Nociplastic pain

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Nociplastic pain
Other namesCentral sensitisation
psychological therapies, pain neuroscience education[4]

Nociplastic pain or central sensitisation is a type of

nerve damage. It may occur in combination with the other types of pain or in isolation. Its location may be generalised or multifocal and it can be more intense than would be expected from any associated physical cause.[3]

Its causes are not fully understood but it is thought to be a dysfunction of the

pain signals may have become distorted or sensitised.[3][5]

The concept and term was formally added to the taxonomy of the International Association for the Study of Pain following the recommendation of a task force in 2017.[6] The root terms are Latin nocēre, meaning to hurt, and Greek πλαστός, meaning development or formation in a medical context.

This type of pain typically arises in some chronic pain conditions, with the archetypal condition being fibromyalgia. It may be a factor in long COVID.[7][8] Exercise is commonly prescribed for such conditions.[9] Nociplastic pain has also been hypothesized to play a role in the persistence of medically unexplained symptoms.[5]

Definition

Nociplastic pain is a longterm complex pain, one of three mechanisms of

nociceptive pain and neuropathic pain.[2] Widespread pain and increased pain have been suggested as important clinical features.[2]

Central sensitization is a broader term referring to a hyperexcitability of the nervous system, usually including hyperalgesia (increased sensitivity to pain), and allodynia (painful perception of non-painful stimuli).[5]

An even broader term is that of central sensitivity syndromes, referring to syndromes characterized by the hyperexcitement of central

temporomandibular disorder.[11]

Mechanism

Its causes are not fully understood but it is thought to be a dysfunction of the

dorsal horn and others.[5]

Diagnosis

It is diagnosed by its clinical features and lack of response to

chronic back pain.[3]

Tools to measure central sensitization include sensory tests to painful stimuli,

urine.[5] Self-report questionnaires such as the Central Sensitization Inventory[12] and the Sensory Hypersensitivity Scale[13] are also used.[5]

Treatment

Treatment generally requires both physical and psychological therapies, along with pain neuroscience education.[4]

References

  1. PMID 29669091
    .
  2. ^
    ISBN 978-91-7929-783-1
    .
  3. ^
    S2CID 235245552
    .
  4. ^
    ISBN 978-3-030-39982-5
    .
  5. ^
    S2CID 58565532
    .
  6. ^ IASP Council Adopts Task Force Recommendation for Third Mechanistic Descriptor of Pain, International Association for the Study of Pain, 14 November 2017
  7. PMID 32701829
    .
  8. ^ Linda Geddes (28 June 2021), "The pain that can't be seen – Sufferers of chronic pain have long been told it's all in their head. We now know that's wrong", The Guardian
  9. S2CID 221937920
    .
  10. PMID 17350675
    .
  11. S2CID 235471910
    .
  12. S2CID 206247498
    .
  13. PMID 26873609
    .
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