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Nociplastic pain

Posted: Mon Jun 28, 2021 4:07 pm
by webslave
Sufferers of chronic pain have long been told it’s all in their head. We now know that’s wrong

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Re: Nociplastic pain

Posted: Mon Jun 28, 2021 10:06 pm
by webslave
Quote from article:
Traditionally, doctors have divided pain into two categories: nociceptive pain, triggered by injuries such as bruises, burns, fractures, sprains or inflammatory conditions such as arthritis, and detected by pain receptors in our skin, bones and other tissues; and neuropathic pain triggered by damage to the nerves that carry sensory signals from these tissues to the brain and spinal cord.

But a few years ago, the IASP introduced a third category: nociplastic pain – pain arising from the altered processing of these sensory signals, without any evidence of actual or threatened tissue damage. One thing that can happen is that the pain signals carried by peripheral nerves from the skin, muscles, joints or internal organs to the spinal cord can become amplified, worsening the pain.

Prolonged activation of the body’s pain pathways can also lead to changes in the brain and spinal cord. According to the old way of thinking, the body’s pain pathways were arranged like a telephone switchboard, with fixed sets of wires (nerves) connecting our peripheral organs and tissues to the spinal cord, and further nerves connecting the spinal cord to the brain as well as feeding back down in the opposite direction.

“The assumption was that this was a fixed, solid, stable system,” Arendt-Nielsen says. “But we now know that these neural networks can be reorganised when there are persistent inputs into the system, and cause increased gain of the pain signal and hence generate a stronger pain.”

For one thing, nerves in the brain and spinal cord – the central nervous system – can become hyper-excitable, meaning that minor bumps and grazes become agonising, and even non-painful stimuli such as brushing your hair or touching your skin can trigger pain. “It is like an allergic reaction in the pain system,” Arendt-Nielsen says.

This “central sensitisation” can also spread. “One of the features that we see in many patients with chronic pain is that they have this generalised pain hypersensitivity. They might have osteoarthritis and pain in their knee, but if you quantitatively assess the sensitivity of the pain system, they have a lower lower pain threshold throughout their bodies,” Arendt-Nielsen says. “This reorganisation of the pain system is the reason why management of chronic pain is difficult, and traditional analgesics are not efficient – and why pain research is so important to discover new ways to modulate this pain reorganisation.”

It may also help explain why so many people with chronic pain conditions subsequently develop more of them. More than 200 million people around the world are affected by chronic overlapping pain conditions – a cluster of painful disorders which often coexist in the same patient.