Nociplastic pain: towards an understanding of prevalent pain conditions

Mary Ann Fitzcharles, Steven P. Cohen, Daniel J. Clauw, Geoffrey Littlejohn, Chie Usui, Winfried Häuser

Research output: Contribution to journalReview articlepeer-review

Abstract

Nociplastic pain is the semantic term suggested by the international community of pain researchers to describe a third category of pain that is mechanistically distinct from nociceptive pain, which is caused by ongoing inflammation and damage of tissues, and neuropathic pain, which is caused by nerve damage. The mechanisms that underlie this type of pain are not entirely understood, but it is thought that augmented CNS pain and sensory processing and altered pain modulation play prominent roles. The symptoms observed in nociplastic pain include multifocal pain that is more widespread or intense, or both, than would be expected given the amount of identifiable tissue or nerve damage, as well as other CNS-derived symptoms, such as fatigue, sleep, memory, and mood problems. This type of pain can occur in isolation, as often occurs in conditions such as fibromyalgia or tension-type headache, or as part of a mixed-pain state in combination with ongoing nociceptive or neuropathic pain, as might occur in chronic low back pain. It is important to recognise this type of pain, since it will respond to different therapies than nociceptive pain, with a decreased responsiveness to peripherally directed therapies such as anti-inflammatory drugs and opioids, surgery, or injections.

Original languageEnglish (US)
Pages (from-to)2098-2110
Number of pages13
JournalThe Lancet
Volume397
Issue number10289
DOIs
StatePublished - May 29 2021

ASJC Scopus subject areas

  • Medicine(all)

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