Nociplastic Pain Part 2 – Interventions and Communications

Interventions for Nociplastic Pain Management

1. Comprehensive Assessment²
   • Explore the emotional, psychological, and environmental factors contributing to pain;
     a wholistic approach.  Use validated pain scales, as well as regular assessments of the quality of life and
     psychosocial factors.
2. Pharmacologic Options
   • Traditional analgesic treatments:  muscle relaxants, NSAIDs, Acetaminophen and the use of opioid analgesics are strongly discouraged³.
   • Low-dose naltrexone: An opioid antagonist has shown some benefit for chronic back pain and complex regional pain; it may also improve memory problems commonly seen in persons with fibromyalgia³.
   • Duloxetine, and pregabalin: Duloxetine had greater efficacy in treating pain and depression³.Pregabalin is effective in reducing pain and improving quality of life and sleep in persons with fibromyalgia³.
   • Tricyclic antidepressants: Certain antidepressant medications (e.g., tricyclic antidepressants and selective serotonin norepinephrine reuptake inhibitors – SSNRI) and antiepileptic medications (e.g., gabapentin and pregabalin) have been shown to be effective in managing nociplastic pain, like they have been in neuropathic pain¹
3. Non-Pharmacologic Interventions³
   • Cognitive Behavioral Therapy (CBT): CBT can help patients cope with the emotional aspects of chronic pain and reduce pain perception through relaxation techniques and cognitive reframing.
   • Mindfulness and Stress Reduction: Techniques like meditation, yoga, and relaxation exercises can be helpful in managing the psychological contributors to nociplastic pain.
   • Physical Therapy: Gentle, guided movement therapies may improve mobility and reduce overall pain levels, especially in musculoskeletal conditions associated with nociplastic pain.
4. Multidisciplinary Collaboration
   • Involve other specialists, including physiotherapists, psychologists, and pain management experts. A team approach ensures that all aspects of the patient’s well-being are considered, from physical symptoms to emotional and psychological health².

Communications

• Health Teaching² Assist persons with nociplastic pain and their families understand the nature of nociplastic pain. This pain is real, even though it may not have a clear anatomical cause. Reassure them that their symptoms are valid and that there are management strategies available.
• Expectations³ Set realistic expectations for pain management. Nociplastic pain can be difficult to completely alleviate, but with a combination of treatments, quality of life can often be significantly improved.

Nociplastic pain requires a thoughtful, individualized, person-centered approach in pain management. By using both pharmacologic and non-pharmacologic strategies, healthcare providers can significantly improve the comfort and quality of life for persons suffering from this complex pain experience. Always keep in mind that managing the whole person—not just the pain, is essential in pain management.

References

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. 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
3. Thapa, R., & Ang, D. (2025, April). Nociplastic pain. Cleveland Clinic Journal of Medicine. https://www.ccjm.org/content/ccjom/92/4/236.full.pdf

Download Tip of the Month

PDF – Nociplastic Pain Part 2 – Interventions and Communication