Nociplastinen

Nociplastic pain is a term used to describe pain that arises from altered nociception without clear evidence of tissue damage, disease of the somatosensory nervous system, or a predominant neuropathic mechanism. The concept was introduced by the International Association for the Study of Pain (IASP) to classify pain that does not fit neatly into nociceptive or neuropathic categories and is thought to reflect changes in central pain processing rather than peripheral injury alone.

Pathophysiology is thought to involve central sensitization and impaired or altered endogenous pain modulation. Amplified signaling in the spinal cord and brain, changes in pain processing networks, and interactions with sleep, mood, and cognitive factors contribute to the persistence and amplification of pain in the absence of clear tissue pathology. This mechanism is often discussed in relation to chronic, widespread, or functionally based pain syndromes.

Clinical features commonly include persistent or recurrent pain that is regional or widespread and may be accompanied by fatigue, sleep disturbance, and cognitive symptoms. Physical examination may reveal little objective tissue damage relative to the level of reported pain. Nociplastic pain is frequently identified in conditions such as fibromyalgia, chronic nonspecific low back pain, temporomandibular disorders, and irritable bowel syndrome, though it may be present across a range of functional pain presentations.

Diagnosis relies on clinical judgment, history, and the exclusion of other causes. Tools such as questionnaires assessing central sensitization can support suspicion, but there is no single definitive test. Management is typically multidisciplinary, emphasizing education about pain neuroscience, regular exercise, psychological therapies, and, when appropriate, pharmacological agents that modulate pain processing. Opioid therapy is generally not recommended as a first-line approach.