Reframing nociplastic pain research and treatment using post-traumatic stress disorder-inspired conceptual models

Pain and fear are aversive alarm signals that serve adaptive protective functions. Pathologically disproportionate fear or pain responses can lead to conditions such as post-traumatic stress disorder (PTSD) or chronic pain. Although they are distinct conditions, PTSD and chronic pain-particularly nociplastic pain-share common risk factors, vulnerability, and exhibit mutual maintenance. Moreover, there exist similarities in the clinical presentation and neurophysiology of PTSD and nociplastic pain that suggest a shared underlying pathophysiology. In this article, we review functional changes that occur in the brain in both conditions to demonstrate parallels between PTSD and nociplastic pain and specifically highlight the role of the amygdala. We argue that differences in a priori conceptual models of these disorders may have influenced research approaches and interpretations that reinforce the current division between PTSD and nociplastic pain, and propose that insights from the study of PTSD can be used to guide pain research and treatment. We suggest the development and use of PTSD-inspired conceptual models of pain to generate testable hypotheses for fundamental and clinical pain research. Finally, we illustrate possible clinical benefits of using PTSD-inspired models for the treatment of nociplastic pain by discussing reconsolidation therapy, a treatment for PTSD whose mechanism of action could also make it a plausible treatment for nociplastic pain.