Pain is felt in different ways dependent on a variety of factors

Everyone experiences pain in different ways so understanding the types of pain can help you when speaking with your doctor. Some pain is obvious and directly related to injury or musculoskeletal issues. Specifically, neuropathic pain, an outcome of those with PAD or Diabetic Neuropathy, is experienced due to tissue damage caused by a lack of blood flow to the extremities.

Acute pain

Generally related to a specific cause such as tissue injury and only lasts for a short period or until the underlying causes are treated and resolved. This may be pain from broken bones, surgery, dental work or childbirth.

Chronic pain

Chronic pain can last over long periods of time and even after an injury may have healed. Chronic pain can be mild or severe and is most likely to impact quality of life. Chronic pain is mostly associated with frequent headaches, nerve damage, low back issues, arthritis or conditions such as fibromyalgia.

Nociceptive pain

Pain that is caused by stimulation to pain receptors throughout your body, especially in the skin and internal organs, known as nociceptors. It is the most common type of pain and felt with any type of injury. This pain can be acute or chronic.

Visceral pain

Visceral pain is often the hardest to pinpoint and results from injury or damage to internal organs. It is generally felt in the chest, abdomen and pelvis and can be accompanied by heart rate, temperature and blood pressure changes and/or nausea and vomiting. Causes can be appendicitis, gallstones or other issues such as irritable bowel syndrome.

Somatic pain

Somatic pain does not result from internal organs rather is directly related to the skin, muscles, joints, connective tissues and bones. Unlike visceral pain, somatic pain is easier to pinpoint. Somatic pain is caused by broken bones, strained muscles, skin or bone cancer, scrapes and burns, osteoporosis and joint pain.

Neuropathic pain

When there is damage or dysfunction to the nervous system, pain signals will misfire. This is referred to as neuropathic pain and is rarely a response to a specific injury. It results from physical activity or change in temperature or materials that touch the skin. Common causes are diabetes and vascular conditions that restrict blood flow. Other causes are any central nervous system disorders, infections, alcoholism, and even radiation or chemotherapy drugs.

Pain associated with PAD and Diabetic Neuropathy

In vascular patients such as those with PAD or Diabetic Neuropathy, the pain is generally associated with what is known as Ischaemia or Critical Limb Ischaemia (CLI), which occurs when there is restricted blood supply to tissues. This, in turn, limits the oxygen necessary for the tissues to remain healthy. As a result, tissue damage occurs and neuropathic pain develops which can limit walking, exercise and generally any physical activity if PAD is not addressed.

Keep in mind that individuals with diabetes or who smoke are at higher risk for PAD and these conditions can increase the impact on vessel constriction and tissue damage, thus increase the severity of pain. It is essential that all underlying causes of PAD are addressed to mitigate the potential for severe pain.


Treating PAD associated neuropathic pain

Opioids are generally not recommended as a first line of treatment for PAD associated neuropathic pain, generally caused by the narrowing of the arteries and constricted blood flow. PAD associated pain can be severe and nearly 25% of all those with PAD are at risk for addiction when being prescribed opioids to treat chronic neuropathic pain. Opioids should only be used as a second-line of treatment for those with PAD associated neuropathic pain. Currently, there are no known treatments for PAD or Diabetic Neuropathy, thus many live long-term with the resulting neuropathic pain. But, the pain can be alleviated with diet and other lifestyle changes as well as non-opioid based treatments such as:

  • Amitriptyline – also used for treatment of headaches and depression
  • Suloxetine – also used for treatment of bladder problems and depression
  • Pregabalin and gabapentin – also used to treat epilepsy, headaches or anxiety

Only your doctor can determine the best way to treat PAD associated neuropathic pain but the use of opioids should be avoided. At JanOne, the premise of TV1001SR, the PAD treatment currently in our pipeline, is the use of nitrites to reverse constriction of the arteries, repair damaged arterial tissues and increase blood flow to near normal function. This, in turn, has the potential to remediate PAD neuropathic pain. That means less risk for opioid abuse at the prescription pad.