nociplastisia

Nociplastic pain is a relatively new term used to describe pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the nociceptive activation. It is a diagnosis of exclusion, meaning other potential causes of pain, such as inflammatory, neuropathic, or nociceptive pain related to tissue injury, must be ruled out first. Nociplastic pain is characterized by hyperalgesia, allodynia, and sometimes spontaneous pain. These symptoms can be widespread and disproportionate to any observable physical findings.

The underlying mechanisms of nociplastic pain are thought to involve changes in the central nervous system, including the brain and spinal cord. This can include increased excitability of neurons involved in pain processing, altered descending pain modulation pathways, and changes in sensory processing. Psychological factors such as stress, anxiety, and depression can also play a significant role in the development and maintenance of nociplastic pain, though it is important to note that nociplastic pain is not a psychological disorder.

Diagnosing nociplastic pain often involves a thorough clinical assessment, including a detailed pain history and physical examination. Objective tests may be used to rule out other conditions. Treatment for nociplastic pain is typically multimodal and focuses on addressing the central sensitization mechanisms. This can include pharmacological interventions such as certain antidepressants and anticonvulsants, as well as non-pharmacological approaches like physical therapy, cognitive behavioral therapy, mindfulness-based interventions, and pacing strategies. The goal of treatment is to improve pain perception, function, and quality of life.