Current understanding of nociplastic pain 2024 Yoo and Kim

Nociplastic pain by the “International Association for the Study of Pain” is defined as pain that arises from altered nociception despite no clear evidence of nociceptive or neuropathic pain. Augmented central nervous system pain and sensory processing with altered pain modulation are suggested to be the mechanism of nociplastic pain. Clinical criteria for possible nociplastic pain affecting somatic structures include chronic regional pain and evoked pain hypersensitivity including allodynia with after-sensation. In addition to possible nociplastic pain, clinical criteria for probable nociplastic pain are pain hypersensitivity in the region of pain to non-noxious stimuli and presence of comorbidity such as generalized symptoms with sleep disturbance, fatigue, or cognitive problems with hypersensitivity of special senses. Criteria for definitive nociplastic pain is not determined yet.

Eight specific disorders related to central sensitization are suggested to be restless leg syndrome, chronic fatigue syndrome, fibromyalgia, temporomandibular disorder, migraine or tension headache, irritable bowel syndrome, multiple chemical sensitivities, and whiplash injury; non-specific emotional disorders related to central sensitization include anxiety or panic attack and depression. These central sensitization pain syndromes are overlapped to previous functional pain syndromes which are unlike organic pain syndromes and have emotional components. Therefore, nociplastic pain can be understood as chronic altered nociception related to central sensitization including both sensory components with nociceptive and/or neuropathic pain and emotional components. Nociplastic pain may be developed to explain unexplained chronic pain beyond tissue damage or pathology regardless of its origin from nociceptive, neuropathic, emotional, or mixed pain components.

Open access, https://www.epain.org/journal/view.html?doi=10.3344/kjp.23326

 

Cringeworthy pseudoscience, just repackaged Freudian myths. It's hard to reconcile how rigorous some aspects of medicine are with how infinitely gullible they seem to be at accepting any and all stories and narratives that "explain" how it's not that they don't understand the problem medically, it's that there can be no medical problem and none will ever be found, disregarding how this is basically how everything happened before.

I have never heard of restless leg syndrome involving pain. Maybe it's more common with, or maybe more reported, but I have never heard it itself described as being painful. Same with MCS/MCAS. Lots of symptoms, lots of suffering, but nothing described as painful in the typical sense. This is really all just the dumping ground for everything they don't understand, all explained by stories about nerves being more sensitive, or maybe not, or whatever. There is no explanation here. But that fits, since it's basically a DSM model, and those are only ever about describing the general non-specific perceptions of some clinicians about part of the subjective experience of other people they hear but don't listen to in a way that satisfies them, rather than being about actually describing things scientifically.

I've never heard depression being associated with central sensitization before, or even featuring pain in the physical sense. I doubt this is the first time it's been put in there, but I don't remember seeing it before. I guess that with functional terminology, it simply survives and grows simply because it's such a generic meaningless term.

Clearly all this shows that medicine doesn't have a clue about the concept of pain beyond the most superficial, and is strictly defining things based on current levels of technology. Things understood by current technology are organic and medical, things not understood aren't. Same as it ever was. This is a primitive, borderline barbaric way of doing things. It features no reasoning, it's roughly the same general concept about technology and social acceptance, where things people are familiar before they reach adulthood are normal and easy to understand, things that happen before roughly 40 year-old are new and innovative, and things that happen after are scary and unnatural. It's basically reactionary conservatism applied to health, progress happening at the pace of funerals.