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Mixed pain: clinical practice recommendations.

Giustino Varrassi1, Giacomo Farì1,2, Marco Antonio Narvaez Tamayo3,4

  • 1Fondazione Paolo Procacci (FPP), Rome, Italy.

Frontiers in Medicine
|October 29, 2025
PubMed
Summary
This summary is machine-generated.

Mixed pain, involving nociceptive, neuropathic, and nociplastic mechanisms, is underdiagnosed. These recommendations offer a framework for its diagnosis and management, emphasizing tailored, multidisciplinary care for better patient outcomes.

Keywords:
interdisciplinary caremixed painmultimodal analgesianeuropathic painnociceptive painnociplastic painpainpain management

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Area of Science:

  • Pain Medicine
  • Neurology
  • Clinical Practice Guidelines

Background:

  • Mixed pain, a complex phenotype involving nociceptive, neuropathic, and nociplastic mechanisms, presents significant diagnostic and therapeutic challenges.
  • It is prevalent in chronic pain syndromes, associated with severe symptoms, functional impairment, and increased healthcare costs.
  • Current management is often suboptimal, highlighting an unmet clinical need.

Purpose of the Study:

  • To provide structured, evidence-informed recommendations for the diagnosis and management of mixed pain.
  • To establish a framework emphasizing mechanism-based therapeutic strategies tailored to individual patient profiles.
  • To promote multimodal and interdisciplinary care models addressing biological, psychological, and functional dimensions of mixed pain.

Main Methods:

  • Systematic literature review.
  • Multidisciplinary expert consensus development.
  • Evidence-informed framework creation.

Main Results:

  • The recommendations emphasize personalized, mechanism-based treatment strategies.
  • Implementation of multimodal and interdisciplinary care is central to the proposed approach.
  • The guidance targets a broad range of healthcare professionals and patients with conditions like chronic low back pain, cancer pain, and osteoarthritis.

Conclusions:

  • Accurate diagnosis and integrated treatment planning are crucial for advancing mixed pain care.
  • These recommendations aim to reduce the burden of mixed pain and enhance patient-centered outcomes.
  • The guidance promotes mechanism-based, multidisciplinary strategies for direct clinical applicability and transforming patient care.