This is the first in a three-part series exploring three important types of pain: nociceptive, neuropathic, and neuroplastic pain.
Understanding the type of pain you may be experiencing can help you choose the right treatment approach. Treating the wrong pain mechanism may provide little more than temporary relief, leaving you stuck on the “treatment merry-go-round”—repeatedly spending money on treatment, only for the same symptoms to return.
The aim isn’t to help you diagnose yourself, but to better understand why you hurt and what may be contributing to your pain.
No matter what type of treatment you’re receiving, if you’re consistently getting only short-term relief, that doesn’t automatically mean you need more frequent appointments or a longer treatment plan.
It may simply mean it’s time to reassess what is contributing to your pain and whether your current treatment is addressing it.
Nociceptive Pain
Nociceptive pain occurs when pain-sensitive nerve endings (nociceptors) are activated in tissues such as muscles, fascia, joints, ligaments, and tendons.
In neck and back pain, two potential contributors are myofascial pain and facet joint pain. These frequently overlap, with many people sitting somewhere on a spectrum between the two.
In my clinical experience, I’d estimate only around 10–20% of people sit predominantly at either end of this spectrum—primarily myofascial or primarily facet-related—with most somewhere in between.
Two useful clues to where you may sit on this spectrum are the characteristics of your pain and how it responds to treatment.
Myofascial Pain vs Facet Joint Pain: What Does Each Feel Like?
Although they can feel very similar, certain characteristics may provide clues as to which is contributing more.
Myofascial Pain
Myofascial pain originates from muscles and their surrounding connective tissues. It is more likely to be:
- Aching, tight, pulling, or burning
- Spread over a broader area
- Associated with muscle tightness or tension
- Reproduced by pressing or massaging tender muscles
- Referred to another area when sensitive points are pressed
- Aggravated by prolonged positions, repetitive activity, or stress
- Temporarily relieved by heat or stretching
For example, sensitive muscles around the base of the skull can refer pain into the head, while neck and shoulder muscles can refer pain towards the shoulder blade and upper back.
Facet Joint Pain
Facet pain originates from the small joints at the back of the spine. It is more likely to be:
- Deep, localised, and achy, sometimes sharp with movement
- Concentrated around one side of the spine
- Aggravated by particular spinal movements, especially extension, rotation, or side-bending
- Associated with stiffness, restriction, or a “catching” sensation
- Less clearly reproduced by pressing or massaging the surrounding muscles
Facet pain can also refer away from the joint, including into the base of the skull, shoulder, or shoulder blade.
These characteristics aren’t diagnostic tests. Muscle and facet joint pain can produce similar symptoms, which is why response to treatment can provide another useful clue.
The Second Clue: How Does Your Pain Respond to Treatment?
After Muscle Treatment
If massage, myotherapy, or other muscle treatments significantly reduce your aching, tension, and tenderness, but you’re left with deeper, more localised pain, stiffness, or a catching sensation with certain movements, there may also be a facet joint component.
You feel better, but there’s still that stubborn spot that feels like it’s coming from somewhere “deeper” that feels like a residual pain, especially over or close to the spine.
After an Adjustment
An adjustment can sometimes provide significant relief even when much of the pain appears to be myofascial.
Spinal manipulation can produce short-term hypoalgesia, a temporary reduction in pain sensitivity through changes in how pain is processed by the nervous system, including spinal and brain-based pain-modulating mechanisms.
This means an adjustment may reduce pain without necessarily treating all of the underlying muscular tenderness and sensitivity.
If you feel considerably better after an adjustment but the same aching, tightness, and muscular tenderness gradually return, it may indicate that a significant myofascial component remains.
This can create a familiar cycle:
Adjustment → pain decreases → you feel better → pain returns after 2 or 3 days → another adjustment.
Rather than assuming this automatically means you need more frequent adjustments or an ongoing treatment plan, it may be worth asking whether the muscular component of your pain is also being adequately addressed.
What If Both Treatments Help?
If muscle treatment relieves the aching and tension while joint treatment improves the remaining deeper pain, stiffness, or restricted movement, you may sit somewhere in the middle of the spectrum.
For these presentations, focusing exclusively on either the muscles or the joints may only address part of the problem.
This is why my approach combines extensive muscle and myofascial work with appropriate chiropractic joint treatment. Rather than assuming every case requires the same treatment, the aim is to identify which components appear most relevant and treat accordingly.
The goal shouldn’t simply be to make you feel better until your next appointment. It should be to achieve meaningful improvement while helping you become less reliant on treatment over time.
