Nociplastic Pain and Central Sensitization in Hip and Knee Arthroplasty: A Practical Primer for Arthroplasty Surgeons

Nociplastic pain is a type of pain distinct from nociceptive pain (pain from damage to tissues) and neuropathic pain (pain from damage to nerves). Mechanistically, nociplastic pain is incompletely understood but is thought to be secondary to altered pain sensory pathways peripherally and in the central nervous system. Nociplastic pain has been identified in more than one-third of patients presenting for evaluation of hip and knee arthritis. Importantly, many of these patients may not carry a formal diagnosis of fibromyalgia or other nociplastic pain syndrome. Patients with nociplastic pain undergoing arthroplasty surgery experience less pain relief and functional improvement, and exhibit increased opioid use after surgery. With an increasing emphasis being placed on preoperative to postoperative change in patient-reported outcome measures for measures of surgical quality and physician reimbursement, recognition of nociplastic pain by the arthroplasty surgeon before surgery is of critical importance.