Nociplastic pain, a third mechanistic pain descriptor in addition to nociceptive and neuropathic pain, was adopted in 2017 by the International Association for the Study of Pain (IASP). It is defined as "pain that arises from altered nociception" not fully explained by nociceptive or neuropathic pain mechanisms. Peripheral and/or central sensitization, manifesting as allodynia and hyperalgesia, is typically present, although not specific for nociplastic pain. Criteria for possible nociplastic pain manifesting in the musculoskeletal system define a minimum of 4 conditions: (1) pain duration of more than 3 months; (2) regional, multifocal or widespread rather than discrete distribution of pain; (3) pain cannot entirely be explained by nociceptive or neuropathic mechanisms; and (4) clinical signs of pain hypersensitivity present in the region of pain. Educational endeavors and field testing of criteria are needed. Pharmacological treatment guidelines, based on the three pain types, need to be developed. Currently pharmacological treatments of nociplastic pain resemble those of neuropathic; however, opioids should be avoided. A major challenge is to unravel pathophysiological mechanisms driving altered nociception in patients suffering from nociplastic pain. Examples from fibromyalgia would include pathophysiology of the peripheral as well as central nervous system, such as autoreactive antibodies acting at the level of the dorsal root ganglia and aberrant cerebral pain processing, including altered brain network architecture. Understanding pathophysiological mechanisms and their interactions is a prerequisite for the development of diagnostic tests allowing for individualized treatments and development of new strategies for prevention and treatment.

中文翻译：

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伤害性疼痛的概念——从这里到哪里？


伤害性疼痛是除伤害性疼痛和神经性疼痛之外的第三种机械性疼痛描述符，于 2017 年被国际疼痛研究协会 （IASP） 采用。它被定义为“由伤害感受改变引起的疼痛”，不能完全用伤害感受或神经性疼痛机制来解释。通常存在外周和/或中枢敏化，表现为痛觉异常和痛觉过敏，但对伤害性疼痛不具有特异性。肌肉骨骼系统中可能表现的伤害性疼痛的标准定义了至少 4 种情况：（1） 疼痛持续时间超过 3 个月;（2） 疼痛的区域性、多灶性或广泛分布而不是离散分布;（3） 疼痛不能完全用伤害感受或神经性机制来解释;（4） 疼痛区域出现的疼痛超敏反应的临床体征。需要进行教育工作和对标准进行实地测试。需要根据三种疼痛类型制定药物治疗指南。目前 nociplastic 疼痛的药物治疗类似于神经性疼痛的药物治疗;但是，应避免使用阿片类药物。一个主要挑战是揭示导致伤害性疼痛患者伤害感受改变的病理生理机制。纤维肌痛的例子包括外周和中枢神经系统的病理生理学，例如作用于背根神经节水平的自身反应性抗体和异常的脑痛处理，包括改变的大脑网络结构。了解病理生理机制及其相互作用是开发诊断测试的先决条件，允许个体化治疗和开发新的预防和治疗策略。