Nociplastic pain is understood to be caused by heightened central nervous system (CNS) symptoms (such as fatigue, sleep, memory and mood problems), increased sensory processing and altered pain modulation (the process of changes to the pain signals along the pain pathway in the body).

Nociplastic pain is a category of pain different from Nociceptive and Neuropathic pain.

-Nociceptive pain is caused by ongoing inflammation and damage of tissues.

-Neuropathic pain is caused by nerve damage.

-Nociplastic pain is a pain that is more widespread or intense or both than would be expected given the amount of identifiable tissue or nerve damage, as well as CNS-derived symptoms.

It’s possible to experience one, two, or a combination of all three types of pain at the same time.

The mechanisms that underlie nociplastic pain are not entirely understood, but it is thought that heightened CNS pain, sensory processing, and altered pain modulation play prominent roles.

This type of pain can occur in isolation, as often happens in conditions such as Fibromyalgia or tension-type headache, or as part of a mixed-pain state in combination with ongoing nociceptive or neuropathic pain, as might occur in chronic low back pain.

It is essential to recognise this type of pain since it will respond to different therapies than nociceptive pain, with a decreased responsiveness to treatments such as anti-inflammatory drugs and opioids, surgery, or injections.

Fibromyalgia often causes widespread nociplastic pain – people describe it as ‘hurting all over’, a ‘burning’ and ‘throbbing’ pain. The pain can vary from person to person, come and go, and change in intensity during the day. Other symptoms can include:

• Fatigue
• Insomnia or poor sleep – waking up tired
• Difficulty focusing and paying attention (often called ‘fibro fog’)
• Changes in mood, anxiety and depression
• Gastrointestinal problems
• Heightened sensitivity to touch and pressure – common trigger points include the neck, shoulders, chest, hips, elbows and knees.

Fibromyalgia often runs in families, and though not a type of arthritis, people with some types of arthritis, such as Rheumatoid Arthritis, Lupus, Sögrens Syndrome or Ankylosing Spondylitis are at greater risk of developing Fibromyalgia.

It is not a disease of the joints or an inflammatory condition and it does not cause permanent damage to bones, joints or muscles.

For these reasons, Fibromyalgia is more often called a syndrome than a disease. It is difficult to diagnose because it can mimic other conditions. No one knows what causes Fibromyalgia, although it has been linked to psychological trauma and the body’s interpretation of and response to pain signals.

Around 1 in 50 people will develop Fibromyalgia at some time in their life, usually between the ages of 25 and 55. Anyone can have Fibromyalgia, but it more commonly affects women.

There is currently no cure, but researchers are working on understanding it better. Medication, lifestyle modifications such as healthy eating, exercise, relaxation, reducing stress, and a clear understanding of the nature of the pain and your triggers all help relieve symptoms.

Sensory processing retraining, such as inhibiting specific primitive reflexes, can reduce sensory hyper-sensitivity and restore a sense of control. With support from their healthcare team, most people eventually find a way to manage their symptoms.

Dr. Jacqui Clark, New Zealand’s first specialist pain physiotherapist, recently spoke to our Arthritis NZ community about nociplastic pain and its relationship to Fibromyalgia. The webinar session was open to anyone experiencing pain, as nociplastic pain can exist alongside nerve and physical damage-related pain. Dr. Clark discussed the characteristics, diagnosis, risk factors, and management of nociplastic pain, as well as the latest updates from the International Congress on Controversies in Fibromyalgia.

Attendees had the opportunity to ask Dr. Clark questions at the end of the 45-minute presentation. It was an informative session, and we thank Dr. Clark for sharing her expertise with us.