Nociplastic

Patients with rheumatic conditions often have mixed pain states, with varying degrees of nociceptive, neuropathic, and nociplastic mechanisms, which exist on a continuum. When individuals with any chronic pain have a nociplastic component to their symptoms, they are less likely to respond to treatments (eg, injections, surgery, biologics, and opioids) that work better for acute or purely nociceptive pain.

Pain can be classified as nociceptive, neuropathic, or nociplastic as per the International Association for the Study of Pain [6, 7]. Fibromyalgia falls within the nociplastic classification.

Peripheral sensitisation of nociceptive neurons can enhance or prolong the pain experience, even without sensitisation of central neurons (i.e. nociplastic or central sensitisation).