Different Types of Pain: What they tell us from Biomedical and TCM Acupuncture perspectives

How a patient describes their pain is valuable diagnostic information. In this post, I will discuss what this information can tell us from a more mechanical/biomedical standpoint, and how we use it from a Traditional Chinese Medicine (TCM) Acupuncture point of view. I'll also look at when the nature of someone's pain can throw up a red flag, prompting investigation for more serious conditions.

Different Types of Pain: What they tell us from Biomedical and TCM Acupuncture perspectives

Type of Pain - Biomedical/TCM Acupuncture distinctions

Sharp or Stabbing Pain

Biomedical view:

• Structural damage or mechanical irritation.

• Often involves joints, ligaments, bone, or compressed nerves.

• Acute injury or muscle tear.

TCM Acupuncture view:

• Blood Stagnation.

• Circulation of qi & blood is blocked, often from trauma, cold invasion or chronic stagnation.

• Fixed pain, intense, and can be worse at night.

Moving or 'Wandering' Pain

Biomedical view:

• Movement can be due to postural compensations for example, altering how you move to avoid pain.

• Often a characteristic of myofascial trigger point referred pain patterns, and systemic issues like fibromyalgia.

TCM Acupuncture view:

• Wind 

• Wind penetrates the collaterals and moves the pain around.

• Can also be a sign of Wind-Bi Syndrome, but more analysis of signs and symptoms needs to be done to diagnose confidently.

• Pain shifts location from day to day.

• Stress-related Qi stagnation may create similar patterns, which relates to fibromyalgia in some cases.

Heavy, Achy, or Swollen Pain

Biomedical view:

• Points to muscular overload, tissue fatigue, or inflammation.

• Swelling suggests fluid accumulation or inflammatory processes.

• Can be a sign of tissue damage, twists or sprain, infection or a result of other systemic issues.

TCM Acupuncture view:

• Indicates Dampness obstructing the channels.

• “Heavy limbs” or a sense of sluggishness with swelling, is a sign of internal Damp - or Damp-Heat if heat symptoms such as redness or hot to touch, or Damp-Cold, if cold, puffy joints.

Pain that gets better with warmth

Biomedical view:

• Cold sensitivity can be associated with poor circulation, Raynaud’s Disease (where blood vessels in the extremities overconstrict as a response to cold or stress), or joint degeneration.

• Warmth improves tissue elasticity and blood flow.

TCM Acupuncture view:

• Cold constricts the channels or Yang deficiency.

• Pain improves with heat and movement.

• Cold constricts the channels leading to a slowing the flow of Qi and Blood, causing contraction and stiffness.

• Yang deficiency relates to the lack of warming capacity within the body, which results coldness.

Burning Pain

Biomedical view:

• Usually associated with nerve irritation, inflammation, or conditions like neuropathy.

• “Burning” is a classic neurogenic symptom.

TCM Acupuncture view:

• Indicates Heat in the body

• Excess Heat - can be generated within the body from stagnation, or from an external source such as food or drink.

• Yin deficiency Heat - Yin has a cooling action within the body. A lack of it allows heat to dominate.

• Burning, red, swollen joints indicate Excess Damp-Heat.

• Burning palms/soles at night, along with sweating at night suggests Yin deficiency (5 palm heat).

• Nighttime is Yin time - a Yin deficiency is most noticeable at night.

Electrical, Shooting, or Tingling Pain

Biomedical view:

• Strong marker of nerve involvement: radiculopathy, entrapment, neuropathy.

• Descriptors like shooting or electric almost always indicate an irritated or compressed nerve.

TCM Acupuncture view:

• Reflects Wind, Phlegm obstructing channels, or Blood deficiency failing to nourish tissues.

• Numbness often indicates deficient Blood or Qi.

• Using biomedical treatment methods within the acupuncture framework often yields better results than only reducing wind, phlegm or tonifying blood in the TCM sense.

Dull, Deep, or Chronic Aching Pain

Biomedical view:

• Typically muscular or postural.

• Also linked to degenerative changes such as osteoarthritis.

• A chronic ache suggests tissue fatigue from overuse or reduced mobility.

TCM Acupuncture view:

• Qi deficiency or Blood deficiency.

• Chronic, mild, or long-standing pain can be lack of nourishment to tissues leading to the TCM pattern of disharmony - Spleen not nourishing muscles.

• “Better with rest, worse with exertion” fits Qi deficiency patterns.

Distending, Pressure, or Bloating-Type Pain

Biomedical view:

• Distention and bloating can be caused by an array of issues such as IBS, food intolerances, dietary habits and hormonal balance, along with more serious issues with liver and gallbladder function.

• The causes of distention and bloating are often more functional rather than structural issues

• Pressure can be structural or stress related - for example, pressure headaches.

TCM Acupuncture view:

• Qi stagnation - often in the TCM Liver organ.

• Pain felt as pressure, bloating, or a fullness that fluctuates (often stress-related).

• Common in chest, ribs, abdomen, and head tension.

How the Acupuncture & Biomedical Pain Systems Complement Each Other

Each acupuncturist will have their own personal style and level of focus on the biomedical approach to diagnosis and treatment, and the more traditional TCM approaches. I tend to decide which is more appropriate by judging each patient individually, but more often a mixed approach is used.

There are parallels within each system, which means that regardless of the split between biomedicine and TCM approaches, your treatment may look very much the same, aside from some subtle differences. The advantage of this blended approach means that the treatment is designed to each patient's specific needs, and can be evolved or altered as the treatment progresses and changes are made. It also means your condition or issue can be viewed through multiple different lenses, ensuring nothing is missed. The thing I most like about this combined approach is that, from my experience, Biomedicine tells us what is injured and what has led to the injury posturally or mechanically; whereas TCM is great at looking at the bigger picture and telling me why the body is responding this way and how best to rebalance it.

Biomedicine looks for:

• Tissue damage

• Inflammation

• Nerve involvement

• Structural changes

• Biomechanical dysfunction

  
  

TCM Acupuncture looks for:

• Patterns of imbalance

• Flow of Qi and Blood

• Exposure to pathogenic factors (Wind, Cold, Damp, Heat)

• TCM Organ system involvement

• Emotional and other internal patterns affecting physiology

  
  

Red Flags Associated With Different Pain Types

The description of pain can hint something more serious that may need a prompt referral rather than conservative care. Here are some examples.

Sharp or Stabbing Pain – Red Flags

Red flags:

• Sharp chest pain with shortness of breath: Possible cardiac event

• Sharp abdominal pain, especially severe or sudden: Appendicitis, gallstones, ectopic pregnancy

• Sharp back pain with loss of bowel/bladder control: Cauda equina

• Sharp pain after trauma and inability to bear weight: Possible fracture

• Sharp neck pain after high-speed injury: Cervical instability

Moving or Wandering Pain – Red Flags

Red flags:

• Migrating joint pain with fever: Systemic infection or rheumatic illness

• Wandering pain with rash after tick bite: Lyme disease

• Multiple migrating pains and severe fatigue: Autoimmune or inflammatory conditions

Heavy, Swollen, or “Full” Pain – Red Flags

Red flags:

• One-sided swollen leg: Possible DVT

• Sudden swelling of a joint with redness and fever: Possible septic arthritis

• Generalised swelling with shortness of breath: Possible heart or kidney issues

• Pitting oedema: Can be a sign of systemic organ dysfunction

Cold Pain (better with warmth) – Red Flags

Red flags:

• Cold, pale limb with no pulse: Vascular emergency

• Progressive cold sensation with colour changes: Severe Raynaud’s or vascular disease

• Severe abdominal cramping with vomiting/rigidity: Bowel obstruction or ischemia

Burning Pain – Red Flags

Red flags:

• Burning pain with open sores or loss of sensation: Diabetic neuropathy

• Burning abdominal pain radiating to back: Pancreatitis

• Burning chest pain with nausea/sweating: Cardiac event

• Burning and blistering rash in a strip: Shingles (especially high-risk if near eye)

Electrical, Shooting, or Tingling Pain – Red Flags

Red flags:

• Shooting leg pain with foot drop: Severe nerve compression

• Electrical pain and saddle numbness: Cauda equina

• Tingling in both hands and feet: Systemic neuropathy from diabetes or B12 deficiency

• Sudden-onset facial numbness: Possible stroke

• Shooting pain with loss of coordination: Possible spinal cord involvement

Dull, Deep, or Chronic Aching Pain – Red Flags

Red flags:

• Dull back pain worse at night, unrelieved by rest: Possible tumour or infection

• Chronic deep bone pain with fatigue: Hematological (blood) disorders

• Unexplained weight loss with a persistent dull pain: Malignancy warning sign

• Dull abdominal pain with bloating with blood in stoo: Possible GI pathology

Distending, Pressure-Type, or Bloating Pain – Red Flags

Red flags:

• Abdominal distension with an inability to pass ga: Bowel obstruction

• Severe pressure in chest or ribs: Possible cardiac or pulmonary emergency

• Head pressure with severe headache: Potential bleed (SAH)

• Pelvic pressure with abnormal bleeding: Reproductive pathology

Differential Diagnosis by Type of Pain

Depending on their training, an acupuncturist won't necessarily 'diagnose' specific conditions in the biomedical sense, but recognising the kind of issue presenting is important when developing treatment. Understanding what the type or nature of pain could be pointing to, is often the first step in narrowing down the list of possibilities.

Sharp or Stabbing Pain

Likely differentials:

• Ligament sprain

• Tendon tear

• Meniscus or labral injury

• Bone fracture or stress fracture

• Joint impingement

• Nerve root irritation

• Kidney stones (if flank pain)

• Pneumothorax or pleurisy (if chest pain)

• Abdominal emergencies (appendix, gallbladder, ectopic pregnancy, depending on region)

Shooting, Electric, or Zapping Pain

Likely differentials:

• Radiculopathy (cervical, thoracic, lumbar)

• Sciatica (L4–S1 nerve root involvement)

• Peripheral neuropathy (B12 deficiency, diabetes)

• Nerve entrapment (carpal tunnel, cubital tunnel, TOS)

• Shingles (during acute nerve irritation stage)

• Multiple sclerosis (rare but possible)

Dull, Achy, or Heavy Pain

Likely differentials:

• Muscle strain or overuse

• Myofascial trigger points

• Postural fatigue

• Osteoarthritis

• Fibromyalgia

• Chronic low back pain (mechanical)

• Venous insufficiency (if lower limbs feel heavy)

Moving or Wandering Pain

Likely differentials:

• Myofascial pain syndrome

• Fibromyalgia

• Systemic inflammatory arthritis (early stages)

• Viral or post-viral pain syndromes

• Referred pain from spinal segments

• Lyme disease

• Autoimmune disorders

Heavy, Swollen, or Full-Type Pain

Likely differentials:

• Acute inflammation

• Bursitis

• Tendinopathy

• Rheumatoid arthritis or inflammatory arthritis

• Fluid retention or oedema

• Lymphatic congestion

• Heart, liver, or kidney-related oedema (systemic)

• DVT (important differential!)

Cold Pain (better with warmth)

Likely differentials:

• Poor circulation or peripheral vascular disease

• Osteoarthritis that worsens in cold

• Hypothyroidism-related muscle pain

• Raynaud’s phenomenon

• Chronic muscular tension

• Postural stiffness

Burning Pain

Likely differentials:

• Peripheral neuropathy (diabetes, alcohol, vitamin deficiency)

• Nerve irritation/compression

• Tendinitis (can produce a “hot” feeling)

• Complex regional pain syndrome (CRPS)

• Post-herpetic neuralgia

• Reflux (if chest/upper abdomen)

• Inflammatory skin conditions

Tingling, Numbness, or "Pins and Needles" Pain

Likely differentials:

• Peripheral nerve entrapment (ulnar, median, peroneal, etc.)

• Cervical or lumbar radiculopathy

• Carpal or tarsal tunnel syndrome

• Diabetic neuropathy

• B12 deficiency

• Stroke/TIA (sudden onset)

• Multiple sclerosis

Distending, Pressure, or Fullness-Type Pain

Likely differentials:

• Muscle tension (especially intercostal, abdominal, pelvic floor)

• IBS or GI dysmotility

• Gas or bloating

• Costochondritis

• Tension headache

• Anxiety-related chest tightness

• Liver/gallbladder issues (if rib-side distension)

Pain is subjective, but by asking the right questions, you will often get some very important information to feed into your treatment such as

• Which methods or techniques are best suited to the patient

• How forceful you can be with these techniques

• If a referral to another practitioner or medical professional is needed

• Which areas to avoid

• What other factors might be contributing to the patient's issue

  
  
  
  

  Whether I am using more TCM Acupuncture techniques or more western techniques, extra on pain information is invaluable.