From this formulation, the choice of treatments usually follows easily as we attempt to intervene on the cause, the contributing factors and, when possible, the barriers. To help us establish the primary cause or type of pain, we must ask about the location of pain, its intensity and its quality. Severe burning pain confined to a single dermatome would suggest post herpetic neuralgia or some other neuropathic process affecting a nerve root. Multifocal pain confined to joints would favor arthritis as a cause. Noiceptive implies active mechanical, thermal or chemical process which stimulates the primary sensory nerves for pain.
Neuropathic pain comes from aberrant signaling in the pain transmission or pain modulation pathways.
The diabetic with neuropathy can experience pain due to spontaneous firing of damaged nerves. The quality is typically burning and often there is a paroxysmal quality such as shooting, jabbing or shock-like pain. Muscular pain is pulling, tight or aching. Certain movements or positions may accelerate or trigger muscular pain. The location is frequently drawn by the patient on a pain diagram in a pattern that coincides very closely with the affected muscles.