Medical Review by Andrea Chadwick, M.D., M.Sc., FASA | Last Updated: March 2026
When you live with pain that doesn’t seem to have a clear cause, the experience can be as isolating as it is exhausting. You might have seen multiple specialists, undergone dozens of scans, and been told “your tests are normal.” Yet the pain remains.
For a long time, the medical system struggled to categorize this type of experience. If there wasn’t a clear cause, pain was often dismissed as “psychosomatic” or “all in your head.” However, a major shift in the understanding of pain has finally provided a name and a biological explanation for this phenomenon: nociplastic pain.
Understanding nociplastic pain is often the first step toward reclaiming your life. It moves the conversation away from “hidden damage” and toward “system sensitivity,” which also offers a new roadmap for treatment.
Three Types of Pain
To understand nociplastic pain, it helps to see where it fits in the broader landscape of how we hurt. For decades, doctors recognized only two main types of pain:
- Nociceptive Pain: This is the “alarm” system. When you stub your toe, burn your hand, or have arthritis, your tissues are damaged or threatened. Nerves called nociceptors send a signal to your brain saying, “Something is wrong.” This pain is usually local and subsides once the tissue heals.
- Neuropathic Pain: This type of pain relates to the “wiring” of the nervous system. It happens when the nerves themselves are damaged. Think of a pinched nerve in your back, or the nerve damage from diabetes. This pain is often described as burning, stabbing, or like an electric shock.
But many people have pain that fits neither category. They don’t have an active injury (nociceptive), and they don’t have nerve damage (neuropathic). In 2017, the International Association for the Study of Pain (IASP) officially recognized a third category: nociplastic pain.
The term comes from “nociception” (the processing of pain) and “plasticity” (the brain’s ability to change). In nociplastic pain, the tissues and nerves are healthy, but the way the central nervous system processes signals has changed. The volume has been turned up, and the “mute” button has been broken.
Central Sensitization: The “Volume Control” Problem
If you have nociplastic pain, your body is essentially suffering not from a glitch in the alarm or the wiring, but in its system control: the central nervous system. This is often referred to as central sensitization.
In a healthy nervous system, your brain acts like a sophisticated filter. It decides which sensations are important enough to notice and which should be ignored. For example, you usually don’t “feel” the sensation of your clothes touching your skin all day because your brain filters that information out.
In a state of central sensitization, that filter fails. The nervous system becomes overactive. This leads to two primary symptoms:
- Hyperalgesia: Things that are usually mildly painful (like a firm squeeze) feel excruciating.
- Allodynia: Things that shouldn’t be painful at all (like a light touch, a cool breeze, or the fabric of a shirt) trigger a pain response.
According to research published in The Lancet, this happens because the brain and spinal cord have physically remodeled themselves to be better at feeling pain (Kosek et al., 2021). The neural pathways that amplify pain become hyperactive, while the pathways that naturally dampen pain slow down.
The Evolution of the Nociplastic Pain
The journey to recognizing nociplastic pain was long and often frustrating for patients. For years, conditions like fibromyalgia, chronic low back pain, and others were treated as separate, mysterious ailments.
The breakthrough came as neuroimaging (like fMRI) allowed scientists to see the brains of people in chronic pain. They discovered that even without a physical injury, the pain centers of the brain were lighting up more than in healthy controls. This proved that the pain was objectively real, not “just in your head.” The source was just the nervous system itself.
In 2019, the World Health Organization (WHO) updated its International Classification of Diseases (ICD-11) to include a new term: Chronic Primary Pain. This category includes conditions where pain is the disease itself, rather than a symptom of another condition. This was a revolutionary shift that validated the experiences of millions of patients who had previously been told their pain was unexplained.
Why Does Chronic Pain Happen?
If you are looking into your own chronic pain symptoms, there are several hallmarks that suggest a nociplastic component. Unlike nociceptive pain, which stays where the injury is, nociplastic pain conditions often behave differently:
- Widespread or Shifting: The pain might be in your neck one week and your lower back the next. It often affects multiple areas of the body.
- Sensitivity to More Than Touch: People with nociplastic pain often report being sensitive not just to touch, but also to bright lights, loud noises, or strong smells. This is because the entire sensory processing system is on high alert.
- The Comorbidity Cluster: Nociplastic pain rarely travels alone. It is almost always accompanied by other symptoms, like fatigue, sleep disturbances, and “brain fog” (cognitive difficulties). Research indicates these aren’t just side effects of being in pain, but are caused by the same overactive nervous system (Fitzcharles et al., 2021).
- Traditional Treatments Fail: Because the problem isn’t in the tissues, traditional “tissue-based” treatments like injections or surgeries often provide little to no lasting relief.
The Shift in Chronic Pain Treatment: Calming the System
The most important thing to know about nociplastic pain is that because the nervous system is “plastic” (changeable), it can be retrained. There are treatments with robust evidence in improving symptom activity, but the type of treatment is different from other types of pain.
Rather than “fixing” a body part, it’s about calming the nervous system and turning the volume back down. This typically requires a comprehensive approach that brings together multiple types of treatment to address the complexity of the symptoms.
Some of the components of a chronic primary pain treatment plan include:
1. Specialized Chronic Pain Physical Therapy and Pacing
In nociceptive pain, we often use rest to let things heal. In nociplastic pain, rest can actually make the nervous system more sensitive. However, “pushing through” can cause a flare-up. That double-edged sword can make people feel particularly nervous about doing something “wrong.”
The key is “pacing”—finding a level of movement that is safe and slowly increasing it over time to teach the brain that movement is not dangerous. Working with a specialized physical therapist trained in chronic primary pain conditions can help find that balance, along with personalized sequences that work for your body.
2. Targeted Medications
Standard painkillers like opioids are generally ineffective for nociplastic pain, and can sometimes make the nervous system more sensitive over time (a phenomenon called opioid-induced hyperalgesia) (Marcianò et al, 2023).
Instead, doctors often use medications that act on the central nervous system, such as certain antidepressants (SNRIs) or glial cell immunomodulators (low dose naltrexone), which help stabilize the “volume control” in the brain.
3. Behavioral and Mind-Body Approaches
Since the brain is the primary processor of nociplastic pain, therapies like Cognitive Behavioral Therapy (CBT) or Acceptance and Commitment Therapy (ACT) have good evidence for improving symptoms, especially over the long term. These aren’t suggested because the pain is “psychological,” but because they provide tools to change the neural pathways of the brain. Newer approaches like Pain Reprocessing Therapy (PRT) specifically focus on retraining the brain to interpret sensations accurately rather than as threats (Louw et al., 2011).
4. Sleep Treatment
Sleep is not just a period of rest; it is a critical biological “reset” for the nervous system. Research consistently shows that sleep and pain have a bidirectional relationship, but the influence of sleep on pain is actually stronger than the influence of pain on sleep (Affleck et al., 1996).
Treating sleep is often one of the most effective “backdoor” ways to reduce chronic pain. Cognitive Behavioral Therapy for Insomnia (CBT-I) is considered the gold standard for treating sleep issues in chronic pain. Your provider might also order a sleep study, discuss supplements, or other ways to improve sleep as the foundation for other treatments.
5. Long-Term Care
Studies show that working with a provider to understand the science of nociplastic pain can actually reduce pain levels in and of itself. This is known as Therapeutic Neuroscience Education. When the brain stops perceiving the pain as a “danger signal” of injury, it can begin to lower its alert level.
Taking a New Treatment Approach
If you are navigating these symptoms, know that the medical world has finally caught up, and you’re not alone. The transition from “what’s wrong with my back?” to “why is my nervous system so sensitive?” is often the turning point in a chronic pain journey.
The good news is that, by focusing on the nervous system as a whole, it is possible to improve symptoms and get back to better days.
Sources
Affleck, G., et al. (1996). Sequential daily relations of sleep, pain intensity, and regional manifestation of pain in fibromyalgia. Pain, 68(2-3), 213-220.
Fitzcharles, M. B., et al. (2021). Nociplastic pain: towards an understanding of prevalent pain conditions. The Lancet, 397(10289), 2098-2110.
Gendreau, R.M., et al. (2024). Self-guided digital behavioural therapy versus active control for fibromyalgia (PROSPER-FM): a phase 3, multicentre, randomised controlled trial Lancet. 2024; 404:364-374
Kosek, E., et al. (2016). Do we need a third mechanistic descriptor for chronic pain states? Pain, 157(7), 1382-1386.
Kosek, E., et al. (2021). Chronic nociplastic pain affecting the musculoskeletal system: clinical criteria and grading system. Pain, 162(11), 2629-2634.
Louw, A., et al. (2011). The efficacy of pain neuroscience education on musculoskeletal pain: A systematic review of the literature. Physiotherapy Theory and Practice, 27(7), 483-496.
Nicholas, M., et al. (2019). The IASP classification of chronic pain for ICD-11: chronic primary pain. Pain, 160(1), 28-37.
Marcianò, G. et al (2023), The pharmacological treatment of chronic pain: From guidelines to daily clinical practice. Pharmaceutics, 15(4), 1165. Treede, R. D., et al. (2015). A classification of chronic pain for ICD-11. Pain, 156(6), 1003-1007.
