You've been in pain for months, maybe years, but tests show nothing abnormal. Doctors don't find a clear injury, yet the pain is very real. This situation can be incredibly frustrating, especially when you start to doubt yourself or others doubt you.

• Your pain is 100% real, even without a visible injury on tests.
• The pain system can become hypersensitive, like an overly sensitive smoke detector.
• This condition affects approximately 15-20% of people with chronic pain.¹
• Approaches combining exercise, education, and stress management are the most effective.

This guide explains what nociplastic pain is and how to recognize it. To understand the brain mechanisms of pain, please read our article on the neuroscience of pain.

Real Pain Without Visible Injury

There is a form of pain that has long been misunderstood: pain that persists without any identifiable tissue damage or obvious nerve disease. For years, these individuals were told their pain was 'all in their head' or that they were imagining their symptoms.

Modern science has helped us understand that this is a very real phenomenon: nociplastic pain (or functional pain). It's not that the pain is imagined; it's that the pain system itself has become dysfunctional.

What is Nociplastic Pain?

Official Definition

Nociplastic pain is defined as pain that arises from an altered pain system, in the absence of:

• Actual tissue damage or a threat that would activate pain receptors

• due to injury or disease of the nervous system that causes pain

In other words, the pain sensors and nerves are working normally, but the system that processes pain has become overly sensitive.

A Recent Classification

The term "nociplastic" was adopted by the International Association for the Study of Pain (IASP) in 2016. Before this, terms like "central pain" or "central sensitization" were sometimes used, which led to confusion.

Today, this classification recognizes three main types of pain:

• Nociceptive: caused by the activation of pain receptors (tissue injury)

• Neuropathic: caused by damage to the nervous system

• Nociplastic: caused by a dysfunction in how pain is processed

How to Recognize Nociplastic Pain?

Clinical Criteria

For pain to be considered nociplastic, it typically needs to:

• Be chronic (lasting more than 3 months)

• Be regional rather than localized (affecting a broader area than a single nerve or structure)

• Not be fully explained by nociceptive or neuropathic pain

Typical Characteristics

• Sensitivity to touch (even light touch)

• Sensitivity to pressure

• Sensitivity to movement

• Sensitivity to heat or cold

• Significant fatigue

• Sleep disturbances with frequent awakenings

• Difficulty concentrating ("brain fog")

• Sensitivity to sound, light, or smells

• Allodynia (pain from normal touch)

• Painful sensations that persist after assessment

• Pain that seems disproportionate to the movements made

10 Quick Tips for Understanding Your Pain

The ones that have made the biggest difference in my patients' lives. 1 a day, 2 minutes.

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Fibromyalgia: The Classic Example

A Recognized Condition

Fibromyalgia is the most well-known example of nociplastic pain. It is characterized by:

• Widespread pain affecting multiple body regions

• Pressure-sensitive tender points

• Chronic Fatigue

• Sleep Disorders

• Cognitive difficulties

For a long time, fibromyalgia was controversial because tests (MRI, blood tests, etc.) came back normal. We now know that it's the pain processing system that is altered, not the tissues themselves.

Other Conditions with a Nociplastic Component

Nociplastic pain can be present in several conditions:

• Irritable bowel syndrome

• Chronic pelvic pain

• Tension headaches

• Chronic fatigue syndrome

• Some cases of chronic back pain or neck pain

Central Sensitization: The Underlying Mechanism

A Miscalibrated Alarm System

The central sensitization is the main mechanism that explains nociplastic pain. It's what researchers consider the 'jewel of modern pain science.' Your central nervous system (spinal cord and brain) has become hypersensitive:

• The 'volume' of your alarm system has been turned up too high

• Normal signals are interpreted as dangerous

• Your brain produces pain in response to stimuli that shouldn't cause it

Where Does This Sensitization Come From?

Central sensitization can have several origins:

• Genetic predisposition

• Past infection or trauma

• Neurochemical imbalances

• Prolonged stress

• Emotional trauma

• Catastrophic thought patterns

• Stressful environment

• Lack of support

• Challenging work-related factors

For this reason, the biopsychosocial approach, which considers all these factors, is essential for effectively treating nociplastic pain.

It's not 'all in your head'

Let's validate your experience

It's crucial to understand that nociplastic pain:

• It is real, reflecting genuine changes in your nervous system.

• It is not imagined; your symptoms are not made up.

• It is not weakness; you are not 'too sensitive' by choice.

• It has a physiological basis; imaging studies show differences in how the brain processes pain.

Just because tests are normal doesn't mean there's nothing wrong. It means the issue isn't with the tissues themselves, but with how your nervous system processes information.

Why this misunderstanding persists

Traditional medicine often focuses on finding visible injuries. When nothing is found, some professionals wrongly conclude that there's no problem. Nociplastic pain forces us to rethink this approach.

Treating nociplastic pain

Essential multimodal approach

Since the mechanisms involve the central nervous system, treatment must target several aspects:

Understanding why you are experiencing pain, and that it doesn't necessarily mean your tissues are damaged, can in itself reduce the pain. Education about pain neuroscience is a cornerstone of treatment.

Regular exercise, introduced gradually, helps to 'recalibrate' your nervous system. It activates the body's natural pain modulation systems.

Strategies that reduce catastrophizing, avoidance, and stress are essential. The psychology of pain offers valuable tools.

Quality sleep is fundamental for regulating the nervous system. It's often an overlooked but crucial aspect of treatment.

Certain medications that act on the central nervous system can help (the same ones used for neuropathic pain). Traditional painkillers are often not very effective.

What generally doesn't work

• Treatments that only target tissues (local injections, surgery)

• Passive approaches alone (massage, manipulation without exercise)

• Prolonged avoidance of activity

• Endless search for a 'structural' diagnosis

The good news: Plasticity

Your system can change

Here's the good news: the same mechanism that made your system hypersensitive can work in reverse. Think of it like a permanent 'false alarm' – the alarm rings not because there's a fire, but because it's gotten used to ringing. Your brain is plastic; it can rewire itself. With the right, sustained approaches, you can:

• Gradually desensitize your nervous system

• Recalibrate your pain threshold

• Reduce your symptoms

• Improve your quality of life

Time and perseverance

Change doesn't happen overnight. It often requires several months of consistently applying strategies. However, studies show that most people can significantly improve.

Key takeaways

• Nociplastic pain is real; it reflects a dysfunction in the pain processing system.

• Normal scans don't mean there's no problem; the issue lies within the system, not the tissues.

• Central sensitization is the primary underlying mechanism

• Treatment is multimodal: education, movement, psychological factors, sleep.

• Neuroplasticity allows for improvement; your system can recalibrate over time.

If this description resonates with you, know that effective approaches exist. Modern physiotherapy, integrated with a holistic approach, can support you through this recovery process.

Additional Resources

• Understanding Chronic Pain

• The Neuroscience of Pain

• The Psychology of Pain

• Neuropathic pain

• Pain Management Strategies