The Difference Between Somatic and Visceral Pain

Somatic pain and visceral pain are two distinct types of pain, and they feel different. Somatic pain comes from the skin, muscles, and soft tissues, while visceral pain comes from the internal organs or blood vessels.

Both somatic and visceral pain are known as nociceptive pain. They occur when pain-detecting nerves (nociceptors) send an impulse up the spinal cord to the brain in response to an injury or inflammation.

Despite similar pain pathways, somatic pain and visceral pain feel very different. Somatic pain is often intense and localized. Visceral pain can be vague, harder to pinpoint, and feel more like an aching or squeezing sensation.

This article discusses visceral vs. somatic pain, symptoms, types, and how they are treated.

What Is Somatic Pain?

Somatic pain is generally described as musculoskeletal pain. Because many nerves supply the muscles, bones, and other soft tissues, somatic pain is usually easier to locate than visceral pain.

What Somatic Pain Feels Like

When you bump your knee, cut your lip, or twist your ankle, the sudden, sharp feeling is somatic pain. Nociceptors in the skin, muscles, bones, and other soft tissues pick up sensations related to temperature, vibration, and swelling and send pain messages to the brain.

Somatic pain is often intense and localized, but can be superficial or deep:

• Superficial somatic pain comes from nociceptive receptors in your skin and mucous membranes, such as in your mouth and nose.
• Deep somatic pain originates from structures such as joints, bones, tendons, and muscles. Deep pain may be dull, aching, and generalized over a wider area of the body, which is similar to visceral pain.

Unlike visceral pain, though, somatic pain usually fades once the injury heals.

Types of Somatic Pain

Somatic pain is caused by injuries or infections in the skin, muscles, joints, bones, and other soft tissue. Temporary somatic pain can be caused by:

• Broken bones
• Cuts or scratches
• Infections
• Muscle injuries, including sprains, strains, and tears
• Tendonitis
• Other injuries

When somatic pain lasts longer than expected, it can become chronic pain. Chronic conditions that cause somatic pain include:

• Arthritis, which causes pain in the joints
• Chronic back pain that is not caused by nerve damage
• Fibromyalgia, which involves widespread pain and fatigue
• Pelvic pain caused by pelvic joint instability
• Tension headaches, which can cause muscle tightness around the head
  

Treatment

Somatic pain often responds well to at-home treatments, including:

• Over-the-counter pain relievers such as Tylenol (acetaminophen) and NSAIDs (nonsteroidal anti-inflammatory drugs) like aspirin and Advil (ibuprofen)
• Hot and cold packs
• Massage
• Relaxation techniques

Deep somatic pain caused by muscle injury may be treated with prescription muscle relaxants like Baclofen or Flexeril (cyclobenzaprine). 

Bone pain related to osteoporosis or osteopenia is treated with a class of medications known as bisphosphonates, such as:

• Actonel (risedronate)
• Boniva (ibandronate)
• Fosamax (alendronate)

Severe somatic pain may be treated with opioids on a short-term basis because they carry a high risk of dependency.

Chronic somatic pain often responds to lifestyle changes, including an anti-inflammatory diet, exercise, keeping hydrated, and getting enough sleep.

What Is Visceral Pain?

Visceral pain is an internal pain that comes from organs or blood vessels, which are not as extensively innervated (supplied by sensory nerves).

What Visceral Pain Feels Like

Unlike somatic pain, visceral pain is often dull, vague, and harder to pinpoint. It is often described as generalized aching or squeezing caused by compression in and around the organs or by stretching of the abdominal cavity.

Visceral pain may accompanied by:

• Changes in body temperature, blood pressure, and/or heart rate
• Gastrointestinal disturbances
• Nausea
• Paleness
• Profuse sweating

Visceral pain can also radiate to other areas in the body, making it even harder to pinpoint its exact location. This is also known as referral pain. An example of referred visceral pain is when an ectopic pregnancy presents as shoulder pain.

Types of Visceral Pain

A common source of visceral pain is functional gastrointestinal disorders (FGID), such as irritable bowel syndrome (IBS). IBS affects up to 15% of the population and is more common in women.

Other conditions that cause visceral pain include:

• Bladder pain (such as cystitis)
• Cancer
• Endometriosis pain, which can cause severe menstrual cramps
• Prostate pain (prostatitis)
• Vulvodynia, which is chronic vulva pain
  

Anxiety, depression, and stress can contribute to visceral pain, although the exact relationship between emotional distress and visceral pain is not yet clearly understood.

Treatments

Visceral pain is often treated in the short term with NSAIDs or opioids. In the long term, visceral pain is treated by finding and identifying the underlying cause.

For example, visceral pain caused by an infection is often treated with antibiotics.

IBS is treated with medications to relieve symptoms of abdominal cramps, constipation, or diarrhea, antidepressants, dietary changes, and probiotic supplements.

Endometriosis is treated with hormone therapy and, in some cases, surgery.

Research is underway to find more effective drug treatments and combinations.

Summary

Somatic pain and visceral pain come from different areas of the body. Somatic pain is in the muscles, bones, or soft tissues. Visceral pain comes from your internal organs and blood vessels.

Somatic pain is intense and may be easier to pinpoint than visceral pain. That's because your muscles, bones, and skin are supplied with a lot of nerves to detect pain. Pain may be superficial, which means it's just on the skin, or deep, involving bone and muscles.

Your internal organs don't have as many pain-detecting nerves, so visceral pain tends to be vague or have a squeezing or aching feeling.

Both somatic and visceral pain can be treated with NSAIDs or, in severe cases, opioids. Muscle relaxants may also help with deep somatic pain.