlight treatment options for each, with a focus on psychological approaches.

Why Understanding Your Type of Chronic Pain Matters

When pain lingers for three months or more, it’s considered chronic. But chronic pain isn’t a single condition—it’s a symptom with multiple causes and underlying mechanisms. Some types of pain stem from tissue damage, while others are driven by nervous system dysfunction or brain-based changes in pain processing.

Accurate classification empowers individuals to better understand their symptoms, make informed decisions about treatment, and reduce unnecessary suffering. It also shifts the focus from simply masking or coping with pain to treating its root causes.

Three Main Types of Pain

1. Nociceptive Pain: Tissue-Based Pain

This is the kind of pain most people are familiar with—it arises from actual or threatened damage to body tissue, such as inflammation, injury, or strain. You might feel nociceptive pain due to osteoarthritis, a broken bone, or rolling your ankle. Because nociceptive pain is directly related to tissue damage, it often resolves when the cause of tissue damage heals or is addressed.

Medical treatments such as physical therapy, medications, or topical analgesics often play a primary role in treating nociceptive pain, but psychological support may be helpful as well. Cognitive-behavioral therapy (CBT) can help to support behavior change (such as activity pacing to support recovery and avoid flare-ups), manage stress that may amplify pain, and address any anxiety or depression that may develop alongside physical symptoms (Ehde, Dillworth, & Turner, 2014). Acceptance- and mindfulness-based approaches, such as Acceptance and Commitment Therapy (ACT), have also been shown to improve pain acceptance and functioning in chronic pain patients (Felieu-Soler et al., 2018).

2. Neuropathic Pain: Nerve-Based Pain

Neuropathic pain is caused by damage or dysfunction in the nerves themselves. It’s often described as burning, shooting, tingling, or “electric.” Common examples include diabetic neuropathy, postherpetic neuralgia (from shingles), sciatica, or nerve entrapment syndromes.

Similar to nociceptive pain, treatment approaches for neuropathic pain often involve medical interventions such as medications, nerve blocks, or topical analgesics. Psychological approaches to chronic neuropathic pain typically focus on helping patients cope with pain, reduce the impact of pain on their day-to-day life, and live values-driven, satisfying lives despite pain using CBT or ACT. Notably, the goal of psychological treatment for nociceptive and neuropathic pain is typically to enhance coping and reduce distress and interference, rather than to eliminate pain completely.

3. Nociplastic Pain: Brain-Based Pain Amplification

In nociplastic pain, the nervous system becomes hypersensitive, and the brain amplifies or generates pain signals even in the absence of clear tissue or nerve damage. This type of pain is sometimes called “central sensitization” (Nijs et al., 2021), but the International Association for the Study of Pain (IASP) now recommends the term “nociplastic pain” (Fitzcharles et al., 2021). Examples of conditions that are often considered to produce nociplastic pain include fibromyalgia, chronic pelvic pain, irritable bowel syndrome (IBS), and some forms of chronic back or neck pain.

Nociplastic pain associated with conditions such as fibromyalgia can also be effectively treated with CBT and ACT. Additionally, there is an exciting, growing research base suggesting that more powerful treatment outcomes may be possible with new psychological treatments that aim to substantially reduce or even eliminate centralized pain (Lumley & Schubiner, 2019). Treatments such as Pain Reprocessing Therapy (Ashar et al., 2021) and Emotional Awareness and Expression Therapy (Lumley et al., 2017) focus on retraining the way the brain processes pain (i.e., reducing perceived danger) and addressing any interpersonal conflicts or trauma that may be generating or worsening pain signals. These approaches seem to be most effective for people whose pain is primarily nociplastic (or centralized), as opposed to those whose pain is primarily nociceptive or neuropathic.

Chronic Pain Essential Reads

Chronic Pain Can Exist Without Physical Injury

How Unwanted Thoughts Drive the Experience of Pain

What If You’re Not Sure What Type of Pain You Have?

Many people don’t know what category their pain falls into—and that’s okay. What matters is getting curious and working with a provider who can help you identify patterns. Keeping a pain journal, tracking flare-ups, and noting what helps or hurts can offer valuable insights. For example, someone might notice their pain flares up more during stressful weeks or after avoiding movement for too long—clues that both emotional and behavioral patterns may be influencing their symptoms.

It is worth noting that you may have “mixed pain,” which involves overlapping pain mechanisms. For instance, someone might have osteoarthritis (nociceptive) but also develop fibromyalgia (nociplastic) or sciatica (neuropathic). In these cases, treatment must address multiple sources of pain.

Interdisciplinary pain clinics and pain-informed therapists can offer comprehensive assessments to guide the path forward. If you've been told “there’s nothing wrong” despite feeling significant pain, that may be a clue that centralized mechanisms are at play—and that a brain-based approach could be helpful.

Personalized Pain Treatment Is Possible

Chronic pain can feel all-consuming—but it doesn’t have to be. By understanding the different types of pain and targeting treatment accordingly, it’s possible to reduce suffering and regain control over your life.

Whether your pain is rooted in tissue, nerves, or the brain’s protective response, there are effective strategies—including psychological treatments—that can help. If you’re curious to learn more about how psychological therapy can help with chronic pain, consider speaking with a health psychologist or pain-informed therapist near you.

Copyright Hannah Holmes. This post was also published at www.holmespsychology.com.