Nociplastic pain and pain induced by mental disorder in dentistry

Abstract

In the dental clinical setting, some patients present with chronic pain despite the absence of mechanical or organic impairment. In the past, it has been called variously “idiopathic pain”, “psychogenic pain”, and “nonorganic pain,” but in 2017, the International Association for the Study of Pain (IASP) propose the concept of “nociplastic pain” as pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage. It is positioned as a “third mechanistic descriptor of pain” following “nociceptive pain” and “neuropathic pain,” which are pain mechanisms. In response to this, in the International Classification of Orofacial Pain, 1st edition (ICOP-1), published in 2020, a chapter on “Idiopathic orofacial pain” was incorporated, in which three diseases that may occur by the mechanism of nociplastic pain in dentistry were classified: “Burning Mouth Syndrome”, “Persistent Idiopathic Facial Pain,” and “Persistent Idiopathic Dentoalveolar Pain”. On the other hand, mental disorders such as Somatic Symptom Disorder, depression, personality disorders, and schizophrenia may cause patients to complain of pain. Although the mechanism is not clear, it is possible that patients experience cenesthopthie or nociplastic pain. This article describes these disorders with case examples.