Nociplastic Pain Criteria or Recognition of Central Sensitization? Pain Phenotyping in the Past, Present and Future
Abstract
:1. Introduction
2. The Past
3. The Present
- (1)
- report pain of at least 3 months duration;
- (2)
- report a regional rather than discrete pain distribution;
- (3)
- report pain that cannot entirely be explained by nociceptive or neuropathic mechanisms;
- (4)
- show clinical signs of pain hypersensitivity (i.e., evoked pain hypersensitivity phenomena such as static or dynamic mechanical allodynia, heat or cold allodynia, and/or painful after-sensations after any of the mentioned evoked pain hypersensitivity assessments) that are at least present in the region of pain [44].
Comparing the IASP Clinical Criteria for Nociplastic Pain with the 2014 Clinical Criteria for Predominant Central Sensitization Pain
4. The Future
4.1. Towards Precision Pain Medicine?
4.2. Research Agenda
5. Conclusions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A. Terminology (Presented in Alphabetic Order)
Term | Explanation |
Central sensitization | A neurophysiological mechanism, defined as ‘amplification of neural signalling within the central nervous system that elicits pain hypersensitivity [7],’ potentially explains chronic, nonspecific pain. |
Central nervous system sensitization | Refers to ‘central sensitization.’ |
Chronic pain | Pain of at least 3 months duration. |
Endogenous analgesia | The body’s ability to activate pain relief, with poor endogenous analgesia considered a feature of central sensitization [17]. |
Neuropathic pain | Pain due to a lesion or a disease of the nervous system. |
Nociceptive pain | Pain due to damage to non-neural tissue (e.g., musculoskeletal or visceral tissue). |
Nociplastic pain | 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 [43]. |
Nonspecific pain | Pain that cannot be explained by tissue damage, pathology or local dysfunctions. |
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IASP 2021 Clinical Criteria for Nociplastic Pain [44] | 2014 Clinical Criteria for Predominant Central Sensitization Pain [45] |
---|---|
Mandatory criteria | |
Patients have to report pain of at least 3 months duration. | Patients have to report pain of at least 3 months duration. |
Patients have to report a regional rather than discrete pain distribution. | Patients have to present diffuse pain that spreads outside the segmental area of primary nociception. |
Patients have to report pain that cannot entirely be explained by nociceptive mechanisms. | The pain should be considered disproportionate to what one would expect based on the available tissue damage or presumed source of nociception. |
Patients have to report pain that cannot entirely be explained by neuropathic mechanisms. | Exclusion of neuropathic pain as the dominant pain mechanism. |
Patients have to show clinical signs of pain hypersensitivity (i.e., evoked pain hypersensitivity phenomena such as static or dynamic mechanical allodynia, heat or cold allodynia, and/or painful after-sensations after any of the mentioned evoked pain hypersensitivity assessments) that are present at least in the region of pain. | - |
Optional criteria | |
Patients present with a history of pain hypersensitivity in the region of pain (i.e., sensitivity to touch, movement, pressure or heat/cold). | - |
Patients present at least one of the defined comorbidities (increased sensitivity to sound, light and/or odours, sleep disturbance with frequent nocturnal awakenings, fatigue or cognitive problems). | A score of at least 40/100 on the Central Sensitization Inventory. |
Comorbidities Included in the 2021 IASP Clinical Criteria for Nociplastic Pain | Central Sensitization Inventory Items |
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Increased sensitivity to light and/or sound and/or odours | I am sensitive to bright lights (Q7). Certain smells, such as perfumes, make me feel dizzy and nauseated (Q20). |
Sleep disturbance with frequent nocturnal awakenings | I feel tired and unrefreshed when I wake up from sleeping (Q1). I do not sleep well (Q12). My legs feel uncomfortable and restless when I am trying to go to sleep at night (Q22). |
Fatigue | I get tired very easily when I am physically active (Q8). I have low energy (Q17). |
Cognitive problems such as difficulty to focus attention, memory disturbances, etc. | I have difficulty concentrating (Q13). I have difficulty remembering things (Q23). |
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Nijs, J.; Lahousse, A.; Kapreli, E.; Bilika, P.; Saraçoğlu, İ.; Malfliet, A.; Coppieters, I.; De Baets, L.; Leysen, L.; Roose, E.; et al. Nociplastic Pain Criteria or Recognition of Central Sensitization? Pain Phenotyping in the Past, Present and Future. J. Clin. Med. 2021, 10, 3203. https://doi.org/10.3390/jcm10153203
Nijs J, Lahousse A, Kapreli E, Bilika P, Saraçoğlu İ, Malfliet A, Coppieters I, De Baets L, Leysen L, Roose E, et al. Nociplastic Pain Criteria or Recognition of Central Sensitization? Pain Phenotyping in the Past, Present and Future. Journal of Clinical Medicine. 2021; 10(15):3203. https://doi.org/10.3390/jcm10153203
Chicago/Turabian StyleNijs, Jo, Astrid Lahousse, Eleni Kapreli, Paraskevi Bilika, İsmail Saraçoğlu, Anneleen Malfliet, Iris Coppieters, Liesbet De Baets, Laurence Leysen, Eva Roose, and et al. 2021. "Nociplastic Pain Criteria or Recognition of Central Sensitization? Pain Phenotyping in the Past, Present and Future" Journal of Clinical Medicine 10, no. 15: 3203. https://doi.org/10.3390/jcm10153203