A Review of the Mechanisms Behind Nociplastic Pain and Its Clinical Characteristics

Abstract

In recent years, in its classification of pain, the International Association for the Study of Pain (IASP) has termed pain that occurs without apparent tissue or nerve damage as “nociplastic pain”. Central sensitization has been hypothesized as a possible underlying mechanism. Central sensitization is a phenomenon in which the excitability of nociceptive neurons in the central nervous system (CNS) in response to ascending stimuli is enhanced, and pain sensitivity is increased. However, it has also been suggested that nociplastic pain has a different mechanism than central sensitization. For example, it may be derived from social pain, somatization, inappropriate cognitive-behavioral responses to pain, and psychiatric disorders. Clinically, each condition differs in terms of patient characteristics, disease course, and responsiveness to treatment. Therefore, it would be useful to distinguish between them to understand their pathophysiology and determine the appropriate treatment strategy. In this review, we discuss the mechanisms underlying nociplastic pain from a literature review and a clinical perspective.