Current understanding of nociplastic pain

Area of Science:

• Pain research
• Neuroscience
• Clinical pain management

Background:

• Nociplastic pain is defined by the International Association for the Study of Pain as pain arising from altered nociception without clear evidence of nociceptive or neuropathic pain.
• Augmented central nervous system pain processing and altered pain modulation are proposed mechanisms.
• It encompasses chronic regional pain, evoked pain hypersensitivity (allodynia), and often includes comorbidities like fatigue and sleep disturbances.

Purpose of the Study:

• To define nociplastic pain and its proposed mechanisms.
• To outline clinical criteria for identifying possible and probable nociplastic pain.
• To explore the relationship between nociplastic pain, central sensitization, and various chronic pain disorders.

Main Methods:

• Review and synthesis of the definition and proposed mechanisms of nociplastic pain.
• Analysis of clinical criteria for nociplastic pain, including hypersensitivity and comorbidities.
• Identification of associated disorders linked to central sensitization.

Main Results:

• Nociplastic pain is characterized by altered nociception and central sensitization.
• Clinical criteria progress from possible (regional pain, hypersensitivity) to probable (widespread hypersensitivity, comorbidities).
• Associated disorders include fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, and headaches, among others.

Conclusions:

• Nociplastic pain represents a significant category of chronic pain driven by central sensitization.
• It integrates sensory and emotional components, extending beyond traditional nociceptive or neuropathic pain classifications.
• Further criteria for definitive nociplastic pain are needed, but current understanding aids in explaining unexplained chronic pain.