Affiliations: [a] Department of Neurology, University Hospital Knappschaftskrankenhaus Bochum, Ruhr University Bochum, Bochum, Germany
| [b] Department of Neurology, BG University Hospital Bergmannsheil Bochum, Ruhr University Bochum, Bochum, Germany
| [c] Department of Neurology, Charité University Medicine Berlin, Berlin, Germany
| [d] Berlin Institute of Health, Berlin, Germany
| [e] AOK Institute for Psychogenic Illnesses, Berlin, Germany
| [f] Neurocenter, BG Trauma Center Murnau, Murnau, Germany
| [g] Department of Psychosomatic Medicine and Psychotherapy, Technical University of Munich, Munich, Germany
Correspondence:
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Address for correspondence: Dr. Stoyan Popkirov, Klinik für Neurologie, Universitätsklinikum Knappschaftskrankenhaus Bochum, In der Schornau 23-25 44892 Bochum, Germany. Tel.: +49 234 299 0; E-mail: popkirov@gmail.com.
Abstract: BACKGROUND:Nociplastic pain has been recently introduced as a third mechanistic descriptor of pain arising primarily from alterations of neural processing, in contrast to pain due to tissue damage leading to nociceptor activation (nociceptive) or due to lesion or disease of the somatosensory nervous system (neuropathic). It is characterized by hyperalgesia and allodynia, inconsistency and reversibility, as well as dynamic cross-system interactions with biological and psychobehavioral factors. Along with this renewed understanding, functional pain disorders, also classified as chronic primary pain, are being reframed as biopsychosocial conditions that benefit from multimodal treatment. OBJECTIVE:To summarize the current understanding of nociplastic pain and functional pain disorders, with a focus on conditions that are common in neurology practice. METHODS:This was a narrative literature review. RESULTS:Chronic back pain, fibromyalgia syndrome and complex regional pain syndrome are best understood within a biopsychosocial framework of pain perception that considers structural factors (predispositions and sequelae) and psychobehavioral mechanisms. Although pain is often the primary complaint, it should not be the only focus of treatment, as accompanying symptoms such as sleep or mood problems can significantly impact quality of life and offer useful leverage points for multimodal treatment. Analgesic pharmacotherapy is rarely helpful on its own, and should always be imbedded in a multidisciplinary setting.
