Nociplastic Pain: It’s not all in your head!
If you’ve been living with chronic pain, you might have heard the term "nociplastic pain" from your healthcare provider. But what does it actually mean? Let’s break it down in a way that’s easy to understand so you can feel more empowered in managing your pain.
What is Nociplastic Pain?
Nociplastic pain is different from the types of pain you may be more familiar with, like nociceptive pain (related to tissue damage) or neuropathic pain (related to nerve damage). Instead, nociplastic pain is a type of chronic pain that results from changes in the way your nervous system processes pain. It’s not caused by an injury or damage to your body but rather by an altered pain response in your central nervous system (CNS) [1].
In simpler terms, nociplastic pain is a bit like a malfunctioning alarm system. Even though there’s no immediate danger, your body’s pain signals are still going off, causing you to feel pain.
How Does Nociplastic Pain Develop?
Nociplastic pain involves changes in how your brain and spinal cord process pain signals. These changes can make your nervous system more sensitive to pain, even if there’s no clear cause for it. This increased sensitivity is sometimes referred to as "central sensitization" [2].
Imagine your nervous system as a highly sensitive radio. Over time, it can start picking up static or noise that wasn’t there before. This “static” can amplify pain signals, leading to persistent and widespread pain.
Common Conditions Associated with Nociplastic Pain
Nociplastic pain is linked to several chronic conditions. Some of the most common include:
Fibromyalgia: A condition characterised by widespread musculoskeletal pain, fatigue, and tenderness [3].
Chronic Low Back Pain: Pain that persists in the lower back without a clear underlying cause [4].
Irritable Bowel Syndrome (IBS): A disorder that affects the large intestine, causing abdominal pain, bloating, and changes in bowel habits [5].
Chronic Headaches: Including tension-type headaches and migraines [6].
These conditions share a common thread: the pain experienced is often out of proportion to any physical findings or injuries.
Signs and Symptoms of Nociplastic Pain
Nociplastic pain often presents with a range of symptoms that go beyond just physical pain. These can include:
Widespread Pain: Pain that affects multiple areas of your body, not just a single spot [3].
Fatigue: Feeling extremely tired, even after a full night’s sleep [7].
Sleep Problems: Trouble falling asleep, staying asleep, or waking up feeling unrefreshed [8].
Mood Issues: Anxiety, depression, or feelings of frustration due to chronic pain [9].
Cognitive Difficulties: Problems with memory, concentration, or thinking clearly [10].
It’s important to note that these symptoms can vary from person to person. You might experience some, all, or different symptoms altogether.
Diagnosing Nociplastic Pain
Nociplastic pain can be tricky to diagnose because it’s not linked to visible injuries or damage. Instead, doctors look for patterns in your symptoms and might use specific questionnaires or tests to assess your pain sensitivity [11].
Sometimes, tests like brain scans are used in research settings to see how your brain is processing pain. However, these are not typically used in everyday practice [12].
Treatment Options for Nociplastic Pain
Managing nociplastic pain can be challenging, but there are several approaches that might help:
Education: Learning about how pain works in your body can help you better manage it. Understanding that your pain is real, even if there’s no clear physical cause, is a crucial first step [13].
Exercise: Regular, gentle exercise can help reduce pain and improve your overall well-being. Activities like walking, swimming, or yoga can be particularly beneficial [14].
Cognitive Behavioral Therapy (CBT): This type of therapy helps you change the way you think about and respond to pain, which can reduce the impact it has on your life [15].
Physical Therapy: Working with a physical therapist can help you learn exercises and techniques to manage your pain and improve your mobility [16].
Hypnotherapy: Hypnotherapy has been shown to help manage nociplastic pain by reducing pain perception and improving coping strategies. Techniques used in hypnotherapy can help alter the way the brain processes pain signals, offering relief for some individuals with chronic pain [17].
Strategic Psychotherapy: Strategic psychotherapy focuses on identifying and altering problematic thinking patterns and behaviours that contribute to chronic pain. By using goal-oriented techniques and reframing strategies, it helps patients develop more adaptive ways of managing pain and stress, which can lead to significant improvements in pain outcomes [18].
It’s important to work with your healthcare provider to find the right combination of treatments that work for you.
Living with Nociplastic Pain
Living with chronic pain can be incredibly challenging, both physically and emotionally. It’s important to have a support system in place, whether it’s friends, family, or a healthcare team. Don’t hesitate to reach out for help when you need it.
Remember, understanding your pain is the first step in managing it. By learning more about nociplastic pain and exploring the treatment options available, you can take back control and start living a fuller life, despite the challenges you face.
Conclusion
Nociplastic pain is a complex and often misunderstood condition, but with the right knowledge and tools, you can manage your symptoms and improve your quality of life. If you suspect that you might be dealing with nociplastic pain, talk to your healthcare provider. Together, you can create a plan that’s tailored to your needs and helps you live your life to the fullest.
References:
Kosek, E., Cohen, M., Baron, R., Gebhart, G. F., & Mico, J. A. (2016). Nociplastic pain: towards an understanding of prevalent pain conditions. The Lancet, 387(10032), 1688-1697.
Woolf, C. J. (2011). Central sensitization: Implications for the diagnosis and treatment of pain. Pain, 152(3), S2-S15.
Häuser, W., Fitzcharles, M. A., Radner, H., & Welsch, P. (2019). Fibromyalgia syndrome and chronic widespread pain: the discrepancy between research evidence and clinical practice. Dtsch Arztebl Int, 116(41), 692-699.
Vlaeyen, J. W. S., & Linton, S. J. (2012). Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain, 152(6), 1144-1148.
Camilleri, M., Andresen, V., & Mawe, G. M. (2017). Nociplastic Pain: A Clinical Review. Gastroenterology, 153(6), 1539-1551.
Ashina, M., Katsarava, Z., Do, T. P., Buse, D. C., Pozo-Rosich, P., & Silberstein, S. D. (2021). Migraine: epidemiology and systems of care. The Lancet, 397(10283), 1485-1495.
Finan, P. H., Goodin, B. R., & Smith, M. T. (2013). The association of sleep and pain: an update and a path forward. The Journal of Pain, 14(12), 1539-1552.
Moldofsky, H. (2001). Sleep and pain. Sleep Medicine Reviews, 5(5), 385-396.
Häuser, W., & Fitzcharles, M. A. (2018). Facts and myths pertaining to fibromyalgia. Dialogues in Clinical Neuroscience, 20(1), 53-62.
Williams, D. A. (2016). Cognitive-behavioral therapy for fibromyalgia: A role in multidisciplinary care? Current Pain and Headache Reports, 20(7), 29.
Bouhassira, D., & Attal, N. (2016). Diagnosis and assessment of neuropathic pain: the saga of clinical tools. Pain, 157(Suppl 1), S17-S23.
Jensen, K. B., Kosek, E., Petzke, F., Carville, S., Fransson, P., & Marcus, H. (2010). Evidence of dysfunctional pain inhibition in fibromyalgia reflected in rACC during provoked pain. Pain, 148(2), 359-367.
Louw, A., Zimney, K., Puentedura, E. J., & Diener, I. (2016). The efficacy of pain neuroscience education on musculoskeletal pain: a systematic review and meta-analysis of randomised controlled trials. European Journal of Pain, 20(3), 131-137.
Geneen, L. J., Moore, R. A., Clarke, C., Martin, D., & Colvin, L. A. (2017). Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews. The Cochrane Database of Systematic Reviews, 4, CD011279.
Williams, A. C. d. C. (2014). Cognitive-behavioural therapy for chronic pain: a review and meta-analysis. The Journal of Pain, 15(3), 212-226.
Linton, S. J., & Shaw, W. S. (2011). Impact of psychological factors in the development of chronic pain. Physical Therapy, 91(5), 700-715. doi:10.2522/ptj.20100330
Elkins, G., Jensen, M. P., & Patterson, D. R. (2007). Hypnotherapy for the management of chronic pain. International Journal of Clinical and Experimental Hypnosis, 55(3), 275-287.
Yapko, M. D. (2009). Treating Depression with Hypnosis: Integrating Cognitive-Behavioral and Experiential Approaches. Springer.
