New pain definition validates left of centre experiences of chronic pain
Pain is way more complex than originally thought. It does not always follow a linear path where cause leads to effect. The pain experience does not necessarily result from an injury. The world of chronic pain research has recently defined a new classification of pain, which proves highly affirming and helpful for chronic pain sufferers.
Many chronic pain patients will be familiar with the stigma of living with chronic pain. Chronic pain often leads to stigma due to its perceived “deviance from expected behaviour, both in medical setting, where symptoms should be independently verifiable and curable, and in broader social settings, where adults are expected to be autonomous and productive until old age” (Williams 2016). Discrimination in both medical and social settings are widely reported, leading to significantly impacted wellbeing (De Ruddere and Kenneth 2016).
It may come as a relief to many, that conceptions of pain are broadening and medical science is beginning to find biological explanations for many unexplained chronic pain conditions. The recent introduction of a new categorisation of pain called nociplastic pain has been instrumental in giving medical practitioners a better understanding of their patients’ pain experiences.
In the past, pain was defined as either nociceptive or neuropathic. These terms sound complex but basically mean pain caused as a normal bodily reaction in the somatosensory system to harmful stimulus (nociceptive pain) or pain caused by disease or lesion (neuropathic pain). The common feature of these types of pain is that they have a measurable cause and effect and distinguishable biological origins. But what if pain arises and continues with no measurable cause or precipitating event?
Nociplastic pain is a category of pain introduced by the IASP in 2017. In this category, pain “arises from altered nociception, despite no clear evidence of actual or threatened tissue damage…or evidence for disease or lesion” (IASP taxonomy 2017). Nociception is the process through which the body takes harmful stimuli and encodes it into ‘pain signals’, thus nociplastic pain is an alteration in this process so that pain signals are activated outside of the normal cause and effect. Kosek et al., argue that this “altered nociceptive function (can) constitute a condition in itself” (2016: 1384).
This introduction of nociplastic pain is highly validating as it gives a biological explanation for unexplained chronic pain conditions. This challenges stigmas related to many nociplastic conditions such as fibromyalgia and Complex Regional Pain Syndrome type 1 (Kosek et al., 2016: 1382). In particular, this new categorisation gives both practitioners and patients a better model of thinking about and treating chronic pain when nociceptive and neuropathic origins cannot be found.
At Metro Pain Group, we understand that discrimination only leads to worse outcomes and that the only route to helping our patients live better begins with believing them.
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De Ruddere, L. & Craig, K. D. (2016). Understanding stigma and chronic pain. PAIN, 157(8), 1607–1610. doi: 10.1097/j.pain.0000000000000512.
Williams, A. C. (2016). Defeating the stigma of chronic pain. PAIN, 157(8), 1581–1582. doi: 10.1097/j.pain.0000000000000530.
Kosek, E., Cohen, M., Baron, R., Gebhart, G. F., Mico, J., Rice, A. S., Rief, W. & Sluka, A. K. (2016). Do we need a third mechanistic descriptor for chronic pain states?. PAIN, 157(7), 1382–1386. doi: 10.1097/j.pain.0000000000000507.