Nociplastic pain describes a category of pain not caused by ongoing tissue damage or a disease of the nerves. It results from a change in how the central nervous system, which includes the brain and spinal cord, processes sensory information, leading to pain without a clear physical injury. The International Association for the Study of Pain (IASP) officially recognized this term in 2017, providing a name for the pain experienced by many with chronic conditions. This recognition helps validate patient experiences and gives clinicians a clearer framework for discussing this pain.
The Three Categories of Pain
The most familiar type of pain is nociceptive, which arises from the stimulation of specialized nerve endings called nociceptors in response to actual or potential tissue damage. This is the pain you feel from a cut, a burn, or a broken bone. It serves as a protective alarm system, correctly signaling that the body has been harmed and requires attention.
A second category is neuropathic pain, which originates from a lesion or disease affecting the somatosensory nervous system itself. Conditions like diabetic neuropathy or sciatica are examples where the nerves that transmit sensory information are damaged or malfunctioning. This can be compared to faulty wiring in an electrical system, causing it to send false signals and resulting in shooting, burning, or electric-shock-like sensations.
Nociplastic pain represents a third, distinct mechanism caused by a disturbance in how the central nervous system processes pain signals, a phenomenon known as central sensitization. In this state, the nervous system becomes wound-up and hypersensitive. This is analogous to a smoke detector having its sensitivity turned up so high that it is triggered by steam from a shower, not just actual smoke. This heightened reactivity means that stimuli that are not normally painful can be perceived as such, and a mildly painful stimulus can be experienced as intensely painful.
Conditions Associated with Nociplastic Pain
Several chronic conditions are driven by nociplastic pain mechanisms. Fibromyalgia is the classic example, where individuals experience widespread musculoskeletal pain, fatigue, and tenderness stemming from amplified pain processing in the central nervous system, rather than from damage in the muscles or joints.
Other conditions include Irritable Bowel Syndrome (IBS), a disorder with abdominal pain, cramping, and altered bowel habits where disrupted gut-brain axis communication leads to visceral hypersensitivity. Some forms of chronic low back pain and tension-type headaches are classified as nociplastic when there is no identifiable structural damage to account for the pain’s severity and persistence.
Temporomandibular Disorder (TMD), which causes pain in the jaw joint and surrounding muscles, can also have a nociplastic component where the pain experience is disproportionate to any identifiable issue within the joint itself. These conditions can overlap, and a person may experience more than one, suggesting a common underlying mechanism of central nervous system sensitization.
The Diagnostic Process
Diagnosing nociplastic pain is a clinical process, as no single blood test or imaging scan can confirm it. The process relies on a clinician’s evaluation, starting with a detailed patient history. The healthcare provider will ask about the pain’s location, duration, and quality, while symptoms like fatigue, unrefreshing sleep, and cognitive difficulties provide diagnostic clues.
A physical examination is another part of the diagnosis. During the exam, a clinician may test for signs of hypersensitivity by applying gentle pressure to different points on the body to see if it elicits a painful response. Another indicator is allodynia, which is when a person experiences pain from a stimulus that does not normally cause pain, such as the light touch of clothing on the skin.
A primary step in the diagnosis is ruling out other causes of pain. To ensure that the symptoms are not due to nociceptive or neuropathic issues, a doctor may order diagnostic tests like X-rays, MRIs, or nerve conduction studies. If the results of these tests are normal or do not adequately explain the level of pain the patient is experiencing, a diagnosis of nociplastic pain becomes more likely.
Management and Treatment Approaches
The management of nociplastic pain is multidisciplinary and aims to recalibrate the central nervous system’s pain processing, not target a specific structural injury. Patient education is a primary component of treatment. Understanding that the pain is real but originates from a sensitized nervous system can empower patients and reduce the fear and anxiety that accompany chronic pain, which can worsen sensitization.
Physical and occupational therapies are also used, with a specific focus. The goal is not to push through pain but to engage in graded exercise and gentle movement. This approach slowly reintroduces activity to the nervous system in a non-threatening way, helping to gradually decrease its sensitivity over time. Therapies such as Cognitive Behavioral Therapy (CBT) are also used to help individuals reframe their thoughts and beliefs about pain, breaking the cycle where catastrophic thinking can amplify the pain experience.
Medications may be used, but they differ from traditional painkillers. Opioids and NSAIDs are not effective for nociplastic pain because they do not target the underlying central sensitization. Instead, clinicians may prescribe certain types of antidepressants, such as serotonin and norepinephrine reuptake inhibitors (SNRIs), or anticonvulsant medications that can help to “turn down the volume” on pain signals.
Lifestyle adjustments are also important in managing nociplastic pain. Improving sleep hygiene is important, as poor sleep can worsen pain sensitivity. Stress management techniques, such as mindfulness, meditation, or yoga, can be beneficial by calming the nervous system. Maintaining a balanced diet can support overall health and may help reduce inflammatory processes that contribute to pain sensitization.