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Glossary

Nociplastic pain

Defined in topic 21

A third category beside pain from damaged tissue and from damaged nerves, seen in fibromyalgia and tension-type headache. It responds poorly to anti-inflammatories, opioids, surgery and injections.

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Where this comes from

In the reference topic that owns this term

Reference topic 21, The Pain You Were Not Supposed to Keep, states the mismatch as a card: what the system evolved to expect, what it gets instead, and what happens in the gap.

Mismatch card

What it expects

Injury, then a return to use while still sore, among people who help.

What it gets

Rest, scans that find "damage" in pain-free people, fear and, for a time, freely prescribed opioids.

What happens in the gap

A sensitized alarm keeps ringing after tissue heals, and ordinary pain hardens into disability.

The full card, and the topic behind it

What that chapter recommends

3 of the 7 graded recommendations in Reference topic 21, strongest evidence first. How the grades work.

  1. When your back first hurts, keep going

    StrongEvidence grade: Strong. Multiple randomized controlled trials, or consistent large cohort studies with a well-understood mechanism.

    Stay as active as pain allows. Bed rest slowed recovery, and most acute back pain settles within weeks, with or without paracetamol (acetaminophen).

    Read it in full

  2. Skip the routine scan

    StrongEvidence grade: Strong. Multiple randomized controlled trials, or consistent large cohort studies with a well-understood mechanism.

    Without warning signs, imaging does not improve outcomes, and "abnormal" findings are common in pain-free people of every age.

    Read it in full

  3. Move as treatment

    StrongEvidence grade: Strong. Multiple randomized controlled trials, or consistent large cohort studies with a well-understood mechanism.

    Choose exercise you will keep doing. In people recently recovered from back pain, a walking and education program that built up over three months to at least 30 minutes, five times a week, cut relapses (Chapter 2).

    Read it in full

Related terms

The argument behind this term, its studies and its notes are in Reference topic 21 of the reference library. The book gives the practical version. Get the book.