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We are only just beginning to understand what causes nociplastic pain

This new kind of pain is poorly understood, as there is often no sign of injury, but as Graham Lawton explains in this personal account, we are finally starting to make inroads

Health 16 November 2022

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WE FIRST knew something strange was going on when Clare, my wife, was given intravenous morphine in the emergency room. She had excruciating pain in her ribcage and back, which had started months earlier and was getting worse. At its peak, she described it as feeling like somebody had thrust two swords between her ribs and was prising them apart.

Morphine gave no relief. The doctors were baffled. Clare spent five days undergoing tests. She was eventually discharged with a diagnosis of complex regional pain syndrome and a bag of powerful antidepressants, sleeping pills and anti-anxiety meds.

She didn’t have complex regional pain syndrome. I looked it up and the pain was in the wrong place. But it took another six weeks to find out what she did have, during which time her physical and mental health declined alarmingly. I eventually secured a consultation with the complex pain team at University College Hospital in London, who told us she had nociplastic pain. It was a non-deteriorating condition, we learned, and it was manageable.

The team’s leader, Fausto Morell-Ducos, explained that nociplastic pain is the “third category of pain”. The first is nociceptive pain, which responds to an injury or inflammation. The second is neuropathic pain, caused by damage to sensory nerves. Both are created by the brain as a defence mechanism against further injury. The brain assesses signals from the damaged part of the body and transmits instructions back to the site of the damage that generate an appropriate level of pain.

Nociplastic pain is when that system goes wrong, a state known as central sensitisation. The brain’s pain centre …