Real pain without visible injury

There is a type of pain that has long been misunderstood: pain that persists without any identifiable tissue damage or obvious nerve disease. For years, people with this condition were told that their pain was "all in their head" or that they were imagining their symptoms.

Modern science has enabled us to understand that this is a very real phenomenon: nociceptive pain (or functional pain). It's not that the pain is invented—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 threat that would activate pain sensors
• Lesion or disease of the nervous system that causes pain

In other words: the sensors are functioning normally, the nerves are not damaged, but the pain processing system has become hypersensitive.

A recent classification

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

Today, the 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 pain processing

How can you recognize nociceptive pain?

Clinical criteria

For pain to be considered nociplastic, it must typically:

• Be chronic (last more than 3 months)
• Being regional rather than localized (affecting a larger area than a single nerve or structure)
• Not entirely explainable by nociceptive or neuropathic pain

Typical characteristics

• Sensitivity to touch (even light touch)
• Pressure sensitivity
• Motion sensitivity
• Sensitivity to heat or cold

• Severe 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 evaluation
• Pain that seems disproportionate to the movements performed

Fibromyalgia: The classic example

A recognized condition

Fibromyalgia is the best-known example of nociceptive pain. It is characterized by:

• Diffuse pain affecting several areas of the body
• Pressure points
• Chronic fatigue
• Sleep disorders
• Cognitive difficulties

For a long time, fibromyalgia was controversial because tests (MRIs, blood tests, etc.) came back normal. We now know that it is 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
• Certain cases of chronic back or neck pain

Central sensitization: The underlying mechanism

An incorrectly calibrated alarm system

Central sensitization is the main mechanism that explains nociplastic pain. This is what researchers consider to be the "jewel of modern pain science." Your central nervous system (spinal cord and brain) has become hypersensitive:

• The "volume" of your alarm system is set too high.
• Normal signals are interpreted as dangerous
• Your brain produces pain in response to stimuli that should not cause it.

Where does this awareness come from?

Central sensitization can have several causes:

• Genetic predisposition
• Past infection or trauma
• Neurochemical imbalances

• Prolonged stress
• Emotional trauma
• Catastrophic thinking patterns

• Stressful environment
• Lack of support
• Difficult professional factors

That is why the biopsychosocial approach—which considers all these factors—is essential for effectively treating nociceptive pain.

It's not "in your head."

Let's validate your experience

It is crucial to understand that nociplastic pain:

• Is real — it reflects real changes in your nervous system
• Not imagined — your symptoms are not made up
• It's not weakness — you're not "too sensitive" by choice.
• Has a physiological basis — imaging studies show differences in how the brain processes pain

The fact that the tests are normal does not mean that you have nothing wrong with you. It means that the problem is not in the tissues, but in the way your nervous system processes information.

Why this misunderstanding persists

Traditional medicine is often organized around the search for visible lesions. When nothing is found, some professionals conclude (wrongly) that there is no problem. Nociplastic pain forces us to rethink this approach.

Treatment of nociplastic pain

Essential multimodal approach

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

Understanding why you are in pain—and that it does not mean your tissues are damaged—can in itself reduce pain. Education about the neuroscience of pain 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 to regulating the nervous system. It is 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). Conventional painkillers are often ineffective.

What usually doesn't work

• Treatments that target only the tissues (local injections, surgery)
• Passive approaches alone (massage, manipulation without exercise)
• Prolonged avoidance of activity
• The endless search for a "structural" diagnosis

The good news: Plasticity

Your system may change

Here's the good news: the same mechanism that made your system hypersensitive can work in the opposite direction. Think of it as a permanent "false alarm"—the alarm is sounding not because there is a fire, but because it has become accustomed to sounding. Your brain is plastic—it can reconfigure itself. With the right approaches, maintained over time, you can:

• Gradually desensitize your nervous system
• Recalibrate your pain threshold
• Reduce your symptoms
• Improve your quality of life

Time and perseverance

Change does not happen overnight. It often takes several months of consistent application of strategies. But studies show that the majority of people can improve significantly.

Key takeaways

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

• Normal test results do not mean there is no problem — the problem is in the system, not in the tissues.

• Central sensitization is the main underlying mechanism.

• Treatment is multimodal —education, exercise, psychological factors, sleep

• Neuroplasticity enables improvement —your system can recalibrate over time.

If you recognize yourself in this description, know that effective approaches exist. Modern physical therapy, integrated into a comprehensive approach, can support you in this recovery process.

Additional resources

• Understanding chronic pain
• The neuroscience of pain
• The psychology of pain
• Neuropathic pain
• Pain management strategies