Rheumatic pain is more complex than previously thought

Pain in the course of rheumatic diseases was previously thought to be purely nociceptive pain. However, current findings indicate that neuropathic and nociplastic forms of pain also play an important role in inflammatory rheumatic diseases. Accordingly, fibromyalgia, a prototypical disease for nociplastic pain, also occurs frequently as comorbidities in, for example, rheumatoid arthritis.

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Pain is usually the first clinical symptom with rheumatic diseases (RMDs). Often, but not always, pain improves when rheumatic inflammation is effectively treated. For patients, pain symptoms are at the top of the priority list, Professor Dr. Neil Basu of the University of Glasgow explains. Pain affects all areas of life such as activity, social life, emotional well-being and often economic status.1

Pain is still commonly measured using a visual analog scale. But it is one-dimensional and does not capture pain in its full complexity as Basu explains. It is becoming increasingly clear that centers responsible for emotion and cognition are involved in the perception of pain in the brain, resulting in a complex picture of pain. This development can be seen in the definition of nociplastic pain as a third type of pain along with nociceptive and neuropathic pain. Nociplastic pain occurs when pain occurs without known causes of pain, tissue damage, or lesions of the somatosensory system. However, Basu emphasizes that nociplastic pain is also based on impaired physiological function.

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