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Nociplastic pain: an introduction.

Christopher B Roecker1,2, Samuel M Schut3,4,5

  • 1VA Puget Sound Health Care System, Care Rehabilitation Care Services, Everett, Washington.

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|October 16, 2025
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Summary

Nociplastic pain, a concept of altered nervous system processing, helps explain chronic pain conditions like back pain and fibromyalgia seen in chiropractic care. A biopsychosocial approach is recommended for effective patient management.

Keywords:
backbiopsychosocialcentral sensitizationchiropracticchronicfibromyalgiaheadacheinterdisciplinary health teamsmanagementneckneuropathicnociceptionnociplasticpainwidespread chronic pain

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Area of Science:

  • Neuroscience and Pain Research
  • Chiropractic and Musculoskeletal Health

Background:

  • Chronic pain is prevalent in chiropractic practice, often lacking clear signs of tissue injury.
  • Nociplastic pain, characterized by altered nociceptive processing, offers a new framework for understanding such conditions.
  • Conditions like chronic back/neck pain, headaches, and fibromyalgia are common in chiropractic settings and may not respond to traditional models.

Purpose of the Study:

  • To introduce the concept of nociplastic pain.
  • To outline potential mechanisms of nociplastic pain.
  • To discuss the relevance and application of understanding nociplastic pain in chiropractic care.

Main Methods:

  • This is a commentary, not an experimental study.
  • It involves reviewing the concept of nociplastic pain and its implications.
  • It synthesizes current understanding to propose a management approach.

Main Results:

  • Nociplastic pain provides insight into chronic pain conditions frequently encountered by chiropractors.
  • Traditional pain models may be insufficient for these complex cases.
  • A multimodal approach is suggested for effective management.

Conclusions:

  • Understanding nociplastic pain is crucial for chiropractors managing complex chronic pain.
  • A collaborative, biopsychosocial framework including education, exercise, and goal-setting is advocated.
  • This approach supports evidence-based, patient-centered care for the whole person.