Nociplastic Pain: Facts, Controversies and Future Tasks

Nociplastic pain, a third mechanistic pain descriptor in addition to nociceptive and neuropathic pain is defined as 'pain that arises from altered nociception' not fully explained by nociceptive or neuropathic pain mechanisms.

We summarise and extend some discussions of a main session on nociplastic pain at the conference of the European Pain Federation EFIC in Lyon at the 26th April, 2025.

We recommend not to mix up concepts and terms: Nociplastic pain is not synonymous with chronic primary pain nor with central sensitization. Nociplastic pain is not a new term for pain of unknown origin. We identified these controversies: 'Nociplastic' might not be the best term. Other specialties (e.g., internal medicine) use different terms and concepts for clinical conditions termed as 'nociplastic pain conditions' by pain medicine. Fibromyalgia syndrome is not always the prototype of a pure nociplastic pain condition. 'Nociplasticity' can be a continuous (and not a separate) component of pain; hence the requirement to 'exclude' nociceptive and neuropathic pain to diagnose nociplastic pain has been questioned.

Future tasks include additional field testing and eventual modification of the criteria for nociplastic pain; development of pharmacological and psychological treatment guidelines, based on the three pain types; unravelling pathophysiological mechanisms driving altered nociception in pain conditions with substantial nociplastic components; development of umbrella concepts unifying the different views of somatic medicine, psychosocial medicine and pain medicine.

The concept of nociplastic pain has gained growing importance in pain medicine and has been introduced into other specialties such as gynaecology and rheumatology. Clinicians should always strive to identify the major pain mechanisms to guide treatment.