Nociplastic Pain

The International Association for the Study of Pain has proposed a new term, nociplastic pain, to describe a third category of pain that is mechanistically distinct from nociceptive pain, which is caused by ongoing inflammation and damage of tissues, and neuropathic pain, which is caused by nerve damage. The mechanisms that underlie this type of pain are not entirely understood, but it is thought that augmented central nervous system (CNS) pain and sensory processing and altered pain modulation play prominent roles. The symptoms observed in nociplastic pain include multifocal pain that is more widespread or intense, or both, than would be expected given the amount of identifiable tissue or nerve damage, as well as other CNS-derived symptoms, such as fatigue, sleep, memory, and mood problems. This type of pain can occur in isolation, as often occurs in conditions such as fibromyalgia or tension-type headache, or as part of a mixed-pain state in combination with ongoing nociceptive or neuropathic pain, as might occur in chronic low back pain. These diverse pain syndromes have considerable overlap, and present with clinical features that are almost entirely subjective, except for tenderness. Management strategies are directed towards attenuating, rather than eradicating, symptoms, with overarching principles that can be individually tailored. Setting realistic expectations is crucial. It is important to recognize this type of pain, since it will respond to different therapies than nociceptive pain, with a decreased responsiveness to peripherally directed therapies such as anti-inflammatory drugs and opioids, surgery, or injections. In addition to pain alleviation, treatment objectives should include improving function and other quality of life indicators. Source: http://www.thelancet.com/