Nociplastic pain is functional pain

With its clear implications towards biopsychosocial management, the concept of nociplastic pain is an important step forward.1Fitzcharles MA Cohen SP Clauw DJ Littlejohn G Usui C Häuser W Nociplastic pain: towards an understanding of prevalent pain conditions.Lancet. 2021; 397: 2098-2110Summary Full Text Full Text PDF PubMed Scopus (76) Google Scholar This concept closes the gap between nociceptive and neuropathic pain but was not accepted into the International Classification of Diseases 11th revision. However, accompanying symptoms of pain (eg, depression, fatigue, and cognitive impairment) are not just epiphenomena. Their suggested pathomechanism (ie, sensitisation) could lead to a wide range of symptoms far beyond pain—eg, other sensory symptoms such as dizziness or tinnitus, or motor symptoms such as tremor or seizures.2Popkirov S Enax-Krumova EK Mainka T Hoheisel M Hausteiner-Wiehle C Functional pain disorders—more than nociplastic pain.NeuroRehabilitation. 2020; 47: 343-353Crossref PubMed Scopus (5) Google Scholar Additionally, processing and generating symptoms are not only a matter of stimulus and response. Humans have experiences, expectations, and narratives, all of which are real and error-prone at the same time, and profoundly shape individual symptom perception and behaviour—especially, but not only concerning pain. A one-sided focus on pain, sensation, and sensitisation weakens the intended human biopsychosocial approach.3Henningsen P Gündel H Kop WJ et al.Persistent physical symptoms as perceptual dysregulation: a neuropsychobehavioral model and its clinical implications.Psychosom Med. 2018; 80: 422-431Crossref PubMed Scopus (86) Google Scholar Functional somatic symptoms result from disturbances in an organism's functions, mechanisms, and effects (instead of its structures). They decrease functioning and have functions (eg, enable rest or help). Persistent functional symptoms are maladaptive internal responses to distress and are meant to restore functional homoeostasis, referred to as autoplastic adaptation by Sándor Ferenczi, Sigmund Freud, and Franz Alexander. The International Classification of Diseases 11th revision lists various functional neurological and gastrointestinal disorders, many of them associated with pain. This tool will also introduce bodily distress disorder, the successor of somatoform, including somatoform pain disorders. But these disorder categories remain unrelated to the new category of chronic primary pain. These concepts should be brought together as disorders of dysregulation and adaptation, with nociplastic pain being functional pain and an important manifestation of bodily distress.2Popkirov S Enax-Krumova EK Mainka T Hoheisel M Hausteiner-Wiehle C Functional pain disorders—more than nociplastic pain.NeuroRehabilitation. 2020; 47: 343-353Crossref PubMed Scopus (5) Google Scholar, 3Henningsen P Gündel H Kop WJ et al.Persistent physical symptoms as perceptual dysregulation: a neuropsychobehavioral model and its clinical implications.Psychosom Med. 2018; 80: 422-431Crossref PubMed Scopus (86) Google Scholar, 4Burton C Fink P Henningsen P Löwe B Rief W Functional somatic disorders: discussion paper for a new common classification for research and clinical use.BMC Med. 2020; 18: 34Crossref PubMed Scopus (48) Google Scholar We declare no competing interests. Nociplastic pain: towards an understanding of prevalent pain conditionsNociplastic pain is the semantic term suggested by the international community of pain researchers to describe a third category of pain that is mechanistically distinct from nociceptive pain, which is caused by ongoing inflammation and damage of tissues, and neuropathic pain, which is caused by nerve damage. The mechanisms that underlie this type of pain are not entirely understood, but it is thought that augmented CNS pain and sensory processing and altered pain modulation play prominent roles. Full-Text PDF Nociplastic pain is functional pain – Authors' replyOn behalf of our coauthors, we thank Constanze Hausteiner-Wiehle and Peter Henningsen for their thoughtful and thought-provoking response to our Series paper.1 We agree with most of their points and will elaborate on several. The Series paper on nociplastic pain is the second in a series of three papers meant to be read and digested together. In the first Series paper,2 the context, rationale, and limitations of categorising pain are explained in greater detail, including within a biopsychosocial framework. Full-Text PDF