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Managing Nociplastic Pain in Rheumatic Diseases

A recent study titled Identifying and Managing Nociplastic Pain in Individuals With Rheumatic Diseases: A Narrative Review digs into the challenges that rheumatologists face in their encounters with patients regarding the ability to differentiate between nociplastic pain and pain related to underlying autoimmune diseases.

Nociplastic Pain is a term used to describe persistent pain that arises from altered nociception, despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors, or evidence for disease or lesion of the somatosensory system causing the pain.

The abstract is as follows–

Chronic pain is a burdensome and prevalent symptom in individuals with rheumatic disease. The International Association for the Study of Pain classifies pain into 3 descriptive categories: nociceptive, neuropathic, and nociplastic. These categories are intended to provide information about the mechanisms underlying the pain, which can then serve as targets for drug or non-drug treatments. This review describes the 3 types of pain as they relate to patients seen by rheumatology health care providers. The focus is on identifying individuals with nociplastic pain, which can either occur in isolation as in fibromyalgia, or as a comorbidity in individuals with primary autoimmune conditions, such as rheumatoid arthritis and systemic lupus erythematosus. Practical information about how rheumatology health care providers can approach and manage chronic pain is also provided.”

The authors – Anne Murphy, Deeba Minhas, Daniel Clauw, and Yvonne Lee point out that a key non-pharmacologic interventions is to validate a patient’s symptoms and provide a clear tracking strategy with well-established goals and expectations (e.g., Patient Reported Outcomes).  Also, they indicate that sleep management, behavioral therapy, and discerning available social supports are key elements in the care plan.