Do we need a third mechanistic descriptor for chronic pain states?
Two articles on PainSci cite Kosek 2016: 1. The 3 Basic Types of Pain 2. A Rational Guide to Fibromyalgia
PainSci notes on Kosek 2016:
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 3 Basic Types of Pain: Nociceptive, neuropathic, and “other” (and then some more).
original abstract †Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
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.
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- No long-term effects after a three-week open-label placebo treatment for chronic low back pain: a three-year follow-up of a randomized controlled trial. Kleine-Borgmann 2022 Pain.
- Exercise and education versus saline injections for knee osteoarthritis: a randomised controlled equivalence trial. Bandak 2022 Ann Rheum Dis.
- Association of Lumbar MRI Findings with Current and Future Back Pain in a Population-based Cohort Study. Kasch 2022 Spine (Phila Pa 1976).
- A double-blinded randomised controlled study of the value of sequential intravenous and oral magnesium therapy in patients with chronic low back pain with a neuropathic component. Yousef 2013 Anaesthesia.
- Is Neck Posture Subgroup in Late Adolescence a Risk Factor for Persistent Neck Pain in Young Adults? A Prospective Study. Richards 2021 Phys Ther.