Nociplastic Pain Part 1 – What is Nociplastic Pain?

Nociplastic pain is a newer concept in pain management – it is listed as the “third” type of pain, and it plays a significant role in the care of persons with chronic conditions known to cause pain³. 

Nociplastic pain is characterized by abnormal processing of pain signals in the central nervous system, even when there is no identified cause for pain in the tissues or nerves¹.

Nociplastic pain can be explained by a top-down pain amplification (via alteration in the descending pain-modulatory pathway, causing diminished efficacy of the pain-inhibitory pathway and increased activity of the pain-facilitatory pathway) and bottom-up pain facilitation (the ascending pathways in the central nervous system become overstimulated by peripheral inputs), leading to hyperalgesia and allodynia⁴.

Key Elements of Nociplastic Pain

• Sensitization The pain is often linked to central sensitization, where the nervous system becomes hyper-responsive to stimuli³. Persons with nociplastic pain may experience an increase in pain intensity from stimuli that are normally not painful (allodynia) or an exaggerated pain response (hyperalgesia) ³.
• Multidimensional Nociplastic pain can be diffuse, involving areas of the body without any identifiable injury or damage, and often fluctuates in intensity; there are dynamic interactions among the biological, psychological, and social factors that mutually affect each other¹.
• Chronic This type of pain is typically persistent and presents in the context of chronic conditions such as fibromyalgia, complex regional or visceral pain syndromes (CRPS) or (CVPS), chronic primary headaches, including migraines, and irritable bowel syndrome.³
• Treatment Response When pain is driven by CNS dysfunction (maladaptive plasticity and sensitization) rather than tissue damage, pain may not resolve with usual treatments for nociceptive or neuropathic pain.³ For example, due to high levels of endogenous opioids, diminished opioid effectiveness and/or opioid induced hyperalgesia, treatment with increasing doses of opioids can be counterproductive.²

Interested in learning about this topic in more detail?

• Nociceptive, neuropathic and nociplastic pain – https://www.youtube.com/watch?v=bNdxG5cYW0E
• Opioid Induced Hyperalgesia – https://www.youtube.com/watch?v=WOuUkJzKPhg

Clinical Presentations

• Diffuse, aching pain³
• Pain that is out of proportion to physical findings or injury³
• Pain worsened by stress or
  emotional factors³
• Often coexists with other chronic pain conditions ¹

Coming – October Tip – Part 2: Nociplastic Pain Interventions & Communication

Resources:

1. Cho, J. H. (2023). Nociplastic pain. Annals of Clinical Neurophysiology, 25(2), 78–83. https://doi.org/10.14253/acn.2023.25.2.78
2. Furlan, A. Courses. (2025). Doctor Andrea Furlan’s Online Courses. https://doctorandreafurlan.thinkific.com/collections
3. Macionis V. (2025). Nociplastic pain: controversy of the concept. The Korean journal of pain, 38(1), 4–13. https://doi.org/10.3344/kjp.24257
4. Thapa, R., & Ang, D. (2025, April). Nociplastic pain. Cleveland Clinic Journal of Medicine. https://www.ccjm.org/content/ccjom/92/4/236.full.pdf

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PDF – Nociplastic Pain Part 1 – What is Nociplastic Pain?