Persistent pain affects 20 to 50 per cent of people with inflammatory arthritis
Fibromyalgia is not “all in your imagination.” Researchers are recognizing that the chronic condition, which causes widespread pain through the body, can be explained as nociplastic pain, now recognized as a new pain category.
“There is no question,” says Dr. Mary-Ann Fitzcharles, a rheumatologist and associate professor of rheumatology at McGill University. “Nociplastic pain is real, even when there is nothing to see.” And it can affect many people with inflammatory forms of arthritis.
Dr. Fitzcharles shared the following insights during an August 2022 Arthritis Talks webinar.
Nociplastic pain: the new third mechanism of pain
We can experience pain when we have a physical injury to our tissues or joints (nociceptic pain) – broken bones and arthritis fall into this camp – or when we’ve had damage to the nerves that transmit pain messages to the brain (neuropathic pain). In both cases, the pain’s source can be seen. That’s not so with nociplastic pain.
Nociplastic pain happens when the transmission of pain messages through the nervous system becomes distorted. A series of “volume controls” along this system’s complex wiring get turned up, amplified by the molecules and cells that help nerves talk to each other. The nervous system goes into overdrive. This happens through a physical or psychological triggering event in about 30 per cent of cases, but there may be a genetic predisposition, or it may come up out of the blue. Researchers have found that a person may suffer from more than one pain mechanism, such as having the nociceptive pain of arthritis due to joint changes as well as nociplastic pain due to a fired up nervous system.
The arthritis connection
Nociplastic pain comes in several forms, such as chronic headaches and facial pain, chronic visceral pain such as irritable bowel syndrome, or chronic musculoskeletal pain, such as neck pain that radiates down the arm and is not explained by sufficient tissue changes in the neck or nerves. A person may have more than one kind of nociplastic pain. But the most well studied and best understood of them all is fibromyalgia. Pain researchers now believe that it may be so common among people with inflammatory forms of arthritis because the arthritis itself may be the physical event that is triggering the disorder.
New approaches to diagnosis
There are no lab tests or diagnostic imaging to identify nociplastic pain or fibromyalgia. Doctors have traditionally diagnosed the condition through symptoms such as pain in most of the body, moderate to severe fatigue, and sleep that is unrefreshing. But testing a person’s experience of touch is a promising new diagnostic approach. Using gentle pressure on the muscles or even a light brushing of the hand or arm may produce sensations of pain or discomfort in someone with a turned-up nervous system. A doctor may also test for increased sensitivity to hot and cold.
Harnessing the mind for pain management
Recent research is showing that mindfulness practices and cognitive behavioural therapy (CBT) can support the ongoing management of chronic pain like fibromyalgia. In CBT, people learn techniques to harness and change their thoughts and responses to mental and physical challenges they are facing. There is strong evidence that this and other psychological therapies can contribute to pain relief as well as reduce a negative mood and fatigue, Dr. Fitzcharles says.
With more discoveries like these, there’s hope for people living with chronic pain and fibromyalgia. “As medical science slowly moves to understand and unravel the many secrets of nociplastic pain,” says Dr. Fitzcharles, “we must remain optimistic, and we must continue collaborative care.”
Looking for help to manage your pain?
Arthritis Society Canada’s Managing Chronic Pain learning guide offers strategies, resources and tips on how to minimize your pain symptoms and find relief.