Chronic Pain- Is It All in the Head

Abstract

Chronic Pain is a distressing experience with sensory, emotional, social and cognitive components and affects millions of people globally with a huge impact on the economy.Pain has traditionally been classified as nociceptive (from tissue injury) and neuropathic (from nerve injury) but more recently a third mechanistic descriptor has been identified and defined as nociplastic pain (from a sensitised nervous system). Nociplastic pain, therefore, is stimulus-independent and does not require inflammation or structural neuronal damage. Central sensitisation is one of the mechanisms that explain chronic persistent pain and represents an enhancement in the function of neurons and circuits in pain pathways and is a manifestation of the remarkable plasticity of the nervous system in response to soft tissue injury, inflammation, and neural injury. Patients presenting with symptoms of central sensitisation typically show higher pain ratings, and greater disability, are more likely to develop future musculoskeletal conditions and show poorer outcomes and increased likelihood of developing chronic persistent pain.