Jenny L.F. Andrus, MD
Clinicians have long held that there are two types of pain – nociceptive (the type of sensation or pain you feel when there is damage to your body tissues, think stepping on a tack) and neuropathic (pain deriving from diseases related to the nerves or damage to them, think diabetic neuropathy of the feet). However, they began to understand that there was a distinct and third type of pain that didn’t fit either of these descriptions, but which arose from the central nervous system and altered how our body sensed and perceived pain. The symptoms varied over many body systems, but most could include widespread pain, increased sensitivity to pain, overactivity of nerves, as well as fatigue, sleep, memory and mood issues.
Almost seven years ago, researchers in the field of pain management coined a descriptive term for that third type of pain experience. Nociplastic pain is pain that comes from altered nociception without clear evidence of any or impending tissue damage activating peripheral nociceptors or proof of disease or wound concerning the somatosensory system creating the pain. The terminology was accepted by the International Association for the Study of Pain (IASP) in 2017. This is the formal, clinical definition.
Exactly why is this so important to regular people? Because it provides validation to millions of chronic pain patients who suffer with conditions such as fibromyalgia, complex regional pain syndrome (CRPS), irritable bowel syndrome (IBS), and non-specific chronic back pain, etc. These folks have pain that is neither nociceptive (meaning you can’t observe something causing the pain to the body) nor neuropathic (the pain doesn’t derive from diseases related to the nerves or damage to them), but their pain has clinical features suggesting altered central nociceptive function.
Nociplastic pain refers to an indication of altered central nociceptive (the type of sensation or pain you feel when there is damage to your body) function in the central nervous system as the potential and relevant mechanism of pain, where there really hasn’t been a good explanation in the past. This gives clinicians the confidence to talk about this type of pain to their patients without sounding vague, condescending, or unhelpful. However, it is important to remember that when the term nociplastic pain is used, it is not a diagnosis but is only a clinical descriptor. There will always be an underlying condition or disease of which nociplastic pain is a symptom.
Also important is that this opens pathways for improved assessment of pain in patients who have been previously underdiagnosed, misdiagnosed or simply sent from provider to provider in search of a diagnosis. It also paves the way for more research into treatments and specific, tailored therapies in the future.
As a physician, it is also important to note that treating patients with nociplastic pain is much different that treating patients with the other two types of pain, as they typically do not respond well to pain medications, anti-inflammatory medications, or surgery. Anti-depressants, such as serotonin norepinephrine reuptake inhibitors or tricyclics work well, as do carefully administered, and monitored gabapentenoids.
Cognitive behavioral therapy has proven to be very effective at helping to reduce pain levels by providing relaxation skills, coping techniques, meditation and other life-coaching to give the patient tools to address emotional issues that could also be exacerbating their pain.