What is nociplastic pain?

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 they involve pain creation or augmentation by the central nervous system through pathways that involve predictive processing, threat conditioning, sensory processing and altered pain modulation. 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.

The amazing thing about nociplastic persistent pain is that can be reversed, or unlearned.

Like any other kind of pain, it is always and absolutely real, it is never imagined.

A note on terms:

Because the term nociplastic alludes to underlying mechanisms and points to effective treatments that can bring about neural repatterning, it is my preferred term.

For epidemiological and descriptive / classification purposes, the term primary pain, used in the World Health Organization’s International Classification of Diseases (ICD-11) can be used as well, though it doesn’t point to the underlying mechanisms or effective treatments.

For some symptoms or diagnoses alluding to the function of certain organs or systems, I might also use “functional symptoms / syndrome” (e.g. functional neurological symptoms like non-epileptic seizures, or functional digestive symptoms such as irritable bowel syndrome).

For our work together, we will start from whatever language makes sense to you, while at the same time engaging in an exploration of whether this language elicits an experience of safety, validation, and possibilities for healing, and whether it enables expanding and deepening your understanding of the many threads at play in your lived experience. And if you feel like you’d like to explore new language that will evoke the felt sense and healing you want to cultivate and grow, we’ll do that.

You might have encountered the following terms: psychophysiologic pain, psychosomatic symptoms, mind-body syndrome, TMS (tension myositis syndrome or tension myoneural syndrome), FND (functional neurological disorder), central sensitization syndromes, and more. Let’s make sense of them together.

If you’d like to learn more about whether there is a nociplastic element to your pain or symptoms, read the next blog entry. And if you’re ready to be supported on your path to healing, let’s work together.