Understanding Pain

Pain is a necessity; we feel pain in order to understand that something is wrong or damaged within our body and it signals us to take alternative and potentially protective actions. However, pain is also the most common reason people seek for medical care and ongoing pain can have negative consequences with a significant impact on overall health and quality of life.

Indeed, uncontrolled pain can severely impact quality of life through physical, psychological, social, and economic consequences. Patients suffering from severe pain frequently experience social isolation, dependence on caregivers and often suffer from impaired relationships with friends and family. Compared to healthy people, those suffering from severe pain are four-times more likely to suffer from depression or anxiety.

Understanding the complexity of pain

Pain is a complex phenomenon that can arise from different origins. Specifically, pain can be divided into the following key types: nociceptive, inflammatory and neuropathic.

  • Nociceptive pain is pain after tissue damage or injury, without a damage or impairment in the function of nervous system. Examples of this type of pain include burns, sprains, bone fractures, and bruises.
  • Inflammatory pain is pain associated with the immune system responding to tissue injury, such as in an infection or from joint inflammation in people with rheumatoid arthritis. Once again, the nervous system is not impaired in this type of pain.
  • Neuropathic pain is pain arising as a direct consequence of nerve damage or disease affecting the nerve fibers. Examples of neuropathic pain include nerve injuries, post-herpetic neuralgia (persistent nerve pain that occurs at the site of a previous attack of shingles caused by the chickenpox (herpes zoster) virus), and toxic and metabolic peripheral neuropathies (for example, nerve damage cause diabetes). Characteristics of neuropathic pain include burning, stabbing, tingling, pins and needles, as well as spontaneous (pain arising without stimulus) and abnormal responses to non-painful or painful stimuli.

Pain is a complex disease, and in many cases, patients suffer from painful conditions caused by multiple, co-occurring mechanisms. This mixture of pain types has been defined as the “mixed pain concept”.

Mixed pain is pain that is derived from both nociceptive/inflammatory and neuropathic origins. In many common conditions, such as low back pain and osteoarthritis, pain can have both nociceptive and neuropathic components. Often, the neuropathic component may go unrecognised, particularly with pain such as osteoarthritis with a strong history of being associated with purely nociceptive/ inflammatory mechanisms.

Management of mixed pain

The nature of mixed pain requires a combination treatment addressing both the nociceptive and neuropathic pain components. Neuropathic component of mixed pain could be adequately managed with medicine indicated to relieve neuropathic pain and medicine such as non-steroidal anti-inflammatory drugs (NSAIDs) help to relieve nociceptive or inflammatory pain in mixed pain.

Alternative treatment option such as neurotropic B vitamins (B1, B6 and B12) are available to target the underlying cause of the neuropathic pain which is nerve damage. Each of these B vitamins has been found to have unique essential roles, which contributes to nerve function. Vitamin B1 is involved in energy metabolism, helps in maintaining the myelin sheath which covers the axon of nerves, and in the synthesis of key signalling molecules in the nervous system known as neurotransmitters. Vitamin B6 is involved in the synthesis of neurotransmitters (key signalling molecules in the nervous system). Vitamin B12 is involved in nerve cell maturation and regeneration, nerve cell metabolism and formation of nerve myelin sheaths.

Neurotropic B vitamins can be used in combination with NSAIDs, to relieve mixed pain. For example, a combination of diclofenac (a type of NSAIDs) and neurotropic B vitamins (B1, B6, and B12) helps to improve low back pain and shorten treatment period compared to taking diclofenac alone, as reported in studies published in scientific journals. While NSAIDs targets the nociceptive and inflammatory pain mechanisms, the neurotropic B vitamins nourish and help regenerate nerves.

Holistic approach to pain management addresses the emotional and psychological effects of pain, and can also include complementary and alternative approaches to pain control. Please consult your doctor for examination and diagnosis of pain, for a proper treatment plan based on your condition.


Read more about the benefits of vitamin B, click here.

The information contained in this article is not intended or designed to diagnose, prevent, treat or provide a cure for any condition or disease, to ascertain the state of your health or be substituted for medical care. Procter & Gamble encourages you to seek advice from your doctor or healthcare professional if you have any questions or concerns arising from the information in this article.


  1. Fishman SM. Recognizing pain management as a human right: a first step. Anesth Analg 2007;105(1):8-9.
  2. Taylor AL. Addressing the global tragedy of needless pain: rethinking the United Nations single convention on narcotic drugs. J Law Med Ethics 2007;35(4):556-70, 11.
  3. King NB, Fraser V. Untreated pain, narcotics regulation, and global health ideologies. PLoS medicine 2013;10(4):e1001411.
  4. International Association for the Study of Pain, European Federation of IASP Chapters. Unrelieved pain is a major global healthcare problem. Accessed July 24, 2015, from http://www.iasp-pain.org/files/Content/ContentFolders/GlobalYearAgainstPain2/20042005RighttoPainRelief/factsheet.pdf
  5. Lohman D, Schleifer R, Amon JJ. Access to pain treatment as a human right. BMC Med 2010;8:8.
  6. Costigan M, Scholz J, Woolf CJ. Neuropathic pain: a maladaptive response of the nervous system to damage. Annu Rev Neurosci 2009;32:1-32.
  7. Treede RD, Jensen TS, Campbell JN, et al. Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology 2008;70(18):1630-5.
  8. Post-herpetic neuralgia. 2014. Accessed September 17, 2017, from http://www.nhs.uk/conditions/postherpetic-neuralgia/pages/introduction.aspx
  9. Head KA. Peripheral neuropathy: pathogenic mechanisms and alternative therapies. Altern Med Rev 2006;11(4):294-329.
  10. Watson JC, Dyck PJ. Peripheral Neuropathy: A Practical Approach to Diagnosis and Symptom Management. Mayo Clin Proc 2015;90(7):940-51.
  11. Freynhagen R, Baron R. The evaluation of neuropathic components in low back pain. Curr Pain Headache Rep 2009;13(3):185-90.
  12. Morlion B. Pharmacotherapy of low back pain: targeting nociceptive and neuropathic pain components. Current medical research and opinion 2011;27(1):11-33.
  13. Gwilym SE, Keltner JR, Warnaby CE, et al. Psychophysical and functional imaging evidence supporting the presence of central sensitization in a cohort of osteoarthritis patients. Arthritis Rheum 2009;61(9):1226-34.
  14. Ohtori S, Orita S, Yamashita M, et al. Existence of a neuropathic pain component in patients with osteoarthritis of the knee. Yonsei Med J 2012;53(4):801-5.
  15. Ohtori S, Inoue G, Orita S, et al. Efficacy of combination of meloxicam and pregabalin for pain in knee osteoarthritis. Yonsei Med J 2013;54(5):1253-8.
  16. Dimitroulas T, Duarte RV, Behura A, et al. Neuropathic pain in osteoarthritis: a review of pathophysiological mechanisms and implications for treatment. Semin Arthritis Rheum 2014;44(2):145-54.
  17. Finnerup NB, Attal N, Haroutounian S, et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol 2015;14(2):162-73.
  18. Sriram K, Manzanares W, Joseph K. Thiamine in nutrition therapy. Nutr Clin Pract 2012;27(1):41-50.
  19. Singleton CK, Martin PR. Molecular mechanisms of thiamine utilization. Curr Mol Med 2001;1(2):197-207.
  20. Smithline HA, Donnino M, Greenblatt DJ. Pharmacokinetics of high-dose oral thiamine hydrochloride in healthy subjects. BMC Clin Pharmacol 2012;12:4.
  21. Frye RE, Jabbour SA. (2014). Pyridoxine Deficiency. Drugs & Diseases. Accessed July 17, 2015, 2015, from http://emedicine.medscape.com/article/124947- overview#showall
  22. Reyes-Garcia G, Medina-Santillan R, Flores Murrieta FJ, et al. Analgesic effects of B vitamins: A review. Curr Topics in Pharmacology 2006;10(1)
  23. Dakshinamurti K, Paulose CS, Viswanathan M, et al. Neurobiology of pyridoxine. Annals of the New York Academy of Sciences 1990;585:128-44.
  24. Zhang M, Han W, Hu S, et al. Methylcobalamin: a potential vitamin of pain killer. Neural Plast 2013;2013:424651.
  25. Stabler SP. Vitamin B12 deficiency. The New England journal of medicine 2013;368(21):2041-2.
  26. Mibielli MA, Geller M, Cohen JC, et al. Diclofenac plus B vitamins versus diclofenac monotherapy in lumbago: the DOLOR study. Current medical research and opinion 2009;25(11):2589-99.
  27. Watanabe T, Kaji R, Oka N, et al. Ultra-high dose methylcobalamin promotes nerve regeneration in experimental acrylamide neuropathy. Journal of the neurological sciences 1994;122(2):140-3.
  28. van Tulder MW, Furlan AD, Gagnier JJ. Complementary and alternative therapies for low back pain. Best Pract Res Clin Rheumatol 2005;19(4):639-54.
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