Chronic nociplastic pain affecting the musculoskeletal system: clinical criteria and grading system

Review written by Dr Sandy Hilton info

Key Points

  1. Nociplastic pain is pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage or evidence for disease or lesion of the somatosensory system.
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BACKGROUND & OBJECTIVE

The International Association for the Study of Pain (IASP) published updated descriptions and definitions of pain in 2017 with 3 descriptors of pain mechanisms: nociplastic, neuropathic, and nociceptive (1). Nociplastic pain is “pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain”. It involves central and peripheral sensitization and is a helpful term for research and clinical use (2). It’s not uncommon to have pain that involves more than one pain mechanism, and identification of the involved mechanism(s) is important for treatment.

IASP formed a task force to establish clinically and research applicable criteria for nociceptive pain. This paper presented criteria for identifying and grading nociplastic pain in the musculoskeletal system.

It’s not uncommon to have pain that involves more than one pain mechanism.
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As the understanding of pain and how to treat it continues to evolve, criteria like this can form helpful guidelines for establishing a plan of care.

PROCEDURES AND PROCESSES:

  • The Terminology Task Force (TTF) consisted of 9 experts in musculoskeletal pain (the authors). Each TTF member presented a set of criteria which were voted on and modified to reach an alternative A with two back up options (B and
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