What Do We Know about Nociplastic Pain?

Abstract

Nociplastic pain is a recently distinguished type of pain, distinct from neuropathic and nociceptive pain, and is well described in the literature. It is often mistaken for central sensitization. Pathophysiology has not been clearly established with regard to alteration of the concentration of spinal fluid elements, the structure of the white and gray matter of the brain, and psychological aspects. Many different diagnostic tools, i.e., the painDETECT and Douleur Neuropathique 4 questionnaires, have been developed to diagnose neuropathic pain, but they can also be applied for nociplastic pain; however, more standardized instruments are still needed in order to assess its occurrence and clinical presentation. Numerous studies have shown that nociplastic pain is present in many different diseases such as fibromyalgia, complex regional pain syndrome type 1, and irritable bowel syndrome. Current pharmacological and nonpharmacological treatments for nociceptive and neuropathic pain are not entirely suitable for treating nociplastic pain. There is an ongoing effort to establish the most efficient way to manage it. The significance of this field has led to several clinical trials being carried out in a short time. The aim of this narrative review was to discuss the currently available evidence on pathophysiology, associated diseases, treatment possibilities, and clinical trials. It is important that physicians widely discuss and acknowledge this relatively new concept in order to provide optimized pain control for patients.

Update: Noziplastischer Schmerz

“…Noziplastischer Schmerz ist keine Diagnose! Darüber hinaus sind in einer kürzlich publizierten Übersichtsarbeit die genannten Mechanismen nahezu identisch mit jenen, die typischerweise mit Mechanismen der "Zentralen Sensibilisierung" assoziiert werden [45] ("often mistaken for central sensitization" [46]).…”

Current understanding of nociplastic pain

“…Spinal mechanisms include convergence, clustering, reorganization of the spinal cord for the pain source, decreased spinal inhibition, winding up, or summation, and immune system activation. In addition, peripheral mechanisms include increased sodium channels and sympatho-afferent coupling ( Table 2 ) [ 2 , 7 ].…”

Opioids for Acute Back and Neck Pain: Time to Move Away from a Useless and Harmful Treatment?

“…Researchers are constantly debating the nature of [nociplastic pain] but have not reached any agreement yet,” according to Kacper Bułdyś and colleagues. (See Bułdyś et al, 2023. )…”