Fast Five Quiz: Neuropathic, Nociceptive, and Mixed Pain

Shaheen E. Lakhan, MD, PhD, MS, MEd


January 14, 2022

Sensitization is the major underlying mechanism of nociplastic pain. Consequently, patients whose clinical picture is dominated by central sensitization are characterized as having nociplastic pain.

According to IASP clinical criteria, nociplastic pain is characterized by regional rather than discrete pain distribution, and clinical signs of pain hypersensitivity (ie, evoked pain hypersensitivity phenomena such as static or dynamic mechanical allodynia, heat or cold allodynia, and/or painful after-sensations after any of the mentioned evoked pain hypersensitivity assessments) present at least in the region of pain.

Symptoms observed in nociplastic pain include multifocal pain that is more widespread, intense, or both, than would be expected given the amount of identifiable tissue or nerve damage; in addition, other central nervous system–derived symptoms, such as fatigue, sleep, memory, and mood problems, are present. This type of pain can occur in isolation (eg, tension headache or fibromyalgia), or as part of a mixed-pain state in combination with ongoing nociceptive or neuropathic pain (eg, chronic low back pain). Nociplastic pain responds to different therapies than nociceptive pain, and has decreased responsiveness to peripherally directed therapies, such as anti-inflammatory drugs and opioids, surgery, or injections, highlighting the importance of its clinical recognition.

Learn more about nociplastic pain.


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