What Type of Pain Do I Have?

Demystifying Pain

One of the first questions we often ask is surprisingly difficult to answer: “What pain condition do you have?”

For many, the natural response is, “Pain is pain—what do you mean what kind?” Others say they have arthritis, but don’t know what type. Others may know they have osteoarthritis, psoriatic or rheumatoid arthritis, but don’t know the stage of disease progression. In other cases, knowing what prescription medications they use can help us to identify their condition. Rinvoq, for example, is primarily prescribed for rheumatoid arthritis, an autoimmune condition.

In the world of chronic pain, even small details can matter. Does the pain come and go, or is it constant? Does it worsen after sitting for long periods, or when you stand up? Has it changed over time? Are everyday movements—like bending to tie your shoes or reaching overhead—becoming more difficult or uncomfortable? Even medications can offer clues since certain prescriptions are associated with specific conditions. However, in many cases, the full picture remains unclear.

As conversations deepen, a new and sometimes intimidating vocabulary can emerge: neuropathy, neuralgia, ataxia, myelopathy. We begin to understand that a “bad headache” isn’t necessarily a migraine, and that osteoarthritis, rheumatoid arthritis, and psoriatic arthritis are fundamentally different conditions—each with distinct causes, patterns, and approaches to care. In fact, experts describe dozens of different types of arthritis alone, many of which present very differently from person to person.

That can be as simple as paying closer attention to details like the stage of your condition, or as structured as keeping a short pain journal to help you remember when it happens, what it feels like, what you were doing, how long it lasts. Those details don’t just help you to potentially recognize patterns—they also give your doctor, physical therapist or other pain care specialists more information which can lead to more precise and effective care.

While Nápreva is not a pharmaceutical product and the company is not a healthcare provider, we believe informed decisions lead to better outcomes. Whether you are considering Nápreva, another dietary supplement, or a prescription medication, having a clearer picture of your pain—how it behaves, how it changes, and how it affects your daily life—can help you make more confident, more personalized choices.

All of this can feel overwhelming. But there’s an important takeaway: the more clearly you understand your pain—and the better you can describe it—the more effectively you can navigate your options and even advocate for better and more comprehensive care.

If you haven’t spoken with a doctor or pain specialist about your symptoms—or haven’t received a formal diagnosis—it’s worth making that a priority.

We know access can be complicated. If cost, insurance, or availability are barriers, there are still options. We’ve put together a list of free and lower-cost resources that can help you get started, wherever you are.

Acute vs. Chronic Pain

In everyday conversation, acute usually means severe or extreme. In pain diagnosis and treatment, it means something very different—and that’s where confusion starts. Clinically, acute pain is defined by duration, not intensity. It refers to pain that lasts roughly 90 days or less. In most cases, the cause is identifiable: sunburn, a sprained ankle, a broken bone, or pain following surgery

Acute pain can be mild—like that sunburn—or intense, as with a surgical incision for hip replacement or open-heart procedure. Because of that range, treatment can vary widely, from over-the-counter options like NSAIDs or topicals to short-term use of powerful prescription medications.

The key distinction is that acute pain is generally treated as temporary. The expectation is that as the underlying cause heals, the pain will resolve along with it.

In contrast, chronic pain is clinically defined as pain lasting longer than 90 days— usually much longer.

Chronic pain is not a single condition but a broad category that includes many distinct types of pain. Some have clearly identifiable causes—such as rheumatoid arthritis or an injury that has failed to heal properly—while others, like fibromyalgia, are defined more by symptoms than by a well-understood underlying mechanism.

Even within the same diagnosis, chronic pain can present very differently from one individual to another. Conversely, similar symptoms may arise from entirely different underlying causes, each requiring a different approach to treatment.

For example, swelling and pain in the underarm may reflect a localized muscle injury, or it may signal lymph node involvement. While the symptoms may appear similar at first glance, the underlying conditions—and appropriate treatments—are critically different.

This is what makes chronic pain so complex. Sometimes healing of the underlying cause is simply prolonged. In other cases, pain persists without a clear, identifiable cause. Increasingly, healthcare professionals recognize what many patients already know from experience: pain itself can become a disease, rather than just a symptom of one.

Neuropathic Pain

Neuropathic pain is caused by damage to—or dysfunction of—the nervous system. That can involve the central nervous system (the brain and spinal cord) or the peripheral nervous system: the vast network of nerves that runs throughout the body, connecting the brain and spine to the limbs, organs, and extremities.

That damage can happen in a number of ways. It may follow a clear physical event—surgery, a traumatic injury, or a fall. In other cases, it develops more gradually. Studies of active-duty military personnel and veterans, for example, have documented a wide range of peripheral nerve injuries related to compression, direct trauma, amputation, blast exposure, toxic chemicals, and even nutritional deficiencies.

Neuropathic pain is also associated with a range of medical conditions. Entrapment neuropathies like carpal tunnel syndrome, chemotherapy-induced nerve damage, and certain infections—including shingles (postherpetic neuralgia), COVID-19, and hepatitis C—can all lead to persistent nerve pain, sometimes long after the initial illness has resolved. Diabetes remains the leading cause of peripheral neuropathy in the United States.

In some cases, the cause is less clear. Conditions such as fibromyalgia, idiopathic neuropathy, or cryptogenic neuropathy may involve nerve-related pain even when advanced imaging and testing don’t point to a single, identifiable source.

The takeaway is that the nervous system is both extensive and highly sensitive. It can signal injury or disease—but it can also continue to generate pain long after the original trigger is gone. That’s part of what makes neuropathic pain so persistent—and, at times, so difficult to treat.

Neuropathic pain reveals itself in a wide range of ways, which is part of what makes it difficult to recognize at first.

For some, it’s sharp and sudden—stabbing, shooting, or even “electric shock” sensation. For others, the issue isn’t intensity but sensitivity: even light touch or mild pressure can feel disproportionately painful. Some people experience numbness, tingling, or that familiar “pins and needles” sensation, punctuated by occasional sharp flares or sudden weakness. Others report a more constant, sometimes widespread pain, often accompanied by weakness or persistent fatigue.

The pattern isn’t always obvious—and it doesn’t always stay the same. That variability is a hallmark of nerve-related pain and perhaps the leading reason that people often don’t immediately rush to see their doctor believing transient symptoms will go away. Although that’s often the case, we urge people to talk to their healthcare provider about any strange or unexplained pain or unusual sensation. Early intervention can often help to prevent escalation or development of a lasting, chronic condition.

Common signs of neuropathic (nerve-related) pain may include:

Sharp, shooting, or electric shock–like pain
Burning or “hot” sensations without an obvious source
Tingling, numbness, or “pins and needles”
Heightened sensitivity to touch (even light contact feels painful)
Pain from stimuli that shouldn’t normally hurt (like clothing or a light breeze)
Sudden, intermittent pain flares with no clear trigger
Persistent pain paired with weakness or reduced coordination
Pain that continues even after an injury has healed

Headache Disorders

Everyone gets the occasional tension or sinus headache. Headaches from over-exertion, dehydration or lack of sleep are common and are generally quickly resolved with a couple of NSAIDs, rest and proper hydration.

But for some, headaches are severe and frequent. Like other forms of chronic pain, recurrent headaches can arise from a known cause, such as sinusitis, sleep disorders like apnea or insomnia, stress and even overuse of pain medications.

In other cases, extensive testing and advanced diagnostic procedures are essential for detecting more complex conditions, such as spontaneous intracranial hypotension, a condition caused by a leakage of cerebrospinal fluid where headaches are worse when standing than lying down. Idiopathic intracranial hypertension (IIH), high pressure of the fluid around the brain, often occurs without a known cause and can lead to intense headaches, vision issues and a "whooshing" sound in the ears.

If that all sounds complicated, it is. The International Classification of Headache Disorders (ICHD)—the clinical standard used to diagnose and guide treatment of headache disorders—identifies thirteen major categories of headache disorders. Within that framework, five primary forms of chronic headache are defined by their distinct patterns of frequency, duration, and associated symptoms. Chronic headaches aren’t just frequent headaches— they are distinct conditions with different underlying mechanisms, patterns, and treatment approaches.

Following is a brief summary of how the ICHD defines and classifies chronic headaches, which may help you better understand your diagnosis—or decide when it’s time to seek guidance from a healthcare provider.

1. Chronic Migraine

Headache ≥15 days/month, with migraine features on at least 8 days

A neurological condition—not just a severe headache

Migraine features are the specific characteristics that distinguish a migraine from other types of headache. They typically include throbbing or pulsating pain, often on one side of the head, that worsens with movement, along with nausea and/or sensitivity to light and sound. Some people also experience visual disturbances (aura), fatigue, or difficulty concentrating. Together, these features reflect that a migraine is not just head pain, but a broader neurological event.

Key features:

Throbbing or pulsating pain
Often one-sided
Nausea and/or sensitivity to light and sound
Functionally disabling

2. Chronic Tension-Type Headache

Headache ≥15 days/month, typically mild to moderate, but persistent

The most common form of “daily headache”

Key features:

Dull, pressure-like pain (“tight band”)
Both sides of the head
Minimal nausea or sensory sensitivity
Usually not disabling
May cause blurring vision or sensitivity to light

3. Medication-Overuse Headache

Frequent headaches driven by repeated use of acute pain medications

A paradox: the treatment becomes part of the problem

Overuse—whether through high doses or frequent, prolonged use—of acute pain medications is a well-recognized driver of medication-overuse headache. The classes most commonly associated include NSAIDs, acetaminophen and other simple analgesics, triptans, combination pain relievers (often containing caffeine, aspirin, or acetaminophen), opioids, and barbiturate-containing medications.

In these cases, medications used to manage pain can become less effective over time and may paradoxically contribute to a cycle of more frequent, chronic headaches.

Key features:

Daily or near-daily headache
Temporary relief with medication, followed by recurrence
Associated with frequent use of OTC or prescription pain relievers

4. New Daily Persistent Headache (NDPH)

A less common but distinct condition.

Abrupt onset distinguishes it from other chronic headaches

Key features:

Sudden onset of daily headache
Becomes continuous within 24 hours
Persists for months or longer

5. Chronic Cluster Headache

Rare, but included due to severity and clinical importance.

One of the most intense pain syndromes in medicine

Key features:

Severe, one-sided pain (often around the eye)
Short, repeated attacks
Tearing, nasal congestion
Restlessness or agitation during attacks

Musculoskeletal Pain

According to the World Health organization, there are at least 150 disease conditions affecting the bones, muscles, tendons, ligaments and other connective tissues forming the structure of the human body. Musculoskeletal conditions can arise from multiple forms of arthritis, fractures, traumatic injury, sedentary lifestyle, amputation and natural physical changes from growth or aging. Many of them cause enduring, chronic pain.

Chronic Back Pain and Lower Back Pain

Chronic lower back pain is the most common musculoskeletal condition in the United States. An estimated 16 million American adults—approximately 8% of the population—live with chronic lower back pain at any given time. Its high prevalence reflects a combination of factors: cumulative mechanical stress on the spine, often nonspecific underlying causes, increasing incidence with age, and reinforcement by sedentary lifestyles and psychosocial influences. Together, these contribute to frequent recurrence and long-term persistence.

The lower back, or lumbar spine, is particularly vulnerable because it sits at the intersection of load, mobility, and biomechanical stress more than any other region of the spine. It supports the majority of the body’s weight—approximately 60–70%—and is subjected to significant compressive forces even at rest, which increase with sitting, bending, lifting, and twisting.

This region must balance flexibility and stability, a combination that inherently increases susceptibility to strain. Over time, even routine daily activities can lead to cumulative stress on muscles, ligaments, discs, and joints. As a result, many individuals experience repeated minor injuries and gradual degeneration without a single identifiable cause.

A key point of vulnerability is where the flexible spine meets the rigid pelvis (the L5–S1 junction), creating additional mechanical stress. Everyday movements—such as bending, lifting, or climbing stairs—can place repeated strain on this region. While acute injuries and specific diseases can contribute to back pain, in most cases it develops gradually through the accumulated effects of normal daily activity.

Nociplastic Pain

Pain is not simply a direct response to injury, but the result of input detection, signal transmission, processing, and response within a complex regulatory system. The brain, spinal cord, and peripheral nervous system continuously communicate, evaluating and modulating signals from both internal and external inputs to determine how pain is experienced.

This system relies on naturally occurring signaling molecules—including neurotransmitters such as dopamine and serotonin, as well as endogenous cannabinoids and opioids (e.g., endorphins)—to modulate incoming signals and prioritize how the body responds. In everyday life, this modulation is often observable: pain may recede during sleep or when attention is focused elsewhere—reading, working, or engaging in a task. This reflects normal pain processing, in which the nervous system adjusts the relative importance of competing signals.

For most people, this system functions effectively, accurately distinguishing pain signals from other sensory inputs and reducing or ceasing pain signaling as those inputs resolve. In some cases, however, the system becomes dysregulated —amplifying pain rather than modulating it and continuing to signal pain in the absence of clear input. This is referred to as nociplastic pain.

Fibromyalgia is one of the best-known examples of nociplastic pain. Even when an initial trigger is identified and addressed, pain regulation may remain altered, with the system shifted toward heightened sensitivity. As a result, normal sensory input—such as mild joint stiffness, pressure from sitting, or light touch—can be perceived as severe or persistent pain.

Fibromyalgia was historically underrecognized, in part because the majority of affected individuals are women. It is now increasingly understood as a disorder of pain processing rather than structural damage, although important questions about its underlying mechanisms remain.

Chronic Visceral Pain

The viscera are the primary organs of the chest and abdomen, including the stomach, intestines, liver, heart, lungs, pancreas, and kidneys. These organs can become damaged, diseased, inflamed, or disrupted, leading to a range of pain conditions often grouped by the affected organ—such as irritable bowel syndrome, Crohn’s disease, duodenal ulcers, gallstones, and kidney stones.

In women, additional visceral pain conditions may arise from the reproductive system, including endometriosis, fibroids, and vulvodynia.

In some cases, symptoms are acute (short term) and resolve when the underlying issue is treated—for example, when a kidney stone passes or gallstones are removed. In others, pain may become chronic, causing constant or intermittent discomfort, over extended periods. Pain may also be referred, meaning it is felt in a location distant from its source. For example, cardiac events can present as arm or shoulder pain, while kidney-related conditions may cause pain in the back, abdomen, or groin. These patterns occur because visceral organs share neural pathways with other regions of the body, leading the brain to misinterpret the origin of the signal.

Persistent or unexplained pain—particularly when it occurs in areas without clear injury—warrants medical evaluation. Conditions such as cancer, gallstones, bowel obstruction, and cardiovascular disease can develop gradually and present with referred or nonspecific pain, making early recognition important.

Autoimmune Disease

A healthy immune system protects the body against bacteria, viruses, parasites, fungi, foreign particles, and even abnormal cells. It plays a critical role in maintaining health and adapting to environmental challenges.

When the immune system becomes disregulated, it can contribute to some of the most persistent and difficult-to-treat conditions, including autoimmune diseases such as lupus, rheumatoid arthritis, type 1 diabetes, multiple sclerosis (MS), and Graves’ disease. In these conditions, the immune system mistakenly targets healthy tissues as if they were harmful, leading to chronic inflammation and tissue damage.

For example, in multiple sclerosis, the immune system attacks myelin—the protective sheath surrounding nerve fibers—disrupting normal nerve signaling. In rheumatoid arthritis, immune-mediated inflammation targets the synovium (joint lining), leading to pain, swelling, and progressive joint damage.

Many autoimmune and immune-mediated conditions present with overlapping symptoms, particularly joint pain, fatigue, inflammation, and, in some cases, nerve-related pain. Conditions such as lupus, rheumatoid arthritis, psoriatic arthritis, Sjögren’s syndrome, and Guillain-Barré syndrome can affect multiple systems, making diagnosis complex and sometimes requiring specialized testing.

As with other chronic pain conditions, these diseases often develop gradually. Early symptoms may be intermittent or resemble more benign issues, which can delay recognition. However, persistent or unexplained pain can serve as an early signal of underlying disease and should be taken seriously and evaluated appropriately.

Chronic Inflammatory Pain

Chronic inflammatory pain arises when persistent immune activity leads to ongoing inflammation in tissues, sensitizing pain receptors and sustaining pain over time. Unlike pain caused by a single injury, it is driven by chemical signaling within the immune system rather than structural damage alone. It is most commonly associated with autoimmune and immune-mediated conditions such as rheumatoid arthritis, psoriatic arthritis, and inflammatory bowel disease, but can also occur in response to injury or infection. In many cases, inflammatory pain overlaps with other pain mechanisms, contributing to its persistence and complexity.

Cancer-related Pain

Cancer can cause significant pain as tumors grow and place pressure on surrounding nerves and healthy tissue, while also damaging and inflaming adjacent structures. Bone cancers, such as osteosarcoma and chondrosarcoma, are often particularly painful due to structural weakening of bone, which increases the risk of fracture. As cancer progresses and metastasizes, pain may become more widespread as additional tissues and organs are affected.

Cancer treatment can also contribute to pain. Certain chemotherapy agents, such as paclitaxel, are associated with nerve damage that can lead to persistent neuropathic pain, sometimes continuing after treatment has ended. This dual burden—pain from both the disease and its treatment—is a defining challenge in cancer care.

Radiation therapy is an important and often effective treatment, but it can also affect nearby healthy tissue. When administered near sensitive structures, such as the gastrointestinal tract or spinal cord, it may lead to inflammation or nerve injury, contributing to longer-term pain in some patients.

Treating cancer-related pain—both during and after treatment—is complex, as the disease and its therapies often result in a weakened condition and multiple co-occurring pain mechanisms, requiring a multimodal approach that may include medications, physical therapy, nutritional support, and other interventions. Physical exhaustion and the emotional and social strains of cancer can further accentuate pain symptoms.

Treating Chronic Pain

Acute pain is clinically defined as pain lasting less than 90 days. Cause is often more readily and specifically identifiable—traumatic injury from a car accident, surgery or broken bone. Both because of the specificity and relatively short duration of the pain, appropriate treatments ranging from ice and topical creams for a sprained ankle to powerful opioids for post-surgical pain can be selected and managed.

Chronic pain is defined as pain lasting more than 90 days. While cause is sometimes known, as discussed throughout this paper, it is very often elusive. Both factors make chronic pain far more difficult to treat.

The challenge begins with duration. Chronic pain persists for months, years, or even decades, and many medications are not well suited for long-term use. Some lose effectiveness over time due to tolerance. Others carry meaningful risks with prolonged use. NSAIDs, for example, can contribute to gastrointestinal and cardiovascular complications, while long-term opioid use is associated with dependence and, in some cases, increased sensitivity to pain. These limitations make sustained symptom control difficult.

Chronic pain also differs biologically from acute pain. Over time, the systems involved in pain signaling and regulation—including those affecting mood, sleep, and stress— become altered. In some cases, the underlying source of pain persists; in others, the nervous system itself becomes sensitized, continuing to generate pain signals even when the original trigger has resolved. As a result, treatments that are effective for acute pain are often less effective in chronic conditions.

Today’s most widely used medications—opioids, NSAIDs, steroids, anticonvulsants, and antidepressants—were primarily developed for acute (short duration) pain or other conditions entirely, and are relied upon for treating chronic pain for lack of better options.

When used for prolonged chronic pain management, opioids and NSAIDs carry significant safety risks, including organ damage, bleeding complications, immune effects, and dependency. Anticonvulsants, anesthetics and antidepressants are often prescribed off-label for pain despite limited evidence supporting safety and efficacy in chronic pain treatment.

Opioids remain the most prescribed medications not because they are clinically ideal, but because they are cheap, fast-acting, reimbursed by insurance, and deeply embedded in clinical practice.

For chronic pain patients, however, opioid risk is materially higher. Dependency rates are estimated at 3-10x those of the broader opioid-using population. Risk rises with prolonged use and multi-drug regimens that often include gabapentin (anti-seizure medications used off-label for nerve pain) and benzodiazepines (sedative or anti-anxiety medications). These combinations remain common in real-world care despite limited evidence of efficacy.

Despite these challenges, treatment approaches have evolved. Management of chronic pain increasingly relies on a multimodal strategy, combining pharmacologic and non-pharmacologic therapies. Medications such as triptans for migraine, as well as certain anticonvulsants and antidepressants for neuropathic pain, have expanded available options. Non-pharmacologic approaches—including physical therapy, behavioral strategies, and lifestyle interventions—are also central to care.

There is also growing interest in novel and naturally derived compounds. Cannabinoid-based therapies and certain plant-derived compounds, including terpenes such as beta-caryophyllene and alpha-humulene, are being studied for their potential role in modulating pain and inflammation. While research is ongoing, these approaches reflect a broader shift toward safer, more sustainable long-term strategies.

Chronic pain is complex, heterogeneous, and often difficult to treat. Continued advances in understanding pain mechanisms—and in developing more targeted therapies—are essential to improving outcomes and reducing the burden of long-term pain.

Learn More:

Arthritis

Acute Pain

Reimagining How We Treat Acute Pain

Chronic Pain: What Does It Mean?

Neuropathic Pain

HIS Classification – ICHD3

Medication overuse headache: a review of current evidence and management strategies

Musculoskeletal health

Chronic Back Pain

Back Pain in the United States

Chronic Low Back Pain