Reply to Russo et al.

Abstract

First, we would like to thank Russo et al. 3 for recognizing the importance of nociplastic pain 2 as well as the relevance of the clinical criteria and grading system for nociplastic pain affecting the musculoskeletal system. 1 Second, we would like to thank the authors for identifying a weakness of the flowchart illustrating the clinical criteria and grading system 1 because it excludes patients experiencing pain that is not nociceptive, neuropathic, or nociplastic. Regarding the flowchart, we agree with the authors that this is indeed a flaw and have revised the flowchart (Fig. 1) accordingly so that it becomes clear that not all types of pain can

Association between descending pain modulatory system and cognitive impairment in fibromyalgia: A cross-sectional exploratory study

“…This modification thus supports the idea that the DPMS and the brain networks involved in cognitive processing have similar neurobiological underpinnings. Given that FM is a condition of nociplastic pain, central sensitization is its primary underlying mechanism (Kosek et al, 2021). Therefore, a characteristic of the clinical picture known as central sensitization syndrome may be the degree of cognitive impairment (Caumo et al, 2017).…”

Effect of Intravenous Sodium Pentobarbital on Pain and Sensory Abnormalities in Patients with Chronic Non-Cancer Pain: Narrative Literature Review, Research Study, and Illustrative Case Reports

“…However, a fourth subgroup with no evidence of peripheral pathology but significant pain and related disability was coded as group X. The term “nociplastic” is a term recently adopted by the International Association for the Study of Pain (IASP) [ 26 ], serving as an umbrella mechanism for pain conditions such as widespread pain or regional pain that lack evidence of discrete peripheral damage and are associated (only) with increased sensitivity to multiple stimuli, including touch, pressure, cold, movement, and sound [ 26 , 27 ]. Therefore, patients with sensory loss and lack of biomedical nociceptive or neuropathic pain generators cannot be classified as nociplastic, hence our use of the term “group X” to include patients who lack structural detectable pathology and present with either sensory gains or deficits.…”

Reply to Hoegh et al.

“…6 Such pain disparities can be measured by examining differences in medical approaches to managing pain such as opioid therapy. 4 However, fears of addiction and opioid tolerance are significant barriers to overcome for Asian populations to accept opioid prescriptions. 8 Xu et al 7 outlined that Chinese migrants receiving ambulatory cancer and/or palliative care services in Australia expressed that taking strong or weak analgesics would further damage their bodies during cancer treatment, but at end of life, they would not hesitate to take opioids because of the fear of severe pain associated with disease progression.…”

“…Yes, we agree that this would be problematic; however, the nociplastic pain algorithm is not dependent on pain of unknown origin. Patients whose pain cannot be classified as nociceptive, neuropathic, or nociplastic have “pain not classifiable according to the current IASP mechanistic pain terminology”, 4,5 in clinical practice referred to as “pain of unknown origin” or “idiopathic pain”. In addition, Hoegh et al 1 fear that patients not classified as having nociceptive, neuropathic, or nociplastic pain “may feel invalidated,” yet they suggest implementing the term “pain of unknown origin” instead of nociplastic pain.…”