Do we need a third mechanistic descriptor for chronic pain states?
PainSci summary of Kosek 2016?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focussed on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided at the bottom of the page, as often as possible. ★★★★☆?4-star ratings are for larger and better studies and reviews published in more prestigious journals, with only quibbles. Ratings are a highly subjective opinion, and subject to revision at any time. If you think this paper has been incorrectly rated, please let me know.
There is currently no formal classification pain that arises from dysfunction of the nervous system, as opposed to damage to it, or damage to other tissues. Serious disease like fibromyalgia and complex regional pain syndrome are in taxonomic limbo. This interesting paper explores the problem and proposes some solutions. Although it’s fairly readable as scientific papers go, I have covered the same concepts in a much more accessible article: The Basic Types of Pain: Nociceptive, neuropathic, and “other”.
The redefinition of neuropathic pain, which specifically excludes the concept of “dysfunction,” has left a large group of patients without a valid pathophysiological descriptor for their experience of pain. This group comprises people who have neither obvious activation of nociceptors nor neuropathy (defined as disease or damage of the somatosensory system) but in whom clinical and psychophysical findings suggest altered nociceptive function. Typical such patient groups include those labelled as having fibromyalgia, complex regional pain syndrome (CRPS) type 1, other instances of “musculoskeletal” pain (such as “nonspecific” chronic low-back pain), and “functional” visceral pain disorders (such as irritable bowel syndrome, bladder pain syndrome). The aim of this topical review was to propose, for debate, a third mechanistic descriptor intended for chronic pain characterized by altered nociceptive function.
These two articles on PainScience.com cite Kosek 2016 as a source: