05/01/2026
Different types of Pain
Nociceptive, Neuropathic, and Nociplastic Pain — and Where Massage, Myofascial, and Movement Therapy Fit In
Pain is not a single entity. It is a complex experience shaped by tissues, nerves, and the nervous system’s interpretation of sensory input. Modern pain science recognizes three primary pain mechanisms: nociceptive, neuropathic, and nociplastic pain. While these categories are often discussed separately, most real-world pain presentations involve an interaction between two or more mechanisms.
Understanding which mechanism is dominant helps explain why some pain resolves quickly, why some persists despite treatment, and why the same intervention can help one individual while failing another.
Nociceptive Pain
Pain from Tissue Stress or Injury
Nociceptive pain arises from non-neural tissues such as muscle, fascia, tendon, ligament, joint capsule, bone, skin, or internal organs. These tissues contain specialized sensory receptors called nociceptors, which respond to mechanical overload, inflammation, compression, or chemical irritation.
How It Works
When tissue is stressed beyond its current capacity, injured, or inflamed, nociceptors activate and send signals through the nervous system to the brain. This pain is an appropriate protective response, encouraging rest, unloading, or behavioral change while healing occurs.
Typical Characteristics
• Localized or clearly regional
• Predictable and proportional to movement, load, or pressure
• Reproducible with specific activities
• Improves with rest, tissue healing, or load modification
• Often described as aching, sore, throbbing, or sharp
Common Examples
• Muscle strain or tear
• Tendon overload or tendinopathy
• Joint inflammation or osteoarthritis
• Acute ligament injury
• Post-surgical pain
• Visceral pain from internal organs (a nociceptive subtype)
Where Massage & Myofascial Therapy Fit
Massage and myofascial therapy are particularly effective for nociceptive pain because they directly address the tissues generating the input. They can:
• reduce excessive muscle tone
• improve fascial glide and hydration
• decrease localized inflammation and ischemia
• improve circulation and lymphatic flow
• restore more normal tissue load-sharing
By improving tissue quality and reducing mechanical irritation, nociceptive input to the nervous system decreases.
Where Movement Therapy Fits
Movement therapy:
• restores appropriate loading patterns
• rebuilds tissue tolerance
• improves coordination and force distribution
Without progressive, well-designed movement, tissues often remain vulnerable to re-injury—even if manual therapy initially reduces pain.
Neuropathic Pain
Pain from Injury or Disease of the Nervous System
Neuropathic pain originates from damage or dysfunction within the nervous system itself, rather than from injured muscles or joints. The source of pain may be a peripheral nerve, nerve root, spinal cord, or the brain.
How It Works
When nerves are compressed, inflamed, traumatized, or degenerate, they can generate abnormal signals. These signals may fire spontaneously, misfire in response to normal input, or amplify sensations that should not be painful.
Typical Characteristics
• Burning, electric, stabbing, or shooting sensations
• Tingling, pins-and-needles, or numbness
• Often follows a nerve distribution
• May occur without clear mechanical provocation
• Frequently accompanied by sensory changes or weakness
Common Examples
• Radiculopathy from disc herniation
• Peripheral neuropathy
• Nerve entrapment syndromes
• Spinal cord injury–related pain
Where Massage & Myofascial Therapy Fit
Manual therapy does not repair damaged nerves, but it can play an important supportive role by:
• reducing mechanical compression around nerves
• improving mobility of neural interfaces
• calming surrounding muscle guarding
• reducing sympathetic nervous system tone
Gentle, indirect techniques are often more effective than aggressive work in neuropathic presentations.
Where Movement Therapy Fits
Movement therapy focuses on:
• restoring neural glide and tolerance
• improving coordination without provoking symptoms
• avoiding positions or loads that irritate neural tissue
Graded, pain-informed movement helps normalize nerve signaling without reinforcing threat.
Nociplastic Pain
Pain from Altered Nervous System Processing
Nociplastic pain occurs when pain is generated by changes in how the nervous system processes sensory input, without clear evidence of ongoing tissue damage or nerve injury. This reflects a state of heightened pain sensitivity, often involving central sensitization.
How It Works
The nervous system becomes overly responsive. Signals that would normally be non-painful—or only mildly uncomfortable—are amplified. The “volume knob” on pain processing is turned up, even in the absence of tissue threat.
Typical Characteristics
• Widespread or poorly localized pain
• Disproportionate to imaging or exam findings
• Persistent or fluctuating symptoms
• Often associated with fatigue, sleep disturbance, stress sensitivity, or cognitive fog
• Symptoms may shift over time
Common Examples
• Fibromyalgia
• Chronic widespread pain
• Persistent pain after tissue healing
• Some chronic neck or low back pain presentations
Where Massage & Myofascial Therapy Fit
In nociplastic pain, manual therapy works primarily through neurological rather than structural mechanisms. It helps by:
• providing non-threatening sensory input
• improving interoception and body awareness
• activating parasympathetic (rest-and-digest) responses
• reducing global muscle guarding
The goal is not “fixing tissue,” but changing how the nervous system interprets sensory input.
Where Movement Therapy Fits
Movement therapy is central in nociplastic pain management. Effective strategies:
• emphasize safety and predictability
• use slow, graded exposure
• prioritize coordination and confidence over strength
• rebuild trust in movement
Movement becomes a way to retrain the nervous system—not just the body.
Mixed Pain: Where Most Cases Live
Most persistent pain presentations involve overlapping mechanisms, such as:
• nociceptive tissue changes
• nervous system sensitization
• altered motor patterns
This is why combining approaches is often necessary.
Massage and myofascial therapy:
• improve tissue quality
• reduce excessive sensory “noise”
• create a window of opportunity for change
Movement therapy:
• consolidates those changes
• re-educates motor control
• improves long-term resilience and prevents recurrence
Neither works as well in isolation.
Why Pain Sometimes Returns After Bodywork
If pain improves briefly after massage but returns quickly, it often indicates:
• a dominant neurological driver (laterality, sensitization, poor motor organization)
• insufficient movement integration
• unresolved load, posture, or training factors
Manual therapy prepares the system.
Movement therapy teaches the system how to use that change.
Final Takeaway
• Nociceptive pain responds best to tissue-focused care plus appropriate loading.
• Neuropathic pain requires neural protection, decompression, and graded exposure.
• Nociplastic pain requires nervous system regulation and confidence-building movement.
Massage and myofascial therapy change the input.
Movement therapy changes the organization.
Lasting change happens when both are addressed together.
https://koperequine.com/exploring-fascia-in-equine-myofascial-pain-an-integrative-view-of-mechanisms-and-healing/
