Nociplastic

Nociplastic pain is a classification of pain that arises from altered nociception despite no clear evidence of tissue damage (nociceptive pain) or somatosensory system lesion (neuropathic pain). The term was proposed by the International Association for the Study of Pain (IASP) in 2016 to describe pain that cannot be explained by tissue injury alone and is thought to involve abnormal processing of pain signals within the central nervous system.

Clinical features include regional or widespread pain without clear peripheral tissue damage, heightened sensitivity to stimuli (allodynia and hyperalgesia), and frequent coexistence with conditions such as fibromyalgia, chronic widespread pain, temporomandibular disorders, or irritable bowel syndrome. Diagnosis relies on excluding nociceptive and neuropathic mechanisms and on assessment of abnormal pain modulation, often supported by patterns of widespread pain and sensory amplification.

Mechanisms attributed to nociplastic pain center on central sensitization and impaired endogenous pain inhibition, with contributions from spinal and supraspinal plasticity, glial activation, and neuroinflammation. These processes are influenced by genetic, psychosocial, and environmental factors and may vary across individuals and conditions.

Clinical relevance and treatment considerations emphasize multidisciplinary management targeting overall pain processing and function rather than a single tissue source. Approaches commonly include physical activity, sleep and mood improvement, cognitive-behavioral therapy, and graded exercise. Pharmacologic strategies are generally chosen to address comorbid pain conditions rather than a specific nociplastic mechanism.

Controversy surrounds the concept, including debates about diagnostic criteria and potential overlap with nociceptive pain. Ongoing research aims to refine criteria, clarify distinctions from other pain types, and improve patient assessment and care.