Chronic Neck Pain

Chronic pain is common in chiropractic practice and often presents without clear evidence of tissue injury. Nociplastic pain is a recently defined concept that highlights altered nociceptive processing within the nervous system. This newer understanding of pain provides insight into chronic conditions such as chronic back or neck pain, chronic headaches, and fibromyalgia. These conditions are commonly encountered in chiropractic practice but may be challenging to address using traditional models. This commentary introduces nociplastic pain, outlining potential mechanisms and relevance to chiropractic care. We advocate a collaborative, multimodal management approach that includes patient education, exercise promotion, and functional goal-setting within a biopsychosocial framework. Understanding nociplastic pain equips chiropractors to support patients with complex chronic pain through compassionate, evidence-based care that addresses the whole person.

Keywords:   back; biopsychosocial; central sensitization; chiropractic; chronic; fibromyalgia; headache; interdisciplinary health teams; management; neck; neuropathic; nociception; nociplastic; pain; widespread chronic pain.

From the FULL TEXT Article:

Introduction

Advances in pain science continue to transform our understanding of pain mechanisms. Traditionally, pain has been mechanistically classified as either nociceptive or neuropathic in nature, and cases that did not fall easily into one of these categories were often labeled as idiopathic or pejoratively suggestive of malingering. [1] This framework, however, was incomplete and left many patients without a clear explanation for their symptoms. By 2017, sufficient evidence had accumulated to describe a third pain mechanistic descriptor (i.e., type of pain), characterized by alterations in nociceptive processing. [2–4] This new understanding of pain is now recognized as nociplastic pain. [5–8]

Table 1

Nociplastic pain is defined as “pain that arises from altered nociception despite no clear evidence of actual or threatened tissue damage causing the activation of peripheral nociceptors or evidence for disease or lesion of the somatosensory system causing the pain” (Table 1). [5, 8] The purpose of this commentary is to introduce nociplastic pain, its purported pathophysiologic mechanisms, management strategies, and its implications for clinical decision-making within the chiropractic profession.

Nociplastic pain

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LOW BACK PAIN Section and the

CHRONIC NECK PAIN Section and the

SPINAL PAIN MANAGEMENT Section

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