Undisciplinary pain, phantom pain
The study of pain is constantly evolving, and the available information is frequently expanded or updated with new concepts and definitions. In the past, pain was classified as nociceptive pain (caused by the activation of nociceptors, the pain receptors) or neuropathic pain (caused by a lesion or disease of the nervous system).
However, since 2017, the International Association for the Study of Pain (IASP), accepts the term “non-disciplastic pain” to categorize another type of pain that did not fit by definition into either of the other two categories mechanically or clinically.
Today we will talk about what is nociceptive pain, its characteristics, and the differences that exist with respect to nociceptive pain and neuropathic pain.
What is non-disciplastic pain?
According to the IASP’s own definition, non-disciplastic pain is pain in which, despite showing altered nociceptive function, there is no obvious activation of nociceptors or neuropathy. This means that the pain receptors do not demonstrate activity in the absence of tissue damage or injury to the peripheral or central nervous system.
The term is quite current, and more literature and studies are still needed, but it is used for the most complex cases to address in which there is no evidence of physical or neuropathic damage, such as fibromyalgia, some visceral pain, irritable bowel syndrome or complex regional pain syndrome.
Characteristics of non-disciplastic pain
Some of the clinical characteristics to define this type of pain, according to some medical publications, are the following:
- Clinical picture of pain for at least 3 months.
- Regional pain distribution, and not specific.
- Difficult to explain completely by nociceptive or neuropathic mechanisms.
- Clinical signs of hypersensitivity in the region where pain is experienced.
- It does not usually occur in isolation and is often accompanied by other symptoms associated with the central nervous system, such as fatigue and sleep disturbances, cognitive impairment, hypersensitivity to external stimuli.
It is important to note that this definition is for clinical use, and does not correspond to a diagnosis as such, just as the terms nociceptive pain and neuropathic pain do not.
In short…
The concept of non-disciplastic pain, although it has yet to be studied in greater depth and is not without some controversy, arose from the need to respond to a type of pain that did not fit, by definition, into the existing categories.
It is a term used to define a third mechanism of pain when it is not associated with organic lesions, and which has its own characteristics. It could also serve to help people suffering from this type of chronic pain to understand their situation a little better, even if they still have doubts.
Usually, chronic pain syndromes in which there are no obvious lesions, such as fibromyalgia, are often accompanied by psychological difficulties, often stigmatizing, due to the difficulty of understanding what is happening. Hence the importance of a psychological approach to pain management.
As more studies are conducted and more literature on the subject becomes available, it may cease to be a controversial concept and become more accepted by the medical community.
At Instituto Aliaga we help our patients through a holistic approach to pain treatment, thanks to a multidisciplinary team of professionals. If you suffer from pain, contact us, we can help you.
Sources:
- Current understanding of the concept of “non-disciplastic pain ” https://www.sciencedirect.com/science/article/abs/pii/S1138359319301522?via%3Dihub
- https://www.asociacionandaluzadeldolor.es/wp-content/uploads/2019/10/nociplastico.pdf
- Nociplastic Pain Criteria or Recognition of Central Sensitization? Pain Phenotyping in the Past, Present and Future: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8347369/#:~:text=Nociplastic%20pain%20is%20defined%20by,Appendix%20A)%20%5B43% 5D
- Fitzcharles MA, Cohen SP, Clauw DJ, Littlejohn G, Usui C, Häuser W. Nociplastic pain: towards an understanding of prevalent pain conditions. Lancet [Internet]. 2021;397(10289):2098-110. Available from: http://dx.doi.org/10.1016/S0140-6736(21)00392-5
- Nijs J, Lahousse A, Kapreli E, Bilika P, Saraçoğlu İ, Malfliet A, et al. Nociplastic pain criteria or recognition of central sensitization? Pain phenotyping in the past, present and future. J Clin Med. 2021;10(15).
- Freynhagen, R., Parada, H. A., Calderon-Ospina, C. A., Chen, J., Rakhmawati Emril, D., Fernandez-Villacorta, F. J., Franco, H., Ho, K. Y., Lara-Solares, A., Li, C. C. F., Mimenza Alvarado, A., Nimmaanrat, S., Dolma Santos, M., & Ciampi De Andrade, D. (2019). Current understanding of the mixed pain concept: a brief narrative review. Current Medical Research and Opinion, 35(6), 1011-1018. https://doi.org/10.1080/03007995.2018.1552042
- Gutiérrez, C. (2019, May 30). In search of a definition for `phantom pain’. Spanish Pain Society. https://www.sedolor.es/en-busca-de-una-definicion-para-el-dolor-nociplastico-o-dolor-fantasma/
Director de la Unidad de Dolor Mivi Sant Cugat y Mivi Sabadell