"Doctor, I don't know what to do anymore, everything hurts, my skin hurts." There is no injury but the pain is, exists and compromises the day to day of the person who consults, affects their quality of life. Dr. Santiago Guaycochea, president of the Argentine Association for the Study of Pain (AAED), says he receives this type of case. "In general, they are patients who arrive with many studies done, who have been visiting specialists for years and receive the answer that they have nothing," says Guaycochea, who clarifies that they do have something and that it is called nociplastic pain.
Until 2017, when the International Association for the Study of Pain (IASP) introduced this concept, "the mechanisms of pain considered were two."
"On the one hand, nociceptive pain, which is protective pain, which occurs when you have a wound, a wound or a fracture, and that warns us not to act on that part of the body that is injured because it can get worse. Then, there is neuropathic pain, which is generated when the connections of the nervous system are damaged, and for which there are neurological diagnostic criteria that prove it, "explains Roberto Rey, head of Neurology at the Finochietto Sanatorium, who recently participated in the Upjohn Hybrid Pain Summit, a division of Pfizer.
"Nociplastic pain is none of those, it corresponds to pain that is difficult to identify and treat. There is no direct line between an injury and the manifestation of pain. The pain manifests itself without injury," says Guaycochea.
Nociplastic pain corresponds to pain that is difficult to identify and treat. Photo Shutterstock.
And he provides more details: "Many times this perception of pain is associated with traumatic (psychological) processes and this leads to usually tolerable pain cease to be, greatly deteriorating the quality of life," details the expert in pain.
He says that among the symptoms of these traumatic processes the person can suffer anxiety, anguish or depression, which are disorders that predispose to this type of pain, and points out, as an example, that also "fibromyalgia is a symptom of nociplastic pain".
"It's very exhausting and distressing for the patient. In some cases they arrive late, after years and going through several doctors," says Guaycochea.
There are patients with "skin pain, joint pain, people who cannot swallow water from pain, cases of brain fog, exhaustion and irritable bowel."
The diagnosis is discarded: first you have to check that it is not a neurological, rheumatological, immunological or oncological disease. Only then does a treatment for nociplastic pain begin.
Guaycochea states that "the traumatic event may have to do with situations of violence, abuse, job loss, death of a loved one or moves" and that the pain does not necessarily skyrocket after the fact.
"Years can go by without anything and one day it appears, although we always go backwards to look for that situation," he says.
Treatment is multidisciplinary. Drugs are used but cognitive behavioral therapy is also usually performed and relaxation and sports techniques are added, depending on the case.
"Many times, if you can relieve or control anxiety, distress or depression, the pain decreases. Nothing is direct or immediate, but in many cases improvements are observed, "says the specialist and emphasizes that this pain is usually limiting and that many people can not get out of bed because of this issue.
It ensures that having a diagnosis and treatment already has a positive impact on the patient. "Many of these people have been thinking for years that they have a tumor and that doctors can't find it. Knowing that they actually suffer from nociplastic pain and that something can be done with it, serves to mitigate the distress," he adds.
Broken heart syndrome
Another example of nociplastic pain is broken heart syndrome. It is an entity "in which a very terrible emotion, such as the death of a loved one, can release at the chemical level an exaggerated amount of catecholamines, a hormone linked to stress, such as adrenaline, and produce cardiomyopathy, which can manifest itself exactly like heart failure or a heart attack," says Nicolás Renna, cardiologist, president of the Argentine Society of Arterial Hypertension (SAHA).
"This speaks to the connection between the heart and the brain beyond the receptors. On the other hand, chronic pain linked to stress, frustrations and emotions can cause chest pain, without there being a heart ailment," adds Renna.