Visual Hypersensitivity as a Transdiagnostic Marker of Surgical Pain Response in Arthritis and Chronic Pain Syndromes

Nociplastic pain is pain primarily driven by the central nervous system and, unlike nociceptive pain conditions, is thought to be refractory to peripherally directed therapies. Nociplastic pain is also associated with hypersensitivity to painful and other sensory stimuli (such as visual stimuli). Nonpainful sensory measures have not been well studied in nociceptive pain conditions nor directly compared with traditional pain sensitivity measures for their discriminative value. The current study aimed to investigate visual sensitivity across multiple chronic pain conditions, particularly in the context of analgesic treatment responsivity.

We compared sensitivity with experimental visual stimulation among individuals with chronic nociceptive pain, including hip osteoarthritis, chronic pelvic pain, rheumatoid arthritis, and psoriatic arthritis. Individuals with fibromyalgia, the prototypical nociplastic condition, and pain-free controls were included for reference. Lack of analgesic response 6 months after surgery in participants with osteoarthritis and chronic pelvic pain served as a model for nociplastic pain.

Participants across all pain conditions reported greater perceived brightness in response to visual stimulation compared with controls. Higher self-reported fibromyalgia symptom severity predicted lack of response to arthroplasty and hysterectomy. Notably, increased visual sensitivity independently predicted nonresponsiveness to surgery, whereas experimental pressure pain sensitivity did not. Visual sensitivity and fibromyalgia symptom severity together predicted greater variance in responder status than either measure alone.

These findings emphasize the potential value of assessing visual sensitivity to identify pain mechanisms across different diagnostic categories.