Scientists and clinicians have recently adopted a new diagnostic pain category called nociplastic pain. What is it, why is it important, and how can you tell if you have it or not? Spoiler alert: if your pain is nociplastic in nature, then it may be time you change how you're treating it.
Demystifying the Different Kinds of Pain
Pain can be broadly classified into three categories: nociceptive, neuropathic, and nociplastic. Although these terms may sound complicated and confusing, it's important to understand which one applies to you so you and your doctor can determine the best treatment for your pain.
Nociceptive pain is the kind we're all familiar with: it's the pain that comes from tissue damage like a bruise, cut, or burn. Other examples include inflammation, sprains, insect stings, broken bones, and pulled muscles. This type of pain can also be internally caused by conditions like tumors and cancer (1). Essentially, this pain occurs because of something happening to the body.
Neuropathic pain, on the other hand, is different because it's the result of physical damage to the nervous system (our body's pain system). It can be caused by an injury or disease (or even something like being pinched or hitting your elbow). Examples of conditions that can lead to neuropathic pain include multiple sclerosis, alcoholism, diabetes, and chemotherapy. Neuropathic pain is more frequently the root of chronic pain than nociceptive pain because nerves don’t always heal properly (2).
Nociplastic pain, meanwhile, arises from sensitization in pain and sensory processing in the central nervous system (our brain and spinal cord) and is sometimes referred to as centralized pain or "altered pain processing" (3). Some conditions that fall into this pain category include fibromyalgia, unexplained migraines, irritable bowel syndrome, and most cases of chronic low-back pain. The causes of nociplastic pain are still being investigated and aren't necessarily clear cut or fully understood (at least, at this point in time).
Nociplastic Pain: Its Symptoms
If your chronic pain doesn't seem to fall into either the nociceptive or neuropathic categories because it's not related to structural or nerve damage, then nociplastic pain may be something worth considering. One way to figure out if this is the kind of pain you have is to see if you have similar symptoms.
People who live with nociplastic pain may experience widespread pain across multiple areas of their body that may feel "dull, deep, and aching" (4). In addition, symptoms can include fatigue, trouble sleeping, and cognitive issues related to memory and/or mood. In many instances, the pain is greater than it should be given the amount of identified damage (whether tissue or nerve-related). It is interesting to note that many people who struggle with this kind of pain also have a history of abuse or pain in their families (5).
Sometimes doctors cast doubt on a patient’s reports of these kinds of symptoms because they don’t understand what is causing them.. They may find it challenging (if not impossible) to diagnose this type of pain because it can be the result of varying or currently unknown causes. To complicate matters further, nociplastic symptoms often occur in conjunction with nociceptive and/or neuropathic symptoms.
If you think that you may be experiencing this type of pain, take Lin’s free quiz. You'll have a lot more clarity about the pain you’re experiencing and what you can do to diminish it in just a matter of minutes.
Nociplastic Pain: Treatment Options
Nociplastic pain has different causes and symptoms than nociceptive and neuropathic pain and responds better to different treatments too. This is why it's crucial to determine whether or not this is the kind of pain you may be experiencing. If it is, you might want to explore other treatment options with your doctor.
Treatments that have been shown to be effective in reducing nociplastic pain include patient education (the promotion of healthy lifestyle habits) and psychological therapies (like cognitive behavioral therapy, mindfulness, hypnotherapy, and biofeedback). Additionally, physical and chiropractic therapies and, in some cases, acupuncture and massage have also been shown to be helpful.
In general, medication doesn't work with this kind of pain and can even cause adverse side effects (6). So while opioids, non-steroidal anti-inflammatory drugs (NSAIDs), and others like muscle relaxants have been shown to help control nociceptive pain, this isn't necessarily the case when it comes to nociplastic pain. So if you believe you are dealing with nociplastic pain, you may find non-traditional treatments to be more effective than the ones that are generally prescribed or recommended for other kinds of pain. Traditional treatments (which can include anti-inflammatory drugs, opioids, injections, and surgery) are not recommended for people who are experiencing nociplastic pain.
Do You Have Nociplastic Pain?
Spend a few minutes today taking a free quiz at lin.health under “sign up” to find out if you have nociplastic pain. Lin is committed to getting to the root cause of your pain and then connecting you with caring health coaches who will work with you to implement effective care plans to help reduce your pain. Our program allows you access to best-in-class, multidisciplinary care from the convenience of your home. Get started today.