Nociplastic Pain – What Clinicians Need to Understand: Recent Insights, Presentation of New Clinical Criteria and Future Development

The term nociplastic pain is a mechanistic descriptor adapted by IASP, alongside with nociceptive and neuropathic pain. Per definition, individuals suffering from nociplastic pain have altered nociception, i.e., pain hypersensitivity. However, as hypersensitivity is also seen in nociceptive and neuropathic pain conditions, and since patients often have combinations of several pain mechanisms, clinical criteria are needed. The criteria and the grading system for nociplastic pain affecting the musculoskeletal system, developed by the IASP Terminology Task Force will be presented. Principles of the classification algorythm, including hypersensitivity phenomena and co-morbidities will be discussed. The audience will be provided with state-of-the art, clinical algorythms to examine hypersentitivity and strategies how to interpret findings in mechanistic terms to distinguish between different pain types. The clinical relevance of co-morbidities forming part of the grading system of nociplastic pain will be discussed in the context of their mechanistic relationships to pain. Finally, recent findings increasing our understanding of altered nociception in nociplastic pain conditions will be presented, including potential autoantibody mediated mechamisms and vulnerability markers. The need to develop new strategies for phenotyping and stratification of the heterogenous group of patients suffering from nociplastic pain will be discussed in a broader context.